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Mammography - is it worth it?


flyingiguana
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http://www.motherjones.com/politics/2015/10/faulty-research-behind-mammograms-breast-cancer

 

"Mammograms do help a small number of women avoid dying from breast cancer each year, and those lives count, but a 2012 study published in the New England Journal of Medicine calculated that over the last 30 years, mammograms have overdiagnosed 1.3 million women in the United States. Millions more women have experienced the anxiety and emotional turmoil of a second battery of tests to investigate what turned out to be a false alarm. Most of the 1.3 million women who were overdiagnosed received some kind of treatment—surgical procedures ranging from lumpectomies to double mastectomies, often with radiation and chemotherapy or hormonal therapy, too—for cancers never destined to bother them. And these treatments pose their own dangers. Though the risk is slight, especially if your life is on the line, a 2013 study found that receiving radiation treatments for breast cancer increases your risk of heart disease, and others have shown it boosts lung cancer risks too. Chemotherapy may damage the heart, and tamoxifen, while a potent treatment for those who need it, doubles the risk of endometrial cancer. In a 2013 paper published in the medical journal BMJ, breast surgeon Michael Baum estimated that for every breast cancer death thwarted by mammography, we can expect an additional one to three deaths from causes, like lung cancer and heart attacks, linked to treatments that women endured."

 

Wondering if people have thoughts on the matter, or perhaps other articles to read on this.

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Unless there is some way to pinpoint--in advance--the small number of women who benefit from mammograms and/or some way to pinpoint--in advance--those who, though diagnosed, are destined never to be "bothered" by the cancer found, I'll stick with my yearly mammogram, thank you.

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Oh man, I wish I had never read this. I'm already super anxious about getting mammograms done and will push them back and push them back until I'm practically dragged in by my hair. My mother had breast cancer so I know it puts me at a higher risk and that these mammograms are a necessity but dang I had no idea about treating lumps that would never have turned into anything.

 

Yes, I'll still do it but this information has definitely give me some food for thought.

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This is how my gynecologist explained it when we were discussing the newer recommendations about when to begin mammograms and how often to get them --

 

Some breast cancers are either so slow growing or so non-invasive that if they weren't detected for many years they still wouldn't be life threatening.  Other breast cancers are so virulent that even if they're caught very early the prognosis still won't be good.

 

It was a depressing conversation, you know?

 

FWIW, I still choose to get a mammogram every year.  I'm with Moxie in that I'll risk being over-treated.  I'd rather risk that than look back and think "If only . .. "

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Oh man, I wish I had never read this. I'm already super anxious about getting mammograms done and will push them back and push them back until I'm practically dragged in by my hair. My mother had breast cancer so I know it puts me at a higher risk and that these mammograms are a necessity but dang I had no idea about treating lumps that would never have turned into anything.

 

Yes, I'll still do it but this information has definitely give me some food for thought.

This is what bothers me about these articles. There are women who will use this kind of information to put off or not get a mammogram. Not that you are saying you won't buy some will say that. I get my medical information from carefully chosen doctors. Period.

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I think early diagnosis has been oversold. Mammograms are definitely needed if someone finds a lump or has other symptoms. For screening, they probably aren't all that helpful unfortunately. For the most part, aggressice cancers are deadly no matter how early they are caught and less aggressive cancers can be caught later and still have a good outlook for survival.

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I wouldn't have it done based on the evidence at this point. 

 

With massive testing schemes like this, you have to look at the benefits vs the problems caused by the testing itself.  Over-diagnosis is a significant problem, but one that medicine only seems to becoming more aware of in recent years, I suppose largely because of having more data about the outcomes of these kinds of programs.

 

Which is to say, we are really only now getting a good look at what the effects of these kinds of testing protocols are, and they aren't necessarily what was expected.

 

Something that often goes unmentioned is that when this sort of information becomes available, often the most significant push-back is from groups that have been involved in promoting it - in this case many breast cancer prevention groups.  Naturally of course it is hard for thinking to change, and many people have anecdotal experiences that influence them more than data ever could.  But another aspect is that a lot of money gets tied up in these programs - there is now a whole industry around mammography, that represents quite a lot of money and jobs and resources that people have committed.  These programs bring in a lot of funding for non-profit organizations - some exist just to provide those services.

