Study Places Doubt on the Value of Mammograms

Mammogram Debate

Study Places Doubt on the Value of Mammograms

You may have heard about the study (published in the British Medical Journal on Tuesday)   and reported on the front page of the New York Times citing that “annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.” Wondering what this means exactly?  Well, the net-net of this report is that the researchers determined that mammograms don’t decrease the death rates from breast cancer — but do increase the likelihood of unnecessary treatment. Wow. Talk about a bombshell, huh?

The New York Times describes the report as: One of the largest and most meticulous studies of mammography ever done. It is indeed big news.

Let me give you a little background on the study: The objective was to compare breast cancer incidence and mortality in women aged 40-59 who did or did not undergo mammography screening. The study included nearly 90,000 women and spanned 25 years. Having done research and worked in academic institutions, let me say that this is a big, big endeavor.

The initial Canadian National Breast Screening Study (CNBSS), which began in 1980, was strongly criticized by Memorial Sloan Kettering for two reasons. First, the mammograms performed were judged by outside experts to be of extremely poor quality, and the skills of the imaging technologists were deemed inadequate. Second, the subjects used for the study were not properly randomized into two groups of equal risk for comparison.

As you can imagine, this study has further polarized advocates for and against mammography. To be completely honest, I’m not sure exactly where I stand. I found my breast cancer and it was corroborated only after a mammogram and handheld ultrasound tests. What I believe without a doubt, from the bottom of my tippy toes is that women need to do self-exams. This is so incredibly important!

The other important aspect of this study goes to the issue of treatment. What has been determined is that all too often, women receive intense treatments (e.g., mastectomy, chemotherapy and radiation) unnecessarily. Yes, that’s right. Unnecessarily. There is an assumption that all cancer cells must be treated. Now, most do indeed need to be treated; however many actually don’t. There are some types of cancers that don’t grow at all or grow very slowly and do not require the draconian treatment that exists today (if you’ve had treatment, I imagine that you will agree with that adjective). Pretty amazing, right?!?

Currently the American Cancer Society screening guidelines recommend yearly mammograms for women starting at age 40 and continuing for as long as a woman is in good health. Clinical breast exams are recommended every 3 years for women in their 20s and 30s and every year for women 40 and over. This study seemingly turns these guidelines topsy turvy.

As quoted in the New York Times, the American Cancer Society has formed an expert panel which will consider all studies of mammography, including this latest study. The panel will then issue revised guidelines later this year.

What I know for sure is that this study mandates that the dialogue, debate and research continue to figure out whether mammograms are useful and if so, how often. What I also know for sure is that patients need to be consumer driven and not simply accept the prescribed status quo.

I’d love to hear your opinions. What do you think about the study?

 

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Comments

  1. says

    How do we know that the annual mammograms themselves aren’t the cause of the cancers in older women?
    I was one of those who did not ever want to do a mammogram. I didn’t want my breast to be exposed to the radiation (no matter how “minute”) nor squished causing who-knows-what kind of unnatural damage. However, I now have a tender spot in my left breast that I’ve never had before and will be getting a diagnostic mammogram next week sometime. Am I happy about going through that? No. But I know I don’t want cancer either. I’m quite mad at my gyn as well because she knows that I’m Estrogen Dominant and has done NOTHING to monitor my hormones since my hysterectomy last year with a diagnosis of Complex Hyperplasia with Atypia (one ‘stage’ away from uterine cancer). She left my ovaries in too so now I get to worry about ovarian cancer as well and that’s even harder to diagnose!
    My fear with this mammo is that it will be a false positive and they will make me go through invasive procedures for no reason. I have Dr anxiety anyway and don’t trust any of them (due to misdiagnosis, misinformation, refusal to give the only pain med that works on me after a recent major surgery, etc) but of course they label me the ‘difficult’ patient because I ask questions. ok, and I freak out a little. Ok. A lot. And end up saying some pretty stupid things because my brain is going crazy with anxiety 😛
    I am praying this tender/sore area is nothing of concern and requires no further observation/treatment after this mammo.
    Will it mean I will do a mammo every year after this? I don’t know yet.

  2. janice says

    thank you hollye for addressing this study. as I understand the study, it concerns screening mammography, not diagnostic mammography. its a tool, one of the few we have in the screening for cancer. it isn't a panacea nor a substitute for self-exams or self awareness. and if we accept the veracity of its findings, my question is will researchers realize that early detection is but one clue in the puzzle that is breast cancer. we need to tone down the fear factor and step back and ask why, after years and billions of dollars spent, we still basically diagnose and treat cancer the same way we've been doing it for 50 years. the chemicals might be more sophisticated and the surgeons more skilled, but that's the truth of it. as a double advanced cancer warrior, I'm just shocked and amazed by this and the big business that cancer has become.

    so far, what I know for sure is be self-aware and trust your gut, get good information, ask good questions,love your doctors but not blindly, try not to be the theme music for sadness, you are still alive to fight the fight after all, and be kind. to yourself of course but to everyone even if they aren't.

