Mammogram Guidelines

HOWARD MEGDAL: At first glance, it’s astounding to consider how hard it is to convince people that annual mammograms should start at 50, not 40. Of course, putting it in personal terms makes people fearful, and want to reach for the nearest medical response to the frightening prospect of cancer involving a wife or mother.

However, the evidence is clear. For every 1,904 women screened in their 40s, we see one life saved. We also see 935 false positives. In other words, you are 935 times likelier to face all the awful aspects of stress, dangerous procedures and potential risk than save your life.

So when I consider this in terms of my wife, I am not content to think of the dangers that can be avoided- 1 in 1904- by seeing her get yearly mammograms at age 40.

I also need to think about the 49.1 percent chance that we’ll go through all the psychological blows inherent in a breast cancer diagnosis, potentially risking her to unnecessary and dangerous medical procedures… and for NOTHING.

Clearly, the hope is that a better detection system is created. In the meantime, let’s not treat mammograms like the cure they aren’t. I’d do anything to protect my wife- even if that means supporting her decision not to have annual mammograms.

JESSICA BADER: The political firestorm over the recent announcement of new mammogram guidelines from the U.S. Preventive Services Task Force was depressingly predictable. Republicans saw an opportunity to use the task force’s recommendations (which did not consider financial cost) to fearmonger about rationing as the debate to begin debate on healthcare reform in the Senate unfolded. Democrats responded by loudly proclaiming their willingness to ignore science when the political optics seemed to favor doing so. Yet as dismaying as it is to see, I have a hard time placing all of the blame for this brouhaha on politicians behaving no more irrationally than the population as a whole.

Why are so many people upset by the sensible, research-backed recommendation that women who don’t have a family history of breast cancer or other risk factors should wait until they’re 50 (when the benefits of early detection outweigh the harms associated with false positives) to start getting mammograms? Ignoring evidence that would disturb the status quo is nothing new, and anecdotes have a much greater emotional pull than data. There’s a lot to be said for decreasing meat consumption to help combat climate change, but environmental organizations won’t say it because people don’t want to hear that their bacon cheeseburgers are harming the planet. Taking things back to preventive medicine, the ample evidence that the benefits of vaccination outweigh the risks is never going to convince the portion of the population that knows someone who developed some sort of serious medical issue shortly after receiving a flu shot. The reaction to the USPSTF mammogram recommendations is a combination of these two impulses; it argues that the current, familiar standard of starting mammograms at age 40 is wrong, and the examples of women who were diagnosed with breast cancer in their 40s after a mammogram are going to impact the mind differently than statistics on detection rates and false positives.

As someone who would like to know that a medical test or procedure is safe and necessary before I undergo it, it distresses me that research on that topic is so often ignored or attacked. I am many years away from having to think about getting a mammogram, and I imagine that between now and then there will be much more research, some of it contradictory, on the effectiveness and accuracy of mammograms, perhaps leading to different guidelines or even the development of a better test than what we currently have. Medical advances can only happen if we as a society are not afraid to question current practices and not dismissive of answers we may not feel like hearing.

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  1. Pingback: About breast cancer, age, guidelines, mammograms, women | Find me About

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