Do Yearly Mammograms Save Women's Lives?
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‘We said, essentially with one voice, very little," Dr. Berry said. "So little as to make the harms of additional screening come screaming to the top."
In fact, the CISNET analysis showed that screening every other year in women over 50 maintains almost all of the benefit of annual screening with only half the number of false-positives.
To summarize their other findings, the task force panel determined that the "harms" or risks of yearly mammography screening for women under 50 outweighed its benefits. These risks include anxiety, false positives that lead to surgical biopsies and over-diagnosis (and over-treatment) of precancerous lesions that would never progress or might disappear on their own. The group found that in women 40-49, 1,904 women must be screened for 10 years before one cancer death is prevented. That ratio drops to 1 death prevented for 1,300 women age 50-59 screened, and 1 for 377 for women 60 to 69 years old.
I've written about the overuse of mammography and the many studies that back up the task force's recommendations here and here in previous posts. It's an issue that has gained traction in recent months, and despite rejection of the new recommendations by some prominent cancer groups, there are others, like the National Breast Cancer Coalition, who support them -- or at least see the guidelines as important tools for helping women make informed decisions about their care. They are too important to be shrugged off as outliers.
The massive campaign to screen early and screen regularly has become so much a part of our culture that it is very difficult to accept an alternative view. Change will not come easily -- and by necessity, it must be gradual. Women have been told for the last 20 years that they should have yearly mammograms starting at age 40. They have been told by countless magazine articles and public health campaigns to conduct self-exams in the shower -- another screening technique the Preventative Task Force no longer recommends.
Through all of these entreaties -- along with the powerful anecdotes from survivors who credit mammography with saving their lives -- women have been made to believe that screening is the same as prevention. Those ideas are hard to dislodge, says Nancy Berlinger, a research scholar at The Hastings Center who has written about comparative effectiveness studies and cancer treatment. "Apart from not smoking, there are not a lot of things you can do to prevent cancer. The idea of a test like mammography as a kind of safety belt, something that provides personal protection against cancer, is very strong." The worry, she says, is that if you take away mammograms, "you leave nothing but fear in its place."
For now, it is unlikely that women will lose insurance coverage for mammography screening anytime soon. The Centers for Medicare and Medicaid Services announced that the new guidelines will not change how the agency covers mammograms for Medicare patients. And the Wall Street Journal reports that Susan Pisano, spokeswoman for America's Health Insurance Plan, an industry trade group, "anticipates mammogram coverage will continue even for those who fall outside the new guidelines' target age range. What may change, she says, are insurers' aggressive outreach efforts to get women to get their screening, such as the reminder postcards they used to receive about getting their annual mammogram."
There is a larger concern here that goes beyond mammography. As evidence has grown that the benefits of some screening tests have been oversold and that there are significant risks involved in widespread use of the techniques, the response from the cancer establishment has been to forcefully dismiss the findings. Could it be that entrenched interests -- in screening, surgery, chemotherapy and other treatments associated with diagnosing more and more cancers -- are impeding scientific evidence? Will we see this same dismissal of comparative effectiveness data when it comes to prostate cancer screening and treatment, cholesterol-lowering drugs, diabetes treatments or other high-cost, high-profit health interventions?