<p>As someone who was diagnosed in her 40s with breast cancer with a routine mammogram, I agree with the author. Interesting article.
[Bottom</a> line: Mammograms save lives | ajc.com](<a href=“http://www.ajc.com/opinion/bottom-line-mammograms-save-525069.html]Bottom”>http://www.ajc.com/opinion/bottom-line-mammograms-save-525069.html)</p>
<p>The current research does not deny that routine screening of women in their 40s could save lives. The issue is that it takes 20,000 mammograms and hundreds of ineffective surgical procedures for each life extended.</p>
<p>There is an interesting claim in the article. It says that breast cancer mortality has declined by 30% since 1990 “when screening was introduced”. It is true that the formal guidelines were changed in 1988 to recommend regular screening for women in their 40s, but screening had been commonplace since the 1960s, with all but one studies showing no or even negative mortality effect from screening women under 50 without a family history of breast cancer. The other thing that happened in 1988 is that the FDA approved tamoxifen for use as a breast cancer therapy. I believe that most public health scholars who have looked at the data think tamoxifen, not the change in screening guidelines, has been responsible for the first reduction in age-adjusted breast cancer mortality in roughly 200 years.</p>
<p>It’s all about balancing Type I error (the cost, worry, etc. over mammograms that turn out to be unnecessary in retrospect) and Type II error (the cost of missing a breast cancer that could have been successfully treated). You can lower one, or the other, but not both.</p>
<p>After all, you could catch even more breast cancers if you started routine mammograms at age 30 vs age 40. Or if you started at age 20 for that matter. Or if you had them twice a year versus yearly. However, we all have collectively made a decision that we’re willing to accept missing a few 25-year-olds because the cost of giving every woman a mammogram twice a year starting at age 20 is just prohibitive.</p>
<p>Also, there’s some bump in cancer risk from each additional exposure to radiation, and there’s a risk of medical error or iatrogenic infection from the additional procedures. Neither is huge, but it doesn’t take a huge risk to be meaningful when you have to have thousands of procedures to produce one net additional good result.</p>
<p>The OP might also have been treated just as successfully if she had been diagnosed later based on symptoms. There is no way to know this for any individual. </p>
<p>With any screening procedure, there is a need to demonstrate that the earlier diagnosis that may result from screening leads to better outcomes.</p>
<p>When diagnosed tumor was 1.2 cm but I already had micro mets (< 0.2mm) to the sentinel node. Had three opinions all said this tumor would not have been detected for another year by palpation.</p>