Ethics in Medicine

Mammograms, the controversy continues

Kristen Sparrow • December 29, 2010

From last week’s New York Times

An expert in breast cancer. Dr. Marisa Weiss, was diagnosed with breast cancer herself. This, is one of many anecdotal stories of early diagnosis leading to successful treatment after a mammogram. These stories abound and fuel the debate over the recently revised guidelines for mammography. The new guidelines stipulate that women with no risk factors do not need regular mammograms until age 50, and then every other year. I’ve done a few posts on the topic, here and here.

Dr. Marisa Weiss scheduled her mammogram this spring, just as she does every year. ..
Dr. Weiss, who soon learned that she had an invasive Stage 1 cancer in her left breast, is not just any physician. A radiation oncologist and a specialist in breast cancer, she founded a popular Web site,, for women seeking comprehensive information about the disease, and she considers herself a woman with a mission…
A year ago, when a federal task force issued new guidelines relaxing the recommendations for mammography screening, Dr. Weiss was one of their fiercest critics. Mammograms aren’t perfect, she said at the time, but they save lives. Now she says one may have saved hers…
If Dr. Weiss had followed them, she might have skipped this year’s scan, giving the tumor more time to grow undetected; and if she had not had a trail of scans from her 40s, doctors would not have been able to compare the images and notice the tumor’s subtle emergence. (In fact, her risk is above average, because of her dense breast tissue and a family history. But she noted, “Most women who get breast cancer don’t have a family history — that’s a huge myth.”)…
Dr. Brawley says that on balance, mammography saves lives. But he notes that it misses some cancers, and that radiation from the scans will actually cause some cancers to develop.
In addition, some women will be called back repeatedly for additional procedures, scans and biopsies that ultimately rule out cancer but can be painful and anxiety-provoking. Mammograms also find some cancers that grow very slowly but look the same as any other cancerous tumor, leading to aggressive but unnecessary treatment..

The article goes on to say that the decision is still a personal one and though some primary care physicians have reduced the number of referrals for mammograms, the new guidelines have not had a big impact on mammogram scheduling nor insurance coverage. Of note, is that Dr. Weiss would have been in a higher risk group anyway, and would have received mammograms as per the previous recommendations.

The trend is disturbing to Dr. Weiss, who says she fears that radical changes in the way women live — earlier puberty, rising obesity and alcohol consumption, environmental pollution, long-term use of oral contraceptives, later childbearing and less breast-feeding — could lead to more breast cancer emerging at younger ages.

Dr. Weiss goes on to say,

“The thing is: every woman is at risk. And every woman needs to do everything she can to protect herself.”

Coincidentally, I went to see my OB/Gyn physician for a checkup, and she was diagnosed with breast cancer over a year ago. The cancer showed up 2 months after her mammogram when she noticed an asymmetric nipple and dimpling. So her mammogram missed it. There are no easy answers here, and I certainly hope we can get some insight and funding to find out the cause of increasing breast cancer rates.

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