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Study casts doubt on value of mammograms
A Canadian study is the latest and largest to raise powerful doubts about the value of yearly mammograms. It found the screening tests made little difference in the detection of cancers and death rates from them.
"It's a provocative and well-conducted study" said URMC Breast Oncologist Dr. Michelle Shayne. "I think it's going to lead to a lot of discussion and analysis on what to do next."
Researchers followed 90-thousand women over 25 years. Half of them received physical breast exams. Half also had regular mammograms. The study found mammograms do not reduce breast cancer deaths and are essentially as good as physical exams alone.
"How we use technology hasn't caught up with what it can really tell us. I know that from my own experience," says Kathy Simpson. The Rochester resident has been diligent about her yearly mammogram.
Yet she discovered her cancer on her hoe through a breast self-exam. She had a lumpectomy Monday. "Sometimes things are very fast growing and they just don't show up," she said. I could have had a mammogram a few months ago and it might not have shown up."
In the United States, 37 million mammograms are performed each year. Yes, mammograms often detect cancers early. But Canadian researchers wanted to find out whether there was any advantage to finding and treating breast cancers when they were too small to feel.
Their answer is no.
"All you did was pick it up sooner but you didn't help them live any longer," says Dr. Shayne. The study concluded women diagnosed after regular mammograms and those diagnosed in the self-exam had the same life expectancies.
In part because of drug advances such as Tamoxifen and other new treatments it is less critical to find cancers early. Further, the study found that in some cases mammograms lead to diagnosis and treatment women didn't need.
"We need to individualize screening," said Dr. Shayne noting that treatment plans are already very indivicualized. "Mammography may work for some and it may not work as well for others. We need to identify which group is which," she said.
The American Cancer society and other organizations say mammograms are proven to help save lives. It continues to recommend yearly screenings.
This study may lead to a deeper divide between those groups and many cancer patients and a growing number of researchers who say the evidence is not there.
It may mean however that women need to have this conversation with their own physicians. The answer may be different for women with higher risk factors than for others.
"I think for some people it's an important safety net," said Kathy Simpson. Yet she adds that she respects this study too. "I look at (this) and question whether mammograms should be required," she said.