Is a Mammogram Safe?

Did you know that a mammogram can harm you? If you did not know that a test could harm you, then you need to read this article.

Mammograms (or mammography) have been under debate for several years now, and it is all over the media.  I haven’t contributed much nor did I dive into the medical studies because I have heard many success stories of lives saved, and unfortunately, lives lost because of lack of mammography.  However, I could not ignore a recent clinical trial that was sent to my email from a very trusted source (www.essentialevidenceplus.com).  They send me daily emails summarizing key, patient-oriented clinical trials.  I subscribe to them, so I can stay up to date on my medical knowledge.  This particular clinical trial revolved around the numbers of mammography.  I will not bore you with the details, but I will tell you that the number of people who benefit from mammography is much less than anyone would expect (physician or layperson).  I will summarize some of the numbers below.

The study classified mammogram findings into 3 broad categories:

1)   False Alarms.

• This means that a woman got a worrisome finding on her mammogram, and she underwent further studies (ultrasound, MRI, or biopsy) that turned out to be normal.
• A breast biopsy is a procedure that involves sticking a needle into the breast to pull out tissue from the concerning area.

2)   Overdiagnosis.

• This means that the patient had biopsy and was subsequently diagnosed with a “disease” that will never change their life or cause any symptoms, but they went on to receive treatment (Chemotherapy, radiation, or surgery).

3)   Breast cancer death avoided.

• This is the number that we want to be large because we want to save lives.

All of these numbers are taken from women who had a mammogram done annually (once per year).  I will round all numbers in order for it to be easier to understand.

Mammogram Numbers:

1)   Age 40 – 49:

• 1,000 women had annual mammography
• 600 women will have at least 1 false alarm
• 70 women had breast biopsies
• 11 women will be overdiagnosed and treated with chemotherapy, radiation, or surgery and never would have had symptoms.
• 1 woman will avoid breast cancer death

2)   Age 50 – 59

• 1,000 women had annual mammography
• 600 women will have at least 1 false alarm
• 85 women had breast biopsies
• 8 women will be overdiagnosed and treated with chemotherapy, radiation, or surgery and never would have had symptoms.
• 3 women will avoid breast cancer death

3)   Age 60 – 69

• 1,000 women had annual mammography
• 450 women will have at least 1 false alarm
• 60 women had breast biopsies
• 12 women will be overdiagnosed and treated with chemotherapy, radiation, or surgery and never would have had symptoms.
• 5 women will avoid breast cancer death

Wow.  I am still shocked at reading those numbers.  I have read these findings multiple times to make sure I understood it correctly.  This means that on average 500 women per 1,000 (that is 50% by the way) will get a false alarm while going through yearly mammograms in 10 years.  Then, 60 of those women (6% of women) will get a breast biopsy.  All of these fears created in order to save 1 – 5 lives per 1,000 (0.5%).  5 precious lives.

After reading this article, my opinion has been in turmoil.  When saving that 1 person’s life out of 1,000 happens, it makes mammograms seem like they are the most crucial test in the world.  Especially if it is my loved one:  my mother, wife, or daughter.  On the other hand, we harmed 50% of women in the process.  They lay in bed without sleep:  full of fear, anxiety, and worry. The stress that they feel while waiting for further studies to be done in order to receive the “all clear” must be palpable.  Although an overwhelming relief usually follows this intense fear when they discover that they are cancer free.

This topic is very controversial right now, and I am certainly not trying to persuade anyone to not get tested as I am still routinely ordering mammograms on my women.  However, I now have a brief hesitation before scribbling the order.  I spend just a few extra moments to let my ladies know that this mammogram does not come without a cost. You might be that 50% that gets an abnormal mammogram, then an ultrasound, then a breast biopsy – only to find out that nothing is wrong.

….Think about it.  Share your comments and thoughts.  How should this change my practice?  Or should it change my practice?

#DrOubre