Mammograms Specialist Johnston RI

Mandatory Mammograms

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By Vonalda M. Utterback, CN

“Time to make breast pancakes,” says one friend of mine, referring to her scheduled mammography screening. And although she may crack jokes about the experience, she’s never once questioned the need for her annual pilgrimage, nor has her physician discussed the risks versus the benefits it entails. After all, if you are a woman aged 40 or beyond, yearly mammograms are simply de rigueur.

When your doctor refers you for a screening, he or she is likely following the guidelines of the two leading national cancer research and information organizations primarily responsible for setting public health policy on cancer screening: The private American Cancer Society (ACS) and the government’s National Cancer Institute (NCI). Both, along with other well-funded, high-profile organizations, such as Susan G. Komen for the Cure, recommend regular mammogram screening of symptom-free women beginning at age 40.

All this official blessing shouldn’t make regular screening mammography sacrosanct, however. In fact, it’s way past time for women to start asking hard questions about the exam’s efficacy and its potential harm, say many women’s health experts, advocates, and researchers. “Screening mammography is clearly a double-edged sword,” explains Lisa Schwartz, MD, co-director of the Veteran’s Administration Outcomes Group in White River Junction, Vermont, and associate professor of medicine at Dartmouth Medical School.

False truths
According to the National Academy of Sciences 2005 publication, Saving Women’s Lives: Strategies for Improving Breast Cancer Detection and Diagnosis, the risk of a false-positive result in a mammogram is about 1 in 10. About three-quarters of the resulting biopsies turn out to be benign, it’s true, but to learn that a woman has to endure the fear that she has breast cancer and bear the cost, discomfort, and risk of additional medical procedures.

“Regular screening will save some lives, but it will cause even more women to be harmed through the unnecessary diagnosis and treatment of cancer that would never have affected their health, were it not for screening,” says Schwartz. She’s referring to false-positives associated with “ductal carcinoma in situ” (DCIS), a result that many experts consider one of the most harmful risks associated with screening mammography.

DCIS is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. It is not cancer, but it may, in some cases, become invasive cancer and spread to other tissues. Because they can’t predict which lesions will become invasive cancer and which will remain contained in the breast duct, doctors usually treat DCIS like cancer. “Most women with DCIS will be advised to undergo invasive treatment of unknown benefit, such as lumpectomy combined with radiation,” reports Schwartz.
Harm from over-diagnosis of invasive cancer also may occur because many malignant cancers grow quite slowly, says Peter C. Gotzsche, MD, r...

Author: Vonalda M. Utterback, CN

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