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Routine Mammograms: More Harm Than Good?

Detection lead mammographer, Toborcia Bedgood performs an advanced imaging screening that promotes early detection of breast cancer  for Alicia Maldonado, at The Elizabeth Center for Cancer Detection in Los Angeles. (Damian Dovarganes/AP)

Detection lead mammographer, Toborcia Bedgood performs an advanced imaging screening that promotes early detection of breast cancer for Alicia Maldonado, at The Elizabeth Center for Cancer Detection in Los Angeles. (Damian Dovarganes/AP)

A new study in the New England Journal of Medicine says that routine mammograms may cause more harm than good, pushing women to get screened every year has had little to no impact on long-term breast cancer survival rates. The medical community and cancer survivors are in an uproar.

We’ll talk to the paper’s co-author and hear pushback from the American Cancer Society.

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  • Denise Falbo

    I have thought for a long time that routine mammograms can be harmful, based on experiences of friends and family. The worry and needless biopsies they have endured have made me decide not to have it done. I would probably feel differently if I were in a high risk group.

  • Denise Falbo

    I have thought for a long time that routine mammograms can be harmful, based on experiences of friends and family. The worry and needless biopsies they have endured have made me decide not to have it done. I would probably feel differently if I were in a high risk group.

  • Cindycb

    If mammography is so inefficient then please tell us what is the alternative screening method?

  • Donnar36

    I had heard about a new system to replace mammography made by the Israeli company Real Imaging called RUTH.  I wonder if anything is being done in this country to  study this and perhaps bring it here.

  • Anne

    I had a routine mammogram last year that detected stage 2 cancer: one in-situ and one “invasive.” I had a lumpectomy and radiation and have had some uncomfortable side effects from radiation. The cancer was so tiny that the doctors were all contratulating themselves for having found it. (I didn’t feel a lump at all…this was just a routing mammo (I’m 67).

    Despite all the discomfort, I am very glad I had it treated. My mother died at 55 of breast cancer (although they didn’t consider me “high risk”), and who knows if I had the kind she had, that would have killed me, or not? I am glad I don’t have to worry.

    In the process, I had a genetic test and found that I don’t have the BRACA gene. Since I have three daughters, that was a relief.

  • Cynthia

    Cindy from
    Providence:

    I think routine mammograms
    are essential and until a better screening process is developed, they should
    remain a staple.

    But unbiased
    education on all available information is also essential. Only through the
    unbiased analysis of all information available can a solid recommendation for
    treatment be made by your doctor.

    *And that’s the
    problem.*

    Money gets in
    the way of an unbiased view by doctors and the medical/cancer industrial
    complex, which includes screening, diagnosis, treatment and research.

    The money isn’t being made on the mammograms; it’s being made on the treatments. I fear that the process of routine mammograms is being used as a fishing net for potential ‘big ticket patients’ by doctors especially at these big Cancer Centers whose Boards are beholden to budgets and bottom lines and who put pressure on their doctors. It could be argued that there has not been a ‘cure’ for anything in over 60 years. Lots of treatments, but no cures. Not because our medical industrial complex is not smart enought but because it’s not interested.

    I am 51 and
    through a routine mammogram was diagnosed with stage 1 DCIS [ductal carcinoma in situ]
    in one breast one quadrant this past summer and was treated with surgery only.
    — Here’s my story: After finding signs of calcifications on the mammogram, I
    had the biopsy. The tests on the biopsy tissue showed cancer. I had the biopsy
    on a Tuesday and got the test results on Friday over the phone. It’s a unique
    experience to have a doctor say the word cancer, regardless of all the
    descriptors that can follow that may ultimately put you in the least dangerous
    category. I was sent to a surgeon the following week and given a rundown then
    sent home with a surgical appointment. — I had had my biopsy on the 16th, got
    the diagnosis on the 20th and had the surgery on the 9th, less than three weeks
    later. I did a ton of research in those two odd weeks. — The tissue sample
    from the surgery was clear. No cancer cells. So the concept of clear margins
    was moot. [I have an intuitive feeling that they got it all through the biopsy
    process]. After all the research, going into the surgery I was already
    considering not doing radiation. The results of the surgery confirmed my
    decision. I was, however, estrogen hormone-receptor-positive but I also decided
    to forgo the option of five years of the chemical / hormone treatment
    Tamoxifen. I’m grateful for the routine mammogram and I’m glad I had the biopsy
    but as much research as I did, it wasn’t enough to suss out the situation. I
    think if I had more time I might not have even had the surgery.

    Do I feel that I
    was pushed into surgery? Yes. And I do feel there was pressure applied to try
    to get me to do radiation and five years of Tamoxifen. Hearing the word cancer
    leaves a ringing in the ear. It was not easy to push back against this kind of
    pressure in that kind of mental state. I know many others likely cannot.

    • hopeful61

      ‘Doctors
      should make it clear that DCIS is not cancer; it is only a possible precancer,’ says Dr Eric Wiener, head of breast oncology at the Dana-Farber Cancer Institute in Boston, Massachusetts.

