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

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

  • The high cost of gender inequity in medicine

    Kolleen Dougherty, MD
  • Women physicians: How can they survive and thrive in academic medicine?

    Elina Maymind, MD
  • How transplant recipients can pay it forward through organ donation

    Deepak Gupta, MD
  • A surgeon’s testimony, probation, and resignation from a professional society

    Stephen M. Cohen, MD, MBA
  • Locum tenens: Reclaiming purpose, autonomy, and financial freedom in medicine

    Trevor Cabrera, MD
  • Collective action as a path to patient-centered care

    American College of Physicians
  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • Why transplant equity requires more than access

      Zamra Amjid, DHSc, MHA | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How robotics are transforming the next generation of vascular care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How robotics are transforming the next generation of vascular care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The high cost of gender inequity in medicine

      Kolleen Dougherty, MD | Physician
    • Mpox isn’t over: A silent epidemic is growing

      Melvin Sanicas, MD | Conditions
    • How your family system secretly shapes your health

      Su Yeong Kim, PhD | Conditions
    • Women physicians: How can they survive and thrive in academic medicine?

      Elina Maymind, MD | Physician
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions

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

  • Most Popular

  • Past Week

    • Why your clinic waiting room may affect patient outcomes

      Ziya Altug, PT, DPT and Shirish Sachdeva, PT, DPT | Conditions
    • Nuclear verdicts and rising costs: How inflation is reshaping medical malpractice claims

      Robert E. White, Jr. & The Doctors Company | Policy
    • How new loan caps could destroy diversity in medical education

      Caleb Andrus-Gazyeva | Policy
    • Why transplant equity requires more than access

      Zamra Amjid, DHSc, MHA | Policy
    • The ethical crossroads of medicine and legislation

      M. Bennet Broner, PhD | Conditions
    • How robotics are transforming the next generation of vascular care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How robotics are transforming the next generation of vascular care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The high cost of gender inequity in medicine

      Kolleen Dougherty, MD | Physician
    • Mpox isn’t over: A silent epidemic is growing

      Melvin Sanicas, MD | Conditions
    • How your family system secretly shapes your health

      Su Yeong Kim, PhD | Conditions
    • Women physicians: How can they survive and thrive in academic medicine?

      Elina Maymind, MD | Physician
    • The human case for preserving the nipple after mastectomy

      Thomas Amburn, MD | Conditions

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...