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The mammography debate rages on

At what age should women begin getting annual mammograms? Researchers disagree.


 

A new study, published in the journal Cancer, claims to prove that annual mammography for women in their forties reduces the death rate from breast cancer in this group by almost 30 per cent. This is sure to throw more fuel on the fire as experts hotly debate at which age women should begin a regular screening program for breast cancer—and even whether awareness and treatment were more important tools than regular mammograms.

The most recent study was authored by Dr. Stephen Duffy of the University of London, and Dr. Laszlo Tabar of the University of Uppsala School of Medicine in Sweden, well-known advocates of mammography, the New York Times reports. It followed over 600,000 women for 16 years, and found that the number of breast cancer deaths among women who didn’t receive mammograms was twice as high as those who did. “It is now time to stop confusing women with conflicting information. Mammography is a lifesaver for women in their forties,” Dr. Gail Lebovic of the American Society of Breast Disease said, commenting on the study.

Still, other research has claimed differently. Just last week, another widely reported study suggested that increased awareness and better treatment—and not necessarily mammograms—were the best way to reduce death rates from breast cancer, the most common cancer in women worldwide. (See Canadian statistics on breast cancer here.) Timely care and “the widespread use of adjuvant therapy have probably combined to make screening now less important, said Dr. Gilbert Welch of Dartmouth Medical School in an editorial accompanying the study, according to ABC News.

This follows even more conflicting advice. In January, two U.S. groups (the American College of Radiology and the Society of Breast Imaging) recommended that women begin getting regular annual mammograms at age 40, just two months or so after the U.S. Preventive Services Task Force recommended against routine mammograms at that age, causing an uproar among some health care professionals and patients alike.

Screening mammograms are meant to detect any signs of cancer tumours in apparently healthy women, but some argue they can do more harm than good, especially at a younger age. The disease is less common in younger women (the annual risk of developing it at age 40 is half what it is at 50), so they’re more likely to get false positive results, which can lead to everything from unnecessary biopsies to stress. That’s one reason medical bodies offer widely conflicting advice, as Maclean’s reported earlier this year. The Canadian Cancer Society says women aged 50 to 69 should get a mammogram every two years and those in their forties should talk to a doctor; both groups should get clinical breast exams. The American Cancer Society, meanwhile, recommends yearly mammograms beginning at 40.

Anyone could be forgiven to feeling confused. Until some sort of consensus on mammography emerges, one position almost every medical expert can agree on is that individual women should discuss the benefits of mammography with their doctors.


 

The mammography debate rages on

  1. Breast MRI's use no ionizing radiation and is much more exact. It can pick up smaller tumours and even tell the diffrence between them. If anything, we should push for more MRI spots instead of starting the barage of ionizing radiation sooner. Not to mention that your breast does not need to be compressed every which way to get the images.

    No matter which way you cut it, early detection works. That's why mammograms are going to work, that's why increae patient awareness is going to work.

    Is mammograms at 40 really the best approach? I think we can do better. Just think of how many scanners and how long we could have run them for the 1 billion $ it cost us for the G20.

    It's all about priorities.

    P.S. Patients who do get mamograms are more likely to be more aware of the dangers of breast cancer and therefore, more likely to seek treament sooner. Those who don't, also include those who do not because they are not aware. We would need more detailed research.

  2. Joel, the entire point of the controversy is that you actually (counter-intuitively, I suppose) do not want to find all breast tumors. Many breast tumors that are detected through screening will never harm the woman while treating those tumors will cause harm. The reason you may not want to find all breast tumors (especially when they are small and may not progress and may even regress) is that once a physician detects a tumor, both the physician and patient feel compelled to treat the tumor because we have no way of knowing which tumors will progress to be deadly. Using a more sensitive screening tool (which it's not clear that MRI actually is) will find more cancers but may not actually save more lives and may cause excess harm through follow-up diagnosis and treatment. When the recommendations in the U.S. came out which suggested that screening for breast cancer in most women ages 40-50 was unnecessary it was because statistical analyses showed that many, many women in that age group needed to be harmed through unnecessary follow-up testing and treatment to prolong one woman's life.

    It's also worth noting that a screening test should have high sensitivity but should also be fast and cheap. If you want to screen millions of women per year, you don't want the test to cost $1000 and require an hour to complete. MRI is both expensive and slow and, thus, not an ideal screening tool.

  3. speaking as someone who gets an annual mammogram, I prefer to have the power of choice and knowledge. To KNOW that there is a lump and the power to investigate it.

    Nobody has to have a breast removed without a biopsy FIRST to determine what that suspicious lump actually IS!

    And as a taxpayer, and an RN I prefer that the mammograms continue. Cheap as a test goes, and every cancer caught in the early stages saves a life which btw ends up saving our whole system a truckload of money. It is similar to an ounce of prevention being worth a pound of cure.

    And as someone who lost her mother when I was just 14, mum was only 39, I can attest to the devastation and destruction of our family, our lives, my father's life, the blossoming alcoholism in him, the suicide attempt of my sister and her years as a street kid and my own struggle with depression.

    Nobody speaks to what it costs taxpayers when a woman dies in her prime. Her kids, the family, the losses, the therapy they may need, the visits to the emergency dept for problems related to that loss.

    I guess those bleeding heart idiots who are so worried about a woman's temporary worry over a suspicious lump caught by a mammogram aren't lining up to help out the kids whose mum died last week because she didn't get a mammogram!

    Then of course there is all the expensive care thru illness and death.

    Yeah, Mammograms aren't cheap, but they are a lot cheaper than the alternatives.

  4. The problem with mammography for 40-50 year olds, according to Dr. Oz has to do with the density of the breast tissue in woman of that age. Simply put, the tumors do not show up well. Thus there are many false positives in this age group. Therefore mammography is not a good test for woman in this decade – hence the recommendation to only do it on 50+ year olds when the breast tissue is not nearly as dense. It has nothing to do with dollars & cents but common sense.

  5. 1-detection-action-reaction.
    May,08 mamg-ult.sd,no findings.I know I'm dying, begged-biopsy-June08- cancer-spread to-nodes.I scared family-get screened-43 yr.old niece told- dense breast-insisted-MRI-bingo cancer,chemo,radfiation followed.
    What we need is a system within a system -a check point within a check point where there is no room for mistakes. Checked twice cut once.
    Take some of the fund raiserd money and work on better education for our doctors and educate women and men on prevention for prostate and breast cancer.
    Here in BC most money for screening PSA and Mammograms is from fundraising,it's not part of our medical system and I and most women and men did not know that.
    Yes I believe in research but I also know that when your told the big C word your made to realy see what and how the system works.
    The system needs a shakedown. Here on my Island they are dying every week- short battle with cancer.
    All this money for research and yet no cure.
    Lets put some of this money where it can make a diffrence-prevention and early detection.
    Yes men get your PSA and Ladies get those mammograms and do not let them tell you there is no money for your tests- insist on it

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