Risks vs. Value of Mammograms

[Guest guest]

Dear Reader,

A radiologist is a doctor, but he's also a businessman. So if the American

Cancer Society says mammogram screening saves lives and all women over 40

should be getting a yearly exam, then it's just good business to embrace that

recommendation and strongly encourage customers…err, patients…to step up to

the compression plates.

After all, radiologists who give mammograms are saving lives, right?

So you can imagine how a radiologist might not exactly warm up to a recent

study that shows the life-saving reputation of mammograms is vastly

overstated. In fact, as a radiologist, you might hope that this study would be

strongly refuted by the ACS.

And it was.

But here's the kicker: The study was conducted by a radiologist.

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Division in the ranks

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The people who promote mammogram screening are pushing the wrong

statistics, according to Keen, M.D. – a Chicago radiologist who conducts

mammograms.

Dr. Keen and his brother, Dr. Keen of the University of Nebraska,

simply set out to analyze the claim that mammography saves lives. To calculate

benefit, the Keens compared several sets of metrics, including survival

percentages (with and without screening), relative risk reduction based on

randomized mammography trials, and a 15- year cumulative breast cancer mortality

program.

Results showed that the average woman has a six percent risk of developing

breast cancer between the ages of 55 and 70. But if you take 1,000 women at

age 50 and give each one a yearly mammogram for 15 years, only about two

lives will be saved.

Of course, this conclusion was disputed by , Ph.D. – the ACS

director of cancer screening. Dr. told Reuters that when 465 women are

screened for seven years, one life would be saved over the course of 20

years.

I wonder if he actually believes that sounds impressive?

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Taking a toll

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One of Dr. Keen's primary problems with recommending such widespread

screening is the high risk of false positive results, which prompt unnecessary

follow up mammograms, ultrasound tests, and biopsies. Obviously this is quite

stressful for patients, while taking a financial toll on patients and

insurance companies.

What Dr. Keen doesn't mention are the two factors that I'm sure most

radiologists would rather not discuss:

1) Radiation

Yearly mammograms expose women to cumulative doses of radiation that may

prompt cancer growth

2) Compression

Rough handling of breasts can cause tumors to spread, and the intense

compression required for mammography clearly qualifies as rough handling.

In an interview with Reuters, Dr. Keen very accurately characterizes the

medical community's relationship with mammogram candidates: " We don't trust

women to make their own decisions about whether to screen. We just tell them

to screen. We just say mammography saves lives. "

In Dr. Keen's view, the patient is making a purchase and he just wants to

let them know what they're buying. " I am saying that women need to be told

the benefits and the harms and they need to make their own decision. "

Decide on their own? Doesn't he know you're not supposed to say things like

that in the medical mainstream?

You can find more facts about mammogram risks, as well as information about

safe alternatives to conventional mammography, in the e-Alert " End of the

Day " (2/22/07).

Sources:

" What is the point? Will screening mammography save my life? " BMC Medical

Informatics and Decision Making, Vol. 9, No. 18, 4/2/09, biomedcentral.com

" Study Argues Benefits of Mammograms Overstated " Maggie Fox, Reuters, 4/2/09,

in.reuters.com

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