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Tuesday, July 21, 2009

Ultimately Congress will decide: Inappropriate mammograms in young women

Ultimately Congress will decide: Inappropriate mammograms in young women

Earlier, I wrote about an inspiring legislator and cancer survivor about U.S. Rep. Debbie Wasserman Schultz. She has now filed legislation, with 350 Congressional co-sponsors, promoting the early detection of breast cancer in young women. Ultimately, she says, Congress will decide.

I admire her determination and passion, and I still consider her a patient advocate heroine.

Yet her efforts are likely to create more suffering than healing. The breast tissue of young women is usually too dense for routine mammograms to be effective. The radiation exposure of mammograms can itself be problematic. Young women rarely get breast cancer. The false positive readings from their mammograms are likely to find too many medically insignificant nodules that would lead doctors to perform unnecessary biopsies, in which tissue is removed for testing. Scarring from the biopsies could make breast cancer harder to detect when the women are older and have a much higher risk of breast cancer. False alarms can lead women to distrust their doctors and skip mammograms later in life when the tests have been shown to reduce the death toll, according to Dr. Otis Brawley, the chief medical officer of the American Cancer Society. Similarly, breast self-exams can lead young women to detect small irregularities of no medical significance. While breast self-exams and mammograms of women in their 40s and older do indeed save lives, self-exams and mammograms of women in their 20s and 30s have not proven to result their death toll, according to Dr. Susan Love, a prominent breast cancer surgeon.

Perhaps in the future, mammography will improve to more accurately detect cancers in young women’s dense breast tissue. Until then, advocates have to look hard at the facts, and have to think carefully about what advice will truly minimize the suffering of young women.

Advice to mothers of young women: Read the excellent New York Times article by Natasha Singer on July 17 about public health experts' criticism of early mammograms, before advising your daughters.

Read a story about anxiety from false positive mammograms.

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