Ladies Only

Axel HeaderOne has become increasingly aware of the potential harms of screening mammography, while remaining cognizant that much of the drop in breast cancer mortality is due to advances in treatment.

To define the relative benefits and risks associated with screening mammography, investigators used study data from Sweden, Canada and the USA to quantify reductions in breast cancer mortality, false positive results (cancer falsely diagnosed) and over-diagnosis of invasive breast cancer.

The authors estimate that amongst 1000 women (at the age of 50) who undergo annual screening for 10 years between 0,3 and 3 fewer deaths from breast cancer will occur. 500 to 670 women will receive at least one false-positive finding and 3 to 14 women will be over-diagnosed and receive unnecessary treatment (JAMA Intern Med 2013 Dec 30, e-pub).

Screening in itself is not always harmless and patients need to be informed that the highest chance is to receive “healthy” as a result of screening mammography, 1000 women need to undergo mammography once a year over 10 years to prevent 3 women from dying from breast cancer,
approximately 600 out of 1000 women will receive a radiology report saying: “suspect for breast cancer, further investigation needed” – only after undergoing MRI scans or/and fine-needle biopsies and a few weeks of Damocles’s sword hanging above them will they get a result saying: sorry – everything normal; but is this the end of the story?

How does one tackle next year’s mammogram and how well does one sleep at night after the whole procedure? Approximately 10 out of 1000 women will be diagnosed with breast cancer, will most likely undergo an operation, be this lumpectomy or even mastectomy, and in the end it turns out it was NOT cancer but something benign which looked very similar.

All this is not saying that one should not do mammograms, but one needs to be aware that there is a chance for falsely uncomfortable results. Very often radiographies are more ambiguous than a lay-woman would think, particularly if there is no symptom or complaint which triggers it.

In other terms: the most important part of a mammogram is the self-examination previous to it. If self-examination of the breast reveals a lump or a nipple oozes liquid, a mammogram is VERY helpful to decide the nature of the symptom.

But it is the symptom PLUS the mammogram which tells the whole story.

Population wide screening programs for breast cancer are not advised anymore.

As mentioned in a previous article: overusing diagnostic facilities can produce harm – they need a knowledgeable hand – or rather head.


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