Top menu navigation

Saturday, February 15, 2014

To Mam or Not to Mam

Okay, so let's talk about this mammogram article in the Times. Here's the basic idea:

"One of the largest and most meticulous studies of mammography ever done, involving 90,000 women and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age.

It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation."

As you might imagine, there's been all sorts of outcry about this. Things from, "no more mammograms," to "this study is bullshit." I really wish that it were possible to have a nuanced discussion about this. The issue is complex, and there are undoubtedly many many things that should change about the way breast cancer is approached. But, until that discussion happens, here are my thoughts, thrown out into the void:

- It's not mammograms' fault that there's no cure for breast cancer.
Mammos don't cure cancer, the way xrays don't heal broken bones. If people are still dying, despite early detection, isn't the onus on the treatment?

- I take serious issue with the "needless treatment" concept. 
DCIS, or stage 0 cancer, gets talked about like it's nothing, and requires no treatment. Actually no. There's no way of knowing in which cases DCIS can become invasive, as it did with me. At the very least it need monitoring. And how do you monitor? Mammos.

- Companies don't make mammography equipment, and hospitals don't administer mammograms, out of the goodness of their hearts. 
It's a business. The idea of "early detection saving lives" true or not, is one that's made a lot of people rich.

- A flaw in this study -- participants were monitored the entire time. 
We all know women that only go to the doctor once a year for a mammo and a pap smear. Or, take advantage of a free mammogram in October, without ever actually seeing a doctor. One thing that I find interesting is that no one is saying, "Wow, clinical exams are really way more effective than we realized!" Hmm.

- Somehow, in all this back and forth, prevention is almost never discussed.
Screening can become perfect, and treatment can become completely effective  -- but if people are still getting BC, I think it's a major failure of medicine.

Mammograms are a piece of the BC puzzle. They are not the be all and end all. They do not protect women from cancer; they aren't a magic spell to keep it away. I think they are important, even if only to keep women aware of what the hell is going on with their bodies. I think with every mammo there should also be an information session on reducing risk. (And let's go beyond the usual patient-blaming thing of staying thin, okay?)

What I hated about this article is that I'm worried that women will stop going all together. I know  people that are so fearful of cancer that they get into this "I don't want to know," mindset. A flattened, simplistic, kind-of misleading article like this might just be enough of an excuse for someone to completely disconnect. And that's bad for everyone.


  1. ...another potential outcome of this study? an end to insurance coverage for preventative mammos? let's hope not!

  2. I think what this research tells us is that mammograms don't prevent anything. They are a diagnostic tool, and no more effective a tool than a thorough clinical exam. And as you said, the research also makes it obvious we need better treatment that targets the cancers that kill women, whatever stage they are found at.

  3. I would hate to think that women would forgo mammograms because of articles like that one. They may not be more effective than clinical exams but if the cancer is caught - why argue about the way in which it was caught? And yeah, that "I don't want to know" mindset scares the hell out of me. My mother has that mindset. If I had that same thought 3 yrs ago when I felt that lump in my armpit I'd have been dead within a year.

  4. Really fantastic write up about women life. I got huge of important idea from your post. A big thanks for sharing with us !!