At a time when we finally are seeing a decreasing trend in cancer deaths, the U.S. Centers for Disease Control and Prevention has reported a decline in the number of women using mammograms to screen for breast cancer.
For this premiere installment of Point/Counterpoint, we considered arguments for and against mammography. A woman’s ultimate decision is highly personal, but being informed is a consensus move.
POINT: Mammograms are not 100 percent effective. At best, mammography detects 80 percent to 90 percent of breast cancers. Depending on the study and the style of analysis, mammography has been shown to help reduce breast cancer mortality rates by as little as 25 percent.
COUNTERPOINT: Even these imperfect stats represent a considerable decrease in breast cancer deaths thanks to early detection by mammogram. In short, it’s the best test we have, and the general consensus among cancer experts remains that women aged 40 and older should undergo routine annual mammography. The American Society for Clinical Oncology (ASCO) has recommended that women with genetic risk or a strong family history of breast cancer also incorporate MRI screening. Procedures such as MRI and sonography (ultrasound), which help close the detection gap, are recommended to augment—not replace—mammography.
POINT: The idea that mammograms prevent deaths from breast cancer has been challengedoutright. A widely cited Canadian study from 2002 concluded that self-exams are nearly as effective.
COUNTERPOINT: “Those arguments have never really been accepted, and they’re easily discounted by a huge volume of data that demonstrates the efficacy of mammography,” says Dr. D. David Dershaw, director of breast imaging at Memorial Sloan-Kettering Cancer Center in New York. “The general medical community—the National Cancer Institute, American Medical Association, American Cancer Society, the U.S. Public Health Service—all support routine mammography as part of a woman’s general health care. There’s no doubt on the part of any of those organizations that mammography has a strong positive impact in reducing breast cancer mortality.”
POINT: The CDC’s report did not analyze why mammography rates are in decline, but limited health care access may be a major factor. Fewer physicians and radiologists are specializing in this area due to low compensation, lengthy patient consults and the inherent stress of the job. Consequently, there are a diminishing number of facilities available to women who want the exam.
COUNTERPOINT: The threat of lawsuits from patients also bears responsibility for driving up malpractice rates and scaring away qualified health care workers. “In all of medicine, the thing we are most likely to be sued for is reading a mammogram,” says Dershaw. “If mammography is capable of finding 80 to 90 percent of breast cancers, you know that 10 to 20 percent of the cancers that come through your screening are going to be missed. If you miss that breast cancer, that’s the most likely thing you’ll be sued for.”
