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Mammograms, Research, and Real Women

Posted by Dr. Suzanne Koven  October 26, 2011 08:32 AM

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488503main_nci-vol-7493-300-226px.jpgI recently posted a blog about the dilemma men and their doctors face regarding the new recommendations advising against use of the PSA test for prostate cancer screening. Now, an article in the Archives of Internal Medicine questions how often mammograms actually save women's lives--and the anxiety this questioning will cause may be, I think, even more intense.

Though heart disease kills more women, surveys show that breast cancer is the disease women fear most. One in eight American women will develop invasive breast cancer in their lifetimes, and nearly 40,000 will die of it this year. (For more breast cancer statistics, see here).
For several years, early detection, with breast self-examination and mammograms, has been emphasized as the key to surviving breast cancer. In 2009, the U.S. Preventive Services Task Force, finding insufficient evidence that it helped in early detection, stopped advising health professionals to teach women breast self exam. Now, after several years during which guidelines for mammography have been debated back and forth, the Archives article, in which data from many medical centers was analyzed retrospectively, finds that early detection of breast cancers by mammography does not save women's lives as often as has been thought. Their conclusion, nicely summarized here by Globe reporter Deborah Kotz, is that early detection of breast cancer by mammograms reduces breast cancer deaths about 15%, far less than commonly believed.
This article will, no doubt, inspire many women whose breast cancers were detected early by mammography to come forward to tell their stories; anger many who feel that the authors' pointing to "only" a 15% reduction in mortality belittles the value of women's lives; and create more concern and confusion among women about are already concerned and confused about how they can best prevent the disease they fear most.
So what's a woman--not a statistic, but a woman--to do?
First, understand, contrary to what some believe, that this study (like the PSA recommendations) is not part of a government plot to deny patients healthcare to save money, and not part of "Obamacare." The data on which conclusions about the efficacy of tests and treatments are based are gathered over many years--sometimes decades. Second, this article is one of many published every year about breast cancer, and does not herald any immediate changes in recommendations about mammography. Third, though the reality is that insurance companies dictate coverage, you and your doctor still have the most important voice in deciding what's best for you--and this new article will be only one of many factors in that decision.

This blog is not written or edited by Boston.com or the Boston Globe.
The author is solely responsible for the content.

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About the author

Suzanne Koven, M.D. practices internal medicine at Massachusetts General Hospital in Boston. She writes a monthly column for the Globe's G Health section and her essays have appeared in the More »

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