The Downside of Mammograms
Written by Faith Anderson on November 23, 2012
Annual Screenings May Be Unnecessary
Women diagnosed with breast cancer typically undergo invasive procedures like radiation therapy, surgery, chemotherapy and hormonal therapy, said H. Gilbert Welch, study co-author and professor at the Geisel School of Medicine at Dartmouth College. “These are major medical interventions and they’re certainly not something you would want to undergo if you didn’t need to,” he said. This research immediately added fire to the ongoing debate over how often women should get mammograms, and is only the latest report to challenge the once-strong consensus that regular mammograms are critical to protecting women’s health.
In the past two years, a large study of Norwegian breast cancer patients concluded that routine mammograms reduced the risk of dying from breast cancer by less than 10%. Another study found no effect on the rate of breast cancer deaths when comparing European nations where mammograms became prevalent in the 1990s, and those where screenings weren’t widespread until the 2000s. Prior to these studies, in November 2009, a federal panel revised its mammogram guidelines, reporting that women should begin regular screenings at age 50 rather than 40, and get the screening every other year rather than annually.
Challengers to the Breast Cancer Study
For all the research advocating less frequent mammograms, there are plenty of dissenters. The American Cancer Society, for example, warned that the recent NEJM study “must be viewed with caution,” and the American College of Radiology claimed that the study authors were spreading “misinformation” and “the cost may be lost lives.” These two organizations also challenged the mammogram guideline revision implemented by the U.S. Preventative Services Task Force, as did the Obama administration. In 2010, lawmakers changed a mandate in the health care law requiring insurance carriers to cover preventative services recommended by the federal panel free of charge. The law indicates that, when it comes to mammograms, insurers must follow the task force’s former guidelines.
Early Detection Isn’t Always Accurate
Researchers involved in the NEJM study examined changes in the rates of early- and late-stage breast cancer in the United States, under the assumption that, if screening were effective, its increasing use would result in more frequent detection of early-stage breast cancers and a drop in the prevalence of late-stage cancers. Instead, they found that, while the rate of early-stage cancers doubled over the past thirty years, the rate of late-stage cancer dropped by only 8%. Welch believes that more advanced mammography technology is allowing doctors to discover breast lesions in an early stage of development, but at that point, it is virtually impossible to distinguish them from benign cell clusters. And, even as mammograms produce false positives, they fail to identify forms of breast cancer that develop rapidly, explaining why widespread screening has done little to reduce the rate at which late-stage cancer is found.
Women Should be Informed of All Possible Options
In light of their findings, Welch believes that women in their 40s who feel comfortable getting screened every year should not be dissuaded from doing so. “But women who have never felt good about it, who felt coerced into the procedure, should feel equally good about not having it,” he said. Welch elaborated: “We should tell women about the trade-offs and should allow them to make their own decision.” Only by being aware of the benefits and risks of an exam, treatment or medication can consumers make an educated decision about what is right for them, and what isn’t. Unfortunately, many patients are persuaded to follow a certain path, without being adequately informed by their doctors of the potential risks or alternative options. If you believe you have been adversely affected by a medical procedure, treatment or pharmaceutical drug, our consumer advocates at the Consumer Justice Foundation can put you in contact with a medical malpractice attorney in your area.