Mammogram Uncertainty Gives Patients, Doctors More Reason To Talk
I am 51 years old and have had a yearly mammogram, more or less, since the age of 40.
I got them despite the fact that there is no history of breast cancer in my family. I did it because that was what my doctor and others, including the American Cancer Society, recommended.
Three years ago, I was diagnosed with invasive ductal carcinoma in situ breast cancer after a screening mammogram. I underwent a mastectomy and chemotherapy. The doctors say my prognosis is good.
I don't know if the mammogram saved my life, because I'm not qualified to make that judgment. No medical professional I've been treated by has ever declared that the mammogram saved my life either.
What I do know is that the challenge of assessing and treating breast cancer, or any cancer for that matter, is all about weighing odds. Since my diagnosis, my doctors have been working to tilt the odds in my favor. First, they sought to keep the cancer from becoming so widespread that it might kill me, and then they focused on keeping it from coming back.
But there's an ongoing dispute over how effective mammograms are in reducing the odds of death from breast cancer — especially for younger women. The latest volley is a study that seems to suggest the tests don't make much of a difference when it comes to the odds of dying from breast cancer.
How did we get to the point where what at one time seemed like groundbreaking technology to aid women's health became the villain? And how much does a large statistical analysis really help me or any other woman make smart choices when it comes to our own health and well-being?
Put simply, our ability to detect cancers has improved greatly over the past three decades, but our understanding of breast cancer and what to do about it hasn't kept pace. Some cancers found by mammograms aren't much of a threat. Others, even when detected early by a mammogram, can be deadly.
Large, long-term studies like the one just published help inform what society, insurance companies and medical businesses should do.
But it's a challenge to make use of those findings in the very personal conversation between doctor and patient. We patients undergo tests, at a doctor's order, to get an answer. And most of us are looking for a definitive yes or no.
Medicine, however, isn't an exact science, and we should prepare ourselves to deal with information that lies somewhere in the middle. We need to become more comfortable with weighing the odds when there are no black-and-white answers.
I will stipulate, for the record, that the breast cancer awareness movement has been so successful in convincing women that a mammogram can save their lives that it is a strong tide to push back.
There is a vast corporate-medical-industrial complex that seems to be invested in this message. The mammography machine used during my most recent mammogram even had a pink ribbon slapped on it!
But a mammogram is no guarantee against dying from breast cancer. The results can lead to biopsies and treatments for conditions that could have been left alone.
Still, one message that some have taken away from the most recent and some other studies strikes me as too simple. That's the idea that some knowledge would be more harmful to a woman than no knowledge.
That's too reductionist a view for me. Mammograms don't have to lead to overdiagnosis and overtreatment. It's what we do with the information provided by mammograms that counts.
The uncertainty about mammography means that doctors need to take the time — and make the effort — to explain the findings of an abnormal mammogram and the options for what comes next, including risks and benefits. Doctors also need to be clear about the things they don't know about breast cancer, which may be hard for some patients to hear.
We patients need to do our part, too. That includes listening carefully and studying our options to make decisions that we're comfortable with. In the face of conflicting studies and recommendations, we shouldn't be looking to particular studies to vindicate our decisions one way or the other.
Instead, we should be arming ourselves with information and demanding that our doctors help us understand what it means for us.
We also should be doing what we can to help ensure that the millions of dollars spent every year in the name of breast cancer are used to pursue the kind of answers that lead to a cure, not a call to complacency, or a smug pat on the back for how aware we are.
Madhulika Sikka is executive editor of NPR News and author of A Breast Cancer Alphabet.
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