Mammography - Less is more

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The evidence continues to mount that routine annual mammography screening isn t such a good thing. Even when a false positive doesn t result in surgery, it takes a psychological toll on women, researchers in Denmark say.

The 13-year study of 454 Danish women with false positive mammograms those with a suspicious abnormality that turns out to be nothing dangerous found that even three years later they reported more anxiety, more pessimism, more insomnia and more problems in their sex lives, when compared to 908 women in a control group with normal mammograms.

When I became a doctor and I took the Hippocratic Oath, I said, Do no harm, says lead study author Dr. John Brodersen of the University of Copenhagen. But this is harm.

Dr. H. Gilbert Welch, a professor at the Dartmouth Institute in Lebanon, N.H., and a frequent critic of over-screening, says this is the first study on the effect of false positive results on women s psyches. Some women feel like their breasts are a ticking time bomb even after learning the test was a false positive, he says. This isn t a short-term anxiety hit.

In the United States, more than half of women who get 10 mammograms will have at least one false positive, while in Denmark, only about 20 percent have that outcome. ACSH s Dr. Gilbert Ross proposes that our litigation-happy society provokes excessive caution in reading mammograms to avoid missing a lesion and later getting sued. It is a real shame that doctors are forced to practice medicine this way

Meanwhile, a study in JAMA tries to provide some clarity on how often women should undergo mammograms. The researchers analyzed data on 11,474 women with breast cancer and 922,624 without it who were screened between 1994 and 2008.

They found that annual mammograms provided no advantage compared to biennial screening in terms of cancer detection for women aged 50 to 74 but they did increase the chances of false positives. For women aged 40 to 49 with extremely dense breasts, annual mammography does provide some medical benefit, but it comes with a high cumulative risk of false-positive results.

Dr. Ross added, A few years ago, a federal panel recommended fewer screening mammograms for women between the ages of 50 and 74, and avoiding them altogether in younger women. The rationale was that the evidence supporting health benefits or lives saved from more frequent screening was far outweighed by the harm done from false positives: procedures, permanent damage, and psychological distress. The advisory provoked a firestorm of criticism, even abuse. However, more and more studies confirm that recommendation.