 

It is typically very difficult to get groups to look at the data rationally under those circumstances.

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This is what bothers me about these articles. There are women who will use this kind of information to put off or not get a mammogram. Not that you are saying you won't buy some will say that. I get my medical information from carefully chosen doctors. Period.

 

Well, yeah.  Why should they not make their choices based on good medical information and their own health goals?

 

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This is what bothers me about these articles. There are women who will use this kind of information to put off or not get a mammogram. Not that you are saying you won't buy some will say that. I get my medical information from carefully chosen doctors. Period.

 

Some of us put them off anyway and just use things like this as fuel for our behavior, but seriously... it's not really due to the article.  I honestly can't see anyone who would normally get them being turned off by the article since the article mentions that some are found via this method.

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I've been getting them yearly since I was 40.  Last year, they found something.  Went through u/s....watch and wait three months....another u/s....then a biopsy.  Biopsy was negative, but I don't regret that we were alerted to something.

 

I'm adopted.  I'm clueless as to my health history.  

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I got my first one before age 50 because my doctor was concerned about a lump she found. It was clear, but they wanted another one done after 6 months instead of a year. I recently had to go back a few days after my screening for a diagnostic exam because of another lump. The results were negative, but it was unnecessarily scary. I do sometimes wonder if it's worth the stress (and in the case of the diagnostic one, the $$$, as I hadn't hit my deductible so I had to pay for it out of pocket). They recommend I keep having them every year, as I have "very nodular breasts."

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Just made my appointment for my bi yearly mammo. I know too many people who did not fit the "typical" patient with Breast cancer. Young women who didn't detect the lumps that eventually took their young life. I want everything I can use to help me prevent this happening. My life is not a statistic. I don't like colonoscopies either... but I am on the 5 year plan, for good reason. Glad I got that one too.

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Hmmm. There are conflicting guidelines about when to start mammograms. Both organizations seem equally qualified to make this determination (of when we should start mammograms and how often to have them), so I have no idea who is right and who is wrong.

 

See: http://www.mayoclinic.org/tests-procedures/mammogram/expert-answers/mammogram-guidelines/faq-20057759

 

My midwife (I still go to her for routine gyn care because I really dislike MDs) follows the "start at 40, have them every year" guidelines, which is a little odd, because midwives are normally more hands off than MDs.

 

Oddly enough, I just visited her a week ago and she reminded me it's time for the yearly mammo. But I was going to blow it off this year because I hate having it done and didn't think it was a big deal.

 

Still undecided about whether to bother with it this year or not. I don't know who is right or wrong or what the wise thing to do actually is. :(

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My family has a history of breast cancer, including my uncle, and me.  The friends I know who have had breast cancer nearly all had it in their 30's or 40's (including me).  Most caught it with a mammogram.  Most survived.  I absolutely am continuing my mammograms.  But I do think patients need to be informed of the risks and be allowed to make the determination based on family history (where available) and take other risk factors into account.  I do think everyone should at least have a base line mammogram at 40, even if they decide NOT to get another one until they are 50.  It makes it much easier to see if there is something wrong if there is something to compare it to.

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I have managed to put mine off for three years because I fainted at my first mamo and I now have so much additional anxiety surrounding the procedure, I have not marched myself to the office to have it done. I have last year's referral still hanging on my corkboard. Meanwhile, during those three years, I assisted my mother through her own breast cancer. That should be enough to force me to go, but it just hasn't so far. I may need a driving buddy and a Valium...

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Would a positive or negative BRCA change the frequency of mammos for anyone here?

It would for me. My mother was negative for BRCA, but if she had been positive, it would have seemed more pressing.

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Had a benign lump when I was 22 (30 years ago).  I get mammos when I get them, sometimes I put them off. I do think it's important, I just am an avoider. I had another scare about 10 years ago and had to go back for a second test, but they didn't find anything in the second scan.

 

If I was positive for the gene, I'd get a mastectomy. I think. It's a big step, but I think I'd go that route.

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A mammogram detected my cancer.

 

Even after I was diagnosed and the cancer pinpointed, no doctor could feel it.

 

I had a lobular breast cancer. It does not make a lump that can be felt for a long time. Mine had already gone to the lymph nodes.

