Doctor: Put risks of breast cancer and mammograms in perspective

WASHINGTON — A lot of women hate them, some tolerate them, and no one really enjoys them.

These days a lot of women are questioning the need for an annual mammogram.

A recent study published in the Journal of the American Medical Association looked at 50 years of data on mammograms and concluded that the benefits, while real, have been oversold. At the same time, the harms have been downplayed.

The findings have one local breast cancer expert very concerned.

Dr. Rachel Brem is the director of the Breast Imaging and Interventional Center at the George Washington Medical Faculty Associates. She also is a breast cancer survivor.

“We have been having a fair amount of recent press about the negative impact of mammography,” she says, noting that all these studies that seem to call the procedure into question also acknowledge that it saves lives.

Brem says she is worried that the studies will make women think twice about coming for their annual mammograms, and that they will focus on the headlines and not on the lives saved by an early diagnosis.

The Harvard University study reported in JAMA speaks of a 19 percent overall reduction in deaths from breast cancer due to mammography. But it focuses on the risks of anxiety-raising false positives, which usually result in repeat imaging or a biopsy.

Brem says those risks need to be put in perspective.

“As someone who has been dealing with this for 30 years, I can assure you that the anxiety of telling a woman she needs to come in for additional views from a mammogram, is far less than the anxiety of telling her that she has a late stage metastatic breast cancer,” she says.

She notes the Harvard researchers crunched numbers from old studies based on old equipment. She says the digital mammography that came into use in 2007 and 2008 represent a huge improvement. Radiation levels are way down, and other forms of screening — such as ultrasound technology — are being used when needed to make diagnoses as precise as possible.

Brem says women with a family history of breast cancer or dense breasts need to work with their doctors to set up a personalized regimen, employing this additional technology when needed.

But her bottom line remains unchanged. Every woman needs an annual mammogram starting at the age of 40, or even younger if a close family member — a mother or sister — has been diagnosed with breast cancer.

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