Mammograms: Can We Live Without Them?

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Woman getting a mammogram

Can getting a mammogram save your life?

Most women wouldn't think twice before answering that question: years of popular opinion have left little doubt that a mammogram, uncomfortable and slightly embarrassing as it may be, is a lifesaving tool in the war against breast cancer. Research conducted in the 1970s and 80s found that mammograms reduce breast cancer deaths by 30 percent — a comforting statistic to the 30 million American women who undergo the procedure each year.

Now, that assumption is the subject of renewed debate, thanks to a two-year-old Danish study. The controversial paper, first published in the British journal The Lancet and updated last October, posits that numerous flaws in current mammography technique render the results virtually useless. It also suggests that while mammograms may mean earlier detection of breast cancer, earlier detection does not necessarily mean a lower mortality rate. Specialists across the country met this proposition with outrage, fearing it could keep women from maintaining their mammography schedule.

This is not a new debate; oncologists and researchers have wrangled for years over the efficacy of recommended yearly or biannual mammograms. But this is the first time in recent memory that an independent study has prompted the venerable National Cancer Institute to review its screening recommendations.

Mammograms, which provide detailed imaging of breast tissue, can catch cancer in earliest stages, and for some women early detection means having a choice between a lumpectomy, in which a tumor and the surrounding tissue are excised, and a mastectomy, a far more radical procedure which can result in the complete loss of a breast.

So where does all this leave us? At this point, no one seems to be able to precisely quantify the benefits of mammograms — but on the other hand, no one is able to debunk them as useful, possibly lifesaving procedures. From that base of information, doesn't it make sense for women to continue having mammograms until they are discounted altogether?

Before women start canceling appointments for mammograms, they should know that most doctors (and the NCI) still agree that women over 40 should have the test every year as a preventative measure. (Women under 40 with a strong family history should speak with their doctors about starting mammograms earlier, and women over 20 should do monthly self-exams).

And those are the guidelines to stick with, says Dr. David Decker, an oncologist specializing in breast cancer at the William Beaumont Hospital in metro Detroit. "I tell patients to continue following the recommendations from the American Cancer Society and the NCI," he says.

Dr. Kelly McMasters, a surgical oncologist at the University of Louisville, is less equivocal about the need for mammograms. "We have the technology to find cancer early and treat it. Not to use that technology is totally irresponsible."

McMasters worries that any push to eliminate mammograms from the medical regimen could have deadly results. "The difference between treating women with cancer found via mammogram and cancers they've found via self-exam is tremendous. If you're depending only on self-exams or clinical exams, you're relying on palpation (feeling a lump with your fingers) to find tumors. And the problem with that is by the time a tumor palpable it's often spread to lymph nodes, and therefore more likely to be fatal."

Sounds like a battle the rest of us are well advised to steer clear of. While the scientists are settling on a bottom line, we'll just keep getting mammograms — and hoping for the best.