I turned 40 last month, and I had my annual visit with my
doctor. After the routine blood pressure check and blood work, she
added another health screening to my growing list of routine
appointments. She told me I should get a mammogram.
American Cancer Society recommends annual mammograms starting
at age 40. The
U.S. Preventive Services Task Force (USPSTF), in its
controversial 2009 guidelines, recommends biennial mammograms
starting at age 50. There is growing evidence to support the idea
that the benefits of early screening do not outweigh the harm
caused by false positives and over diagnosis. But, many
institutions and physicians continue to recommend annual mammograms
beginning at age 40. Including my own.
This is a tough topic. It is emotionally fraught. It brings up
things we don't like to think about, and it is particularly
sensitive for women who have survived breast cancer or who are
currently undergoing treatment. The real problem is that with our
current scientific understanding, it is impossible to know if a
cancer that was caught by early screening will ever cause
noticeable symptoms during a woman's life. This means that all
cancers found through screening must be aggressively treated. A
study published in the New
England Journal of Medicine in 2012 concluded that nearly
one-third of women diagnosed with breast cancer would never have
developed the full-blown disease if left untreated.
There are scientific studies that support both sides of the
debate, of course. But, the USPSTF reviewed the best evidence
available at the time and developed statistical models to determine
if the benefits in terms of decreased mortality outweighed the
negatives and found (for women 40 to 49 with no other risk factors)
that they don't.
I want to stand on the side of science. And math. MMG's work
with the Division of Cancer Control and Population Sciences has
taught me the importance of evidence-based approaches to medicine
and has given me great respect for the researchers who are trying
to understand the science and to give us the best health
information possible. And yet, I don't want this to become a
well-reasoned argument to avoid a procedure out of fear of the
unknown, or discomfort, or embarrassment.
And so, I had the mammogram. And it wasn't that bad;
uncomfortable, but very brief. I don't yet know the results. Will I
get another next year? I would like to say no. But, I'll have to
talk to my doctor about that. And you should too. Every woman is
different, and thus every situation is different. What is right for
me, at this time, might not be right for you, but the important
thing is that you have the conversation.