Shame on you, Dr Mukherjee!

Shame on the New York Times best selling author, Dr. Siddhartha Mukherjee for his comments in his book on the value of mammography screening in combating breast cancer deaths.

Dr Mukherjee wrote a recent best selling book entitled “The Emperor of All Maladies”.   A biography of cancer that traces the fight to find the cure for cancer throughout the years.  The book is a fascinating read, but when I came to the part about breast cancer I was enraged.

He states: “a mammogram is not a particularly good tool for detecting early breast cancer and for women ages 40 – 50 years.  The incidence of breast cancer sinks to a point that a “mass” detected on a mammogram, more often than not, turns out to be a false positive.”
He also quotes a statistician who  states that the risk of harm from not having a mammogram until after age 50 is the same risk of harm as riding a bicycle without a helmet for 15 hours.  Mr Bean-counter…How can you possibly compare the two?

Opinions and statistical numbers concerning the effectiveness of mammograms have been thrown around recently when a poorly implemented study done by the British Medical Journal showed countries that offered routine mammograms had the same death rates from breast cancer as those that did not.  This study was flawed in many ways (see my whole post on this subject here) and gave the sensationalist media a reason to grab your attention with headlines, however irresponsible those headlines were.

Google “mammograms not effective” and you will get over 200,000 results.  Not because that is true, but because it gets you to their website.

More headlines and more “copy and paste” blog posting exploded when a US government agency suggested implementing healthcare guidelines that contained no breast cancer screening at all under age 40, eliminate self-breast exams, and routine mammograms would be done only every 2 years after the age of 50.  (I wonder if those in government and their families would be OK adhearing to those guidelines…)

Absurd!

What prompted me to sit down and (angrily) write this post, is the fact that I just came from my routine oncology (cancer doctor) appointment.  I sat in the waiting room with 3 other women, all of whom were there for breast cancer chemotherapy.

One of the women was 35 years old and the other was 32.  They both found their breast cancer themselves during routine self breast exam.  To put it bluntly, these women would be dead in 5 years if they had not found their cancer.

I was 41 when I was diagnosed with stage III breast cancer.  My diagnosis was made through routine mammography.

I had a chat with my oncologist about all the articles written lately about the ineffectiveness of mammography.  She said, “The medical community as a whole is outraged at those reports.  It’s just not true. Statistics support it, and  I see women every day who find their cancers themselves, and unfortunately, a lot of them are very young…in their 30′s and 40′s.  The fact is: Mammography is 85% accurate in finding most cancers.  Add ultrasound and a clinical manual exam, and the accuracy jumps to 95%.  Where in medicine do you find a better diagnostic predictor?”

My doctor also told me that the #1 reason in the USA for medical malpractice is mammograms.  The #1 reason women choose to sue their doctors is over a mammogram x-ray…either under-read, or over-read.  The number of radiologists (MD’s who read x-rays) who read mammograms is rapidly dropping because they can’t afford the malpractice insurance.

Ironically, as the lawyers get richer from women’s lawsuits, women are the losers because we are losing good radiologists who are experts in reading these sensitive x-rays, and there are more radiologists who are being “cover-your-a*s” cautious about recommending that women get further diagnostic studies like ultrasounds and biopsies, just in case.

But a mammogram is still the best tool we have today to find early breast cancer.

This doctor of mine has physician friends in other countries doing missionary work, working for other governments, etc.  She told me in certain areas of Iraq women don’t go for screening as preventative medicine as it is not part of their culture.  When she asked a physician friend  what kind of breast cancer treatment women receive there, she was told, they die.  There is no treatment because by the time the cancer is found, it’s too late to do anything.

She also told me she has patients that come over to the states from India to get mammograms because India doesn’t consider it a preventative screening method.

The fact is:

• 7 million humans will die of cancer this year
• 1 out of 3 women, and 1 out of 2 men will develop some form of cancer this year in the US.
• sensationalism in media–television, newspapers, and the web lead to some very irresponsible reporting.

