MAMMOGRAPHY DEBATE CONTINUES

Mammography: Not Perfect, but Saving Lives

Opposition to mammography screening has been going on for decades despite the fact that it has fulfilled all of the criteria for an effective screening test. Recent claims that the "harms" of screening (too many recalls) should preclude testing ignore the fact that the vast majority of these are resolved by a few extra images or ultrasonography. Fewer than 2% of women have an imaging-guided needle biopsy under local anesthesia, and 20%-40% of these prove to be cancer. Welch advises women to wait until they feel a lump, yet the yield of cancers among these women is even lower (15%), ^[19] and palpable cancers are larger and at less curable stages.

Those who wish to limit access to mammography screening always fail to provide any frame of reference. Breast cancer is diagnosed in more than 200,000 women each year and still kills almost 40,000 women annually. Cervical cancer is diagnosed in approximately 12,000 women each year, and approximately 4000 die of the disease. ^[20] The recall rates for cervical cancer are the same as for mammography. There has never been a randomized controlled trial to prove that Pap testing saves lives. Why is there such a concerted effort to stop mammography screening?

With mammography, breast cancers are detected at a smaller size and earlier stage. Randomized controlled trials have shown a statistically significant mortality reduction for screening women beginning at 40 years of age, and when breast cancer screening has been introduced into the general population, the breast cancer death rate goes down dramatically. In the United States, the death rate from breast cancer had been unchanged for more than 50 years. Screening began at a national level in the mid-1980s, and as expected, the death rate suddenly began to decline. ^[21] Now, more than 30% fewer women die of breast cancer each year, largely as a result of screening.

The arguments in support of screening are based on rigorous studies and have not changed. They have been reinforced as more women are screened and new data are analyzed. The fundamental reasons to urge women to participate in screening are based on science. Mammography is not perfect, nor is it the ultimate answer to breast cancer. It does not find all cancers and does not find all cancers early enough for a cure, but no universal cure is on the horizon, and mammography screening is available and is saving thousands of lives each year.