I thought I would take a short step away from the usual drug analysis to discuss mammograms. Given the recent US Preventive Services Task Force recommendations discouraging the routine use of mammograms in ages 40 to 50, it is important to re-examine this test.
On the surface, mammograms would appear to be unassailable, diagnosing 80-90% of breast cancers even while asymptomatic, leading to a 15% reduction of deaths from breast cancer between the ages of 40 to 60. But the task force is concerned that the incidence of breast cancer between 40 and 50 is still so low, and the risk of false positives is so high, that many women must endure the anxiety of not knowing as well as the physical discomfort of unnecessary biopsies.
But this analysis ignores the fact that though only 1/1,900 women between 40 and 50 have their lives saved by 10 years of screening, many more see a significant improvement in their quality of life when their cancer is diagnosed before it escapes the breast.
Not to mention the art of medicine, where erroneous results are reduced by utilizing the best of mammographers. These experienced practitioners frequently replace biopsies with careful follow-up studies for comparison.
Screening mammography is an important tool for a primary care physician, and it should be applied to women after the age of 40, especially when there is some family history of breast cancer.
With mammograms being slammed in the media, it is too easy to forget just how important this test is to the diagnosis and treatment of breast cancer.
Marc Siegel, MD, is an internist and professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear