There was quite a bit of controversy when the US Preventative Services Task Force released new recommendations in 2009 for mammography. These recommendations did not include mammography for women under 50. Man did the fecal matter hit the fan. This was a taste of Obamacare to come. This was rationing of health care. The national organizations like the American Cancer Society and radiology societies across the country were in an uproar. The news channels had a heyday.
No one seemed to want to take a step back and evaluate how much of this reaction was emotional and how much rational. A few things to consider rationally.
There is no doubt that there is a high degree of false positives with mammography. The psychological damage (which leads to a lowered perceived quality of life), additional cost and additional harms associated with radiation exposure and biopsy procedures (such as fine needle aspirations) are not to be ignored. Remember that mammography itself is a risk factor for cancer because of the radiation exposure.
Far worse is the finding in several research studies that 22% of cancers found on mammography would be taken care of by our own immune system. Imagine the numbers of women exposed to surgery, chemotherapy and radiation for a cancer that would never have grown. THIS is the true problem with mammography being recommended too early.
Somehow the facts like this get glazed over in the emotional debate and the benefits of mammography get blown up larger than life, making the recommendation to wait to get mammography an emotionally scary process for women.
This particular study asked women aged 39-49 to evaluate their own personal risk for getting breast cancer and their desire to get a mammogram before aged 50. Common sense and data be damned–88% of the women overestimated their risk of breast cancer and 89% want to be screened before age 50.
In addition, just under half of breast cancers (around 41-43%) are NOT detected initially via mammography, but rather through accident or deliberate self examination.
And nowhere are we using this opportunity to discuss prevention. Many women mistakenly believe that breast cancer is genetic and their is little they can do to avoid it other than “prevention” via early mammography. As a society we have done an astronomically poor job of educating the public on prevention. Heck–the general public does not even realize you CAN prevent it, let alone HOW despite millions upon millions of dollars raised in the name of awareness.