Commonly, women in general view mammograms as the last measure to prevent breast cancer. Failure to take the typical routine exam is considered irresponsible behavior. But should mammograms really be done or should we question and analyze them?

More and more research shows that using mammograms in female patients who are healthy and have no symptoms is really controversial . There is an ongoing discussion about the benefits and risks of this procedure. Therefore, before you go to have your next (or if it is the first) mammogram, make sure you are informed and do not just agree to go to the medical establishment.

About mammograms

If you’ve ever had a mammogram, you know it’s not exactly nice to do. And, the breasts are compressed inside a mammography unit or machine and low-energy x-rays are used to examine the tissues. All this to detect premature breast cancer and other potentially cancerous masses.

In almost all Western countries, women who have the average risk of developing breast cancer undergo routine mammography exams from the age of 50, and check-ups are performed every two years. Well, now, the American Cancer Society is recommending having mammograms at the age of 40 and annually.

However, it was recently decided to discontinue mammography due to insufficient evidence of its supposed benefits. Clearly, there has been no consensus on this issue, which makes the decision-making process even more difficult, and women and doctors are often facing a dilemma on this issue.

A large study doubts the benefits of mammograms

A 2014 Canadian study rocked the breast cancer industry in the prominent British Medical Journal . Comparisons were made of breast cancer incidence and mortality over a 25-year period in groups of women aged 40 to 59 who underwent (one group yes and one no) a mammogram examination. The women who did not receive the mammogram had an annual physical examination of the breasts. Almost a total of 90,000 women were included in this study which is considered one of the largest on this subject to date.

At the time the study was done, a total of 3,250 women who were in the group where the mammogram was performed and a total of 3133 women who were in the control group obtained a diagnosis of breast cancer. A number of 500 and 505, respectively, died of breast cancer. This showed that death from breast cancer was very similar between the two groups and the presence of mammography had no influence.

It was concluded that:

The mammogram that is done annually in women between the ages of 40 and 59 does not lower breast cancer mortality more than the physical exam or usual care.

Additionally, 22% of women in the mammogram group had an overdiagnosis, according to this study. And this resulted in one in 424 women in this group of participants receiving unnecessary cancer treatment, including chemotherapy, radiation and surgery.

5 points about mammography you should consider

Having said all the above, we believe that it is an opportunity to take this method with respect, and before wanting to have a mammogram you should consider the following points:

1. Mammograms may not be as beneficial as you think

Many women have full confidence in their mammograms. And yes, the procedure might be able to save your life, but the success rate is not really as high as we really would like it to be. In the best of cases, mammography provides a risk reduction of about 20 to 25%. This does not seem very significant, but when we look at the absolute numbers of death prevention, the detection itself prevents only one death from breast cancer in 1,000 women.

The studies that found mammograms helpful were mostly done some time ago and did not meet strict scientific rigor. Additionally, Dr. Mette Kalager, an epidemiologist and screening researcher at the Harvard School of Public Health and the University of Oslo , explains that early detection of breast cancer is currently not as important as better treatments are available. According to many experts, it is having access to some medications (such as tamoxifen) that has lowered mortality from breast cancer, and mammography actually plays a much smaller role.

2. Women with a specific gene mutation can increase the risk of breast cancer with mammography

Women who carry a specific  genetic mutation called BRCA 1/2 (which is related to cancer) are more affected by being exposed to radiation from mammography. According to the BMJ study, women with this genetic mutation who received a dose of radiation before their 30th birthday were twice as likely to have breast cancer compared to their peers who were not screened. The higher the radiation dose, the more likely cancer will occur.

Mammography will expose you to a certain amount of radiation and there are currently conflicting opinions about the dangers of that. While some hold the idea that modern mammography involves a reduced amount of radiation, others are actually more cautious, warning that it could be particularly dangerous for women who are very young.

3. False negatives cannot be avoided

There are also numerous cases where cancerous and precancerous growths are missed. It becomes a difficult job to detect masses that are suspicious if the breasts are dense. About 50% of women have dense breast tissue, which appears white on X-ray images. But in the case of cancer, it also appears white, which makes it very difficult to see the difference. Patients with dense tissue should be aware that the mammography procedure is much less helpful for them.

4. False positives are common

No breast cancer test is definitive, and one of the problems with mammography today is giving the patient a diagnosis that is false. If you are told that you may have breast cancer, this will, of course, lead to anxiety and psychological stress. You will be referred for additional tests, which carry their own risks.

According to a 2014 study published in Cancer Epidemiology , women who test false positive are more likely to develop cancer later in life. The excess risk is not yet fully explained.

5. There are other options for detection

It is normal that many women today are concerned about the health of their breasts and are willing to do what is best for them. You should be aware that there are other options to detect a possible cancer, and the only test that can really confirm cancer is the biopsy. An MRI or ultrasound may be best suited but only for certain women, and you have the right to explore all of these possibilities and use them in conjunction with mammography.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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