Demystifying Medicine One Month at a Time

Mammograms: Find Your Sanity

Fairly typical week in health news: Mammograms.

The big story is that the American Cancer Society issued an updated guideline recommending that women undergo mammography less frequently than before.

mammogramThis announcement was denounced on both “sides” of the perennial debate. Those in the “mammograms save lives” camp are outraged that a scientific society dedicated to cancer prevention and treatment would issue a proclamation that seems to run counter to the notion that “early detection saves lives.”

Those in the “putting scientific evidence in the forefront” camp are actually somewhat pleased that the ACS is finally “moving in the right direction,” but displeased that the society didn’t get all the way to the vicinity of, for example, the US Preventive Services Task Force, which has the most heavily-weighted (and least stringent) screening mammography recommendations: for women at average risk (i.e. those that don’t have a mother or sister with breast cancer), start breast cancer screening at age 50 and get a mammogram every 2 years until age 74.

The new ACS guideline: start screening at age 45 (well, 40 if you want to) and have mammograms annually until age 55, at which point you can go to every other year.

If a woman at average risk for breast cancer follows the USPSTF guideline to the letter (and is lucky enough to avoid a ‘call-back,’ i.e. further looks for a possible abnormality), she’d have 13 mammograms over 25 years. If she follows the new ACS guidelines to the letter, she’d have 20 mammograms, possibly more. Of course, every mammogram not only increases the cumulative total of lifetime radiation exposure, it increases the odds that an abnormality will be found and a call-back will be issued.

The best analysis regarding the new ACS recommendation (and actually, one of the best pieces about the whole breast cancer screening issue in general) is from FiveThirtyEight’s lead science writer, Christie Aschwanden, whose piece is titled, “Science Won’t Settle the Mammogram Debate.” Aschwanden correctly points out the ‘right thing’ depends on you, the patient, and your values. There is no right answer.

For some, not getting mammograms annually (or even at all) is the right choice. For the rest, following the ‘rules’ such as they are provides the best piece of mind.

And that’s OK.

Here’s the thing: because choosing to have mammograms or not is a personal decision, we should refrain from blaming people who choose one way or the other. People have their reasons. As with many social and medical issues, the personal has become very political, because people’s beliefs are strongly held. Ultimately, a lot of economics is impacted by the politics here. Pro-screening partisans are always uneasy when edicts cutting back on screening are issued, because the fear is that the health care ‘establishment’ (i.e. insurance companies) will stop covering the tests.

That’s simply not going to happen with mammography.

If we strip the emotion out of the issue and just try to stick to facts, what, at heart, is undergoing a mammogram like?

The video below comes from the the UK’s Cancer Institute. It’s just more than a minute, and is very matter-of-fact.

WARNING: THE VIDEO SHOWS AN ACTUAL WOMAN UNDERGOING AN ACTUAL MAMMOGRAM, THUS INCLUDES BARE BREASTS. Therefore, NSFW in most workplaces.

1 Comment

  1. Aillv

    What remains carefully hidden from the discourse and the recent changes in mammogram guidelines by the American Cancer Society into a direction opposite what the cancer business has been fiercely advocating for decades is the fact is there has never been any solid sound scientific evidence in support of mass mammography since its systematic introduction but since the beginning a solid body of data (actual evidence-based data) showed it is seriously harmful to most women and, therefore, mass mammography should have never been introduced in the first place (sources: “Mammography Screening: Truth, Lies and Controversy” by Peter Gotzsche and “The Mammogram Myth” by Rolf Hefti).

    The American Cancer Society rationalizes its guideline changes with “The changes reflect increasing evidence that mammography is imperfect, that it is less useful in younger women, and that it has serious drawbacks” – all of it had been known in the 1970s/80s. It’s just that the massive orthodox cancer business, especially the American Cancer Society, ignored or ridiculed the real evidence and consistently overstated the benefits of mammography.

    This “change of heart” by this pawn group for the interests of corporate medicine is hypocrisy at its best (a move to save face?), it’s corruption at its worst. The increasing narrative that mammography is a personal choice is another one of medical cartel’s hypocrisy-corruption propaganda pieces, merely to cleverly avoid culpability for the massive damage they’ve caused (how can it be a real “personal choice,” or say an informed personal choice, when the cancer business has always been obstructing women from making an “informed choice” about mammography’s benefits and risks which have been inaccurately depicted by the medical industry, favoring their business interests?).

    Mammography has always been about politics and marginally about science because if one had relied on the latter the test would have never a common medical practice from the get-go.

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