Too many mammograms lead to unacceptable complication rate


There is an emotional outcry against the new guidelines for mammogram screening for breast cancer that recommend that  women between 40-49 years no longer obtain routine yearly mammograms, but instead consult with their physician at least every two years as to their risk and need for the test. The press is widely and inaccurately reporting that the guidelines recommend no mammograms between age 40-49.

This is an example of emotions being used to shield the facts and harm women, in addition to wasting money. The facts are that too many mammograms (yearly after several negative mammograms) are harming women by exposing them to unnecessary surgery (biopsies) and the complications associated with surgery such as emotional distress, infection, disfiguration, death, and cost.

These are NOT death panels. A panel of persons trained to understand risk verses benefits and medical issues, as well as trained to interpret statistical data has determined that more harm occurs with too many yearly unnecessary mammograms.

They have examined the facts and statistics and come up with a rational plan as to how many mammograms are necessary and at what interval to best balance the risks versus benefits. They are more in line with European and international recommendations.

Women are willing to put up with some unnecessary emotional distress, surgery, infections, costs, and even death as long as the benefits (numbers of cancers discovered early) outway the risks (numbers of complications including deaths). However irrational emotional statements that we have to do everything possible to uncover every cancer early are nonsense. Certain groups are at higher risks and patients should discuss this with their doctors. There is not a one size fits all answer here.

If we uncover one (1) cancer early for every two (2) deaths from complications due to unncecessary mammograms then the risk v. benefit calculation for the population, not the individual, suggests we are doing too many unnecessary mammograms. This is what the experts have found. This is why the overall general recommendations have been changed. This does NOT mean that those at incresed risk should follow these recommendations. Recommendations should be individualized by a person’s physician knowing their family history and risk factors.

Either way there are going to be deaths. The experts based their recommendations on reducing the OVERALL number of deaths to the minimum. When those that make decisions based on emotion instead of fact understand this, then the population will be informed. Until then, this discussion is total nonsense.

The new guidelines DO NOT apply to women with a family history of breast cancer. They should have yearly mammograms starting earlier in life, sometimes as early as age 20-30.

The bottom line is this: Do we want to make difficult decisions based on fact and risk versus benefit so that lines are drawn in favor of benefit, or do we want to make decisions based on emotions, feeling good, and with a total disregard to costs and available resources? 

The actual guidelines published in the Annals of Internal Medicine.

Opinions in favor of frequent mammograms for everyone over age 40 .

Recommendations of DHHS and Secretary Sebelius.

Medical News Today summary of reasons for new guidelines.

Advertisements

Tags: , ,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


%d bloggers like this: