The Top Ten Things That You Should Know About Mammograms in 2018

Let me preface this by saying that mammograms are the best screening available for breast cancer.  They are the recommended screening tool something better comes along.  But they are far from ideal.

 

1--No one agrees on when to start them, went to stop getting them, and whether to get them yearly or every other year.

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there is no evidence that one scheme is better than another.  most researchers however agree though that mammograms before 50 and after 70 are likely the least cost-effective.

 

2--mammograms miss about 1/3 of early cancers

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if we are going to significantly reduce mortality from breast cancer, we are likely going to need to use a whole new approach.   mammography simply is not having the impact on reduction of breast cancer mortality that it needs to.  it is interesting to point out, though, that missing these early cancers does nothing to worsen overall mortality.  it seems like it would.  but it doesn’t.

 

3--over 80% of women who get breast cancer have no family history of it. 

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your risk of breast cancer increases as you age until the day you die.  there is no “peak” age.  but there is no data showing survival benefit from screening over the age of 75.

 

4--many of the cancers found on mammograms are not life-threatening (seen retrospectively).  They are very slow growing tumors.  So getting diagnosed with breast cancer is not a death sentence.  It’s scary.  But not universally fatal.  Have hope.

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especially if they are very slow growing tumors.  so getting diagnosed with breast cancer is not necessarily a death sentence.  intuitively it would seem that more frequent testing or earlier testing would improve outcomes.  but there is no proof that it does, unfortunately.

 

5—over-diagnosis is a significant concern with mammography.

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i can't emphasize the importance of this enough.  it is estimated that 1/3 of women who get mammograms will at some point have a call back, require further testing, and often biopsies or other invasive procedures, not to mention the worry that goes with that.  this even aggressive call-back policy has done little to change breast cancer mortality in the last 25 years.

 

6--overall cancer mortality (all types included) rates is the same in women who get mammography and those who don't

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mammography SHOULD decrease the overall cancer rate in women who get mammography versus those who don't, but studies do not show that.  studies show exactly the same cancer mortality in both groups.  what does this mean?  it means mammography is perceived at being much better than it actually is in preventing mortality.  

 

7--clinical and self-breast exams have not been shown to reduce breast cancer mortality

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unfortunately true.  they are no longer recommended.

 

8--for younger women with a breast lump, ultrasound is usually the next step, not mammography

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most lumps are cystic (fluid-filled) and can be safely watched.

 

9--the internet is full of outdate, biased, misleading, or flat out incorrect information about mammography

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the biggest fallacy that is perpetuated is in overstating the effectiveness of mammography in preventing mortality.  so much so that it seems ludicrous to even question getting a mammogram.  however, what the data shows is that mammography prevents about 1 death from breast cancer per 1000 women screened.  it is much less impressive than you would think based on what you find on-line.

 

10--the decision to undergo mammogram should be an informed one.  

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i want to stress that breast cancer research needs funding now more than ever.  campaigning for “a mammogram for every woman” is not an effective way to reduce mortality from breast cancer.  it is the best tool available but it is not nearly as effective as is generally believed.   it has even reached our major media outlets know, too (NY Times, Time Magazine, LA Times, Reuters, et al) who have all reported on the overall unimpressive results of mortality reduction using mammography.   knowing this enables you to make better decisions for yourself, to understand where things stand and why it is more essential than ever that breast cancer research be funded to find effective ways to screen for, prevent, and cure this terrible disease.