Mammography Screening: Is the Harm Worth the Benefit?
Decisions about breast cancer screening just got tougher for women in their forties. On Monday, the U.S. Preventive Services Taskforce (USPSTF), a government-sponsored panel of clinicians and preventive medicine experts, released new guidelines that for the first time recommend against annual mammography for "normal risk" women in that age group.Instead, it recommends they have the test every two years. Sounds pretty straightforward, right? The problem is that the recommendation conflicts with those of almost every other major U.S. health organization. They include the the American Cancer Society, which is strongly critical of the USPSTF. Why the disagreement?
The debate centers on the potential risks versus the benefits of screening.There's
growing recognition within the medical field that too much screening
can be harmful. False positive results can lead to costly imaging and
biopsies and even to treatment of lesions that might otherwise have
disappeared on their own. They can also cause unnecessary stress and
anxiety for patients.
"Consistent with the attitude in U.S. medicine that if some is good then more is better, we've opted hellbent for more [screenings] with no evidence [of benefit]," says Donald A. Berry, Ph.D. As chair of biostatistics at the University of Texas M.D. Anderson Cancer Center in Houston he helped advise the USPSTF on its new recommendations. "This change is overdue," he says.
Still, the ACS stresses that routine annual screening can lead to early detection and treatment of lesions that could otherwise be fatal. For this reason, it stands by its recommendation of annual screening mammography for women in their 40's. "Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early," it said in a statement this week.
Dr. Peter Gøtzsche, director of the Nordic Cochrane Centre and author of several large studies of mammography screening, strongly disagrees with that statement. "One survey from the U.S. showed that only 8% of women were aware that screenings can harm them," he said in an e-interview from Copenhagen.
Maybe it has to do with how you define harm.
The debate over the harms and the benefits of mammography screening may never be resolved because in the end, it's a value judgment that is highly subjective. Some women might be willing to undergo extra tests and the risks of false positives (even unnecessary treatment) for the assurance of knowing they're getting checked out regularly. I've written about high-risk, yet healthy women who are willing to go to extremes--removing their breasts and ovaries--for peace of mind. But even normal-risk women worry about breast cancer; aside from skin cancer, it is the most common cause of the disease among women (and the second most common cause of cancer deaths, according to the CDC). For the worrying type, the potential harms of regular screening might be worth it for the benefits of seeing a clean screen.
Related link:
The Real Woman's Guide to Breast Cancer
"Consistent with the attitude in U.S. medicine that if some is good then more is better, we've opted hellbent for more [screenings] with no evidence [of benefit]," says Donald A. Berry, Ph.D. As chair of biostatistics at the University of Texas M.D. Anderson Cancer Center in Houston he helped advise the USPSTF on its new recommendations. "This change is overdue," he says.
Still, the ACS stresses that routine annual screening can lead to early detection and treatment of lesions that could otherwise be fatal. For this reason, it stands by its recommendation of annual screening mammography for women in their 40's. "Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early," it said in a statement this week.
Dr. Peter Gøtzsche, director of the Nordic Cochrane Centre and author of several large studies of mammography screening, strongly disagrees with that statement. "One survey from the U.S. showed that only 8% of women were aware that screenings can harm them," he said in an e-interview from Copenhagen.
Maybe it has to do with how you define harm.
The debate over the harms and the benefits of mammography screening may never be resolved because in the end, it's a value judgment that is highly subjective. Some women might be willing to undergo extra tests and the risks of false positives (even unnecessary treatment) for the assurance of knowing they're getting checked out regularly. I've written about high-risk, yet healthy women who are willing to go to extremes--removing their breasts and ovaries--for peace of mind. But even normal-risk women worry about breast cancer; aside from skin cancer, it is the most common cause of the disease among women (and the second most common cause of cancer deaths, according to the CDC). For the worrying type, the potential harms of regular screening might be worth it for the benefits of seeing a clean screen.
Related link:
The Real Woman's Guide to Breast Cancer
Kate Johnson is a freelance medical journalist who writes for both physicians and the general public. Her goal is to increase medical understanding, stimulate thought, and foster illuminating exchange between her two audiences.
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What are the side affects of mammograms?
If there would be a study/pole of women across the US, asking if they think annual mammograms are necessary, what do you think they would answer? I'm a RN, I'm a survivor, I'm biased. I didn't feel any lump, a routine mammogram found mine. But, I would be interested if finding out what women think as a majority, not just a comment or two. If there is grant money, I'll conduct the study.
Please read the article at the following link to gain some insight into just what kind of harm mammograms can do:
http://www.westonaprice.org/women/mammography.html
It sure opened my eyes.
we are so glad for this information ,, i am working at Egyptian Medical Student Association ,, and i am leading Breast Cancer campaign,,i would love to cooperate with you
thanks,
joumana asser