Debate Over The Benefits Of Routine Mammograms
http://thedianerehmshow.org/shows/2012-12-12/debate-over-benefits-routine-mammograms
It’s been generally accepted that early breast cancer detection and treatment can improve a patient's prognosis. For decades women have been advised to get an annual mammogram starting at age 40, and now there’s 3-D mammography which can improve chances of spotting something suspicious. 3-D mammography can also reduce the number of women who need to be called call-back for a follow up test, but some say widespread routine screening is leading to unnecessary treatment: Please join us to discuss the benefits and consequences of regular mammograms.
Guests
Shannon Brownlee
acting director of the Health Policy Program at New America Foundation.
Dr. Daniel Kopans
professor of radiology at Harvard Medical School.
Dr. Gil Welch
professor of medicine at Dartmouth Institute for Health Policy and Clinical Research and
internist, VA Outcomes Group
Comments
Please familiarize yourself with our Code of Conduct and Terms of Use before posting your comments.
I once heard on NPR that in Europe a study was done that compaired 2 groups, women who had mamo every 2years compaired to those that had mamo every 6 years and I believe that the conclusion was that mamo actually caused the early cancers. Of course, I never heard anything more about it. I'm sure here in the states they don't want news like that getting around.
If you've ever scheduled surgery, you will sign papers given permission for surgery. One of the statements is (if you even bother to read it) "medicine is an inexact science". I have learned the hard way how true that is.
Mammography is one way to detect the possibility of breast cancer. A hundred years ago, there was no way to detect the possibility until a woman discovered a lump on her own, or else her doctor might have done so. By the time it was discovered, it was probably too late.
No system is perfect; there is some risk.
But the question is, do we want to return to methods of 100 years ago? Because without mammography, it seems that is what is being suggested.
Please comment on detection of lobular breast cancer. Mammography can detect ductile cancers, but cannot detect lobular cancers. My wife was eventually diagnosed with stage 3 lobular cancer, but her regular mammograms didn't find it. She finally detected it once there was some distortion of the shape. Once they were able to measure the tumor, the surgeons and oncologists agreed that she had probably had it for over 10 years.
Hurray for Dr. Welch! When will women finally wake up and realize that breast cancer screening is a cash cow? It's a way to suck women into a black hole that will bankrupt them financially, scar them physically and emotionally, and will ruin their lives.
I have annual mammograms at MGH, which, for the last three years, have been 3-D. I have small breasts and a prominent sternum,which presents a problem for technicians. They usually take several extra oblique images before getting an acceptable one. I'm getting worried about the additional radiation exposure. I'm 69, have always had normal mammograms, and am at statistically low risk for BRCA. Can I go to an every-other-year screening schedule?
Just an anecdote. I had very dense breasts. A routine mammogram saved my life. I ended up with stage 2. Double mastectomy and chemo. Grade 3 tumors in both breasts. This was in 1999. I am doing well and enjoying my life at this time.
You mentioned metastatic breast cancer. Is there anything new for that other than first andromyacine and then abraxine? If we find the abnormalities while treatment advances, then together we should improve survival rates, I would think.
I also worry about these broad attacks on screening, for both prostate and breast cancers, without noting the populations that are most at risk and may decide not to be screened. African American, for example, should have these tests, as their death rates from both are higher than that of caucasions.
I was diagnosed with stage one breast cancer this past summer in conjunction with a routine physical prior to joint replacement. I opted to go through a lumpectomy followed by four weeks of radiation (at Dartmouth Hitchcock Memorial Hospital). My mother was a survivor of a much more invasive breast cancer so I knew both my chances of developing the same cancer as well as the possibilities of full recovery. Although it has only been months since my treatment, I would make the same decision again. I can now approach my re-scheduled knee replacement with more confidence in my overall health. Virginia, Center Harbor, NH
My Stage 1 BC was discovered via routine mammo in 6/09. It was small, the size of a pea, but very deep. My surgery was successful and I underwent high dose radiation treatment, 5 days, twice a day, followed by estrogen blocking hormone drugs. I am 3.5 years into a full recovery which has gone extremely well. Had I not been faithful to my yearly mammo schedule, I could have been diagnosed at a higher stage and required more drastic surgery and recovery. I speak loudly and often endorsing yearly mammo.
I believe in 3-D mammograms. I was diagnosed in 2010 with breast cancer. I was invited to join a clinical trial using tomosynthesis. The images found a third tumor that none of the numerous mammograms nor the MRI found.
As far as who should/shouldn't receive them, there is no easy answer. Another choice yet a woman should be able to make about her own health.
Dr Kopans sounds so critical of Dr Welches study, which was a new view that seems valuable. It begs the question if Dr Kopans has some financial interest at risk from Dr Welch's study. If Dr Welch's recommendations were put into greater use, how would it impact income of radiologist's and hospitals? Given the power of Wash DC lobbyists, how will big money influence this debate?
