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Just a year ago the news headlines blazed with the opinions of experts that women under 50 did not benefit from annual mammograms. Today a team of researchers will discuss findings that mammograms actually save lives.

Women under 50 do not benefit from annual mammograms - not true!

These conflicting recommendations come from two groups with two very different orientations to the subject of breast exams and women's health. The recommendation back in 2009 to avoid excessive mammograms was made by the United States Preventive Task Force, a group of experts that writes policy for healthcare.

The idea of the task force was that mammograms sometimes result in false positives. There may appear to be a tumor that is not actually there, or, more often a tumor that appears potentially cancerous is not actually cancerous. Women then have biopsies or even prophylactic mastectomies they do not really need. Since relatively few women develop cancer before the age of 50, the United States Preventive Task Force reasoned, it might be better to let a few more women die of breast cancer than to have more women undergo unnecessary treatment.

Today's findings are based on facts rather than policies. Mr. Stephen Duffy, an epidemiologist at the University of London worked with a team of Swedish researchers led by Dr. Håkan Jonsson at the University of Umea and Dr. László Tabár and colleagues at the University of Uppsala. Since 1986, some counties in Sweden have made mastectomies routinely available to women under 50 and some have not. The researchers examined records for the 19 years from 1986 to 2005.

Clearly, mammograms lead to treatment that saves lives

During this period, 803 Swedish women under the age of 50 who had access to mammograms died of breast cancer that began before the age of 50. During the same period, 1,230 Swedish women who did not have access to mammograms died of breast cancer that began before the age of 50. When women had mammograms, they were 29 per cent less likely to die of breast cancer. Clearly, mammograms lead to treatment that saves lives.

An interesting twist in the findings, however, is that the availability of mammograms leads to lower death rates even among women who did not have them. What this seems to mean, according to Donald Berry, a statistician at MD Anderson Cancer Center in Houston, Texas, commenting on the results of the study to the New York Times, is that doctors are now catching cancers that they would have never been able to detect before the advent of the technology.  When doctors see more patients with more kinds of cancer, they develop the skills in treating patients that come with experience. When women are simply never diagnosed, their doctors do not develop the expertise that tells them when to look for cancer even without mammography.


Even when women have accurate mammograms, the next step in diagnosis, the biopsy, is not necessarily perfectly accurate. Unless there is an obvious tumor, before submitting to radical surgery, women should confirm with their doctors that the biopsy absolutely confirms the cancer diagnosis. It is not always easy for the pathologist to determine whether a tiny tumor is really cancerous. When a tumor is not clearly identifiable and there are no signs of its spread, second and third opinions are appropriate. Just as there can be errors in mammograms, there can also be errors in biopsies, leading to surgery that sometimes can be repaired but that never can be reversed.

 

  • Hellquist, B. N., Duffy, S. W., Abdsaleh, S., Björneld, L., Bordás, P., Tabár, L., Viták, B., Zackrisson, S., Nyström, L. and Jonsson, H. , Effectiveness of population-based service screening with mammography for women ages 40 to 49 years. Cancer, n/a. doi: 10.1002/cncr.25650