Mammograms' Value Debated, Especially For Older Women

From Kaiser's Monthly Update on Health Disparities:

The role of mammograms in reducing breast cancer mortality was the topic of conversation at a forum at the Harvard School of Public Health and of a recent article from The Washington Post.

The forum, which consisted of doctors and policy officials, debated the role annual mammograms have in reducing breast cancer mortality as compared to treatment advances. When mammograms first became available, women were encouraged to "catch-it-early-when-it's-curable." Over time however, the understanding of breast cancer has changed as scientists have learned more about the biology of cells. "There are some tiny cancers that are destined to relapse no matter how early you find them, while other large aggressive cancers may not even spread," said Julie Gralow, a professor of oncology at the University of Washington Medical School. Experts noted that access to good care was a contributing factor in reducing death rates from the disease. The article also noted that the debate for when it is most efficacious to screen persists. Whereas European countries recommend mammography screening for women between the ages 50 to 69 years, the United States encourages annual screening, beginning at age 40. Opponents believe that over-detection may lead to unnecessary medical treatments causing more harm than good including surgery, drugs, or radiation.

The article noted that sometimes research and personal experiences collide. For example, Mette Kalager, a surgeon at Oslo University Hospital and a visiting scientist at the Harvard School of Public Health, discussed the findings of a study she led in Norway that analyzed the records of 40,075 women who were diagnosed with breast cancer between 1986 and 2005, and found that only a third of the decline in death rates was due to screening. She said, "The evidence seems to be that mammography screening plays less and less of a role in reducing mortality in countries of the Western world." These findings contradicted the experience of Felicia Knaul, director of the Harvard Global Equity Initiative, who was diagnosed with breast cancer during her baseline mammogram at age 41. "If anything saved my life, in addition [to expert care], it is that mammogram," she said. The author concluded that in the end, "there's a lot of sorting out to do." (Trafford 6/13).