I heard DR. Kopans say that he invented the 3-D mammogram screening technique. Does that mean that he profits when hospitals buy whatever machines are needed to do 3-D mammograms?
Isn't the issue NOT with the additional information provided by mammography (or screenings for any condition), but rather the overuse and over-diagnosis by physicians upon detection. If you were aware of a mass, you could simply monitor it rather than treat it, as in BPH and prostate cancer.
What percentage of breast biopsies are negative? When a pathologist reviews a biopsy specimen, how often does the diagnosis come back as suspicious or positive "just to be safe"?
What percentage of breast biopsies are negative? When a pathologist reviews a biopsy specimen, how often does the diagnosis come back as suspicious or positive "just to be safe"?
I have read that bungled mammos that were repeated (and in some cases repeated again) can cause breast cancer because of the accumulated radiation. Please comment.
Women are asked to take routine tests all the time - especially, for example, during pregnancies. That does not necessarily mean we have to undergo any of the futher treatments. Why aren't we advocating mammograms or some of the other passive testing tools (like the new 3d imagery) to follow potential cancers and track their growth habits, rather than make statements like "I don't get mammograms because I don't want to risk unnecessary treatments." How can anyone advocate intentional ignorance as good health policy?
45 Washingtonian when i had my regular mammogram. Non smoker, two breast fed kids, no history...had all of the work ups and found DCIS...after breast removal found cancer stage 0. I would encourage ALL women to have an annual mammogram.
What are these doctors thinking?!
I am confused about whether or not someone has breast cancer or not: once the biopsy is performed and cancer cells are found, why does Dr. Welch make it sound like it is all unnecessary?
Like Shannon Brownlee, I also do not get mammograms. I think it is an overrated screening and those who think they were "saved" because of it, don't really know that. We develop tumors all the time. Not all of them are lethal. I don't trust the medical "industry" to tell the difference.
Dr Rebecca Faulkner, Oklahoma City
At age 33 I found a lump on self exam that was determined to be an early stage but aggressive cancer. Now after bilateral mastectomies, chemo, radiation and hormonal therapy, I am a five year survivor. I had long advocated to my patients to adjust their lifestyle to prevent illness like heart disease, stroke and diabetes, but it was not until I became a patient that I heard of the lifestyle changes that could help PREVENT breast cancer. Now I drink purified water from non-BPA containers, choose organic foods to avoid pesticide, consume green tea, flax, and olive oil and reduce my use of animal products and avoid alcohol. I screen all my body and household products for chemicals that have been linked to cancer and I exercise regularly, all things which have been shown to PREVENT cancer. Women need to hear the message that PREVENTING cancer is better than screening for it. We need as a country to stand up and demand less exposure to carcinogens for us all.
I am a two time breast cancer survivor. My first case was in 1992 when I was 42, the second in 2006 when I was 56. Both were caught early in the ducts via mammogram. The first was during my 2nd mammogram. The result was a mastectomy for both. The first with no radiation or chemo needed, the second with a set of radiation since the cancer area was close to the edge of the breast that was removed. The radiation was to ensure any cancer left behind was taken care of. Was I happy to have my breasts removed? NO But I left the hospital each time with a reconstructed breast, which helped with my mental recovery. Loosing my breasts was a small cost to being able to live a full life and seeing my sons grow to adulthood and now to be an active grandmother.
Please talk about Thermography
Mammograms have frustrated me over the years. Each time I had a mammogram (and yes I no longer have the mammogram) but each time I had one, I was told my breast were too fibrous for the mammogram to be effective. I then would have to wait, i.e. prolong the appointment until a sonogram could be performed. Same result, no lumps, etc were found. So I no longer go for the mammogram or a sonogram. There is no history of breast cancer in my family. I eat very little processed food and am for the most part healthy.
When you see fish that have tumors and cancers on them, so you treat the individual fish? Or do you know that it is the body of water that is polluted? Our current medical system does little for prevention--even knowing enough to be able to prescribe a healthy diet or even recognizing what a healthy diet consists of. Until our medical community begins to shift into getting rid of the chemicals and processed foods and GMO's etc and get the healthy vegetable and whole foods into the diet we are using screening techniques to find and treat the fish rather than clean the pond.
11 years ago I had breast cancer second stage; I am an R.N.;
Twice a year I had a mammogram (I keep records of every test I do) and when the cancer was discovered it was known to be there for at least 8 years. So why did the mammogram not pick up on that? Besides the breast cancer I also had malignant melanoma. So after a mastectomy and femara (a hormone treatment), I decided against chemotherapy.
