The True Value of Mammograms

Who ever thought up the word, “Mammogram?” Every time I hear it, I think I’m supposed to put my breast in an envelope and mail it somewhere. -Jasmine, breast cancer survivor

American women face a peculiar danger with mammograms. We risk succumbing to the notion getting regular mammograms somehow prevents breast cancer. “There’s almost, I think, a magical belief that getting regular mammography may prevent breast cancer. This is something I’ve experienced myself as a patient,” said Dr. Susan Bennett, of Brigham and Women’s Hospital, the teaching hospital of Harvard Medical School. “Sort of this ‘clean-bill-of-health’ concept that it (a mammogram) will give you a sort of ‘inoculation’ against the disease.”

When a respected doctor ‘fesses up’ like this, it’s time to start rethinking the purpose of mammographic screening. Not only do mammograms not prevent cancer, mammograms completely miss 15 to 25 percent of breast cancer. And 80 percent of what looks suspicious on a mammogram turns out not to be cancer, according to the 2005 American Cancer Society Report.

Mammograms are particularly ineffective when women have dense breasts. A mammogram depicts dense tissue as white, so a dense breast will produce a predominantly white mammogram. Breast masses are also white. Picking out a small white spot (which may be cancerous) against a predominantly white background is like finding a snowball in a blizzard. The inability to identify cancerous masses in dense tissue is what makes mammograms so notoriously inaccurate on younger women.

Breast cancer is not a textbook cancer, where indications are clearly given and treatments are well agreed upon. A woman can think she doesn’t have breast cancer because she’s not fully informed about all the possible warning signs of breast cancer. She may have a symptom that usually signals a benign situation, but in her case it signals a problem.

There is strong evidence that routine mammography for women in their 50s and older reduces the breast cancer death rate, but the benefit of screening women in their 40s remains a subject of intense medical dispute. Recently the National Cancer Institute stopped advising routine mammograms for women under 50, however the American Cancer Society advises women to receive screenings in their 40’s. Outside the United States (in Canada and most European countries), yearly mammograms are generally recommended only for women above the age of fifty.

There are things we can all do to get the best out of mammograms—however imperfect they are as a screening method. Try to go to the same facility every year. If you can’t, make sure the new facility has copies of your old mammograms. Doing so will help avoid false positives and make it easier for changes in your breast tissue to be quickly detected.

In addition, insist on getting the results of the mammogram in writing. Most facilities will mail a report, but don’t assume everything was okay if you don’t receive one. Contact the facility and request the report be mailed.

Finally, don’t fall into the trap of relying strictly on mammograms. Be sure to get a yearly clinical breast exam and keep alert to any changes in appearance or feeling in your breasts. Mammograms save lives, but if a breast lump is felt, a negative mammogram is meaningless. The woman can still have breast cancer.

Excerpted from Busting Loose: Cancer Survivors Tell You What Your Doctor Won't by Cheryl Swanson