A few weeks ago, a government task force concluded that women don’t need annual mammograms after all. In fact, according to the US Preventative Services Task Force (USPSTF), usually only women over the age of 50 need them, and then only every other year.
Needless to say, doctors and hospitals that get paid per mammogram took umbrage at this pronouncement. “The net effect of the new guidelines is that screening would begin too late and its effects would be too little. We would save money, but lose lives,” said Dr. Stephen Feig, the president-elect of the American Society of Breast Imaging. Maybe it’s just me, but I’m not quite sure if the “president” of a society whose members rake in big bucks from mammograms on a reliable, repeat-business basis qualifies as impartial.
In fact, if every woman had followed the previously recommended annual imaging guidelines, the annual revenue reaped by health care facilities just for administering mammograms would be a staggering $5 billion, with $2.5 billion of that coming from pre-menopausal women. And don’t forget to add to that the profits from sales and servicing of imaging equipment, administering biopsies, and treating the extra cases of cancer caused by mammograms. In other words, the health establishment stands to lose a whole lot of money if fewer women get annual screenings.
But, to be fair, mammograms aren’t just about profits. Detecting breast tumors early does save lives, and if mammography did a great job of it (and didn’t potentially create more tumors in the process), the new recommendations would be criminal. In fact, plenty of women are outraged at the recommendation to reduce screenings, convinced that the benefits of mammograms outweigh the risks. The problem is that mammograms just aren’t that reliable, plus they actually raise breast cancer rates — and safer, better alternatives are available. If women knew all the facts, they truly would have something to be outraged about.
First, as for accuracy, I’ve written before that mammograms can miss up to 30 percent of all tumors, because the technology just can’t pick up all tiny masses, particularly those hidden from view. More importantly, though, the rate of false positives by some counts is as high as 90 percent. In fact, the USPSTF task force cited the anxiety caused to women and the unnecessary treatments resulting from false positives high among the reasons for suggesting changes to mammogram recommendations. Many medical experts, though, found the “false positive” argument lame.
“You’re going to have some false positives, if you detect cancer early, when it is most curable,” Dr. Feig says. (Personally, I have to admit I find the word “some” an interesting adjective to use when referring to “90 percent.”) And Dr. Judi Chervenak, an associate clinical professor at Montefiore Medical Center in New York, says the false-positive argument “is insulting to a woman’s intelligence. It’s assuming that women can’t take the news that they have a false positive. Women know there can be a false-positive.” (Perhaps even more insulting to women’s intelligence is how blithely Dr. Chervenak totally ignores the fact that false positives may lead to more than the shock of getting bad news — they can, and do, lead to invasive biopsies and unnecessary treatment on a massive scale, which women may not “take” so well.
Then, there’s the “mammography may cause cancer” issue. In fact, a large study that just came out found that high-risk women who had mammograms or chest X-rays before age 20 had two-and-one-half times the risk of developing breast cancer compared to high-risk women who didn’t have the tests. If the same group waited until after 20 to have the test done, they raised their risk of breast cancer by 1.5 times. Other studies have found similar risks, particularly for younger women. As I’ve written before, the four films shot during a mammogram expose women to 1000 times more radiation than they would get during a chest x-ray, and it’s a no-brainer that can’t be a good thing.
In fact, experts warn that pre-menopausal women increase their risk of cancer by two percent for each mammogram they have. The incidence of one particular form of breast cancer, ductal carcinoma in situ, has skyrocketed in direct relationship to the increase in mammograms performed, and experts believe there is a close link. Plus, the compression applied during the screening can spread cancer cells. Curious how the American Society of Breast Imaging found that not worthy of mentioning, don’t you think?
And so, the new recommendations appear to have definite “health” merit, although it is maddening that the announcement does seem to be based not on concern for women’s health but more out of concern for containing costs. And lest we forget, as stated above, good alternatives to mammograms do exist, and few women have been educated by their doctors about those options. For one thing, thermography is relatively cheap, safe, and effective. Breast sonograms also provide a safer, relatively inexpensive alternative, and according to the American Journal of Radiology, sonography detects twice as many cancers as mammography. Plus, there’s a new imaging technology called elastography, which used in conjunction with sonography not only finds tumors, but also reveals if they’re cancerous, without biopsy.
Someone should mention to Dr. Chervenak that not reminding women that there are safer and more effective alternatives than mammography is truly insulting to their intelligence. But she is hardly alone. Experts like Harvard University radiology professor Dr. Daniel Kopans act like starving people in a Swedish smorgasbord who claim they can’t find anything to eat. “The [mammogram] guidelines tell women in their 40s that they can go back to the 1950s when they had to wait until a tumor was too large to ignore, and then go to the doctor when there was no longer any chance of a cure,” says Dr. Kopans. He makes it sound like mammography is the only diagnostic tool available. Seems like he and many of his peers need to pay more attention to the literature in their own professional journals.
And let’s not forget Dr. Stephen Feig, the president-elect of the American Society of Breast Imaging. If he acts quickly, he should be able to nail down the top spot at the as yet to be formed American Society for Elastography and Sonography. Go get em Stephen.
:hc
