Outrage Over Mammogram Mix-Up

For over 50 years the idea of early cancer detection has been a cornerstone of American medical advice. The American Cancer Society promoted this concept with its slogan, “Fight cancer with a checkup and a check.” The idea was that if every tumor were found early enough, there could be an effective treatment, and possibly a cure.
After hearing the message for so many years, it is hardly any wonder that millions of women were mystified and outraged by the announcement of the new mammogram guidelines. When the U.S. Preventive Services Task Force declared that routine mammograms should begin, not at 40, but at 50 years of age, many women felt they were being cheated out of something that could save their lives. And the additional recommendation to have a mammogram every other year instead of annually also stirred up strong emotions.
Susan Love, MD, one of the world’s foremost breast cancer specialists, welcomed the new guidelines. But she was one of the few public figures who seemed to understand the limitations of mammograms. Most people have come to believe that they are the Holy Grail of early detection. What has not been appreciated in the discussion is the inadequacy of this test and the amount of radiation a woman receives every time she gets a mammogram.
Even more confusing is the idea that not all cancer requires aggressive treatment. We have seen this in the realm of prostate cancer. Many men are uncomfortable with the concept of “watch and wait.” We have been so convinced that a diagnosis of cancer requires instant and often aggressive treatment that delay seems tantamount to malpractice.
Experts are beginning to realize that breast cancer may be somewhat comparable to prostate cancer in that some tumors will never become life threatening. Treatment of such cancer may be counterproductive. The difficulty lies in determining which tumors are dangerous and which are not. Unfortunately, mammograms do not always help with this determination. Just as the PSA test is inadequate for many prostate cancers, so too the mammogram leaves a lot to be desired.
If you want to hear more about this controversial topic we encourage you to take a few minutes to listen to Nortin Hadler, MD. This brilliant physician describes the appropriate uses and shortcomings of screening tests.