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Mammogram screening: What you need to know (2)

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By David Liu

Many women may not be well informed of the risks from the mammogram screening procedure when they are asked by their doctors to start the mammogram screening.  Much of the following is based on a report published by Chicago Tribune in 2002.  No detailed references are cited and therefore statements in the article should be considered opinions of a non-medical person.

1) Most medical experts say that mammograms save lives and women should continue to have them every year starting at 40. Early studies suggest that mammograms reduce risk of a woman's dying from breast cancer by 30 percent.

But recent Danish studies have found that those early studies are flawed or poorly designed or executed. One study reported this year found that the screening method does not save lives at all, particularly the lives of patients who have advanced or aggressive breast cancer. Breast cancer in younger women tend to be more aggressive than those found in older women.

2) Not all cases of breast cancer are life-threatening. Some are so virulent that they are lethal no matter how early they are detected and how the conventional treatments are used. Some on the other hand are indolent and may not pose any harm to women because they grow very slowly or never develop into something that kills the patients.

3) Mammogram screening can find small tumors that will need to take years or even decades to develop into a breast cancer at the clinically significant size. women with such a breast cancer can survive (by definition five years), without medical intervention. The diagnosis is not necessary and cases like this are called over-diagnosis.

4) Doctors cannot distinguish the slow-growing breast cancer from the ones that can grow aggressively and spread and kill. Because of this, some women will be treated with surgery, cancer-causing radiation and toxic chemotherapy for tumors that would never hurt them.

5) Mammography is not as accurate as thought. Further harmful tests such as biopsy are required in many cases only to find that the tumor or lump is benign.

6) Mammogram screenings can result in false-negative diagnosis. About 20 percent breast cancers will not be diagnosed by the method. Reading of mammogram results by different radiologists can lead to different diagnoses.

7) Breast cancer itself does not kill women. What kills women are the resulting complications after the cancer spread to vital organs like the liver, lung and brain. Just because a woman develops a breast cancer does not means the cancer will definitely spread to other organs threatening the woman's life. By the way, not all cases of malignancy defined by oncologists are not life-threatening.

Just simply removing breast cancers does not always help, particularly in metastatic cases in which the conventional modality like chemo, radiation and surgery are unlikely to save a woman's life or the prognosis is very poor.

9) Women whose breast cancer is found on screening mammograms generally have a better prognosis. That is not because of early detection, but because of more of less aggressive breast cancers are found that otherwise may not lead to any death.

10) Each year in the United States about 50 million mammogram exams are performed, about about 5 million of them show some abnormality in the breasts. Breast cancer accounts for a small rate. Mammogram cost can be as high as $7.7 billion each year.

11) In the United States, about 175,000 women are diagnosed with breast cancer each year in the country and about 50,000 die annually. Survival is defined as living more than five years of diagnosis.

12) Mammogram screenings use fairly large doses of x-ray for each exam. It is estimated that with 55 million exams performed each year, thousands of women each year may get radiation-induced breast cancer by exposing themselves to mammogram procedure.

13) Mammography is useful for diagnosis. Advocates for cancer prevention suggests that this tool is reserved for diagnosis, but not as preventative screening. For most healthy women, this technique may cause more harm than good.

14) U.S. Preventive Services Task Force Agency for Healthcare Research and Quality announced early this month that it has updated its mammogram recommendations. The new mammogram screening guidelines say women should begin biennial screening for breast cancer at age 50 rather than 40 as early breast cancer screening guidelines dictate.

15) A new review, funded by the National Cancer Institute, examined 20 screening strategies with different starting and stopping ages and intervals. And data derived from the analysis show that screening every other year delivers an average of 81 percent of annual screening results, with almost half the number of false-positives.  

Researchers also found mammogram screening every other year from ages 50 to 69 reduces breast cancer mortality by 16.5 percent over a life time, compared to no screening whatsoever. Screening beginning at the age of 40 reduces the mortality rate by 19.5 percent, or one woman in every 1000, compared to screening starting at age 50. But false-positives, unnecessary biopsies and anxiety increase.


Women urged to consider mammograms' hidden risks Cause for concern? Written by Judy Peres Tribune staff reporter, Published by Chicago Tribune on February 17, 2002

US women want to start mammogram screening at age 40

US women want to start mammogram screening at age 40

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Why Mammography is NOT an Effective Breast Cancer Screen

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