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By Jacob Molyneux, senior editor/blog editor
Diana Mason, AJN‘s emeritus editor-in-chief, posted here on the new U.S. Preventive Services Task Force mammography recommendations earlier this week, noting some troubling questions AJN had raised years ago about how much evidence actually supports the wholesale acceptance of yearly screening for women age 40 and older.
But we know that the bottom line for many American women remains this: “Are you really telling me that it’s better not to know as early as possible that I might have cancer? You must be kidding!” After all, we’ve all heard of someone whose life may have been saved by the early detection provided by a mammogram or a breast self-exam.
What about the other side of the experiential coin? Forget the evidence for a minute. Let’s not talk about the fact that, as Maryann Napoli pointed out in AJN in 2004, the “technology leads to the unnecessary treatment of some cancers that might have remained latent, and it also detects invasive breast cancers so slow-growing that women will have long lives regardless of when tumors are found.” That’s what the science may be telling us. That’s for the number crunchers.
What we want to know is more basic: have you or your patients ever experienced real suffering and anxiety from a false positive result, or negative consequences from treatments that you may now believe to have been unnecessary? Is there really anything to this concern—and will it ever be enough to convince women without significant risk factors for breast cancer that it might actually be better to wait for that mammogram?
(For some illuminating historical perspective on the topic, see the Op-Ed piece in today’s NY Times, Addicted to Mammograms.)
For a more comfortable experience, look for a Giotto mammography machine. This is an Italian machine developed by a man that lost his wife to breast cancer as the Italian Government would not allow her to leave the country for proper care & treatment. In Europe, Giotto has stereotactics that allows quadrants for needle biopsy while holding the breast firmly. The FDA has not allowed this technology in the USA. Also, molecular mammography has been installed at Baylor in McKinney,TX, two in L.A., one at Cedar-Sinai. The response at the Radiologic Service of North America (RSNA) was enormous. Look for these new technologies at major teaching institutions.
Thanks Jacob. It’s not easy to balance technology and peace of mind. I’m curious about how other women are doing it.
Thanks for the great comment, JParadisi RN! It contains all the complexity of the real world situations people face every day. -Jacob
I’ve had one mammogram in my life, and it was bad.
My mammogram was not for screening; it was to diagnose the lump in my breast that virtually appeared overnight a few days before. The black and grey films revealed a calcification so dense that a needle aspiration came up without any fluid. “Where is your baseline mammogram?” the radiologist and the technician both wanted to know. “This is my baseline mammogram,” I told them. “I’m not 40 yet; my insurance won’t pay for a mammogram until I’m 40.”
The mammogram results confirmed the need for a tissue biopsy. The lump became a tumor, and 10 years later, I am a breast cancer survivor.
Over the years, I’ve become more philosophic about surveillance labs (I don’t need mammograms anymore, because of my treatment choices). If the cancer recurs, it’s likely to find its home in my lungs, bones, brain, or liver, and I would have some tough choices to make. I’ve made lifestyle changes to increase my odds of remaining cancer free. However, while I believe I’m cured, like all cancer survivors, I know I’m out on visa from Cancerland, and my green card could be revoked at anytime. I’ve learned to make friends with uncertainty.
My serenity is not unshakable though, as I learned when my daughter called one evening to tell me she scheduled a mammogram, because she found a lump in her breast. She wanted me to go with her. Of course I was going; as soon as I peeled my over-the-top-with- anxiety self off of the ceiling.
The radiologist knew I was a breast cancer survivor and an oncology nurse. He handled the situation deftly. Introducing himself to me in the waiting room, he requested I stay there while my daughter had the mammogram. He would call for me when he had the results, and explain them to both of us.
I waited. As promised, I was called in and her films hung on the light board. I sat next to my daughter as he explained the lump was merely a bit of fatty tissue. Fortunately, my left-brain was functioning, and I could clearly see he was right, even though part of me wanted to scream, “Just take the damn lump out, let’s be sure, this is my daughter!” He explained her risks for breast cancer, and that she doesn’t need annual screening. She is more at risk of suffering from too aggressive treatment than from the disease itself.
Later, my daughter and I discussed my cancer experience, and how it affects her. I offered to go through genetic testing, but she asked me not to. She will take reasonable precautions, but like me, she chooses not to live in the shadow of cancer.