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Questioning The Mammography Debate

November 24, 2009 5:48 AM

New guidelines on breast cancer screening have sparked a fair amount of anger and confusion among women. Dr. Jennifer Ashton answers some of her own patient's questions about the U.S. Preventive Services Task Force's new recommendations.

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by sshivers November 24, 2009 9:26 PM EST
Dr. Ashton: I applaud you for an effective attempt to explain a somewhat complex issue to an overly emotional public. But, you failed to point out that the panel's findings do NOT actually recommend against annual mammograms in all women over 40, as widely reported in the media. The panel simply advises women to discuss their individual risk for breast cancer and the advantages and disadvantages to yearly mammogram screening with their personal physician before making the decision about what is best for them as an individual. The panel's assertion that we do not (yet) have sufficient scientific evidence to recommend that ALL women over 40 have yearly mammograms based soley on their age is spot on! As you said, government recommendations about such issues should be based on the best scientific evidence available and not overly influenced by what is best for our own medical practices.

In short, for American women over 40, you should have a frank and thorough discussion with your personal physician about the pros and cons of mammography and then decide what is best in your situation. If you and your physian decide that you need (or want) a mammogram at age 40, then I believe you could actually use the panel's recommendations to fight your insurance company (if necessary) to make sure that it is covered.
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by writer10 November 24, 2009 6:58 PM EST
I don't care what the article states...I'm not skipping my mammogram, nor pap...even if I have to pay for it myself...ridiculous money hungry idiots we have calling the shots...and they *wonder* why we're fed up with health care on EVERY level from the care-givers to the insurance companies??? Yeah...it sure is rocket science to figure that one out, greedy, greedy, greedy ba$tards who could care less about the individual..."treat'm and street'm...that's their motto.
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by baileyccc November 24, 2009 5:54 PM EST
No women in my life take this cancer dosing of radiation for the profit of health care. When I as a man get a chest x-ray that is a low dose of radiation but a woman takes 100 times the amount of radiation for a mammogram. This is just bad science for profit, nothing new to the health care industry. Posted by Baileyccc
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by mammographer November 24, 2009 3:24 PM EST
We have long hoped for a better test than mammography for breast cancer screening. It is a very difficult task to find 3 to 8 breast cancers in 1000 mammography exams. While MRI is certainly promising, it has limitations in cost, a significantly higher number of false positive exams compared to mammography, and current number of machines capable of the exam. Although there are many MRI machines in the US, only a small percentage have the special resources (receiver coils and software) for doing the study. It also takes special training for the imaging specialist. Also, there is some misconception that just because it does not use 'ionizing radiation' it is automatically safer. It uses microwave radiation which produces free radicals, not ions. There currently is no good evidence to indicate this is a concern, but if we were to use it as a screening procedure, some more strict guidelines would have to be developed. Digital tomosynthesis has demonstrated the potential to improve both our ability to detect breast tumors in dense breasts, and significantly reduce false positives. However, large scale trials have not been completed. It will also cost more than mammography, and result in a higher radiation dose. Sonography can detect tumors in dense breasts, and large scale trials are underway. Dr Love, who has appeared in the national media supporting the USPSTF recommendations, is testing a screening method that involves a process similar to PAP tests.
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by peacefulperson November 24, 2009 3:11 PM EST
Exactly. Mammogram is outdated technology with a poor track record. MRI and sonography is much better at detecting breast cancer. We shouldn't hold on to mammography just to placate political sensibilities.
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by mammographer November 24, 2009 2:55 PM EST
Thank you for pointing out the estimate of the total number of lives saved from breast cancer in the United States when women in their 40's are screened. This is a figure that would have been computed from the computer models cited by the USPSTF. One would have to wonder why they didn't report it. 7500 women dying from breast cancer across the United States is a much more notable number than 1900 women screened for evry life saved. I guess it is another of those 'tricks with data'. Since the USPSTF is about to granted more authority, and I would assume greater reimbursement, by the House of Representitives healthcare reform bill, I can no longer believe that they were not motivated by politics. Now please, please point out the estimate of the number of lives we could save if we screen on an annual basis (they estimate that biennial screening is 80% as effective). Since obviously I am an advocate for the current guidelines, I would report the difference in mortality if all women followed the guidelines for annual screening, versus biennial screening. That number will of course be reduced by the number of women who choose not to have the exam every year... but let them know how many we could potentially save. My concern is that the recommendation by the USPSTF for biennial screening may become the rule for insurance and medicare/medicaid reimbursement if there is not more public reaction.
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by darkferious November 24, 2009 2:14 PM EST
Why are we even using mammograms anymore when MRI technology gives much better images without any radiation?
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