Wednesday, November 18, 2009

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.


  1. since I was diagnosed at age 48 by a routine mammo, and was already stage 3, looks like I would have been the 1/1904. my youngest son was 5 and in kindergarten at the time.

    agree with you wholeheartedly Barbara!!

    ps, so glad you are writing again.

  2. Perhaps even more disturbing is the discouragement of breast exams. WTF! How are you supposed to find cancer if you avoid looking for it. I believe in evidence-based medicine, but this is just stupid. I don't know a single woman whose cancer wasn't found either by breast exam or mammogram. My particular cancer was highly aggressive. If I hadn't found it in my monthly BSE, I would be dead. Period.

  3. I can't help but think that the insurance lobby didn't have a part in this. It will save them money not to be paying for as many mammograms... and they will need to save money somewhere if they are going to have to insure everyone (not to mean that they shouldn't... just that someone will have to pay.)

  4. Just wait for Obama/Reid/Pelosi care this is just the beginning of rationing.

  5. I agree with Mia. What are these clowns thinking telling women that they don't need to do a self-exam?

    One thing I consider is that everybody has different "worry" issues. They "should" be determined by your actual risk profile, but often they're determined by your emotional state.

    Breasts are an emotional trigger. But let's not forget that heart disease is the major killer of women.

    I wish that every woman who is ready to storm Capital Hill over the mammogram issue would make an appointment, get her bp/lipids checked, and then take effective action.

    I don't think we always worry about the right thing.