When I turned 40 years old, my doctor asked me to have a baseline
mammogram, and I thought nothing of it until a trusted friend (ten
years older than I am) told me she had never had a mammogram, and
never will, because she believes they cause cancer.  She told me that
as no relatives of mine have had breast cancer, and since mammograms
involve radiation, I would be increasing my risk of developing cancer
if I started having mammograms.

I chose to listen to my doctor, and have had a mammogram every other
year since then.  I'm now 45, had my last mammogram exactly a year
ago, and now my doctor has found a small lump in my breast, and wants
me to have a mammogram and ultrasound next week to get a look at it.

I am not particularly worried about this little lump (have had various
scares of different kinds before that didn't go anywhere serious), but
naturally, my friend's words are coming back to me, and I have this
sort of sick feeling that I have brought this on myself and should
never have submitted to the test in the first place (I sort of
passive-aggressively defied my doctor by only going every other year
instead of every year, just in case my friend was right...how silly). 
I also am unhappy about having another one right away...seems like the
doctor would wait and do a touch-check in a couple of weeks just in
case it's something else that won't even be there next time.

My doctor, just as naturally, can't begin to fathom why anyone would
second-guess her on something like this.

So...here's what I would like to know.  What information do doctors
have that leads them to conclude that the benefits of regular
mammograms outweigh the risks?  What information do the naysayers like
my friend have that leads them to reject having even one?

Please don't lecture me one way or the other.  I just want to know how
they justify their respective positions.  It will help me talk to both
my friend and my doctor with more confidence.

Thank you very much.

Greetings Yreka.  As you wish no opinion or lecture, I will only point
you to the resources I located on the Internet that have to do with
your query.

Findings conflict on benefits, risks of mammograms - TWO STUDIES IN
SAME JOURNAL PUT FORTH OPPOSITE CONCLUSIONS, ADDING TO DEBATE - By
Gina Kolata, New York Times
http://www.bayarea.com/mld/mercurynews/news/nation/3991530.htm

Of mammograms and millirems - The lowdown on radiation risks from
routine breast X-rays
http://www.msnbc.com/news/722231.asp

Breast X-rays: Do Benefits Outweigh Risks? By Molly Mechtenberg,
Nukewatch Staff
http://www.nukewatch.com/spring02/sp024.html

Mammograms: Yes or No? The Government enters the debate By Jae Hong
Lee, MD, MPH
http://www.center4policy.org/mam0302.html

Steinberg Diagnostics Medical Imaging Centers (see "Benefits VS risks
of a Mammography" sub-heading about halfway down the page)
http://www.sdmi-lv.com/patients/services/mammography.htm

Mammography
http://www.radiologyinfo.org/content/mammogram.htm#Benefit&Risk

Imaginis - Benefits and Risks of Mammography
http://imaginis.com/breasthealth/mammo_benefit-risk.asp
"Many women are concerned about the exposure to x-rays during
mammography. However, the level of radiation used by modern
mammography systems does not significantly increase the risk for
breast cancer."  [note the word "significantly"]

NCI and NIH Consensus Panel Issue Recommendations on Mammography
for Women Ages 40 to 49 (about 3/4 of the way down the page)
http://www.aafp.org/afp/970515ap/special.html
"The NIH panel concluded that a universal recommendation for screening
mammography in all women in their 40s is not warranted on the basis of
current available data. The panel stated that the data show a
statistically significant mortality reduction for women in their 40s
and that each woman should decide for herself whether to undergo
mammography screening."

Mammography For Women 40 And Over  (see "What are the benefits?" and
"What are the risks?" about halfway down the page)
http://www.drdonnica.com/guests/00005158.htm


If you need clarification before rating my answer, please request it
and I will be happy to conduct further research in this area.  Also,
if you are curious as to my personal opinion (and I am not a
physician), please ask for that as well and I will be happy to
respond.


SEARCH PHRASES:

benefits risks mammograms

---

Request for Answer Clarification by yreka-ga on 07 Nov 2002 07:44 PST

Thanks for narrowing the information down for me; you've provided a
manageable number of links and each one has something to add.  Now
that I've had a chance to review the articles, I am interested in your
take on the issue.  Are we being duped by well-meaning doctors who
have swallowed, without questioning, the recommendations promoted by
corporations who have their stockholders' best interests at heart?   
Are both my friend and my doctor right?  I agree with the friend that
I have no risk factors for breast cancer other than having breasts,
and so an aggressive annual exam seems uncalled for, and that given
the huge number of damaging factors we have no control over we need to
eliminate those that we can.  I agree with the doctor that in
principle it's better to catch something earlier rather than later,
and that with all the radiation we're exposed to in our lives, this is
relatively speaking a drop in the bucket.    Given the unclear nature
of the "data," should women simply go with their gut feelings on
mammography?

Thanks again... I'll go ahead and rate your answer, but am interested
in your conclusions and am prepared for anecdotes in the comments
section as well.