 

I believe strongly in mammograms. I'm so lucky a friend of mine nagged me until I got one.

 

By the way, my mom died at 55 from breast cancer. I was diagnosed at 54. My mom missed seeing my kids grow up. If having a mammogram or two keeps alive to see your kids and grands grow, then it's a small price to pay.

 

I am not BRCA positive--but my doctor's believe there is a genetic component.

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A mammogram detected my cancer.

 

Even after I was diagnosed and the cancer pinpointed, no doctor could feel it.

 

I had a lobular breast cancer. It does not make a lump that can be felt for a long time. Mine had already gone to the lymph nodes.

 

I believe strongly in mammograms. I'm so lucky a friend of mine nagged me until I got one.

 

By the way, my mom died at 55 from breast cancer. I was diagnosed at 54. My mom missed seeing my kids grow up. If having a mammogram or two keeps alive to see your kids and grands grow, then it's a small price to pay.

 

I am not BRCA positive--but my doctor's believe there is a genetic component.

 

I think the issue, as I read it, is that some women will be harmed, or perhaps die, from the complications of overtreating. So some women will be saved by mammograms,and some will be killed by them, from the complications of overtreatment. Without knowing if you will be one saved, or one killed, how do you decide?

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Yes. Absolutely worth it.

 

I have two dear friends who would not be here today if it were not for early detection at a routine mammogram.

 

I am willing to accept the risk of a good deal of anxiety and discomfort if it saves even one more life.

 

Mammography was only the first step in their eventual diagnosis and treatment. Mammograms were followed by ultrasound and other scans and minimal exploratory surgery in order to determine the extent of the cancer and the treatment plan. If there are doctors out there who are not following these kinds of diagnostic protocols, mammography is not the problem.

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I think the issue, as I read it, is that some women will be harmed, or perhaps die, from the complications of overtreating. So some women will be saved by mammograms,and some will be killed by them, from the complications of overtreatment. Without knowing if you will be one saved, or one killed, how do you decide?

I reserve the right to change my mind... but should I ever get a mammogram and should it ever detect something, I think the most I would do is have it cut out. That may depend on the type of cancer and if there have been any major breakthrough with cancer research and what stage it's at... But I am pretty convinced that chemo actually accelerated my mom's cancer and killed her faster than it would have if she'd never had that damn routine mammogram.

 

That being said, I was also really shocked to see that Pres. Carter was receiving radiation for brain cancer. If it were me at 90 years old, seeing how painful radiation therapy is, I would just prefer to let it go untreated. Radiation was awful.

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I get yearly mammograms, at least most of the time.  I skipped when I was pregnant and nursing and I skipped when we didn't have insurance.  Other than that, every year since I was 32.  That's when a doctor doing a regular check-up after a car accident found a lump, a mammo was inconclusive, had an ultrasound that was still inconclusive, and then had a lumpectomy. 

 

There's a lot of breast cancer in my family but as far as I know, no one has had the BRCA test done yet.

 

If a malignant lump is found, is there any way to tell how aggressive it is before treatment is started?  Sounds like the issue in the article is that cancers that wouldn't be aggressive were treated aggressively causing other health problems.  Can that determination be made before starting treatment?  If not, how did they figure out that the tumors that were treated would not have been aggressive?  If so, it sounds like the patient should have the option for how to treat based on how aggressive it is (or thought to be, is it a sure thing?)

 

Might need to do some more research.

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I had my first routine mammogram at 40.  Then I had to go back because they saw calcifications and wanted another look.  Radiologist then said he was sure it was nothing but I needed a diagnostic mammogram in 3 months just to be sure.  I am doing that this Wednesday.  It is strange to have them say "we are sure it is nothing, but come back in 3 months to be really sure".  Not sure how I feel about it but I made the appointment and won't miss it.  I have little kids that need me.  But, if my kids were grown I could see not following through with it.  

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I get yearly mammograms, at least most of the time.  I skipped when I was pregnant and nursing and I skipped when we didn't have insurance.  Other than that, every year since I was 32.  That's when a doctor doing a regular check-up after a car accident found a lump, a mammo was inconclusive, had an ultrasound that was still inconclusive, and then had a lumpectomy. 

