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Mammograms: Overhyped? Underused? Both?

May 3, 2013
Written by: , Filed in: Breast Imaging, Medical Ethics
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People want to be told, “Do this; don’t do that.” People like definitiveness, not nuance.

That’s what has sparked the mammography wars. That’s why we have two recent pieces of writing that suggest mammography screening for breast cancer is both oversold and underused.

You probably already have read, or at least heard about, “Our Feel-Good War on Breast Cancer,” the April 25 article in the New York Times Magazine by breast cancer survivor Peggy Orenstein. She begins:

I used to believe that a mammogram saved my life.

In the fifth paragraph, she adds, “Sixteen years later, my thinking has changed.”

Orenstein thoughtfully reviews mammography screening, the organizations that promote it, and the latest research about it and its consequences. She’s not anti-screening; she just wants people to be aware of the nuances.

She concludes: “All that well-meaning awareness has ultimately made women less conscious of the facts: obscuring the limits of screening, conflating risk with disease, compromising our decisions about health care, celebrating ‘cancer survivors’ who may never have required treating. And, ultimately, it has come at the expense of those whose lives are most at risk.”

In contrast comes an article published today by Health Imaging exploring the underuse of mammography among women in minority populations, especially those who are Hispanic, African-American, or American Indian.

Bridget A. Oppong, MD, a breast surgeon and assistant medical director at the Capital Breast Cancer Center in Washington, pinpointed one of the issues:

We are happy if a woman comes in even every other year. Our problem is, we have women who come in once and they feel, ‘I have a clean bill of health. I am done with that.’

Some strategies do succeed in increasing mammography use. They need to be tailored for particular populations, and they can be costly and time-consuming. But they’re necessary, say Dr. Oppong and others.

“Minority populations, populations that I consider high risk because they may lack health access, have higher rates of presenting with more advanced cancers,” Dr. Oppong said. “A lot of it is because of screening underutilization.”

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Implants may—or may not—make breast cancer less survivable. For details on a new study, see our Facebook page.

Related seminar: Breast Imaging and Intervention: A Comprehensive Review (discount and free domestic shipping and handling for a limited time)

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