What's This About Mammograms?
Breast Cancer Screening Benefits Debated
An estimated 175,000 new cases of breast cancer are expected to be diagnosed among women in the United States during 2003.
After fighting for years to get women to go through a procedure that can be both uncomfortable and embarrassing, the message is finally getting through. Regular mammograms DO improve survival.
The earlier breast cancer is diagnosed, the better the chances are for survival. An article in the British journal The Lancet reported that mammograms do not improve the survival rate for Breast Cancer.
I first saw the article on the Internet, then watched in horror as all of the local TV news shows picked up the story. Is it possible that one article may destroy years of education and immense gains in lives?
The Lancet article reviewed eight studies. The six that found mammograms lowered breast cancer death rates were deemed to be flawed. The two that showed no gains in survival were well designed.
If this is a call for better design of scientific studies, there is no argument. If it causes women to put off getting a mammogram, it is dangerous.
Not A Perfect Tool
There are cases where mammography is not the ideal tool for diagnosis of breast cancer.
- Mammograms are known to miss a significant number of breast cancers, especially in younger women.
- Approximately 5-15 percent of breast cancers are not detected on mammograms
- Often cancers are only revealed at more clinically advanced stages.
- False positives can occur.
- Of the women who follow up with biopsies of an abnormality, about 70 percent do not have cancer.
- Magnetic Resonance Imaging (MRI) has been shown to be effective in detecting and staging invasive lobular breast cancer, a form of breast cancer that historically has been difficult to diagnose accurately by mammography or ultrasound.
Clearly, mammography is a tool that can be improved and superior training of technicians who are responsible for interpreting the findings is vital.
Do these findings mean that mammograms are useless?
The American Cancer Society and the Susan G. Komen Foundation's response to The Lancet article gives solid facts to show the results of increased use of mammograms by women in the United States.
Harmon J. Eyre, MD, chief medical officer for the American Cancer Society (ACS) states that, "In the early 1980s, when only 13 percent of American women were getting mammograms, the average size of breast tumors at diagnosis was 3.2 centimeters (about 1 1/4 inch). By the late 1990s, 60 percent of women in the US were having regular mammograms and the average tumor size had dropped to 2 centimeters. Also, in most cases diagnosed today, the cancer has not spread to the underarm lymph nodes; decades earlier this was not the case."
In England, 1995 figures showed death rates from breast cancer had fallen by 13% among women aged 50-64 since their mammogram breast screening program was introduced in 1988.
The Real Results of This Report
After the article in The Lancet appeared, many breast screening centers reported a drop in appointments for mammograms.
The established breast cancer research and medical communities in the United States and Great Britain have come out resoundingly in favor of the benefits of regular mammograms.
Hopefully, the community of potential breast cancer victims will listen. The odds of catching a malignancy in the earliest, most treatable stages without regular mammograms are not good enough to bet your life on.
January 10, 2000
Last updated March 30, 2009
also see featured How To -> How to Prepare for a Mammogram
Elsewhere on the Web:
Screening Mammograms: Questions and Answers
Mammograms and Other Breast Imaging Procedures
Breast Cancer Screening Trial Shows Digital Mammogram Benefits