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Mammograms Can Save Lives of Women in Their 40s: Study

Rating

4 Star

Mammograms Can Save Lives of Women in Their 40s: Study

Our Review Summary

Although the article presents some interesting new findings regarding mammogram for women in their 40s, the article lacks a strong critical analysis to point out the weaknesses with the current study.

 

Why This Matters

Since the U.S. Preventive Services Task Force published their revised recommendations in November of 2009, many women between the ages of 40-49 have continued to be confused about what the evidence shows and what they should do.

News organizations that continue to report each new study on one side of the debate or the other should try to dedicate a considerable chunk of the story to an info-graphic or fact box to guide shared decision-making.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

No discussion of costs regarding mammograms.  Stories should not assume that every woman in the 40s who chooses to get a mammogram will have this covered by their insurance.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

We’ll give the story the benefit of the doubt for presenting lots of numbers – in contrast with the WebMD story that included NONE.

However, more critical analysis would have been appreciated.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story did discuss why mammography in younger women is not always beneficial and described several of the harms that the US Preventive Services Task Force discussed.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The article never pointed out that this was NOT a randomized controlled trial.  The article also should have discussed:

  • the fact that the study was based on referrals to the Swedish cancer hospital making it more likely that the woman had access both to a primary care physician and health insurance (which may be lead to improved health outcomes)
  •  the study included women with Stage 0 cancer – the stage that generates so much controversy regarding screening in younger women. Stage 0 breast cancer has high survival and is more likely to be diagnosed through mammography.
  •  the study excluded women who had Stage 4 cancer which could skew their survival results.  No information was given about why the study was limited to women up to Stage 3 cancer.

Does the story commit disease-mongering?

Satisfactory

No disease mongering.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The article did interview the chair of the U.S. Preventive Services Task Force (USPSTF).

Does the story compare the new approach with existing alternatives?

Satisfactory

In allowing Dr. Virginia Moyer of the USPSTF to talk about the need for women “to make their own decision,” the story at least implies that declining screening is a choice.  It could have been far more overt, but we’ll give the story the benefit of the doubt that the alternative choice was at least implied.

Does the story establish the availability of the treatment/test/product/procedure?

Not Applicable

Not applicable.  Availability of mammograms is not in question although access to care is dependent upon many factors including distance to facility with instrument, insurance coverage, etc.

Does the story establish the true novelty of the approach?

Satisfactory

The story at least acknowledged some past studies in the ongoing debate about “the best age to start routine mammograms and the best screening interval.”

Does the story appear to rely solely or largely on a news release?

Satisfactory

It appears that the story did not rely solely on a news release.

Total Score: 7 of 9 Satisfactory

Comments (2)

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Stacey Vitiello, MD

February 28, 2012 at 9:09 pm

The single most common cause of death for women age 35 to 50 is breast cancer. I’ve commented on this new study, and on the most appropriate age to begin screening mammography, here: http://staceyvitiellomd.com/2012/02/first-do-no-harm-the-spectacular-failure-of-a-government-panel/

Reply

Jessica Schwartz

February 29, 2012 at 12:53 pm

The study concludes that “less treatment” rather than “overall suvival” should be the new criteria for judging the merits of mammograms. Since treatment now has more to do with the biology of the cancer rather than the stage at diagnosis, this conclusion has no merits. My personal experience with mammograms is that I had a suspicious mammogram in 2003, which was subsequently biopsied (stereotactic) in 2005. The biopsy was from the wrong spot–yielded a benign result. Had 2 mammograms per year for 5 yrs (because of dense breasts–which I was not notified about (ties into your article about informing patients). Radiolgists watched calcifications grow and spread assuming it was benign because of the 2005 finding. Another stereo in 2010 (again from the wrong spot) came back DCIS covering most of my breast. Mastectomy and sentinel node revealed 8mm metatasis is sentinel node. Path discovered 2.5cm invasive tumor. (by the way I had an MRI before surgery and the radioligist recorded a 3 cm mass, but concluded that it was consistent with “biopsy proven DCIS.” So I wound up with stage 2b IDC even though I had mammograms from age 40 and minum of 2 mammos per year from age 45. I was told by my first onc that I needed chemo. After she violated HIPPA (gave my contact info to a university to ask me questions about how financial decisions impact my medical choices–also ties into your article on patient information) -I sought a second opinion and asked for oncotypeDX (even though I was node positive 1 of 12). That test revealed that chemo would only reduce my risk of recurrence by 2-5%. I took a pass on chemo. So my risk of recurrence is high but the more agressive treatment would not have treated my ER positive breast cancer. It is imperitive to inform women with dense breasts that Mammograms are not for them. Further, women with gene mutations such as BRCA and others that lead to breast cancer should also avoid over exposure to ionized radiation. I was diagnosed 2 years ago. I have had NO peace because I can not trust my doctors and because I have constantly had to dictate my own care. A lot of the arguments against early mammograms is that it leads to overtreatment because of false positives. But how about all the cancers that mammos do not detect? The only thing mammos are good at is detecting DCIS. In my case, the technology did detect it, but the doctors made a lot of erroneous asumptions at my expense. Mammograms DO NOT SAVE LIVES, nor are they responsible for “less treatment.” I had a bilateral mastectomy, bilateral oophorectomy and am on an aromatase inhibitor which but for semantics is a slightly less toxic chemotherapy.

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