Before I begin, a disclaimer: I’m sick of writing about mammography. It feels like groundhog day — I’ve been writing the same damn story, over and over and over again, for nearly 15 years. This is at least the fifth time I’ve written a LWON post about mammograms. (See also: Breast cancer’s false narrative, The real scandal: science denialism at Susan G. Komen for the Cure®, FAQs about breast cancer screening, and Breast cancer’s latest saga: misfearing and misplaced goalposts.)
So why I am I writing about mammograms again? Because even though I just published a story at FiveThirtyEight explaining why science won’t resolve the mammogram debate and a feature at Mother Jones asking how many women have mammograms hurt? (the answer is millions) the harms of mammography continue to be ignored or mischaracterized in the media. Every time this happens, I get letters from people asking me to please clarify this point again. Just this past week, a New York Times editorial penned by two breast radiologists and a breast surgeon declared, “Let’s stop overemphasizing the ‘harms’ related to mammogram callbacks and biopsies,” while an op-ed in the Washington Post titled, “Don’t worry your pretty little head about breast cancer” claimed that, “the idea that anxiety is a major harm doesn’t have much scientific support.” (In fact, at least one study has found long-term consequences from a false alarm.)
What both of these opinion pieces miss and what too many women still don’t know is that while 61 percent of women who have annual mammograms will have a callback for something ultimately declared “not cancer,” this isn’t the most damaging problem. Such false alarms are more devastating than they might seem (I can’t think of another recommended medical test with such a high false positive rate), but most women would probably gladly accept this risk in exchange for a reasonable chance to prevent a cancer death.
Here’s the bigger problem: screening mammography has failed to reduce the incidence of metastatic disease and it’s created an epidemic of a precancer called DCIS. The premise of screening is that it can find cancers destined to metastasize when they’re at an early stage so that they can be treated before they turn deadly. If this were the case, then finding and treating cancers at an early stage should reduce the rate at which cancers present at a later, metastatic stage. Unfortunately, that’s not what’s happened. Continue reading
