 A recent analysis in The
Lancet raised eyebrows among health educators like me who spend a
lot of time urging women to get routine mammograms.
Danish researchers analyzed previous mammography studies and concluded
that using breast X-rays for routine screening is "unjustified."
The researchers identified
flaws in six studies that had concluded routine mammography saves lives.
The only two studies that were not flawed, they
said, found no benefit.
I know of no health
professional involved with breast cancer care who takes those
conclusions seriously. Every day we see women who are spared the ravages
of advanced breast cancer and the aggressive treatments it requires
because their cancer was found early - by mammography. I should know.
I'm one of them.
In 1992, a benign cyst in my
right breast prompted my doctor to suggest a mammogram of both breasts.
The test found stage 1 cancer in my other breast, the left one. I needed
a mastectomy because the cancer was scattered throughout my breast, but
most other women with such early-stage cancer need only a lumpectomy,
and many can forgo chemotherapy.
The Danish analysis faults most
previous mammography studies for failing to ensure that the two
comparison groups - women who had mammograms and those who didn't - were
closely matched in other respects, such as age, family history and
socioeconomic status. Differences in treatment and in the length of
follow-up can also skew the findings.
I would argue that it's next to
impossible to design a study that takes all such factors perfectly into
account. But based on the facts we have, I think the picture is
clear.
We know that mammograms can
discover cancer long before the tumor can be felt as a lump. We know
that breast cancer requires less invasive
treatment at early stages than at more advanced stages. And we know that
women have a better chance of surviving cancer if it's discovered before
it has had a chance to spread.
Most importantly, all of the
studies analyzed by the Danish researchers looked at death rates only.
As the researchers themselves point out, the
studies didn't look at the type or amount of treatment the women had.
There was no mention of quality of life, which is of utmost importance
to a woman with breast cancer. Who wouldn't want the least amount of
treatment possible?
I believe that the only reason
questions are raised about mammography is that it's a relatively
expensive test, averaging between $120 and $150. My
concern about a study like this is that insurance companies may try to
use the findings to deny coverage of routine mammograms.
I also worry that some women
will use the negative news as an excuse to skip a procedure that they
may find uncomfortable. I encourage anyone
considering that excuse to talk to a woman who had breast cancer
discovered through mammography, who had minimal treatment and who is
alive and well as a result.
I agree with the American
Cancer Society, which recommends an annual mammogram beginning at age
40. Women with a first-degree relative - a
mother, sister or daughter - who was diagnosed with breast cancer before
age 50 should get mammograms earlier. Subtract 10 years from the age
your relative was when her cancer was diagnosed and start then.
Lillie
Shockney
Lillie Shockney RN, BS, MAS, Education and Outreach Director at Johns
Hopkins Breast Center, is the author of Breast Cancer
Survivors' Club and co-founder of the national nonprofit
organization Mothers
Supporting Daughters with Breast Cancer.
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