Thursday, November 19, 2009

My 2¢ on Mammogram Screening

As I predicted, the controversy and backlash against the recommendation to change mammogram screening to women over age 50 is huge. Special interest groups are coming out of the woodwork and every woman who found a breast cancer by mammogram has been interviewed by CNN and Fox news. Here is my 2¢.

We have thousands of tests we can perform on people. Why not perform these tests on everyone? Lung cancer is more prevalent than breast cancer and it shows up in young women with no risk factors. Why don't we get Chest X Rays on everyone every year? Why don't we get EKGs or thyroid scans on everyone every year to find silent heart attacks or thyroid nodules? Why not get CT scans annually? That way we could find early adrenal, kidney, brain or pancreatic cancer.

The decisions about screening exams for the population are made by scientific groups like the USPSTF. There is often confusion because other groups like the American Cancer Society and other specialty medical groups (Radiologists, Surgeons, Urologists, Cardiologists, Republicans and Democrats) also offer their own recommendations. Those groups are not impartial and can be influenced by politics or gain.

The impartial and independent physicians and scientists are crucial for making recommendations for the Nation.

The USPSTF studied over 500,000 women for more than a decade. They found that yearly Mammograms in women under 50 could possibly be detrimental to health. The effects of excessive radiation have been known for decades. They based their screening recommendation on the best and current science that is now available.

Mammograms do save lives by detecting early cancer. Other tests can also detect early cancer but determining where the benefit of the tests exceed the risk (in both $$ and health ) is the goal before we recommend mass screening. Some women have breast cancer in their 30's. Why not start screening at age 30? It is because we have determined that the risk exceeds the benefit. The new recommendations are saying the same thing for under age 50.

I will continue to prescribe mammograms to women younger than 50 if the woman wants it. I have never believed there is a magic age (40?, 41?) that made logical sense. We must keep in mind that detecting cancer is not the same as preventing cancer. We have not yet found a way to do that.


Anonymous said...

For the second part when a women reaches 50 do you think they should have one every year or every other year?
I makes everyone wonder then why in the first place did they say at 40 everyone should have a yearly a mammogram?
Or why do they have 50 be the magic number for colonoscopy?

Jonathan said...

Doc Gurly, in her blog on the mammography controversy, made several excellent points. In particular, see items 11, 12, and 13 regarding the cost/benefit methodology used in the USPSTF study.

I agree with Dr. Brayer - let the patient choose.

Anonymous said...

Jonathan: I agree I read Doc Guley's blog last night and it was excellent the way she spelled out the pros and cons and gave a perspective on both sides.

Anonymous said...

Dr. Brayer, you said we don't RX mamm's for women in their 30's because the "risk exceeds the cost." This new study isn't a cost comparison, it's a benefit vs risk study. The risks outweigh the benefits in women under 50, is what they're saying. I don't see any reason to order procedures if a pt "wants" it, what about a medical indication it's necessary? Why can't we RX mamms to every woman who NEEDS one, in other words other symptoms? Family history? A medical reason? Would you order exploratory surgery simply because your pt wanted it, or would there be a medical reason to suggest it?

Anonymous said...

Anon Nov.20 7:28 am:
"Would you order exploratory surgery simply because your pt wanted it, or would there be a medical reason to suggest it?"
This is ridicules Dr.Brayer is a much stronger and professional person and physician then that with ethical medically based sound ,valid evidence based reasons for what she orders or doesn't order.

As a patient of Dr.Brayer's I can tell you she does not simply order tests or surgery just because a patient wants it. She is open minded to listen to her patients wants or needs, evaluates it based on her exam, pt's medical history, symptoms and what is needed medically in their individual case.
Any problem that has come up she goes through it with you as a team.

Sometimes what a patient wants or doesn't want is for the wrong reasons and they don't always have all the correct facts or see the whole picture. I feel very fortunate to have her as my doctor with high quality medical standards and not be swayed by any bias reasons of influence or financial gains. She really focuses, is extremely knowledgeable, cares about her patients has excellent skills, training, and education enriched with many years of experience. As you can tell by her blog she keeps informed and up on what is the latest out there and has integrity. It is refreshing to have her as a doctor with a feeling of confidence and trust in.

Toni Brayer MD said...

Anon 7:28: You caught my error (risk vs benefit, not cost). That is what happens when you blog at 6AM or midnight. (I have now corrected it. As the author I get to do that!)

Anon 9:58: Gee, thanks a lot. You made my day.

Michael Kirsch, M.D. said...

I'm adding my own '2 cents' on the mammography maelstrom at
I'm not sure I am qualified to comment on mammography, since I've never ordered one or undergone one.

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Anonymous said...

X-rays are radiation. by getting tested every year for multiple different things, you're guaranteeing you'll get cancer. terrible idea

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