TO SQUEEZE OR NOT TO SQUEEZE

Linda and Carolyn

What can I say?  Beautiful.

 

If you watch NBC news you will be familiar with Dr. Nancy Snyderman.  Dr. Snyderman is Brian Williams’ go-to expert on medical news.  Last night Dr. Snyderman reported on a newly-released study performed in Toronto that purports to show that mammography does women little if any good, and in fact may be harmful on balance.  A large cohort (90,000 women) were followed for up to 25 years.  There were two comparison groups: women who had a breast examination from a nurse, accompanied by mammography, and women who had the examination alone.  The mortality rates between the two groups were indistinguishable.  The mammography + examination group did report more cancers, but – as mortality was the same – it was possible to conclude that these extra cancers were non-lethal and best ignored.  And, of course, dealing with those “benign” tumors was costly in terms of expense and anxiety.  So, I guess we scuttle the mammogram?  Not so fast.

Note that this is big news, as testified to by the fact that it appeared next day in the pages of The Bellingham Herald, no less.  I imagine it will have come to a newspaper near you; this is big medical stuff, that’s for sure.

The counter-attack, as you might have predicated, was swift.  For instance, a Harvard medical expert testifies that, when he was asked to comment on the Canadian research, he had noted that the equipment used was old, second-hand and inadequate.  Naturally, the Toronto doctors in charge of the work replied, with palpably hurt feelings, that the Harvard expert is full of crap.  And so it goes, and will go – for a long time.  I predict we will have a feminine version of the Prostate Cancer Wars, about which I have written many times.  (See blog for 3/27/12). 

It is important to add that this dispute is between having a breast exam + mammogram, or the exam alone.  It is not suggested that women skip the exams altogether. 

So, what to think?  It probably depends on your point of view.  If your main concern is to reduce the overall burden of medical expenses on the economy, then it may follow that mammography should be discontinued.  However, from the point of view of the individual woman, until it is shown without question that mammography does not contribute to survival, surely the prudent thing to do is to continue it.  The American Cancer Society recommends mammograms every two years for women over 50.  If I were a woman with a familial history of breast (or ovarian) cancer, I would start earlier.

Finally, withhold judgment; there will be lots more studies and statistics brought to bear on this problem.  As I have said several times above, this is a big deal.