  3. Kristen White says

    I am a statistic… How are you Hollye??? I had my first mammo about a year after I finished nursing the twins (so it was just this past December…I am about to turn 42 in a week)… They did a follow-up mammo…2 ultrasounds and a core biopsy to discover I have fiber cystic breast disease…a harmless, condition… Just saw my OB/GYN last week for my annual and she handed me this study and said that as my Dr. it becomes VERY hard to know how to advise me from here… Basically, I have had to endure 4 additional tests/procedures and the emotional / financial stress to find…NOTHING… In not so many words, she basically said she would think LONG and hard before having "regular" mammograms in the future… An annual clinical breast exam is a MUST, but mammograms…not so sure anymore!

    • silverpen says

      Hi Kristen. Thank so much for sharing your story. Please always trust your instinct. There is so much white noise out there. Clearing the clutter and listening to the voice inside is the best place to start. Please stay in touch!

  4. says

    The NYT article is very eye opening but honestly, I don't know what the answer is. I also (like many others in this comment trail) found my lump myself, and since I have dense breasts mammograms never really showed much anyway, but I still worry that without them, some cancers will go undetected and those women may present with later stage/larger tumors that could then spread throughout the body through the lymph nodes. It's a very difficult decision, I think every woman needs to be in touch with her body, and find good drs. to help guide her in her decisions, then make the decision and stick with it.

  5. says

    So confusing…my cancer, too was not palpable…nor did it show up on a mammogram. Thank goodness I request a sonogram every year because I have dense breasts. Only there did the tumor show up. I wonder how long and how much larger it would have been to feel it or see on a mammogram and what would have happened to me at that point….a whole different outcome. I guess the bottom line is that each cancer and each woman needs to be treated differently. But I sure am glad I go for yearly mammo/sonograms. It's all kind of scary….

    • silverpen says

      Thanks for sharing, Bethany. It is all scary indeed. It's so nice to know that so many strong and smart people are in it together!

  6. Mary Morris says

    I had a physical to start a new job-inlcuding a breast exam. Eight days later I felt a mass in my breast. I went to my doctor who told me that it had to be a cyst-I had just had a physical two weeks before. I was post menopausal and cysts occur in a very small percentage of post menopausal women. I was starting a new job, and it was about 5 weeks before I did the mammogram they had given me a requisition for. It was not a cyst-it was cancer. The image on the mammogram led me to the test that saved my life.

  7. Nanette Jacobs says

    Wow indeed Regan..I have goosebumps. I had cosmetic implant surgery one year ago. After weight loss and long breast feeding of two my breasts had "left the building"…but because of Hollye, I actually asked my surgeon not to be afraid to cut me wide open and have a "good look around" before placing the implants. Sounds weird and I do have a large vertical "anchor" scar but I thought it made sense as they did the same thing when I had an appendectomy. Thank you for sharing your story and I hope you are doing well.

  8. Kerry Rose says

    Hi Hollye, I am not sure what to think either. I had nipple drainage and went in for a mammogram and nothing showed up….6 months later I had it again and had an ultrasound which ultimately diagnosed me with breast cancer stage I. Once diagnosed I then had another mammogram and Brst MRI prior to surgery….so was it beneficial to me to have that first mammogram? I was told at the time that mammograms don’t catch 20% of invasive ductal carcinoma early on. So had I not had any symptoms I would have returned a year later to receive my annual mammogram and hopefully then they would have found it!? I count my blessings that we caught it early!

  9. says

    I will be the odd man out here. I had a dream I had cancer but an exam and testing showed nothing. Six months after the dream I found the lump clearly by accident. After a lumpectomy I continued to have dreams that there was still more cancer which my doctor waved off as utter nonsense. Six months after that she confirmed these new dreams. There was more cancer. After a mastectomy and volunteering three years in a chemo clinic I can assure you that everyone is different. Tests are not always accurate. I have seen women die from doing "everything right!" I have also seen women live that did not! Also know that mammograms don't see a thing if you have dense breasts. Paying attention to your body is the best test. And if in your heart you feel that a mammogram is calling, do it. But don't depend on testing or doctors to be your gods because they will fail you. Unfortunately they are not perfect.

    • silverpen says

      Very well said, Mary Beth. I wholeheartedly agree that paying attention to our own body is the very best thing to do. Thanks for sharing!

  10. Kerry Rose says

    Hi Hollye, I am not sure what to think either. I had nipple drainage and went in for a mammogram and nothing showed up….6 months later I had it again and had an ultrasound which ultimately diagnosed me with breast cancer stage I. Once diagnosed I then had another mammogram and Brst MRI prior to surgery….so was it beneficial to me to have that first mammogram? I was told at the time that mammograms don't catch 20% of invasive ductal carcinoma early on. So had I not had any symptoms I would have returned a year later to receive my annual mammogram and hopefully then they would have found it!? I count my blessings that we caught it early! :)

  11. Leslie in Little Roc says

    I listened to the Diane Rehm show on this study today and truly felt that I need to have a honest talk with my physician about what is best for me and yes, a self exam is a necessary part of taking care of my health. I appreciate all your posts and the guidance they bring!

