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?