---

Clarification of Answer by journalist-ga on 07 Nov 2002 11:19 PST

(Well, darn - I responded in Comments so as not to highlight a
Clarification in your GA account but now must reply here to clear the
highlight in my own account.  lol  Please see below in the Comments
section.)

Thanks for narrowing the information down for me; you've provided a
manageable number of links and each one has something to add.  I also
appreciate your resisting the urge to get your two cents worth in on
the subject before I was ready for it.

Dear Yreka:

Thank you for your rating and comments.  Again, let me state that I
not a physician and that my opinion is just that: my personal opinion.

That being said, I believe that the most important preventative
medicine one can practice is positive thought.  I feel this way
because of the manner in which my father has conducted his own
wellness regime (he's 75) and from discussions I have initiated with
physicians on the subject.  While my father acknowledges that there
are conditions that can be life-threatening and they certainly might
need to be treated, he is also of the belief that "what you don't know
can't hurt you."  A physician would likely shudder at those words but
I do believe that positive thought has merit in a wellness regime.

I am in my mid 40's and have made the choice not to pursue a
mammogram.  The last physical I had was this past spring and it showed
me as a healthy individual.  My doctor suggested that I should have at
least a baseline mammogram and I told him I had thought about it and
had decided I didn't want to pursue one. He stressed the importance of
the procedure and I thanked him for his thoroughness but, because I
have no family history of breast cancer, I would decline at present. 
Also, when I was a youngster, I had a severe eczema on my hands and
feet and a treatment for it in the late 1950's and early 1960's was
radiation.  I was subjected to "X ray treatments" from the age of two
until about the age of six, every six months.  I told my doctor I felt
that I already glowed in the dark and did not want to subject myself
to more radiation, no matter how small an amount, unless it was
absolutelty necessary.

I then proposed to him a theory I have which is that I believe cancer
(and other serious health conditions) can spontaneously appear and
disappear in persons during the course of their lives without them
ever being aware that they had the condition.  I told my doctor that I
believed that "aggravating" cancer might actually make it worse.  I
then related to him the following story.

An uncle of mine, by marriage, has mild digestive problems for about
seven years.  He would complain on and off about it and his wife
finally dogged him into going to the doctor to get some medicine for
it.  At the doctor, he was given tests and the tests showed he had
stomach cancer.  Three months later, he died from stomach cancer.

I told my doctor that this example made me wonder about how my father
has always conducted his wellness with positive thought and I remarked
to my doctor that I wondered how long the uncle might have lived if he
hadn't been told he had cancer.  Of course, there is no way of knowing
-it is all speculation- but my doctor did concede that a he believed a
person's mental state had everything to do with general wellness and
recovery.  My doctor also agreed that my theory about spontaneous
cancer had merit and that yes, it was possible.

I also had spoken with a doctor a few years ago (at a breast cancer
dinner) and I asked him "Off the record, do you find that most of your
breast cancer patients are women with small breasts or women with
medium to large breasts?"  He stated that anyone could get breast
cancer but that, in his experience, women with medium to large breasts
get breast cancer most frequently (more mass, more opportunity for it
to grow unnoticed).  Since I do not belong to that group, I include
that in my personal aversion to a mammogram.

Lastly, my father had an experience which ,at first, dismayed me when
I discovered it but it does seem to prove his personal theory.  About
20 years ago, he had a physical and a "dark spot" was discovered on
one of his lungs.  He was supposed to return the doctor for more tests
and he didn't.  When I found out, I was livid that he had ignored
this, but he pointed out it was his choice (and his body) to pursue
the possible problem and he had chosen not to know.  That was 20 years
ago and, except for macular degeneration, he is a healthy man today.

As to your question "Are we being duped by well-meaning doctors who
have swallowed, without questioning, the recommendations promoted by
corporations who have their stockholders' best interests at heart?" I
would answer, in my Pollyanna way, "no."  I believe the majority of
doctors only want to help their patients, not their bottom line or
personal investments.  However, with malpractice insurance being
outrageously costly, I believe doctors want to be certain they explore
all the potential problems of a patient's complaint or concern to
remain responsible physicians. I truly believe that a physician has
the patient's best interest at heart and a physician would be remiss
in his/her responsibility if he/she didn't keep a patient
well-informed.

As to your question "Are both my friend and my doctor right?" that is
up to you to decide after carefully reviewing all opinions.  As to
your statement "Given the unclear nature of the 'data,' should women
simply go with their gut feelings on mammography?" all I can say about
this is what I have done for myself after exploring all the angles on
the matter and taking my past radiation and family history into
account.

On a closing note, I also believe that quality of life far outweighs
quantity of life and I base many of my life decisions on this belief. 
However, your decisions are your decisions and I do not want to be
seen as suggesting you should make my decisions yours.  Your body is
your body, not your friend's nor your doctor's, and you must weigh and
judge the benefits and risks for yourself.

