Dedicated to Paula Mariniello

Here’s the problem:  Mammogram screening is the ONLY SCREENING METHOD WE HAVE for the MOST COMMON MALIGNANCY WE HAVE.  Breast cancer is the #1 killer of women under the age of 60 and becomes alarmingly menacing every year after that.   The ONLY WAY WE KNOW HOW TO FIND BREAST CANCER EARLY AND SAVE LIVES, NOT TO MENTION BREASTS, IS VIA MAMMOGRAM SCREENING.  Alas, they are imperfect. They often trigger – especially in younger women – additional tests that ultimately show everything to be just fine.  This is expensive and tedious, as every woman knows.

Thank you.  We did not need another study or another set of guidelines to tell us that.  What we need less is to be made more confused and told that perhaps we need fewer mammograms, overall.  We don’t have less cancer.  The incidence of breast cancer has risen 300% since mammogram screening was introduced.

The new guidelines put out by the American Cancer Society try to salve the wound they inflict by pointing out that these guidelines are only for “average risk” women.  Allow me to point out that over 80% of the women who are diagnosed with breast cancer each year are “average risk” women with NO IDENTIFIABLE RISK FACTOR OTHER THAN THAT THEY ARE WOMEN.


Is the solution to the problems that attend mammogram screening for women to forego them if they are under 45, or have them every other year after they are 55, and stop altogether if it seems that they have less than 10 years to live and JUST TAKE THEIR CHANCES?  Is that what their doctors should encourage them to do?

Should we also stop wearing seat belts because they are expensive to install, wrinkle our clothing, restrict our movement in the car, and only save a few lives for every 10,000 car accidents?

How did we come to this AGAIN?  Years ago, about the time the War On Cancer got rolling (circa 1971), it became clear that if we wanted to increase breast cancer survival then we needed to employ the ONLY SCREENING METHOD WE HAD – MAMMOGRAMS – to find it as early as possible.  Mammogram screening took off and we did save lives.  Experts agree, we’ve saved approximately one life in every 1000 for women whose breast cancers have been found as a result of mammogram screening.  We have saved breasts too, which is NOT NOTHING.  But no one on the guideline committees or in the executive suites seems to have even thought of that or of its worth.

Mammograms are expensive, tedious, complicated, and flawed but at the moment they are THE ONLY THING WE HAVE.  (Everyone agrees that breast self exams are important but they rarely save a life.)  Why take away the only screening method we have for the most common killer we have and replace it with nothing?  Are we to take our chances because we have nothing better?  Is that the foundation of the new guidelines?  How about we stick to what we have for the moment while we find something better. (See my note below.)

How about we stay the course with mammogram screening, tolerating it like some crazy uncle that we are forced to sit with at Thanksgiving dinner every year, while we work to find a better way?

Oh, and if we would apply ourselves to finding the cause of breast cancer ( then we could ship one mammogram machine to the Smithsonian for history’s sake and ship all the rest to China:  they could melt them down and make paper clips.  With all the paper coming out of Washington these days, the demand for paper clips ought to go sky high.

Note: It’s not like we don’t have alternatives to mammogram screening sitting on the shelf.  A new imaging device made by Gamma Medica has a true positive rate for finding breast cancer that approaches 100% and a false negative rate that approaches 0%, and it looks like it might prove to be an excellent screening method that women could use every several years instead of annually.  (I do not have a financial or political relationship with this company.  I am familiar with their product and have used it in my practice to great effect.  Medicare covers it but many private insurance companies still do not; they are dragging their feet, trying to save a dime like they always do.)

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