In response to Jon Van`s recent story, ”Experts split on worth of breast X-ray,” I am concerned about the overemphasis of negative aspects of mammography. Dr. Eddy and other critics of early routine mammography stress that women should know mammography`s ”downside” and ”scant benefits” in order to make an informed decision.
The issue of whether or not a woman should have routine mammography between the ages of 40 and 50 concerns the benefit of the mammogram offset by the risk of the procedure and the cost to the woman.
The HIP study of New York in analysis showed that if 10,000 women had a mammogram yearly for a decade, 20 lives would be saved. The benefit of early routine mammography, however, is not as yet accepted by the entire scientific community. Recently a dozen health organizations have endorsed screening mammography every one or two years beginning at age 40.
The risk cited is needless biopsies and their resultant anxiety. Presume I have a mammogram at age 45 and a spot is found that leads to a biopsy that proves to be benign and, therefore, ”needless.” Now consider that I don`t get my first mammogram till age 50. The same spot is still there. I have not avoided a biopsy, but simply put it off five years, since the indications remain the same. The difference is that sometimes the spot is not benign but cancer and if this is true, it has had five years to grow.
The cost of an annual mammogram over 10 years for a woman from age 40 to 50, if she chooses a center doing the exam for $50, is $500. The benefit to her is 1 in 500 that her life is saved from death from breast cancer. She might consider that $500 is a worthwhile investment in preserving her life, since the risk is minimal.
As a woman and a physician treating women with breast disease, I do believe in a correctly informed decision. My reinterpretation of the article`s negative data leads me to conclude that there is a more positive value of mammography.
