Opinion: Mammograms and the confused women of America
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Do mammograms prevent breast cancer deaths? How about breast self-examinations? Like most other women in this country, I’m confused. Two years ago, the U.S. Preventive Services Task Force shocked women -- and a number of breast oncologists -- by announcing that women younger than 50 could do away with routine mammograms, while women ages 50 to 74 might want to get them every other year instead of annually.
Many of the cancers found by mammograms would never turn deadly, the task force found, while other cancers are so aggressive that even annual mammography wouldn’t find them in time.
The American Cancer Society, though, stuck to its recommendation of annual mammograms for women 40 and older.
Now a study in the Archives of Internal Medicine suggests that of the breast cancers discovered by mammogram in women age 50, only 13% of the time does the screening prevent death. Of course, ‘only’ is the researchers’ way of looking at it. The actual numbers of deaths prevented would range from 4,000 to 18,000 a year, according to the New York Times.
Of course, a woman with breast cancer would like to think she might be among those. And the number doesn’t sound all that small. According to the National Cancer Institute, an estimated 4,290 women will die of cervical cancer in the United States in 2011. Yet as a matter of government policy, we urge girls -- and now boys -- to be inoculated against the strains of human papillomavirus that are linked to about 70% of cervical cancer cases. That might be because the vaccine is considered to be quite safe; false positives on mammograms are not so safe, leading to unnecessary surgeries and other treatments. Still, the number of lives saved by mammograms appears to be meaningful.
Where does this leave women? In the same old place: pondering age and family histories and their own preferences when it comes to medical care in an attempt to achieve some sort of answers for themselves.
At least they don’t have to feel guilty if, over all these years, they have been less than vigilant about breast self-examination. The Preventive Services Task Force recommends against even teaching women to do the monthly exams, and many oncologists agree. Yet even there, the American Cancer Society leaves room for doubt. It’s ‘acceptable’ for women to examine themselves seldom or never, the society says, yet the exams can help them know what is normal for them -- and that can be of real help.
Got that now?
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--Karin Klein
