My Case for Mammograms

Since the announcement earlier this week by the United States Preventive Services Task Force that guidelines for mammograms should be changed, there's been an outcry from doctors and others opposing the proposed changes. I also oppose the changes. In fact, you could call me a poster girl for mammograms.

I was in my early fifties when a tiny (3 mm) invasive breast cancer was detected by a routine mammogram. I had been having mammograms once a year since I turned 40, as suggested by the earlier guidelines. The new guidelines recommend mammograms every two years starting at age 50, not 40. If I had waited an extra year to have a mammogram as the new guideline suggests, who knows how much my breast cancer would have grown? Because it was caught early, I was able to avoid chemotherapy and I have an excellent prognosis. With a year's more growth, the cancer might have become advanced or even metastatic, requiring chemotherapy. I would have had a poorer, perhaps even a dire, prognosis.

Three years later, a second breast cancer, this one in my other breast, was also caught by mammogram. This second cancer was found at an even earlier stage than the first, when it was still in the ducts and had not become invasive. Of course, having already had cancer, I was considered high risk and screened vigilantly. But the fact is that a mammogram found my second cancer very early, way before it could be felt. Mammograms do save lives.

The Task Force report doesn't deny that mammograms save lives. Instead, it points out that mammograms prevent "only" one cancer death for every 1904 women age 40 to 49 who are screened for 10 years. From age 50 to 59, the number is one death for every 1339 women and from age 60 to 69, it's one death for every 377 women. The odds seem pretty good unless you're the one unlucky woman. It should be noted that these statistics are concerned with deaths from breast cancer. It's virtually certain that fewer mammograms would result in diagnoses of more advanced cancer, requiring more aggressive treatment and causing far greater anxiety in those diagnosed.

Speaking of anxiety, in analyzing the supposed harms of starting mammograms at age 40, the Task Force cites false positives and claims that, in addition to leading to unnecessary biopsies, false positives cause great anxiety. True, it is scary to have a suspicious mammogram. But that's nothing compared to the anxiety felt by a woman whose cancer is detected at a later stage because she didn't have an annual mammogram.

No one's claiming mammograms are the ideal test. They're uncomfortable and can lead to false positive results, while sometimes missing cancers. But they're one of the best tools we have for detecting cancer early. I'd hate to see the new guidelines become common practice. And I hate to think what that might mean for insurance coverage of mammograms. Nothing good, I suspect.