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Two Bombshells In The Mammography Wars

September 24, 2010
Written by: , Filed in: Breast Imaging, Medical Ethics
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Mammography advocates have had an interesting week. On Wednesday, a radiologist-backed campaign was announced to advocate annual mammograms starting at age 40. On the same day came word of a study finding that the benefits of mammography screening are minimal.

The campaign is Mammography Saves Lives, which is also the name of its supporting coalition, consisting of the American College of Radiology, the Society of Breast Imaging, and the American Society of Breast Disease. Through a new Web site, www.mammographysaveslives.org, the coalition suggests that women get a mammogram every year once they turn 40. The site says mammography has helped reduce the breast cancer death rate by nearly a third since 1990.

The study, published Thursday in the New England Journal of Medicine, made a huge splash in the popular as well as the medical media. It looked at 40,075 women in Norway who were diagnosed with breast cancer from 1986 through 2005. Participation by women age 50 to 69 in an every-two-years mammography screening program was associated with a 10 percent reduction in the rate of death from breast cancer. However, the researchers found that only a third of that reduction could be attributed to the screening. They said the rest came from enhanced awareness of breast cancer and improved diagnosis and treatment.

An accompanying NEJM editorial by H. Gilbert Welch, MD, MPH, of the Dartmouth Institute for Health Policy and Clinical Practice at Dartmouth Medical School in New Hampshire, said that because of those improvements in awareness, diagnosis, and treatment, “It is quite plausible that screening mammography was more effective in the past than it is now.”

If the new study’s findings are correct, Dr. Welch said, “the number of women who will not die from breast cancer rises from 995.6 to 996 per 1,000 women with the addition of screening mammography.” Accordingly, he said, “the decision about whether to undergo screening mammography is, in fact, a close call.”

Of course, if you’re that not-quite-half of a woman whose life would be saved by mammography, it’s not a close call at all. That’s the heart of the issue that doctors face when advising actual patients in their offices, as opposed to analyzing statistics from studies. That task didn’t get any easier this week.

Related seminar: Pittsburgh Breast Imaging Seminar

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One Response to “Two Bombshells In The Mammography Wars”

  1. Radiology Daily┬╗AlertArchive ┬╗ Mammograms For Ages 40-49 Get A Boost on September 30th, 2010 at 10:05 am

    […] week we heard about a Norwegian study that found only minimal benefit from regular mammography screening in women age 50 or older. This […]