Breast cancer mortality has in fact decrease by a third since 1990, which is a wonderful thing. Attributing that decline to mammography, however, is controversial; there have been huge advances in chemotherapy during that period. A recent Canadian study showed no benefit to routine screening of women under 60.
And who performed the Canadian study? Their government, who is highly invested in saving money and stretching their resources?
Early detection doesn’t save lives, just better chemotherapy? I hate mammograms as much as the next person, probably more, and would love a good excuse to avoid them. However, I just don’t know. There is so much conflicting information out there. My doctor, still says absolutely every year. I don’t think she has anything to gain or lose by giving her honest opinion.
They are invested in giving the advice they’ve spent a career giving; it’s understandable that it’s hard to step back and say differently.
I honestly think that believing in mammograms is almost religious, and it doesn’t work to try to argue that with evidence. People want to think that the right mantra, ritual, or prayer, will stave off the bad stuff.
My GP, after the standard advice was questioned by me, admitted she’d stopped routinely getting them herself.
No. Researchers at Dalla Lana School of Public Health, University of Toronto; Women’s College Research Institute, Women’s College Hospital, Toronto; and Child Health Evaluative Services, The Hospital for Sick Children, Toronto. If you want to read the study, which was published in the prestigious British Medical Journal, it’s [url=http://www.bmj.com/content/348/bmj.g366]here[/url].
Not to mention research such as:
(I’m not sure which of these links is available to the general public so I apologize if they’re behind a paywall.)
Negative effects of false-positives
http://ebn.bmj.com/content/17/3/73.extract
Or their general uselessness in younger women:
http://www.ncbi.nlm.nih.gov/pubmed/23074501
The literature on mammograms is EXTENSIVE to say the very least.
Does the panel have a recommendation for women who are at a risk for breast cancer? I believe I fall in that group. My mother and her sister both died of breast cancer. My cousin (daughter of the aunt who died of breast cancer) is a breast cancer survivor. Unlike my mother and her sister, my cousin got mammograms and did self-exams.
Dstark: May I assume that you also believe that insurance should pay of the annual screening, even if its not medically-indicated? (Wasn’t reducing non-medically-indicated procedures one of the goals of the ACA?) Not trying to get back into the political argument about ACA, but just inquiring how we, as a society, can reduct health care costs if insurance continues to pay for such stuff if it is not indicated?
btw: many moons ago, I was attending a preso by Hopkins’ top GYN, and he threw up a couple off slides and pointed out the conundrum: they could predict with near certainty, that monthly paps would catch xx more problems than annual paps, for example, but the cost to society would be yy, not including the false positives which require further testing/procedures. And, then he made it personal: what should he recommend for his wife? his daughter?
No easy answers, I get it…
ACA or no ACA, as long as people keep thinking that more medical care is always better, medical care costs will rise, whether paid for directly by the patient or by third parties (government, employer, etc.).
Of course, having even routine small stuff paid by (government or private) insurance encourages overuse by patients, and providers who may be laboring under heavy medical school debt themselves have little incentive to discourage overuse.
Deleted.
You know, I routinely see this claim but I’ve never actually seen any evidence of it.
I’m sure you have a link for me, right ucb? (And please, a study of some sort. Not a link to someone who upped their use or a hospital that saw an increase.)
It certainly looks like insurance companies and employers do their own studies on the subject, but do not directly make the results public. But when high deductible medical insurance with an employer HSA contribution that fills in the deductible is lower cost than the more common low deductible medical insurance, that does indicate something here.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2821897/ is a paper suggesting different levels of insurance cost sharing (deductibles and co-payments) depending on the value of the medical service (high value means low cost per life year).
My understanding is the biggest advantage of mammogram is that it detects bc before it’s large enough to be felt during an exam–by provider or self-exam. My mother was a huge proponent of self-exam–understandable since she found her bc thanks to self-exam back in the days prior to mammogram.
Today, lots of women I know don’t bother with self-exam. Mom would sit these ladies down and tell them a thing or two!!
@Bromfield2 much of the family risk assessment depends on the age (menopause status) of your relatives at the time of diagnosis. Breast cancer after menopause does not confirm higher risk to the next generation. Due to significant family risk I’ve had close to 20 years of mammograms. My mother’s first breast cancer was at 45 which increased my risk. As other family members have aged, the doctors have disregarded the breast cancers in my mother’s cousins at post-menopause ages.
^^^@Mom22039 My mother was post-menopausal (so less risk for me there). My aunt and her daughter were pre-menopausal. Not sure if that puts me at risk. I usually go every 18 months–would be happy to wait 24 months.
In order to have earlier detection be a benefit, it would have to be the case that early detection from mammograms makes a difference. Apparently, it doesn’t. Here’s a simplified explanation of why that might be true:
We have slow-growing tumors and fast-growing tumors.
Fast-growing tumors are very bad-- but a mammogram is very unlikely to detect a fast-growing tumor before it becomes palpable, since it goes from nothing to palpable so quickly, and even a yearly mammogram is unlikely to happen just in the right time between detectable only by mammogram and detectable by feel.
Slow-growing tumors are not so bad. They are treatable even if detected when they’re big enough to feel. Mammograms detect slow-growing tumors, but we might as well have waited and treated them when we could feel them, because we’d have had just about the same results.
Meanwhile, mammograms not only detect cancers. They also cause cancers. The benefit from the few times that a fast-growing tumor is detected in time to make a difference are balanced by the extra cancers caused by the mammograms.
^. This. Plus, many which are found early would NEVER need to be treated as they are so slow-growing. They might never be known about in the woman’s lifetime without mammo, and wouldn’t matter.
As far as the fast-growing, yeah, that was my MIL. She had a mammogram months before her lump was detected. It had shown nothing. The cancer grew that fast, and killed her three years later. Yearly mammogram was useless against this sort of cancer.
Now the American Cancer Society is on board with recommending fewer mammograms:
http://www.nytimes.com/2015/10/21/health/breast-cancer-screening-guidelines.html?hp&action=click&pgtype=Homepage&module=first-column-region®ion=top-news&WT.nav=top-news&_r=0
Yesterday I was at the GYN and she said that if you are HPV negative, they will not do a PAP every year any more. They are doing a more specialized test to check for HPV along with the PAP. With my medical history, I still want hte mammo and PAP every year. My chemo drugs are too new on the market to know what late effects they might trigger.
I had a dexascan three years ago (age 51) and it was normal. GYN said I don’t need another one til I’m 65. My mom had a catastrophic femur fracture at 64 and was bedridden for the last ten years of her life. NO WAY I am not getting that checked every five years. If she won’t do it, my primary will order it, I have no doubt.
http://fivethirtyeight.com/features/science-wont-settle-the-mammogram-debate/ has more discussion about mammogram frequencies and effects.