Like everything else in our world these days, it seems as if we are asked to pick a side on the mammogram debate. Are you with us or against us?
If there’s anything I hope you’re learning this month, it’s that none of these stuff can be summed up on a bumper sticker or a 140 character tweet.
People love to say that a mammogram/breast self exam saved their lives, but the statistics just don’t bear those claims out.
It may be surprising, therefore, to learn that numerous trials of mammography have indeed randomly assigned nearly 600,000 women to undergo either regular mammography screening or no screening. The results of more than a decade of follow-up on such studies, published more than 10 years ago, show that women in the mammogram group were just as likely to die as women in the no-mammogram group. The women having mammograms were, however, more likely to be treated for cancer and have surgeries like a mastectomy. (Some of the studies include trials fromNorway, the Netherlands, Sweden, and this major review of the data.)
And this (emphasis mine).
In other words, mammograms increased diagnoses and surgeries, but didn’t save lives—exactly what the researchers behind last week’s observational study concluded.
As discussed earlier, we cling to this simple idea that cancer works like this — first one cell goes bad. Then two, then three, etc. So the earlier we can catch it, the better. We can stop it from marching on, like ants in my kitchen every spring. Makes sense, right? Unfortunately, it just isn’t how cancer works, which is why we see some early stage cancers come back as metastatic cancer.
What good is it to be able to identify cancers earlier if we can’t tell which tumors will advance to existential threats and which ones won’t?
And what good is it to be able to identify cancers earlier if we can’t cure the ones that do become existential threats?
If we treat all cancers the same, which we do because it’s all we can do, we expose women to risks from treatment. The side effects are real and can be dangerous. Chemotherapy lowers the body’s ability to fight infection. Any surgery is risky. Radiation therapy is a delicate balance of curative vs creating further harm. Lost work time, psychological problems, families in crisis, health care costs – significant risks.
Mammograms aren’t harmless either. They expose you to radiation; possibly to anxiety and stress. They are known for returning high false negatives and false positives. They are notoriously inaccurate at detecting cancer in dense breasts. If you are pre-menopausal, you likely have dense breasts.
I had my second mammogram at age 41 and the breast itself came back as clear, but the edge of a lymph node in my armpit was caught on film looking suspicious. Diagnostic mammograms came back clear as well, except for the armpit. Three biopsies, an ultrasound, an MRI, a CAT scan, a bone scan, and the worst-summer-of-my-life later, I found out I had breast cancer. Not just breast cancer, but an eight centimeter tumor in my right breast that evaded detection in two screening and probably 10 diagnostic mammograms.
However, that lymph node contained a tumor that had broken free and was on the march. So had the person reading the mammogram not caught it… well… I don’t like to think about that. But had the mammogram caught it in previous screens, my treatment might not have been so extreme (slash/burn/poison).
So what does all this say?
First of all, there is no simple answer here, like there’s no simple answer anywhere. But rather than getting caught up in the “are you with us or are you against us” debate, we should join together and demand better. Better tools, real education, and of course, a cure.