NCS RESPONDS

Mammogram Controversy
Reported by: Eric Taylor, KOIN 
November 17, 2009
Dr. Kevin Olson responds to KOIN interview on mammogram guidelines.

Northwest Cancer Specialists responds to changes in mammogram guidelines
by Dr. Kevin Olson, Practice President of Northwest Cancer Specialists

Screening for any disease involves balancing the risks and costs associated with the test against the benefits of early detection in terms of preventing death or limiting the harmful effects of the disease. There is undisputed research to show mammography reduces death from breast cancer in several large trials. Mammography has always been recognized as an imperfect tool as it detects roughly 80% (not 100%) of breast cancers, and it can result in some falsely positive tests. However it is relatively inexpensive and on balance has been an effective tool in the fight against breast cancer.

Some recent studies have suggested the benefits of mammography to be overestimated in terms of reducing deaths from breast cancer. Additionally there is limited evidence that suggests some cancers detected may not need treatment. The methodology used in these studies has been criticized and the conclusions from the studies have not been uniformly embraced as a result. There is increasing recognition that mammography can lead to some undesirable effects including false positive tests requiring biopsy, exposure to radiation and unnecessary financial cost.

Many national and international organizations are attempting to balance the discordant research in this arena in order to make recommendations to patients and to determine how best to invest limited public resources to reduce breast cancer mortality. In my opinion, the U.S. Preventive Services Task Force recommendations are overestimating the harm and underestimating the benefits of mammography, given the admittedly confusing research mentioned above. I believe these recommendations are not likely to result in better care for women concerned about preventing death from breast cancer.

The decision to pursue screening tests of any sort is best made as a result of an informed discussion between each patient and his/her physician, taking into account individual risk factors for the disease. However, I will continue to recommend yearly mammography for my patients with “average risk” beginning at age 40.