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.
Posted by Toni Brayer, MD at 6:34 AM