 

There's a lot of breast cancer in my family but as far as I know, no one has had the BRCA test done yet.

 

If a malignant lump is found, is there any way to tell how aggressive it is before treatment is started?  Sounds like the issue in the article is that cancers that wouldn't be aggressive were treated aggressively causing other health problems.  Can that determination be made before starting treatment?  If not, how did they figure out that the tumors that were treated would not have been aggressive?  If so, it sounds like the patient should have the option for how to treat based on how aggressive it is (or thought to be, is it a sure thing?)

 

Might need to do some more research.

Diagnosis is getting more accurate for which types of cancer may act aggressively and which won't.  It really isn't getting a mammogram that is the biggest issue, it is what the doctors do afterwards.  Some are old school and hit it with everything they have, even if current research is indicating that is not necessary in many cases.  It is up to the patient, unfortunately, to stay on top of what is happening, do their own research, ask LOTS of questions, seek multiple opinions, etc.  

 

My niece has a brain tumor.  She has had it since she was tiny but it wasn't diagnosed until she was in elementary.  The first doctor to find it was extremely unhopeful but was planning on destroying her vision and possibly part of her brain to remove the tumor (although the surgery itself would probably kill her).  They got a second opinion.  The next doctor pointed out that it was extremely slow growing and not that invasive.  If they could slow it down with mild chemo, they could buy her time.  It would hopefully preserve the quality of her life AND technology might improve to help her more later on.  She is now in her 20's, graduated High School with honors, and was able to make it through school still having enough sight that she didn't need braille or a seeing eye dog.  Her mother did extensive research and was her advocate every step of the way.  She knew more than the doctors by the end of her treatments and questioned things frequently (which saved her life several times).

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I get yearly mammograms, at least most of the time.  I skipped when I was pregnant and nursing and I skipped when we didn't have insurance.  Other than that, every year since I was 32.  That's when a doctor doing a regular check-up after a car accident found a lump, a mammo was inconclusive, had an ultrasound that was still inconclusive, and then had a lumpectomy. 

 

There's a lot of breast cancer in my family but as far as I know, no one has had the BRCA test done yet.

 

If a malignant lump is found, is there any way to tell how aggressive it is before treatment is started?  Sounds like the issue in the article is that cancers that wouldn't be aggressive were treated aggressively causing other health problems.  Can that determination be made before starting treatment?  If not, how did they figure out that the tumors that were treated would not have been aggressive?  If so, it sounds like the patient should have the option for how to treat based on how aggressive it is (or thought to be, is it a sure thing?)

 

Might need to do some more research.

 

My mother's breast cancer was the most aggressive type.  They cut it out of her breast and because it was the aggressive kind, did chemotherapy "just in case."  We found out later that the cancer had already spread to her head (long story) before it was ever diagnosed. As soon as she was done with the "just in case" chemotherapy, the breast cancer that had already mestastized to her head began to grow rapidly.  I've read (on the internet... I'm no expert) that chemotherapy can make some cancers come back even more aggressively.   She went back and forth between radiation and chemotherapy for several years, and each time she stopped chemotherapy, the cancer came back with an ever-lovin' vengeance. She'd go back on chemotherapy, only to find the previous effective chemotherapy no longer worked for her. It was horrible. One day the doctor was trying to be optimistic and that there was still a chance she could beat it and LITERALLY the next day we're being told to take her home to die, which she did just a couple weeks later.  I'm still kinda pissed about it, to tell you the truth. It's just my gut feeling, but I really believe that had she not had chemotherapy, the cancer would have eventually killed her, but much more slowly and she wouldn't have been so daggum sick for the last 3 years.

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My mom is 63 and got her annual mammo this year. They called her back because they saw a lump. She was actually considering not going back for followup exams because they have called her back so many times over the years for what turns out as fibrous breast tissue.  My dad said just go and it eventually was biopsied and found to be a tiny lump.  None of the doctors or my mom could feel the lump.  She ended up having a lumpectomy and a small round of radiation.  She declined taking the routine tamoxifen for the next 5 years.  So, in my moms case the mammo saved her life.

