Annual Mammograms: To Test or Not to Test?

The New York Times featured an important article about breast cancer testing entitled, “Retesting Breast Cancer Axioms” by Jane E. Brody. The article discusses the fear, anxiety and hope that comes along with testing for breast cancer.

The controversy surrounding testing is rife with baffling questions. Brody notes that “Dr. Lisa Rosenbaum, a national correspondent for The New England Journal of Medicine, has called [this issue] “considerable uncertainty and complex trade-offs.”

The author of this article says that despite the controversy, she still advocates annual mammograms due to her own personal battle with cancer, which may never have been found without going for her routine mammogram. Testing and retesting can yield both positive and negative outcomes.

Some patients feel relieved when they are tested and it gives them the confidence and security in knowing that they are cancer-free. Many women have seen the devastating effects of breast cancer and know that breast cancer is still the most common cancer among women and the second-leading cause of cancer deaths among women. These factors lead women to rely on testing. However, there are some women who have had negative experiences with testing and more specifically, over-testing.

A fallout of testing can be a false-positive result or “a suspicious image on mammography that turns out to be nothing” (Brody D5). A false-positive will lead to additional screening and possibly a biopsy, which will lead to further complications:

Most importantly, “the lesion might turn out to be benign; still, the patient has endured considerable anxiety, inconvenience, and expense. And what if the biopsy reveals a malignancy? Then the patient faces another possible consequence of screening: over-treatment” (Brody D5).

Some doctors debate whether every cancer detected needs to be treated and also how extensive the treatment should be because some cancers can disappear on their own or never develop into malignancy.

However, given this information “Dr. Rosenbaum cited a survey in which more than 99 percent of women knew mammography could result in a false-positive diagnosis, but only 38 percent believed this possibility should be weighed in decisions about whether to have the test. Even among those who had a false-positive result, ‘more than 90 percent still believed that mammography could not harm a woman who ended up not having breast cancer,’ she said.”

Clearly, many women experience contradictory thoughts and emotions surrounding this complex issue. The final takeaway is that a woman should consider all of the risks of testing and not testing in order to arrive at the best decision.

It is important to remember that this is a global issue. Rabin Medical Center has a state-of-the-art BRCA Multidisciplinary Clinic, which serves as a preventative treatment center for high-risk women. Each year we host the Cheryl Diamond NYC 5k Schlep to help fund the BRCA Multidisciplinary Clinic. To learn more about the center click here. To donate to the center click here.

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