Bottom Line Inc

Do You Really Need a Mammogram?

0

Women, you’ve been trained to be on the ball about keeping up with mammograms for breast cancer detection—and, while there’s room for improvement, you’re doing a decent job. About two-thirds of American women older than 40 years go ahead and get mammograms every two years, according to the US Centers for Disease Control and Prevention. But we’re guessing that most women who are keeping up don’t need national statistics for motivation. Just take a head count of women in your neighborhood, social circle or family who have had, currently have or have died from breast cancer. If you are counting on your fingers, you might need two hands! It’s serious stuff.

You’ve also followed some recent controversies about how often mammograms are really needed—and how they can lead to false-positives, “overdiagnosis” and even unneeded cancer treatment.

So here’s the latest twist. Right now, the leading experts who crunch the research numbers and influence health-care guidelines are again rethinking who needs a mammogram and how often. And the question they are focusing on is this—what if breast cancer screening were a personal decision between each woman and her doctor and not an edict from on high? Sure, there still will be guidelines for doctors to follow, but patient decision making and responsibility for outcomes may play a much bigger role than they have in the past.

If that sounds radical, it is. That’s why we spoke with one of those leading experts who helps steer preventive-care guidelines, Russell Harris, MD, MPH, professor of medicine and adjunct professor of epidemiology at the University of North Carolina School of Medicine and Gillings School of Public Health in Chapel Hill, North Carolina, and a consultant to the US Preventive Services Task Force. He believes that there should not be generalized breast cancer screening guidelines—and we asked him why.

BENEFITS IN PERSPECTIVE—SCREENING AND AGING

What Dr. Harris said, in a nutshell, is that it’s time to stop all the public pressure for screenings and instead place decisions about whether or not to get a mammogram (and when) firmly into the hands of women—albeit well-informed women. Also, guidelines that are especially for elderly women (70 years and older) need to be rethought.

While American doctors follow guidelines that screening should be offered at least every two years to women who are 50 to 74 years old, and although we definitely know that risk of breast cancer increases with age, do you really need a mammogram when you hit 70? A Dutch study says no. In fact, it found that breast cancer screening for women age 70 and older may actually cause more harm than good, leading to unnecessary treatment that puts elderly women at even higher risk than they already are for anemia, gastrointestinal problems, fatigue, infection, memory loss, effects of bone loss (osteoporosis) and heart disease. This all boils down to quality of life in your later years.

And statistics bear this out.

Follow us here…If 1,000 women started biennial mammography screening when they were 50 years old and continued for 10 years, one to three breast cancer deaths would be prevented over the next 15 years. If 1,000 60-year-old women had biennial screenings for 10 years, three or four deaths would be prevented over the next 20 years. For women in their mid-70s, however, their average remaining life expectancy—about 13 more years—is shorter than the 17-year lag time in which a death attributed to breast cancer could be prevented. “Suddenly,” said Dr. Harris, “the number of women being helped by screening starts going down, not up.”

But maybe you are 72 and expect to live until 102. Fair enough. In that case, breast cancer screening and next steps if breast cancer is detected should be a personal, individualized decision between you and your health-care provider, according to Dr. Harris.

APPROACHING BREAST CANCER DETECTION FROM ANOTHER ANGLE

Dr. Harris isn’t suggesting that all breast cancer screening guidelines should completely go out the window and leave women and their doctors high and dry. But his wish—and what he says he expects to happen, based on discussions with his colleagues in the public health field—is that for older women, at least, we will end up with new, more individualized guidelines that will be conveyed to gynecologists and primary-care physicians over the next few years.

That makes sense.  But you may be surprised by something else Dr. Harris said that may work for some women and not for others depending on complex issues related to health care, such as patient education and access to care, especially among minority or disenfranchised women. He believes that the same broad leeway being proposed for elderly women should be extended to all women, of every age—and he points to these downsides of breast cancer screening as the rationale…

 

  • Cumulative radiation exposure. Although the amount of radiation received per mammogram is minimal, every time you get a mammogram or are otherwise exposed to radiation in the medical setting, it has a cumulative effect on your body.

 

 

  • Possible unneeded treatment. Some breast cancers are so slow-growing that they would not have caused any harm if they had gone undetected.

 

 

  • Side effects of treatment. As mentioned—and as we all know—cancer therapy itself is wrought with side effects. Surgery, radiation, chemotherapy and hormone therapy all come with risks that become riskier with age. Radiation to the breast can damage the heart and lead to lung cancer, and hormone therapy raises a woman’s risk for serious blood clots and stroke. For some women, the treatment can be just as devastating as the disease it’s meant to conquer.

 

WHY IT’S A PERSONAL DECISION

In Dr. Harris’s view, each woman—young, old and in between—needs to evaluate the pros and cons of her own screening in relation to her personal health, family history and life situation. The physician’s role is to help women make informed, individualized decisions about breast cancer screening—not to automatically pressure them into decisions based on screening statistics.

Part of being informed means recognizing that screening isn’t the only way to protect yourself. “There are other approaches to prevention that we’ve de-emphasized at our peril,” said Dr. Harris. “It’s time to stop putting all our eggs in the screening basket. Screening is not our only hope to reduce the scourge of breast cancer.” Maintaining a healthy weight, remaining physically active, not smoking, being moderate in our drinking habits and proactively working with a gynecologist and primary-care physician to know and address personal risk factors are important ways for women to protect themselves against cancer, stay all-around healthy and have a great quality of life.

print
Source: Russell Harris, MD, MPH, professor of medicine and adjunct professor of epidemiology, University of North Carolina School of Medicine and Gillings School of Global Public Health, Chapel Hill, North Carolina. Dr. Harris is the director of the Research Center for Excellence in Clinical Preventive Services at the Cecil G. Sheps Center for Health Services Research at University of North Carolina and a consultant to the US Preventive Services Task Force. Date: July 17, 2014 Publication: Bottom Line Health
Keep Scrolling for related content View Comments