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Pink is not my favorite color.

April 29, 2013

I’m definitely going to get some hate mail for this post.  I read an extraordinary feature article in the New York Times Magazine this week.  A breast cancer survivor who is actually questioning the whole “breast cancer awareness” thing.  It’s a good article in general, but it’s extraordinary in that you won’t find many women who have had cancers diagnosed by mammogram who aren’t blindly committed to mammography as the savior of all women.  The author, Peggy Ornstein, actually admits to having changed her mind, or at least had second thoughts, about the widely held belief that mammograms save lives.  Here are some of the things she says with a little editorial:

1. Mammography reduces, by a small percentage, the number of women who get diagnosed with late stage cancers.  (This from a recent New England Journal of Medicine article)

2. It also increases, by a large percentage, the rate of over-diagnosis and over-treatment.

3. Even when mammography was first coming out, there was no particular evidence that the size of a tumor had anything to do with whether or how rapidly it would spread.

4. After the breast cancer awareness movement really got going, more women had cancers detected and more had treatment.   But the mortality rate for breast cancer DID NOT CHANGE.  The identity of being a breast cancer patient just got longer.

5. Your doctor can’t tell what of a few different kinds of cells your cancer is made of.  Some types respond very well to conservative treatment.  DCIS, ductal carcinoma in situ, might not be a cancer at all, as 50-80% of the time it never progresses beyond that “in situ” location.  You could live your whole life with it and never know.  The really aggressive kinds are usually galloping out of the gate before mammography picks them up.

6. There has been no decrease in the incidence of metastatic cancer since screening started.  That is, the same number of cases involve spread to other parts of the body.

7. Some lesions that mammography detects are things that will never be a problem in the person’s lifetime.  They either don’t grow or go away.

8. Annual mammograms will reduce a 40-year-old woman’s chance of dying of breast cancer in 10 years by 0.05%. Driving your car is more lethal than that.

9. For every 2000 women screened annually for breast cancer, 1 will actually benefit and 10 healthy women will get a diagnosis and unnecessary treatment.

10. Some breast cancer “survivors” have survived DCIS, which is often non-lethal and 100% treatable.

11. Women are getting both breasts removed when DCIS is found in one breast, when the chance the other breast will get cancer is only 5%.

There’s a lot more.  Read Peggy’s article:

I’m not against mammograms.  I’m not anti-woman.  I don’t want to take away women’s health care.  I’m not even Republican.  I am pointing out that screening tests have their place, and can do great good.  They can also do great harm.  Get a mammogram.  Just understand what you’re doing before you go.


From → Healthcare

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