Delaying Mammogram Sensible in Many Cases by Dr. David Lipschitz on Creators.com

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Delaying Mammogram Sensible in Many Cases

The U.S. Preventive Services Task Force Committee, an independent, government-sponsored panel of experts, recently issued new recommendations for mammography — and the public outcry has been immense.

Women of all ages are confused, overwhelmed and fearful that this is the first step of rationing health care. But beyond the headlines and the confusion lies sound scientific research that deserves a more thorough explanation than the 24-hour news cycle allows.

Based on extensive review of scientific data, the committee now recommends a first mammogram at age 50 instead of 40 and that the test be performed every two years for women ages 50 to 74. Furthermore, the committee states there is insufficient evidence to recommend mammograms in women over the age of 75, and they question the value of teaching women self-examination of the breast.

Needless to say, this recommendation is very controversial with the general public and many within the medical community. Women all over the country are coming out to tell their story of how mammography and self-exams saved their lives. And yet, why did the committee come up with these recommendations?

First, the committee reviewed the results of studies involving annual mammograms in thousands of women age 40 and above. Statistics proved that the probability of breast cancer in women under the age 50 is very low. In order to identify two cases of cancer, doctors must perform 1,000 mammograms every year for 10 years. More simply put, diagnosing one true case of breast cancer requires that thousands of mammograms be performed.

Some claim that preventing one cancer is worthwhile, despite the hundreds of thousands of women who must receive an annual mammogram. However, the committee determined that the harm outweighs the benefits.

Mammography is not a perfect science. Interpreting mammograms in women under age 50 is very difficult because the breast contains little fat and a great deal of breast tissue. On the mammogram, fat appears very dark and breast tissue is very light. Without this contrast, even the most skilled mammogram reader will see areas that might be suspicious.

Without a good fat-to-tissue ratio, this leads to the need for more tests and often a biopsy to confirm that the area of concern is not cancer.

The anxiety of thinking you may have a tumor and the needless invasive procedures are deemed by the committee to be too great.

In addition to the concerns about false positives, there is little evidence that for most women screening more than once every two years adds any benefit. More importantly, the research shows that mammograms save the most lives in women between ages 50 and 74. Beyond 75, the evidence is not compelling that mammograms identify breast cancer or save lives.

The committee based its recommendations on the science and a cost-benefit ratio — not the financial cost, but the emotional cost, the physical cost and the medical cost of unnecessary and inappropriate tests.

Like many scientific studies and comparative analyses, these recommendations have opponents from within the medical community. There is an ongoing debate about tests and procedures for illnesses across the board. Dr. Otis Brawley, medical director of the American Cancer Society, says that even if mammograms save only one life, the test is worth it. He urges women to continue to have their first mammogram at age 40.

Be aware of all the facts when you discuss screening for breast cancer with your physician. Medicine is an art and a science, and your physician can be your best guide. If you are at low risk of breast cancer (i.e. a woman with no family history of breast cancer who has breast-fed and never smoked), a mammogram every two years after age 50 may be sufficient. For high-risk women, mammograms every year beginning as early as age 40 still seems prudent.

Forget the anecdotes; it is vitally important that everyone understand the science and reasoning behind the new recommendations. Although women want to do everything possible to prevent breast cancer, we must admit that the current screening tests are neither perfect nor ideal. As physicians it is much harder to do nothing when we can do something. But when the evidence indicates that we are doing too much, it is time to re-evaluate.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.