Wednesday, October 17, 2007

Mamograms

Sorry it's been a while since my last post. Thankfully we have not had any major local medical news that needed sharing but I have not come up with two new topics to write about. This week the value of mammogram screening and the debate about it. Within the next week or so who still needs to get a PAP smear.

In the past we have been telling women over the age of 40 to get annual mammograms to help detect breast cancer as early as possible. Therefor there are recommendations from most professional organizations such as the American Cancer Society, the American Academy of Family Physicians and many others are that all women receive annual mammograms. There are even recommendations that are newly emerging that women with certain very high risk groups receive regular breast MRIs to screen for breast cancer. But this later test is still being developed and few insurance companies will pay for it yet.

The real question that leads to debate about mammography is does it just detect cancer or does it lead to longer life. Some people argue that even if it does not chance the course of things they would rather know sooner that they have cancer while other people would say that if it makes very little difference they would rather not know. Another side is that whenever you test for a disease some people will have false positive test results. This means that they will not have the disease but the results will suggest they do. For these women there is significant psychological stress associated with the worry as well as the expense and risk of surgical procedures to test to see if they really have the cancer.

Last month American Family Physician (the journal of the American Academy of Family Physicians) had some statistics that help show the effect of mammograms. These facts are the benefits and harms if 2,000 women are offered regular mammograms for 10 years. (Note that the city limits of Glasgow only has about 900 women over the age of 40.)

1) One woman will have her life prolonged because of it and 1,999 will receive no benefit.
2) Out of those 2,000 women 10 healthy women will be treated unnecessarily for breast cancer.
3) About 200 healthy women will have the stress of additional testing because the mammogram suggested they may have breast cancer.

Right now none of the professional organizations are changing their position of mammograms and all still recommend routine mammograms. As a physician I am still offering them to patients but I try to talk with women about this when I can. I assume many women who read this may use this information in making their personal choice about getting their own mammogram done.

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