Benefits of mammography may not outweigh the harms

Stop pushing screening mammograms now.

One by one, the big-time screening tests for dread diseases, begun with good intentions, the best science known at the time, and a mass public health campaign, bite the dust.

Real science, that of statistically and clinically valid outcomes over time, obviously takes time to be realized. It also takes unbiased scientists and physicians with minimal conflicts of interest to study, deduce, report and then take the heat while putting change into practice.

Sometimes the most intuitive and seemingly logical observations and conclusions are simply wrong. But once an erroneous “fact” becomes established dogma in the mind and actions of the profession and the public, it is very hard to change that belief and those practices.

Of course, a change also interrupts many income streams.

The new large study out of Norway reported in the Sept. 22, 2010 issue of NEJM again documents that any benefits of mammography are so small. We already know that the harms and costs are not small.

Finding a breast cancer or a prostate cancer early so it can be treated when tiny seems so logical. However, such an approach has always meant also finding “cancers” that are not going to hurt the patient even if untreated.

A new large Swedish study published in Cancer just a few weeks ago proclaimed that even women between ages 40 and 50 years should have mammograms.

I’m Swedish, but this Norwegian study trumps the latest Swedish findings.

In another twist, in the 1960s, I worked for a while as a pathologist in west Texas. One hospital there was famous for its very high breast cancer cure rate. Then someone looked at some of those “cured breast cancers.” Guess what; on pathologist second opinion, many were not cancers in the first place.

The strangely controversial 2009 recommendation of the U.S. Preventive Services Task Force, which downplayed the value of mammograms is looking better all the time.

It further said that the patient and the physician together should consider the data and share in deciding about mammography. I like that, especially if both the patient and physician are well informed.

Stop pushing screening mammograms now.