What you must know before you agree to a mammogram

Dear Reader, I've never been a big fan of mammograms. This is primarily due to their all-too-common overuse. The insistence upon yearly pictures is bad enough. But even the slightest abnormality then leads to multiple views and six-month repeats. And guess what? If you radiate a tissue repeatedly, you are going to cause cancer in your efforts to detect it. Now, if you think the reason for this overzealousness in testing is to protect women's lives, think again. It's protocol simply because mammography is one of the most litigious areas in all of medicine. In other words, the docs handing out mammograms get sued regularly. So they overtest to make absolutely sure they don't miss anything. And they intervene at even the faintest whiff of trouble. That's just the way things are done today. Which is exactly why this latest study made front page headlines around the world. Among the most succinct was a piece in theNew York Times, simply titled "Vast Study Casts Doubt on Value of Mammograms." What these researchers were trying to find out through their study was whether there is any advantage to finding breast cancers when they were too small to feel. It's a topic I've discussed here repeatedly. And I wasn't at all surprised to hear that the answer to this question was basically NO. I counsel patients regularly on screening exams, starting with the risks and benefits of these practices. And I am happier than ever that I have always been conservative with my advice regarding mammograms. In the past, I've generally recommended a baseline mammogram at 45, followed by screening every two years after the age of 50. (That's if you don't have a family history of breast cancer.) But it's absolutely worth exploring alternative screening methods that don't use radiation. (Especially if you fall into a higher risk category.) Ultrasound and MRI tests are both very sensitive alternatives to mammogram. The former is particularly useful for women who have dense breasts. While the latter is better at picking up earlier stages of breast cancer. Unfortunately these tests are also more expensive than mammograms. And you may have to fight with your insurance company to receive coverage for them. Which is one reason why the mammogram has continued to reign supreme. This is just another sad reality of breast cancer screening protocols in this country. But it's not even the reason I'm commenting on this study today. After all, you know how I feel about the risk of overdiagnosis when it comes to cancer testing by now. The reason I'm sharing this story with you is to comment on all of the letters to the editor that I just read this morning. Every single one of them was emotionally charged. There were loads of women asking questions like, "how can a doctor deny me a screening that could save my life?" Or making comments like, "I'm glad my two breast cancers were detected early." And so on and so on. Nothing in medicine is without controversy. But there are few procedures in medicine that carry as big an emotional component as the mammogram. We do a lot of irrational things in medicine--but especially in the "war" on cancer. People are frightened of cancer and therefore tend to do things that make no logical sense in their efforts to fight it. This is understandable, of course. Cancer is serious and it's scary. But as a doctor, it's my job to keep my head on straight for my patients. And to help them make decisions based on scientific evidence. Many people, once handed a diagnosis, rush into treatment decisions because everyone thinks something should be done yesterday. But just because we can detect a disease earlier doesn't mean we need to do something about it. In fact, a test should only ever be performed in the first place if its results are going to change your course of treatment or behavior. Doctors have been warning men about PSA tests for years for this very reason. And lately, mammograms are beginning to look just as problematic. So the best advice I can give is simply to educate yourself. Take the time to get all of your options in a row. Choose the best one for you. And then believe in it, with all of your heart and soul. Nearly one in seven women in this country is diagnosed with breast cancer. With all the treatments and surgeries that follow these diagnoses, it's become a highly profitable disease. But is all of this necessary? You know my answer. But I guess only time will tell for certain. Until next time, Dr. Fred Source: "Vast study casts doubt on value of mammograms." New York Times. 11 Feb. 2014.