Health Column: Mammography & its effectiveness
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
The American Cancer Society is not one of my favorite organizations. They rank with doubters of climate change and believers that our local geology is 6,000 years old. Their edicts defy basic science. And their mantra that screening for any malignancy is holy, just and unarguable rankles my sense of fairness; it’s a disservice to women.
Recently in preparing a talk for my colleagues, I discovered a study that compared women’s perception of breast cancer frequency and the effectiveness of mammography screening with real world statistics.
The first part of the study was derived from a survey of 1,003 American 50-year-old women who were asked about the effect that screening mammography every two years for 10 years would have on the lives of 1,000 women aged 50.
The women believed that unscreened, 160 of the 1,000 women would die of breast cancer over the ensuing 10 years. They thought that screening mammography would save half of those women, and at the end of 10 years 80 more women would be alive than if not screened.
The second part of the study reflected data from the National Cancer Institute and U.S. mortality statistics for 2008, assuming a generous 20-percent reduction in breast cancer deaths related to screening mammography. In reality, only five of 1,000 unscreened women would die of breast cancer over 10 years and screening would save one of these five women. Only 10 percent of the total deaths in both the screened and unscreened groups were related to breast cancer. The women overestimated the frequency of breast cancer by a factor of 30. In addition, they felt that screening mammography was much more effective in preventing breast cancer deaths than it really is.
• There are some huge misconceptions both of the frequency of breast cancer and how effective screening mammography is in saving lives. Only one of a 1,000 women benefited over 10 years from screening mammograms.
• This study does not address the other important issues of “call backs” for more views and of over-diagnosis, wherein breast cancers — that would never have caused symptoms or had any influence on a woman’s life — are diagnosed by screening mammography and treated.
• Talk to your physician before your next mammogram to learn the pros and cons of screening for breast cancer and then make the decision that is best for you. There are no right or wrong answers to the question: ”Should I have a mammogram?”
• The Public Health Agency of Canada (http://www.phac-aspc.gc.ca/cd-mc/mammography-mammographie-eng.php) provides an excellent detailed discussion of pros and cons of screening for women in their 40s, 50s and 60s.
GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at email@example.com.
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