 

A few months later I had pain and thought I felt something (I am so hypersensitive now because of my mom), since I am nursing my gyno suggested an ultrasound which was inconclusive so my gyno had me do a double breast MRI.  My gyno says that breast MRI are often a way better option than a mammo, but insurance will never allow that to become the standard.  I was nervous about the MRI and yes it is more to "deal" with, but I think I am going to state that is the form of monitoring I would like to take for myself in the future.  With the inconsistency in results from mammos and the exposure to radiation on your chest I would prefer to go another route.  And this with my mom's life having been saved with a mammo.

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My mother's breast cancer was the most aggressive type.  They cut it out of her breast and because it was the aggressive kind, did chemotherapy "just in case."  We found out later that the cancer had already spread to her head (long story) before it was ever diagnosed. As soon as she was done with the "just in case" chemotherapy, the breast cancer that had already mestastized to her head began to grow rapidly.  I've read (on the internet... I'm no expert) that chemotherapy can make some cancers come back even more aggressively.   She went back and forth between radiation and chemotherapy for several years, and each time she stopped chemotherapy, the cancer came back with an ever-lovin' vengeance. She'd go back on chemotherapy, only to find the previous effective chemotherapy no longer worked for her. It was horrible. One day the doctor was trying to be optimistic and that there was still a chance she could beat it and LITERALLY the next day we're being told to take her home to die, which she did just a couple weeks later.  I'm still kinda pissed about it, to tell you the truth. It's just my gut feeling, but I really believe that had she not had chemotherapy, the cancer would have eventually killed her, but much more slowly and she wouldn't have been so daggum sick for the last 3 years.

 

My mom had a similar story. Chemo was just never effective.

 

When I was first diagnosed, my oncologist did plus and minus columns on a piece of paper describing my cancer. I'm a triple positive...used to be they could do good things with someone who had two of the three receptors, but not that pesky third one. With a flourish she drew a line from the negative side to the positive side....but now we have Herceptin....

 

I do believe all the surgery, chemo, and radiation for me was worth it because the drugs are more effective than when my mom was sick in the 90s.

 

A medical friend of mine when he saw I was drowning in the news of my diagnosis said...'you may have your mom's breast cancer, but you do NOT have her treatment.' Talk about floaties for a drowning gal. :)

 

So...I'm grateful for my treatment...for the moment, we've stopped it dead in it's tracks.

 

I get a mammo next week so if y'all are so inclined, say a prayer it's as boring as the last few have been. :)

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Would a positive or negative BRCA change the frequency of mammos for anyone here?

My mom and sister are bc survivors. My mom didn't have the test. My sister ( not my moms child) had the test and it was negative.

 

My moms cancer was not detected by a Mammo. In fact a GP found it in a routine exam and sent her for a Mammo.....they couldn't see it. 3 months later it was over an inch.

 

 

I have had yearly mammos since I was 37 ( the year my mom was diagnosed). But I don't have a lot of confidence in a Mammo being what saves my life. In April they found a small 3mm spot. They sent me back for ultrasound......right next to it is another small spot.....so small that they can't determine if it is a cyst or a lump.....but it is round so probably a cyst. Radiologist wants me back in six months ( end of October) to recheck....he half heartedly offered to biopsy it.....um, no ty ..so small how would you biopsy it! In July I saw my gyno and he looked at Mammo and ultrasound and did a very thorough physical exam...and whatever it is hasn't grown enough for him to feel it.....

 

 

Anyway, I am rambling, but basically it is like someone else said......if it is aggressive a yearly Mammo probably won't catch it in time ( unless the timing is just right) and if it isnt aggressive waiting until it is big enough to feel probably won't worsen your odds of survival.

 

Everyone has to do what they think best.

 

I do hate the worry of every small thing being enough to be brought back for rechecks. Not to mention this 6 month recheck just ruined my life insurance application....they denied me coverage because of a very cautious radiologist.

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Would a positive or negative BRCA change the frequency of mammos for anyone here?

 

 

Yes.

 

You need to scroll through this:

 

http://cyrcadiahealth.com/why-mammography-screening-is-being-abolished-in-switzerland/

 

a little ways to find the relevant info under the heading WOMEN CARRYING THE BRCA 1 or 2 GENE.

 

HTH somebody.

 

I didn't know about any of this 24 hours ago. Thank you for sharing, flyingiguana.

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