Not only did I do conventional treatment but also alternative treatments. A person cannot just let the medical field decide over what is best for you. A person needs to do research and do what works for you.
When I met with my oncologist during a routine exam 4 years later, she told me that they do not treat my condition with chemo any longer. So do what works for you. It is your body and 5 years later you need to be happy with the decision you made.
It's hard to express how angry this show has made me. The only thing Shannon Brownlee said that made sense is that women should be able to make their own medical choices. The rest of her commentary and that of the doctor advocating fewer mammograms were patronizing, ill-judged, and based on scientific cherry-picking.
I'm very aware of the risks of annual radiation exposure through mammograms. I am sure that some tumors, even cancerous ones, are treated more aggressively than is perhaps necessary. In a perfect world, their advice might make sense. But what neither panelist seems to have taken into account is that we don't live in a perfect world.
Normal US lifestyles tend to increase breast cancer risk
Most women don't do monthly self-exams
Insurance companies don't pay for optional treatments, which means women who wanted screenings might not be able to afford them
We don't yet know for sure which cancers will move quickly and become fatal in a particular patient
Not catching cancer early can MAKE more radical treatment necessary. Anecdotally, I'd rather have a lumpectomy than a mastectomy. I bet that's true for a lot of women.
If the object is to empower women to make medical decisions, then fix the system so doctors can spend more time explaining the risks and advantages, and make sure that patients have better, and more comprehensive coverage for *their* needs.
@jcp: I respect your and Ms. Brownlee's position, but I don't understand it. I do understand that you don't want unnecessary treatment, or radiation exposure from excessive screening. But no mammograms at all, even every 5 or 10 years?
Just because you have the screening you don't HAVE to accept the treatment. Why wouldn't you want to know if there's a lump that's just not yet detectable by touch? Especially if screening has improved enough to eliminate many false negatives, and when the 3D dosage is lowered as whoever-he-was said.
You don't have to be a sucker or victim of the medical industry in order to get some use out of it.
I really would like to know why someone would never have a mammogram.
Thanks.
Brian
Have you considered the preventive value of Vitamin d3 for better general health and preventing Breast and other cancers?
2 websites to view.
www.vitamindcouncil.org Dr.John Cannell
Welcome to the Vitamin D Council website
This website is for anyone interested in vitamin D news and research. Many come here to find more information on deficiency, toxicity, health conditions related to vitamin D, and supplementation.
~~~~~~~~~~~~~~~~~~~~~~~~~
www.grassrootshealth.net Carole Baggerly (breast cancer survivor) and many other Vitamin d experts
Can we Prevent 80% of Breast Cancer?
Come Hear a Breast Cancer Survivor’s Discovery: Vitamin D
August 6-17th, 2009 Canadian Tour
Montreal, Toronto, Saskatoon, Edmonton, Calgary, Vancouver
For more information and to schedule a presentation in your area, contact outreach@grassrootshealth.org This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Dear Health Advocates:
Are you ready to prevent breast cancer NOW? A recent story from Canada was that there was a 94% greater probability of cancer recurrence in women with low vitamin D levels.
Must this continue? Can we stop breast cancer now?
This presentation will address what we really know, what we don’t, what current research is going on and what needs to be done. There will also be information presented about the latest model for how vitamin D prevents breast cancer, the DINOMIT model of Dr. Cedric F. Garland of the University of California San Diego. The focus is especially on what individuals can do safely TODAY to help prevent breast cancer.
AMEN. Of all the millions raised by "pink ribbons organizations," only 15% goes to prevention; only 5% of research goes to the environmental cause of breast cancer.The Environmental Working Group has databases full of what to avoid in cosmetics, sunscreens, household cleaners, etc. www.ewg.org
Also, Dr. Faulkner, have you seen the documentary film Pink Ribbons, Inc.? Important. I screened the film in Charlotte, NC and featured a panel discussion afterwards. Here's the official trailer of the film http://www.youtube.com/watch?feature=player_embedded&v=fxlc-ASgB9Y
Takeaways:
Pharmaceutical companies use money to provide a marketable product, something that will increase survival for a period of time — even three weeks — but which can be very profitable for that slight period of time. “They don’t seem to be interested in prevention, but this is how capitalism works.” ~Ellen Leopold, author of A Darker Ribbon: Breast Cancer, Women and Their Doctors in the Twentieth Century
Big players on the nonprofit boards of the “cancer establishment” are filled with members from pharmaceuticals, chemicals and energy industries. This is a co-mingling of those responsible for the perpetuation of the disease with those trying to cure/prevent it. ~Dr. Samantha King, author of Pink Ribbons, Inc,: Breast Cancer and the Politics of Philanthropy
More takeaways from my experience as an "accidental cancer advocate" http://tamelarich.com/2012/perspective/my-breast-cancer-advocacy-focus-a...