I’m a medically compliant gal. Once I hit 40, I had my first mammogram.
All clear, said the postcard that came in the mail.
At 41, I had another.
That time I got a phone call.
The radiologist at the reputable cancer center reading the state-of-the-art digital screening mammogram detected something strange in a lymph node in my armpit. I needed to come back for some more tests. I went and was given a series of diagnostic mammograms. That weird armpit lymph node was still weird, but the breasts were clear.
This kicked off a series of tests – increasingly invasive and scary that lead to a diagnosis of Stage IIIA breast cancer in 2008. The original mammogram, or more specifically those reading it, caught the 1 centimeter tumor that had spread to the lymph node but missed the 8 centimeter tumor in my breast.
So how am I supposed to feel about mammography?
I’ve been thinking about that last question for over eight years now. Some of the best analysis I’ve read comes from Christie Aschwanden at 538. Take some time and read these three articles:
If early detection is key, then an increase in detection of tumors too small to be found manually should correspond with a decrease in detection of larger tumors and death. That is not the case. From Aschwanden’s third article:
But the new study found that although the incidence of cancers smaller than 2 centimeters rose quite dramatically after widespread mammography was introduced, by 162 cases per 100,000 women, the incidence of larger tumors fell by a much smaller amount — only 30 cases of cancer per 100,000 women.
How does that play out in graphic form? Well, that’s the most sobering part. Stage IV, or metastatic breast cancer, is the cause of virtually all deaths from the disease. Remember, the goal here is saving lives. Again, from Aschwanden’s third article:
Increased detection. Flat line of deadly breast cancer. The evidence just isn’t there to show that mammograms save lives.
But what about my case?
I’ve talked about the first article in this blog previously. Cancers can be divided into three groups. Turtles, ones that move so slow that they’ll never threaten lives. Rabbits that hop to other parts of the body but if can be fenced. Mammograms can help stop rabbits. Birds that are flighty and aggressive and defy fencing. Birds cause the vast majority of cancer deaths because they are currently unstoppable.
Those of us who’ve been through cancer treatment want to believe that we were rabbits and I’m no exception. The truth is: I don’t know.
I read counter arguments as well, most often those articulated by Dr. Elaine Schattner. After all, 5-10 lives saved per 1,000 is not the same as zero. I think my story highlights the most important point about this debate: It is complicated.
As Schattner argues in her article, “The Case Against The Case Against Mammography,”
The overdiagnosis campaign reflects a lack of respect for women’s capacity to make rational choices about their health. If a woman learns she has a breast tumor, she can weigh the information and consult with her doctor about the best plan forward.
I agree with this, but a rational, informed decision requires breaking through the noise with up-to-date and accurate information.
The simplistic message that mammograms are life-saving tools is dangerous not because it is wrong but because it is incomplete. And it is insidious because it leads to complacency. The majority, I think, stop listening once they hear it because it gives them false comfort that this unwieldy beast of a disease has been tamed.
When the message was first developed, scientists sincerely believed it was true. The numbers rolling in since the 1980s paint a more complex picture and the messaging now lags behind what scientists know to be true.
I don’t think that’s an accident. Those who stand to benefit financially from maintaining the status quo, such as organizations that use this overly simplified message to raise money, have a vested interest in keeping the simple, positive, incomplete, insidious message alive.
I agree with Schattner – women and their doctors can decide the right course of action. But we’ve been conditioned by sloganeering to believe some things that aren’t quite accurate. (If mammograms save lives and a mammogram says I have cancer then my life must be in immediate danger.)
Basic survival instincts can cloud rational judgment.
I know – I’ve been there.
Sitting in the doctor’s office, getting a diagnosis that comes with a 67% five-year survival rate.