Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

I don’t know if this test will save your life

Justin Reno, MD
Physician
February 1, 2018
Share
Tweet
Share

“So, will this mammogram save my life?” she asked.

I thought for a few seconds …

“I have no idea.”

“What?” she sounded perplexed.

“Well, if you have a cancer that’s aggressive enough to kill you before everything else, but not aggressive enough to have already had cells metastasize, and not so aggressive that it responds appropriately to chemo but it still needs to be rapidly dividing enough to respond to chemo, and we hit this all with perfect timing — then it absolutely will save your life. Assuming you’re currently asymptomatic …”

I continued, “But, of course, simply by ordering this test, there’s no guarantee that you won’t have any sort of overtreatment. It’s possible that we may find cancer that wouldn’t have caused any problems. It’s also possible that we’ll find irregular cells that could resolve on their own, or you could have cancer that’s not picked up by mammography, falsely reassuring us. Or, we could find cancer, you could get all of the cells removed surgically, and you could develop a deep vein thrombosis postoperatively or a horrendous infection at the surgical site.”

“So you’re telling me that there are campaigns for mammography, but you can’t quote me exact numbers?” She sounded flabbergasted at this point.

“Yes. Unless you consider that there have been recent advances in technology.” I replied confidently.

“So that technology should make things better, right?” She sounded reassured again.

“Well, I really don’t know. It’s possible that it’s picking up on smaller tumors that would evolve into aggressive cancers, or it’s possible that it’s picking up on smaller tumors that won’t cause any problems.”

She looked at me again and said, “So what should I do?”

“Well, the United States Preventive Services Task Force says you should get a mammogram every two years from age 50 through 74 assuming you’re at average risk. You could also start at age 40 according to them. The American Cancer Society says you should get yearly screening from 45 until 54, then get screened every two years until you have a ten-year life expectancy, unless you want to get screened annually after fifty-four. They also say you’re more than welcome to get screened from 40 until 44. The American College of Radiology recommends that you get screened annually starting at age 40. And I’m not sure what the American College of Obstetricians and Gynecologists says.”

She looked as confused as I was.

I continued, “And I’m sorry, but it’s all very possible that those guidelines have changed since I last read.”

ADVERTISEMENT

“So what should I do to reduce my risk of breast cancer?” She almost seemed angry.

I thought for a while again: “Stop smoking. Stop drinking alcohol. Start exercising more. Normalize your BMI. Breastfeeding would have been a good idea. Avoid radiation. You may want to consider something for birth control other than oral contraceptive pills. And let me know if you ever find any lumps on your breasts. If you truly want to decrease your risk of breast cancer, do all of that. I’ll order a mammogram too, but that other stuff is far, far more important.”

Justin Reno is a family physician.

Image credit: Shutterstock.com

Prev

How a symbol influenced this patient encounter

February 1, 2018 Kevin 8
…
Next

The single most important phrase every doctor must learn

February 2, 2018 Kevin 0
…

Tagged as: Oncology/Hematology, Radiology

Post navigation

< Previous Post
How a symbol influenced this patient encounter
Next Post >
The single most important phrase every doctor must learn

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Justin Reno, MD

  • If you’re obeying the law, you’re contributing to CEOs’ astronomical salaries

    Justin Reno, MD
  • What this family physician learned from his dog

    Justin Reno, MD
  • Medical students are viewed as dollar signs

    Justin Reno, MD

Related Posts

  • The hidden benefits of your health insurance plan can save your life

    Michael L. Millenson
  • Ethical humanism: life after #medbikini and an approach to reimagining professionalism

    Jay Wong
  • The life cycle of medication consumption

    Fery Pashang, PharmD
  • My first end-of-life conversation

    Shereen Jeyakumar
  • When breast cancer screening guidelines conflict: Some patients face real consequences

    Leda Dederich
  • There’s no such thing as work-life balance

    Katie Fortenberry, PhD

More in Physician

  • True stories of doctors reclaiming their humanity in a system that challenges it

    Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO
  • Why wanting more from your medical career is a sign of strength

    Maureen Gibbons, MD
  • How a rainy walk helped an oncologist rediscover joy and bravery

    Dr. Damane Zehra
  • How inspiration and family stories shape our most meaningful moments

    Arthur Lazarus, MD, MBA
  • A day in the life of a WHO public health professional in Meghalaya, India

    Dr. Poulami Mazumder
  • Why women doctors are still mistaken for nurses

    Emma Fenske, DO
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How deep transcranial magnetic stimulation is transforming mental health care

      Muhamad Aly Rifai, MD | Conditions
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Recent Posts

    • How deep transcranial magnetic stimulation is transforming mental health care

      Muhamad Aly Rifai, MD | Conditions
    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician
    • How Gen Z is transforming mental health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nurses aren’t eating their young — we’re starving the profession

      Adam J. Wickett, BSN, RN | Conditions
    • Why wanting more from your medical career is a sign of strength

      Maureen Gibbons, MD | Physician
    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • First impressions happen online—not in your exam room

      Sara Meyer | Social media
    • How deep transcranial magnetic stimulation is transforming mental health care

      Muhamad Aly Rifai, MD | Conditions
    • Dedicated hypermobility clinics can transform patient care

      Katharina Schwan, MPH | Conditions
    • Why ADHD in adults is often missed—and why it matters [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why recovery after illness demands dignity, not suspicion

      Trisza Leann Ray, DO | Physician
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
  • Recent Posts

    • How deep transcranial magnetic stimulation is transforming mental health care

      Muhamad Aly Rifai, MD | Conditions
    • True stories of doctors reclaiming their humanity in a system that challenges it

      Alae Kawam, DO & Kim Downey, PT & Nicole Solomos, DO | Physician
    • How Gen Z is transforming mental health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nurses aren’t eating their young — we’re starving the profession

      Adam J. Wickett, BSN, RN | Conditions
    • Why wanting more from your medical career is a sign of strength

      Maureen Gibbons, MD | Physician
    • U.S. health care leadership must prepare for policy-driven change

      Lee Scheinbart, MD | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

I don’t know if this test will save your life
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...