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
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I am happy to say I am a 6-year Breast Cancer survivor. It is never OK to assume one group over another is at less risk. Cancer is indiscriminate Without my annual mammogram I would not living today. My tumors were not palpable, during a routine mammogram. A core biopsy confirmed the tumors were cancer. At this point, more sophisticated technology revealed the cancer had spread to my lymph nodes.
This topic is interesting. I have been reading Overdiagnosed by Dr. Welch and his team, and I recommend the book because it is filled with statistics that change the way we look at the whole picture.
It's a personal decision and different factors will come into play for every person. I personally have a high anxiety temperament. that is actually a bigger problem for me than my health. going to the doctor when i am not sick and getting blood tests and mammograms and then waiting for results and then being called back and then finding something that turns out to be nothing has happened to me more than once. They have found in me fibroadenomas at least 3 or 4 times. If you don't know, it is a normal little nothing. I now know what they feel like. I am a healthy 52 year old woman with a stellar family history of longevity and zero cancer. I eat healthy, and i am active.
I have decided to stop the cycle of anxiety by declining the screenings. I found a doctor who respects my attitude. Maybe at a later date I may change my mind. You are kind of in a catch 22 because if youre going to get a bad cancer, it can pop up between mammograms. that is a big point he makes in the book. so going to every 2 or 5 years, like almost why bother?
I personally am offended and upset by the tone of our whole society. my local npr station is loaded with Public service announcements about cancer and tumors and tests and studies and risks and safety and all these things that freak me out when I hear about them . I have stopped listening and contributing to that station and I listen online to another station that doesn't have that.
I think it is great we are having this discussion. thank you.
Individual women might differ in the risk of over-treatment they would be willing to run in order to save their lives. But your guests seem to be giving drastically different probabilities on the ratio of lives saved per mamograms given. Could they be asked to state their estimates and how they got them?
Raymond Neutra MD Dr.PH
If you believe that routine screening to prevent a possibly fatal disease is overused, how can you justify flu shots or vacinations? Early diagnosis and routine screening save lives. I am a survivor of an agressive, invasive breast cancer that would have killed me if not detected early. I am not a statistic! I am a person.
Barbara
Anacortes, WA
Has thermogram is much more accurate without using radiation.
http://en.wikipedia.org/wiki/Thermography
Mammograms can actually cause cancers by the radiation.
I agree with both jcp and Shannon Brownlee -- missed half the show, unfortunately, but I am so glad to hear other women speaking my mind. I am almost 65 and have never had a mammogram and don't expect I ever will. jcp said it perfectly -- we develop tumors all the time. Not all of them are lethal. I don't trust the medical "INDUSTRY" to tell the difference!
My mother is 73 and was diagnosed with breast cancer this past summer. She falls waaaaaay out of the range of women recommended to have annual examines. In fact, with no family history, her health pro said it wouldn't be necessary any longer. And then the diagnosis.
I'm not sure what was more sobering in this process, the fact that there was perceived assurance of healthy breast tissue until the abnormal discovery or the post surgery reveal of a breast less chest. Both, a realignment of what was thought to be true.
I'm not a woman. But, you can bet your bottom dollar I would get an exam every year and ask a lot of questions. We only get one life, living curiously and informed, although difficult in the face of fear, provides great strength in managing next steps with confidence and courage.
I appreciate the show. I did not think though that Dr. Kopans added much to the discussion. He mostly dismissed the other perspectives with the justification basically "most agree with me". They might be right but simply an appeal "believe the experts" seems unsatisfactory, especially from someone who, no offense, would have some bias towards the test given his involvement in the development of 3D mammography. Kudos for his development, but he did not help the conversation much.
The science is irrefutable. Screening mammography saves lives. Men get the same type of invasive ductal breast cancer as women and their prognosis , stage for stage, is the same as that of a women. The difference is that men do not get screened. There has been no decrease in breast cancer mortality for men over the past 30 years. Women get screened and their mortality has decreased 30% over the same time period. Draw your own conclusions.
Murray Rebner MD
For those of you who might be interested in the remainder of the data:
http://www.nejm.org/doi/full/10.1056/NEJMoa1206809
Why is Diane Rehm so uninformed about her guests? First she was unaware that one of her guests was actually a medical doctor, then she kept saying he was from Virginia rather than Vermont. What he said was that he worked for the VA (Veterans Administration), NOT that White River Junction is in Virginia!
If whoever invented the mammogram (male, I must assume) had to be tested every year for testicular cancer with his machine, it never would have hit the market.
I had my first and last mammogram 18 years ago and will not submit to this barbaric device again.
There are methods of examining breasts for cancer that are more accurate, detect cancer much earlier than the current mammogram machine, do not cause pain, and because they are more accurate at early detection do not need to be taken as often.
I used to believe like most of you - that routine mammograms were unnecessary. That it was a "cash cow" for the medical "industry". Even after my sister got breast cancer, I still did not think I needed a screening that was so fallible. I do not have a family history of BC, other than my sister, or carry the gene. Then two more friends were diagnosed, both under 40. I decided to get one at age 54. They found dcis, after my doctor missed it and I missed it. It was so small, you couldnt feel it. I was lucky. I didnt lose my breast or need chemo, and Im still alive. Ive lost 2 friends in 6 months to breast cancer. It's not the way you want to leave this earth, trust me. Its an equal opportunity disease. I tell all my friends and family to get screened. If I hadnt gotten screened, I might have faced something a lot more serious than I did. Im grateful. There are a million stories like mine - and more that dont end as well. You decide.