Who Should Have a Mammogram?

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I'm in the business called research. We have to search over and over for the truth, and every time you find the truth you have to question whether it's actually the truth and the way you do that is by doing studies and by comparing studies by looking at how strong studies are. In the case of screening, what we all like to see as a prospective randomized trial where a group usually 10-20, 000 people got the screening test and an equal size group did not get the tests and we followed them over 10-20 years.

Nobody has the patience to wait that long for those sorts of tests, so we're going to have to look at the data that we have and make what is frequently a best guess. In the case of breast cancer for women in their 50's and 60's we actually have eight randomized prospective trials, some actually going back into the 1960's that show that mammography and clinical breast exams lowers risk of death, by the way we always want to look at mortality or risk of death.

Some people mistakenly think that we want to look at survival, survival has so many biases it is not a worthwhile indicator to judge adequacy of a screening test. In the case of women in their 40s with breast cancer screening, it's never really been adequately assessed, but we have to extrapolate back, where the American Cancer Society for some years have recommended that women in their 40's get an annual mammogram.

Other organisations that we fully respect have said there's not really the data that show it so we can't recommend it. The US Preventive Services Task Force a few years ago actually recommended that women be informed of the risk and benefits and suggested that maybe women in their 40's who at low risk of not concern, not get mammography.

We also need to realize the second paragraph in the ACS recommendation which is the limitations of mammography. If all women were to get mammography and it will work it is absolutely best, it would always save 30% of the lives are lost to breast cancer. We still need a better test to try to save that other 70% number one.

Number two mammography is not perfect, it will flax in people who have an abnormality it turns out not to be cancer and it's going to miss some people who actually do have cancer, so mammography is not perfect and so I always say we recommend mammography but we recommend to tell people with limitations of mammography.