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New Book Doubts Mammograms’ Usefulness

February 9, 2011
Written by: , Filed in: Breast Imaging, Medical Ethics, Practice Management
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Should women—any women—get mammograms? “It’s an incredibly close call,” says the author of a new book titled Overdiagnosed: Making People Sick in the Pursuit of Health.

As you might guess from the provocative title, the book has attracted a lot of attention since it was published January 18. Among all the billions (or is it trillions?) of books carried by Amazon, it currently ranks 864th in sales.

Lead author H. Gilbert Welch, MD, is a professor at The Dartmouth Institute for Health Policy & Clinical Practice in Lebanon, New Hampshire. He made the “incredibly close call” comment in an interview with Michelle Andrews of Kaiser Health News.

“I believe mammography does help some women avoid a breast cancer death, but it’s rare,” Dr. Welch continued. “Our best guess is that you have to screen 2,500 50-year-old women for 10 years in order to help one avoid a breast cancer death.

“To be fair to patients, I believe we need to be clear about what happens to the other 2,499. Nearly half will have an abnormal mammogram over that period and have to worry about cancer needlessly. Half of them will have to go on to have a biopsy. And somewhere between 5 and 15 will be overdiagnosed and receive surgery, radiation, and/or chemotherapy for a cancer that was never going to bother them.”

Dr. Welch describes a comprehensive annual physical as “a total waste of time.” He believes recommended treatment thresholds for blood pressure, cholesterol, and blood sugar have fallen too low. And he thinks that early detection of diseases often causes more problems than it solves. As he said in the interview:

I don’t think people fully understand the ramifications of early detection, and that’s why I’m raising questions about it in this book.

What ramifications does he mean? “It certainly won’t save money. The reason is that early detection identifies so many new patients. Any savings from avoiding the cost of a few patients with advanced disease quickly evaporate in the face of the new cost of intervening early on millions of additional patients.”

As for the health benefits, Dr.Welch said, “It may improve health for some, but it also harms the health of others. The reason is overdiagnosis: the detection of abnormalities in people who are never destined to develop symptoms—or die—from their condition.”

How much of an effect will this book have? Frankly, probably not much. The tide is moving in the opposite direction, toward more promotion of and insurance coverage for screenings, wellness programs, and other early detection and prevention measures.

And if you were a patient, would you rather be overdiagnosed or underdiagnosed? If mammograms really help only 1 in 2,500 women, then they don’t seem very useful—unless you’re that 1 woman.

The bottom line is that the skeptics will probably remain skeptics and those who value caution and safety will continue to get mammograms. As Dr. Welch put it, “No one can say what is the ‘right’ thing to do. It’s a personal choice.”

Related seminar: Breast Imaging and Intervention: A Comprehensive Review (on sale, with free shipping and handling)

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One Response to “New Book Doubts Mammograms’ Usefulness”

  1. Earl on February 11th, 2011 at 4:01 pm

    Just another quack trying to sell books.Find out if is wife eschews mammography

    MD