Conclusion:

ALL women should have a baseline mammogram screening somewhere between the age of 35-40.

ALL women should continue to get routine yearly mammograms after the age of 40.

ALL women should be doing self breast exam (see tab at the top of this page if you don’t know what I mean) every month.

ALL women should have a clinical (going to a doctor for a manual, hands-on exam) breast exam every 2-3 years age 20 – 30 and every year from 30 on.

For women at high risk (family member, especially father, with breast cancer, or those that have the BRAC breast cancer gene) you should discuss screening that may include an MRI scan which is more specific, but also more costly.

Just because the “pink ribbons” have disappeared this month, doesn’t mean you shouldn’t stay breast healthy the rest of the year!

New Study Finds Mammogram Screenings Ineffective

I had to cringe when I read these headlines, because it gives women excuses not to go for their routine mammograms and it casts a confusion cloud on proper guidelines for staying healthy.

Death rates for breast cancer have been steadily decreasing over the past 20 years in most countries, but it is unclear why.  Is it the early screenings? or the better treatment?

A study published in the British Medical Journal on July 28, 2011 finds the mortality rates (how many women died) from breast cancer did not change when they compared countries that had routine screenings against countries that did not.

This was a study where they took data already logged, and looked at how the numbers compared.  3 pairs of countries were compared.  One had routine screening in place about 10 – 15 years after the other one did.  When the death rates were compared, there was virtually no difference between the countries.

There are several issues I have with this study:

1. As the researchers themselves noted, the observation period may not have been long enough to get a reliable study.
2. The studies measured “organized national screenings”. That is, an invitation was sent out to women by the government of the country telling them of screening recommendations.  In the 1990′s and 2000′s it was well known that women should get routine screenings for breast cancer and women could already have been getting screened before the “formal invitations” were instituted.
3. No actual numbers were given in the study, only trends.

Please be careful when seeing headlines like this one that you do not ignore the recommendations that are currently in place for women and breast cancer screenings.

One previous example of irresponsible reporting, was in 2009 when a useless US government agency decided to suggest new guidelines for breast cancer screening based on what they deemed to be reliable research. In my opinion, the doctors on the committee were working for a team trying to set guidelines for the new US national healthcare program.  Instituting these guidelines would save the US government millions of dollars over the screening that are currently in place at the expense of women’s lives. It included:

• no screening for women under age 40
• doctors should stop teaching women to do self breast exams
• routine mammograms should be done every 2 years after age 50

This is assenine in my opinion and the  Mayo Clinic, the American Cancer Society agrees:

Screening mammograms can detect breast abnormalities early in women in their 40s. Findings from a large study in Sweden of more than 1 million women in their 40s who received screening mammograms showed a decrease in breast cancer deaths by 29 percent. And it’s important to remember that most women who get breast cancer have no family history or other known risk factors for the disease.

At Mayo Clinic, a three-tiered approach is currently used:

• Breast health awareness, which includes a woman becoming familiar with her breasts in order to identify breast abnormalities or changes, and to inform her doctor of any changes that may need further evaluation (self breast exams)
• Clinical breast exam performed by a health care provider and recommended annually beginning at age 40
• Screening mammography beginning at age 40

As I have mentioned before, if I had followed the new 2009 guidelines, I would not be writing this post because I would be dead.  My stage III cancer was detected by a mammogram at age 41 in 2005.  I have no risk factors for breast cancer just like over 50% of all women have no risk factors, so according to the 2009 guidelines, I would be slated to get a mammogram in 2014.

                                                                Take away

Don’t jump to conclusions over one research study’s results.  Often news stories want to grab your attention, and they don’t give you the whole story.  Use common sense and don’t change your routine screening schedule without consulting your medical professional.

If you have any questions about this subject, please e-mail me as I would be happy to discuss.

Thanks for reading and stay well!