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Posted April 18, 2014: by Bill Sardi
A New England Journal of Medicine report is the latest to condemn mammography. Its title (Abolishing Mammography Screening Programs) suggests it’s time to close up breast cancer screening centers altogether.
Cited as evidence is a 25-year study among thousands of women detected just 484 cancers and 22% of them were unnecessarily treated with surgery, radiation or other therapies.
Also cited was a larger trial of over a half-million women that showed no evidence that mammography screening reduces over-all mortality. The report is even more sobering. For every breast-cancer death prevented in the U.S. prevented by annual screening beginning at age 50, 460-670 women are likely to have a false positive mammogram with repeat examination; 70-100 a needless biopsy and 3 to 14 an over-diagnosed case of cancer that would never be life threatening.
The two bio-ethicists who wrote the report concluded that mammography “does not clearly produce more benefits than harms.” [New England Journal Medicine April 16, 2014]
A report with less scientific jargon that airs these current doubts about mammography was recently published in The Wall Street Journal. [Wall Street Journal April 1, 2014]
Most women have little understanding of the science. They trust their doctors. They have fears, particularly those women with a family history of breast cancer.
The New York Times published a more revealing report about women’s response to information about the drawbacks of mammography screening. Even after acknowledging the information was helpful to them in making this important healthcare decision, 6 of 10 older women elected to undergo another mammogram within 15 months.
The New York Times article says women don’t evaluate risk/reward ratios. A leading doctor says “women go for reassurance, for affirmation of their health.” [New York Times March 14, 2014]
But from the doctors’ side, why do doctors allow patients to expose themselves to increased risks? It’s kind of like the doctor saying, “Well, if the patient insists, I guess I’ll have to turn on the mammography machine.” In other words, it is the old “devil made me do it,” shove the blame on the patient rationalization.
Where are the medical review boards, the hospital utilization committees, the reimbursement review organizations? Stop paying for this needless and oftentimes troublesome care.
Annual screening of women between 40 and 84 years old costs an estimated $10.1 billion per year. [Health Imaging Feb. 5, 2014] With about 39 million American women undergoing mammography annually, that amounts to about $2564 per woman screened. That’s a lot of women who are looking for reassurance.
Do you think any amount of science is going to stop this parade? Yet the Affordable Care Act forces providers of healthcare to scientifically justify the treatments they provide. With limited healthcare dollars (Medicare faces trillion-dollar shortfalls) can America continue offering $10 billion of reassurance?
And should doctors and hospitals be allowed to continue to shun the science and continue to collect ill-gotten insurance money? Maybe the only way to do this is shut down the mammography centers altogether, as the title of the New England Journal of Medicine report suggests. But imagine the outrage women’s groups are going to volley at politicians, the accusation that we’re rationing care at the expense of women’s lives. Who is going to say no to a fearful 70-year old woman whose mother and grandmother succumbed to breast cancer? – ©2014 Bill Sardi, Knowledge of Health, Inc.
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