To mammogram, or not to mammogram?

A slightly personal blog entry today in an area of medicine that’s a bit outside of my scope of practice.  I hope you’ll bear with me because it’s an area I care deeply about- just one in which I happen not to specialize.  I’ve lost a couple of friends to breast cancer and have seen friends lose spouses and parents to it.  I’ve watched survivor friends go into remission then cure.  I’m proud of my involvement for the last 5 years in the Susan G. Komen 3-day because it has managed to give me a sense of doing something about this rotten disease.  However, I do cringe when I see the signs on the route about mammography because they are just a bit misleading…

I’m 45 years old.  I’ve been getting annual screening mammograms for the last 5 years, since I turned 40.  At age 41, I paused to wonder if I really “need” an annual mammogram, particularly because that’s the year that the highly controversial USPSTF recommendations came out; as a woman in my 40s with essentially no clinical suspicion, best evidence says I probably don’t need an annual mammogram, and may not need a biennial one.  If you risk assess me using the Gail model, I’m below-average risk for my age.  And, of course, as a clinician who tries to be mindful of resource utilization, there are all of the issues that come with over treatment for many lesions found on mammography (discussion of this is around 26 minutes in if you want to fast forward- but it’s a great PBS show and worth the 50 minute watch).

Then, last week more fodder in the form of the 25 year follow-up from the Canadian National Breast Screening Study. Conclusion?  “Annual mammography does not result in a risk reduction in breast cancer specific mortality for women aged 40-59 beyond that of physical examination alone or usual care in the community.”  Please recognize that this says NOTHING about diagnostic mammography, which is an entirely different study and one that is both meaningful and helpful.  The issue here is screening and how that should be handled.  As a woman with a less-than-average risk of breast cancer, do I really need annual screening, or even every-other- year screening? The more I think rationally about this question, the more I realize the answer is probably not.  But if I read the American Cancer Society recommendations I do, and if I read the National Cancer Institute recommendations, I should have annual or biennial screening.  Yet the science keeps telling me that both of those sets of recommendations are wrong, at least for me.

Now, for the influence of logic on behavior, did I go get my mammogram this morning that has been scheduled for the last 3 months?

I did.  But I’m not sure I’ll do the same next year.