Not mentioned in this Journal Watch article are the many thousands of women for whom mammograms are useless and potentially dangerous. My wife received mammograms for years followed by letters that gave a false sense of security in proclaiming that her results were "normal". In June 2012, one month after yet another "normal" mammogram, my wife, who was exercising strenuously at the time, found a hard, ill-defined mass in her right breast. She was dead in 62 days. This otherwise remarkably health woman had never been told that her dense breast tissue meant that mammography might be worthless. Mammography did nothing to identify or avert the stage 4 lobular carcinoma that killed her. Only on April Fool's Day, 2013 did California enact a law requiring health care providers notify patients with dense breast tissue of their risk. The odds that mammography will detect cancer in women with dense breast tissue is statistically equivalent to a coin flip. Had we known of the risks associated with and the limited value of mammography, I would have spared no expense in accessing other and better screening methods. Millions of women carry this risk and never are told, and like my wife are not given a chance to live.
Featured in NEJM Journal Watch: Backing Off from Mammography Screening? — Physician’s First Watch
Featured in NEJM Journal Watch: Backing Off from Mammography Screening?
By the NEJM Journal Watch Editors
A new analysis in JAMA Internal Medicine fails to identify a clear net benefit of annual screening mammography. Of 1000 women aged 50 who undergo annual screening for a decade, analysts estimate that 0.3 to 3.2 fewer deaths from breast cancer will occur, 490 to 670 women will receive at least one false-positive finding, and 3 to 14 women will be overdiagnosed (usually leading to unnecessary treatment).
Reader Comments (6)
I guess you would need to ask the 3 women whose cancer was found about whether screening is needed. The Q becomes is any screening warranted if you worry about NNTT
Perfectly reasonable information.
Are current recommendations to decrease cervical pap smear screening and mammography screening just attempts to save small amounts of money now? And will we pay a huge financial price when there is more cervix and breast cancer to treat?
I have personal experience of the effects of a false positive and over treatment. I'd always been dubious about the benefit of mammography, but went because I was "doing my duty." I spent a couple of weeks terrified and went through a very uncomfortable biopsy only to find that it was s cyst.
I think screening mammography is one of those things that sounded like a good and noble ideal- saving women from breast cancer- but ignored the disconfirming evidence and got hijacked by the business interests who quickly sold a lot of imaging equipment, built expensive "Breast Health Centers" and mounted pink ribbon campaigns- but failed to deliver real results for patients.
For myself, I decided to try to lose some weight, get a little exercise and stop mammography.
very helpful review which directs to papers I would otherwise not necessarily see