Breast health awareness -- are mammograms harmful or helpful?

by Julie Snyder

MamogramBreast cancer...those words associated anywhere near a conversation between a woman and her doctor immediately strike fear.

Thanks to the various "awareness" efforts most women are schooled with the premise that early detection is imperative to saving a life.

Understand that this article is not intended to dissuade anyone from pursuing a mammogram if it's deemed needed. Instead, we hope that reading this will spark each person to do their own research and engage their medical caregiver in a discussion to determine the wisest screening plan given their individual medical history.

Mammograms -- harmful or helpful?

A mammogram is a diagnostic and screening tool using low energy x-ray technology to detect signs of breast cancer. Recommended screenings for women with normal health conditions are once every two years after age 50 according to the U.S. Preventative Services Task Force. Both the American Cancer Society and American College of Radiation believe women age 40 and over should have regular screenings…and even sooner for those considered high risk.

As early detection does save lives, why would anyone even questionable that doctors wouldn't be shoving women in line to get a mammogram? What causes some women and their medical caregivers to hesitate?

The stats

According to the American Cancer Society, about 10 percent of women who have a mammogram will require more tests. Eight to 10 percent of these women will need a biopsy, and about 80 percent of these biopsies will turn out not to be cancer.

Over-diagnosis and treatment

Breast cancer screening and mammography may lead to overdiagnosis and overtreatment. In a 2009 Cochrane Database Systematic Review of breast cancer screening and mammography, the authors wrote, "For every 2000 women screened for 10 years, one will have her life prolonged, and 10 healthy women who would not have been diagnosed if they had not been screened, will be treated unnecessarily."

These numbers don't tell the whole story. H. Gilbert Welch, MD, MPH, explains further. Certainly, the one life saved is valued deeply. However, Dr. Welch points about that it's important to consider what happens to the hundreds of other women for that one.

In addition to the anxiety and true angst that these women experience, others may undergo invasive testing or worse -- life-altering ones such as lumpectomy, mastectomy, radiation, surgery.

David L. Katz, the founding director of Yale University's Prevention Research Center agrees and clarifies the task force's recommendations. For the general population, routine mammography in women under 50 does enough harm -- because of false-positive results, unnecessary procedures, and the fact that the tests don't often catch the most lethal breast cancers anyway -- to outweigh the good.

As a cause of breast cancer

A new study released by leading European cancer agencies offers a warning to young woman who fall into a high risk category for breast cancer, particularly those with gene abnormalities. The added radiation from mammograms for these women was found to actually cause the very disease it was meant to help.

Weighing the odds

The bottom line is that there's no one size fits all answer. Mammograms are certainly not without merit. Still, most women will find waiting until age 50 sufficient.

"But that equation is very different for an individual woman," says Katz. You and your doctor should discuss the pros and cons to personalize these one-size-fits-all recommendations.

Has your doctor discussed mammograms as part of your breast health awareness? If so, when did he or she recommend you begin?

Photo courtesy of iStockphoto.