The Mammogram Debate: Multibillion Dollar Industry

From the May 2004 edition of Dr. Fuhrman's Healthy Times:

Mammograms have been positioned as the centerpiece of women’s health care, and they are the most prevalent “medicine” delivered to our female population. Women shuffle from their doctors to radiologists and back, and if their mammograms show abnormalities, they are transferred to surgeons for needle biopsies and excisional biopsies. Today’s woman goes to doctors to get yearly mammograms and breast exams with little thought given to the medical literature on these subjects and the shocking facts it reveals. Suffice to say, gynecologists whose practices revolve around giving postmenopausal women estrogen replacement therapy (a disproved and dangerous practice) and ordering mammograms will have little left to do if women become better informed about the risks associated with mammograms.

Mammograms help detect breast cancer, and they help detect it earlier than other diagnostic tools. But in the process, they cause a lot of fear and result in countless unnecessary breast biopsies. In order to uncover cancer and not give false reassurance, radiologists are forced to advise biopsies even when the findings suggest the chance of cancer is small. More than 80 percent of all breast biopsies are negative for cancer.1 In addition, these mammograms with false positive results (sent for biopsy and then found to be negative) occur most frequently in the forty to fifty age range. By the time a woman has nine mammograms between the ages of forty and forty-nine, her chance of having a false positive result that requires her to have a biopsy is 43 percent.2 Nearly half of all women getting mammograms are eventually sent for biopsies to evaluate “suspicious” findings. When a woman with risk factors (such as a family history of breast cancer) gets nine or ten mammograms between ages thirty-five and fifty, her chance of the radiologist finding something suspicious and sending her to get a biopsy that returns negative for cancer rises to 98 percent.

The problems caused by false positives and unnecessary biopsies might be acceptable if the increased use of mammograms saved women’s lives. But it does not appear from the statistics that many lives are being saved by this so-called “early detection.”

Between 1970 and 1990, as more and more women got mammograms at the urging of the medical profession and health authorities, breast cancer rates rose 24 percent. As expected, more cancers were being detected, and they were being detected “earlier.” Five- and ten-year survival rates improved, and it appeared that women were living longer with their cancers. But those figures were misleading. Sadly, the exact same percentage of women still died of breast cancer at the same age as they did prior to the widespread use of mammograms. (See chart below.) Increased use of mammography has accomplished little more than giving an increasing number of women the painful knowledge that they have breast cancer.

For more on The Mammogram Debate check out these posts:
1. Wright CJ, Mueller CB. Screening mammography and public health policy: the need for perspective. Lancet 1995;346(8966(:29-32.

2. Christiansen CL, Wang F, Barton MB, et al. Predicting the cumulative risk of false-positive mammograms. J Natl Cancer Inst 2000 Oct 18;92(20):1657-66.
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