      Sorry to hear of your ordeal, Cynthia.  I have done a lot of research about DCIS because I know of several women who had this diagnosis or atypical hyperplasia, and in my opinion, were overtreated.  One woman had surgery AND radiation and I shudder to think of the side effects she could have in 15 years from the radiation.  Hopefully she will be fine.   This article is also quite good, perhaps you have already read it.  http://www.nytimes.com/2010/07/20/health/20cancer.html?pagewanted=all

      I am also 51 and have had normal mammograms since I started at age 39.  I don’t feel the need to have one every year and just worry that I’ll be the next one with a diagnosis of DCIS (that reportedly has a 30% chance of becoming “cancer”).  Also, once that diagnosis is in your medical record, it can be used against you by insurance companies (until perhaps the Affordable Care Act becomes effective)I am thankful for Dr. Welch’s work and research in this area.

      • Cynthia

        This was one of
        the more frustrating elements of my research and my communications with my
        doctors. Your statement [DCIS is not cancer] is NOT entirely true and is
        misleading.

        In my research I
        did encounter the claim that DCIS was not cancer…AND I did encounter the
        claim that it is cancer. The bottom line is that the lab results of my biopsy
        said ‘CANCER’. No arguing there. No grey area. The struggle for me was to
        determine, through research, exactly what my risks were. What all the data was
        saying about % of time this specific type of cancer for me [with some family
        history and positive for hormone receptors] would become invasive and leave the
        ducts and how might it act and what it said that I had it at all.

      • Cynthia

        There can be pre-cancer cells in your ducts…but DCIS is in fact cancer. please do more research. Making unfounded unequivical comments such as you made “DCIS is not cancer” Is DANGEROUS.  http://www.mayoclinic.com/health/breast-cancer/HQ00348
        CLICK TO ENLARGE
        Breast anatomy
        The type of tissue where your breast cancer arises determines how the cancer behaves and what treatments are most effective. Parts of the breast where cancer begins include:
        ·                                 Milk ducts. Ductal carcinoma is the most common type of breast cancer. This type of cancer forms in the lining of a milk duct within your breast. The ducts carry breast milk from the lobules, where it’s made, to the nipple.

      • Cynthia

        I’ve talked to a representative at Dr. Eric Winer’s office at Dana-Farber.

        They confirmed that the statement ‘DCIS is not cancer’ attributed to him in hopeful61′s reply above is at the very least out of context, incomplete and inaccurate. 
        In my opinion the statement in hopeful61′s reply, which states that DCIS is not cancer, is grossly incorrect, misleading, dangerous and emotionally harmful to me but also possibly to potential readers.The ordeal of a breast cancer diagnosis is sufficiently disorienting, confusing and frightening on its own. Erroneous unequivocal comments such as ‘DCIS is not cancer’ made by uninformed and unqualified individuals is unconscionable. My thanks to anyone that has taken the time to read these posts. This will be my last post on the matter in this forum.
        In my opinion the statement in hopeful61′s reply, which states that DCIS is not cancer, is grossly incorrect, misleading, dangerous and emotionally harmful to me but also possibly to potential readers.

        The ordeal of a breast cancer diagnosis is sufficiently disorienting, confusing and frightening on its own. Erroneous unequivocal comments such as ‘DCIS is not cancer’ made by uninformed and unqualified individuals is unconscionable. 

        My thanks to anyone that has taken the time to read these posts. This will be my last post on the matter in this forum.

        • hopeful61

          My apologies, Cynthia.  I should have read your story a second time to get the details.   I am sorry you had a positive biopsy and that you were so upset by my comment.  Also am glad you are OK now.  From what I’ve read (and maybe you can’t believe everything you read) a lot of women ARE being overtreated for the diagnosis of stage 0 DCIS. That’s all I was trying to say, certainly I have no right or grounds to assert that you in particular did not have a cancer diagnosis. 

          From Dr. Susan Love’s website:
           http://dslrf.org/mwh/content.asp?L2=3&L3=2&SID=164: 
          “What is ductal carcinoma in situ (DCIS)?

          As more women have gotten mammograms on a regular basis, DCIS has been
          found far more often.  DCIS is a noninvasive precancer.  It is not life
          threatening.  If you have DCIS, it means that you have abnormal cells in
          the lining of a duct.  While virtually all invasive cancer begins as
          DCIS, not all DCIS will go on to become an invasive cancer. An invasive
          cancer is one that has the potential to metastasize (spread). Right now
          we have no way to determine which DCIS will go on to become invasive
          cancer and which will not. That’s why doctors recommend DCIS be
          treated.”

          According to the New York Times, ‘an expert panel at the National Institutes said the condition should be renamed. Get rid of the loaded word “carcinoma,” the panel said.  A carcinoma is invasive; D.C.I.S. has not invaded the breast. If those cells do invade, they are no longer D.C.I.S.  Then they are cancer. So
          call the condition something else, perhaps “high-grade dysplasia.”

          http://www.nytimes.com/2011/11/22/health/cancer-by-any-other-name-would-not-be-as-terrifying.html?_r=0
          The above is the point I was trying to make.  I am, again, quite sorry to have unintentionally caused you emotional harm and as I said, should have read your story more closely.

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