Earlier today, the U.S. Preventative Services Task Force (USPSTF) issued new recommendations on regular mammograms for women in their 40′s. In short, they’re against them.
The findings are based, in part, on a finding from a meta-review of studies by the Oregon University Health Sciences Center showing that mammography reduced deaths from breast cancer by about 15% in women ages 40-49. This data was put into a set of models that then predict that, if women postpone their first mammogram to age 50, only 3% more would die. The study authors then weighed this risk of death versus the harms, identified in the study as “false-positive mammograms, unnecessary biopsies, and overdiagnosis,” and concluded that “the benefits of screening from ages 40 to 49 years were small.”
So, mammograms help save lives. Just not enough lives.
One other point. If you go to the original paper that discusses the models (Mandelblatt et al 2009), and click to see the data tables that show the details behind the 3% above, you learn that the 3% is a median of the six models used. Individual, stand-alone models predicted additional deaths of 2-10% if women postponed their first mammogram to age 50. That seems significant to me (perhaps because I can name so many women whose cancer was discovered by mammogram in their 30s or 40s, and I am better for having known them). But beyond that, Table 3 shows clearly that mammography starting at age 40 not only saves lives, but results in between a predicted 11 and 57 “life-years gained because of averted or delayed breast cancer death,” for every 1000 women.
Let me translate that.
Because of effective screening strategies, such as mammograms, for every 1000 women, someone or some combination of them are living a collective 11 to 57 (median 33) years longer than they would have otherwise.
Let’s try that again.
Say I have 2000 followers on twitter who happen to be women. If all of us get mammograms, there’s an extra 66 years of life to be lived. 66 years, among us, to raise our families. To raise questions. To raise hell. Without mammograms, those 66 years evaporate.
Which would you prefer?
Annual or biannual mammograms, regular self-exams, and a chance to spend more time with your family? More time at work? More time laughing, and giggling, and throwing your kids in the leaves as you rake them? More Thanksgiving dinners, more Christmas mornings, more birthdays?
Yeah, me too. So before you write off mammograms, please read more about the report, find out what groups like the American Cancer Society have to say (there’s a good explanation at Dr. Len’s blog), and talk about these recommendations with your doctor. Know the risks. Know the benefits. Know your own body … and always remember — if you notice a change in one breast but not the other, call your doctor right away.
As I meet more and more mothers with cancer, the importance of early detection just grows in my mind. Tonight at 5 and 6, I’ll be on the Channel 5 newscast, talking about the importance of mammograms as one tool for early detection, as well as another important tool that we can all use … breast self-awareness.