Breast care centers with enormous investments in mammography machines and technicians continued to promote the benefits of annual screening. The general public, including most health professionals, clung to the belief that early detection saves lives. They are heavily influenced by vociferous groups and experts with a stake in perpetuating the status quo.
If you are the one in two thousand whose life is extended, that’s all that counts.
If you are somehow harmed as a result of annual mammograms, that’s the price you pay for access to a test that is considered the “gold standard” in breast cancer detection.
Because I understand that the clinical debate about screening mammograms is far from settled, I’d like to share my own perspective and action plan in the hope that, over time, a new consensus will be reached.
Metastatic breast cancer is terrible, no question. But I agree with the writers of the commentary in the January 13, 2010, issue of the Journal of the American Medical Association that breast cancer is just as treatable and just as deadly regardless of screening. I’ve opted out of routine screening.
I might accept the statistical evidence that because I have a first-degree relative who had breast cancer, my own risk is increased, perhaps even doubled. But that fact doesn’t make screening any more valuable to me than it would be to another woman—unless I believe that early detection will guarantee a better outcome for me. I don’t.
I’ve made sure that my primary care physician accepts my reasoning and supports me in my choice, although I welcome information from him about new findings that might affect my decision.
I don’t do breast self-exams. There’s no evidence to support their effectiveness. But that’s not to say I don’t pay attention to my body. If I should happen to discover a lump in my breast, I’ll have it evaluated. I’m not opposed to having a diagnostic mammogram.
If I’m told a lump is cancerous, I’ll seek other opinions. The interpretation of cell changes can be subjective. I want two—or three—expert pathologists to concur on any changes in mine. In July 2010, a New York Times article titled “Prone to Error: Earliest Steps to Find Cancer” reported that there is often “outright error” in diagnosing breast cancer in its earliest stages, leading to unnecessary surgery, radiation, and drug treatment—as well as fear—for some women.
I won’t rush into treatment because I know that cancers don’t develop or spread overnight. Any cancerous lump I find has probably been growing for years. Of course I understand that there are exceptions.
If there are research breakthroughs that dramatically increase the value of early detection, I’ll rejoice and change my attitude toward screening accordingly. I accept that sooner or later, I’ll die of something. It could be breast cancer. It’s also possible that I’ll die with cancerous changes in my breast (or some other location) that never progressed enough to cause harm.
I won’t think less of any woman who continues to get screening mammograms. The weight of public and professional opinion is still on her side.
It’s been ten years since my last mammogram. I don’t have to wonder whether this will be the year for a false alarm, false reassurance, or discovery of a cancer that might or might not require treatment. I accept the fact that life is uncertain.
I’m grateful for the gift of good health, recognizing that that’s what it is: a gift. I will always mourn my sister’s untimely death, which took place three years after her diagnosis despite state-of-the-art treatment. If it were in my power, I’d honor her by redirecting the $5 billion this country spends each year on screening mammography to other purposes. I’d direct those sums instead to the study of how breast cancer starts, and what we can do to treat it more effectively.