  12. Joan Aldrich says

    Dear Hollye

    Hmmmm …. I have been having mammograms since I was 30 as I have dense cystic breasts. I'm in my 60's now and still have a yearly mammogram and last year had the the new lazer ultra sound one as well. These studies that come out are iffy I think as imperial scientific knowledge is not a for certain science. For example who are these results being tweaked in favor of ie: thec government like the socialized medicine they have in the United Kingdom or the dreadful ObamaCare Affordable Care Act the whose best interests I feel are not the individual patient but for sake of keeping costs down. Denying the tests to keep their $$$ $bottom line down. It is sad but I am leary that the honest and caring guidance I have had with my Dr's is slowly being sabatoged by the insurance companies and now by the government. I feel fortunate to have my Doctors quarterback for me with the tests that they have prescribed to determine and diagnose
    the good lumps from the bad.
    Thanks for listening :-)
    Hearts love,
    Joanie

    • silverpen says

      Thanks so much for your comment, Joanie. I'm so happy that you have such great physicians. Talk about a major Silver Lining! :)

  13. Carolee Groux says

    This research doesn't change my opinion about having yearly mammograms from age 40 on. A mammogram found my breast cancer tumor early onset. After a lumpectomy with no lymph node activity, I was essentially cured. However on my doctor's recommendation I had adjuvant therapy; both chemo and radiation, (just in case). This is where I am not sure that the treatment might not be overkill, and do more harm than good. Now those women who elect to have double mastectomies because they have the positive chromosome marker of susceptibility, to me is unnecessary overkill. I guess this proves that science and research is never settled or stable; new findings can change practices.

    • silverpen says

      Thanks so much for your comment, Carolee. New findings can indeed change practice. The key is knowing when the findings are accurate.

  14. ann boyer says

    First, I don't understand this last sentence:
    "patients need to be consumer driven and not simply accept the prescribed status quo."

    Second, we would be wise to remember that the Dartmouth folks seem to be anti-diagnosis in general, not just with regard to breast cancer. I begin to be a bit dubious
    when I see the dominant theme of scholars from a single institution tending to adhere to one party line. Having had one politically-correct position, let us not now
    plunge to another.

    • silverpen says

      Hi Ann,
      Thanks for your note. I really appreciate it!

      The last sentence refers to my belief (derived from my years as a nurse and now as a patient) that patients need to be their own advocates, interview and then hire their healthcare teams and to partner in the development of their plan of care. Hope that makes sense.

      Thanks for your feedback on the study. We do indeed need to look at all studies with critical eyes. For sure.
      Take good care!

  15. Shawn Tesser says

    I agree women need to do self exams, but that's not always the answer either. I did self exams and had just had yearly and thorough breast exams by my female internist and female gynecologist and none of us felt anything suspicious. Two weeks later, my 2nd routine mammogram ever at 41 showed a mass which a biopsy confirmed to be malignant. And you and I are just two women after all and our experiences are wildly different! Regardless of the protocol every woman should be aware of any family history at all of breast and ovarian cancer; she should consider whether or not she has "dense" breast tissue that might benefit from screening including an MRI; and she should know and consider the risk factors for breast cancer. I don't know the answer either; in my experience every woman's story is completely different. In my case, the mammogram made a difference. Furthermore, I was diagnosed at stage 2A, so having to decide on whether or not to treat the cancer was not really an issue either. I think the reality about breast cancer in 2014 is that there is a tremendous amount that is unknown. Even 10 years ago all breast cancers were treated the same and we've come so far from since then, but clearly we're not at the end of discovery or "the answers" involving both diagnosis and treatment. And don't get me started on the lack of a cure…that is the ultimate frustration.
    At Memorial Sloan-Kettering Cancer Center where I am patient, they have an opinion and made it clear today: http://www.mskcc.org/blog/recent-study-should-not
    Thanks, Hollye

    • silverpen says

      You're so right, Shawn. Self exams is a start. The sad thing is that so many people don't actually do their own exams.
      Thank you for sharing your story and the link to MSKCC.
      Take good care!

  16. says

    I think the mammogram can give a false sense of security sometimes. I found my cancer on my own. When I went in it could not be seen on a mammogram because my breast are dense. My tumor was 2.0 cm and could only be seen with an ultrasound. Having dense breasts is a risk factor for breast cancer. Some states are now mandating people be told of their status. If you have dense breasts you need additional diagnostic testing. Sorry this is a little pet peeve of mine :) Mammogram or not, everyone needs to do their self exams. It is so important to know the general landscape of your breasts to detect the abnormal.

    Jennifer

  17. Jill Baldauf says

    Hey, Hollye! I ready the study also and re-read it! Loved your explanation, way better! It definitely pains me to see that mammograms aren't proving to impact deaths by cancer, but I must admit a mammogram didn't turn up my breast cancer either. I found it in July when a December mammogram saw nothing! So there ya go! Love the word Draconian, it's so true. If penis cancer were are prevalent as breast cancer would we be so fast to lop off that bit of men's anatomy? Hmmmm!