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Health Column: Why screening mammograms can be a gamble

Phil Mohler, M.D.
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist

Riddle: Why is a trip to Caesar’s Palace like getting a screening mammogram?

Answer: They both involve some serious gambling.

One of the huge quality of care and cost issues in medicine today is that rarely do patients really understand what they are risking when they agree to a screening test. It’s a gamble and we physicians don’t often teach the odds.



EXAMPLES

How often does it happen? Rarely.



What is the outcome? Hit it big!

What happens in Vegas? Win lots of money.

What happens with a screening test? Find a cancer that would have killed you. It saves your life. It happens with one out of 1,000 mammograms.

How often does it happen? Very Commonly.

What is the outcome? Lose a little.

What happens in Vegas? I lose $40 in quarters before the hostess brings back my beer.

What happens with a screening test? Experience a false positive result and have to return for another x-ray or biopsy. Overall 60 percent change if you have annual mammograms for 10 years.

How often does it happen? Too common.

What is the outcome? Lose a whole lot.

What happens in Vegas? Lose your house and your kids’ college money; then your spouse divorces you.

What happens with a screening test? Find a breast cancer that you would never have known about or affected your life. Be treated for it with all the side effects of surgery, chemotherapy and radiation. Happens with 15-20 percent of all breast cancers diagnosed by screening.

HOW TO MAKE AN INFORMED DECISION

If you journey to Las Vegas, you have some idea about what your odds are when hit the slot machines. (The house wins mostly.) It is time that patients and physicians have more open discourse about the gamble of screening tests. Use the three legs of the evidence-based medicine stool to make an informed decision.

1) What is the best scientific evidence? What do the studies show about the pros and cons of the test?

2) What is your physician’s experience with this testing?

3) What do you, the patient, bring to the decision making? What are your values, hopes, fears?

And in Vegas parlance, you — the patient — play the final decision, making trump card.

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 nancyandphilmohler@gmail.com.


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