The Debate on Mammogram Guidelines

As a young woman from a family that has a history of breast cancer (among other types of cancers) and has already undergone breast surgery, the recent recommendation for mammograms is relevant to me. Although I have, at the earliest, 14 years until I even contemplate having a mammogram, as someone who has already had two benign tumors removed from my breast I am familiar with the process and procedures involved.

Initial Reactions from a twentysomething

Initially my first reaction when I consider mammograms involves the pain associated with the procedure. Although I have never had one this is the main aspect any women that ever has will describe to you. Of course this alone doesn't dictate my decision to have one or not to, it is the main factor in hoping and praying a new and better technology is found when my time comes around.

Arguments

In Canada only women between the ages of 50 and 69 are recommended to have mammograms, and even than only once every two years. In some provinces mammograms are offered and recommended annually, and they may offer them to women in their 40's with a physician's referral. It seems silly to even debate having a test done which could possibly detect cancer, but there are some cons to have mammograms which physicians and PS announcements fail to mention. For one, there are types of breast cancers that are non-progressive and if not found will not spread and really do not require any surgery. A mammogram is not able to detect what specific cancer one has and thus requires biopsies and resulting anxiety over this. Overdiagnosis and unnecessary treatments are two of the largest arguments against this screening. Another major aspect is false positive results and even more daunting missing malignant masses.[1] Most of the time masses revealed through mammograms turn out to be benign, but again, this is not discovered until costly biopsies and testing is done. The last issue is that of radiation induced cancers from the mammograms, which women in their 40's would be more prone to.

Statistics in Support

Although breast cancer is still the second most common type of cancer diagnosed in women, the five year survival rate is 98% with proper treatment. This statistic sounds promising enough to adopt the new rules, but there are still approximately 40,000 women who will die from breast cancer and 190,000 new cases in 2009, the NIH estimates. [2]

Clinical Opinion

A controversial Danish doctor, Peter C. Gotzsche, proclaimed years ago based on examining results from seven clinical trials on the topic that from the results of two of those studies there is no decrease in breast cancer mortality among women who are given regular mammograms. The other five indicated only small reductions. [3]

Closing Thoughts

Overall, my opinion on the topic is that when and if you have mammograms done should be an individual and personal decision between you and your doctor. What works for most of the population should not apply to all. I think considering the clinical research that has been done on the subject it is not completely absurd to make the recommendation to defer mammograms until the age of 50, but if a woman feels she has the need to have one before that age no medical insurer should be able to reject covera

[1] Bator, M. & Chmielewski, L. Pattern Analysis + Applications, Dec 2009, Vol. 12, Issue 4, p 377-390, 14 pages.

[2] FDCH Congressional Testimony, October 7, 2009. Frank Pallone, Jr. Chairman House Energy Commerce subcommittee on Health, retreieved from the MAS Ultra, second edition database.

[3] Health Facts, Mar 2009, Vol. 34, Issue 3, p. 3.