I am replying in the Comments section so that a Clarification
highlight will not occur on your GA account and I thank you for the
opportunity to share my personal opinion.

yreka,

I hope you will allow me to offer you a counterpoint position.

I wholeheartedly agree that a person's attitude has a great deal to do
with their health. Some studies have shown that people with positive
attitudes get sick less and seem to be able to fight disease better
than those who have negative, fatalistic attitudes. Most physicians
these days consider a positive mental attitude one really good weapon
in the arsenal against illness and disease.

However, I strongly believe that mammograms should be an important
part of that healthy attitude. To me, knowledge is power. The more
knowledge I have, and the sooner, the better equipped I am to make
good decisions and head serious disease off before it gets too much of
a hold on my body.

Please stop blaming yourself for the fact that your doctor has
discovered a lump. Having tests done to check for a disease or illness
does NOT give you that disease or illness. The mammograms that you
have had did NOT cause the lump in your breast. The amount of
radiation to which a woman is exposed during the annual mammogram is
negligible. The risk of getting breast cancer -- for any woman, even
one without "risk factors" -- is NOT negligible.

My husband is a Pathologist. Although he is not a Forensic
Pathologist, he has done more than 250 autopsies. He tells me that if
males live long enough, nearly all of them develop prostate cancer; if
females live long enough, nearly all of them develop breast cancer (I
believe the figure is 8 out of 9 women by the time they are in their
eighties). Now, for some people "long enough" may be in their nineties
or hundreds. However, most people DON'T live that long, because
something else causes their death before prostate or breast cancer
gets around to doing it. Autopsies on people who have died of other
causes can often reveal that they had breast or prostate cancer; it
just wasn't far enough along to be the cause of their demise.

Many women develop breast cancer long before their eighties. My cousin
was in her forties. She found the lump while doing her monthly
self-examination in the shower. A subsequent mammogram confirmed a
small tumor. She had caught it soon enough, had a lumpectomy, and
today is still alive and well for her husband and two sons, 10 years
later.

My mother was in her sixties when she was diagnosed with breast
cancer. Her doctor forgot to have her get her mammogram one year. One
year... that's all it took. By the time she had her mammogram the
following year, the cancer had developed so far that her 5-year
survival prospects were only 20%. She had to have radical surgery and
extensive chemotherapy. The treatment itself nearly killed her. We are
extremely fortunate that, 5 years later, we still have her around. She
was the 1 in 5 people with cancer at that advanced stage that actually
lives 5 years or more past her diagnosis. But I can tell you that she
has never been the vital, active person she was before her cancer was
diagnosed. If that missing mammogram had actually happened, she would
be in much better condition, and her future survival prospects would
be much better than they are today.

The story of the man with stomach cancer is worth considering; perhaps
finding out he had cancer so demoralized him that he did not have the
strength to fight it, and succumbed to it earlier than he otherwise
would have simply because he knew about it. Then again, perhaps the
reason that he died three months after being diagnosed was because he
put it off until the symptoms became so painful -- because the disease
had progressed so far -- that he was that simply that near to dying
from it by the time he went to the doctor.

On occasion, there have been reports that people who were diagnosed
with cancer were "cured spontaneously" without receiving treatment for
it. Unfortunately, the reality is that they were most likely
erroneously mis-diagnosed with cancer and did not actually have the
disease in the first place.

Refusal to acknowledge the possibility of a disease doesn't keep you
from getting it. It just keeps you from getting the timely treatment
that may extend your life much, much longer.

If you have a spouse, or children, or parents who depend on you, or
other people who love you, if you won't get a mammogram each year for
your own sake, then please, PLEASE get it for theirs.

I hope you will seriously consider my words.

And I hope, most sincerely, that the lump your doctor has found is
just a lump, and that you will live many more happy, disease-free
years.

You have my best wishes -- and you will be in my thoughts.

aceresearcher

Thanks to both of you, journalist and aceresearcher, for your generous
and heartfelt comments.  They will help me refine my own position on
future testing.  I expect this particular episode to end happily, and
appreciate your kind and encouraging thoughts.  Yreka

as a surgeon whose practice is heavily weighted toward breast disease
and breast cancer, I can say unequivocally that mammography is an
important and irreplaceable tool for breast screening and evaluation.
I would also add that having "no risk factors" is true for the vast
majority of women who develop breast cancer. Around one in 8 or 9
women will develop breast cancer in their lifetime. That is for the
AVERAGE woman. The ones with "risk factors" have a higher than average
chance of developing it.  While it is true that no amount of radiation
is "good" for you,  mammography delivers a dose of radiaion that is
TINY in terms of the doses considered carcinogenic. It would take
hundreds to get to a level of minimal concern. One can only study
populations; statistics don't do much for the individual at the ends
of specta; however, the benefit of finding breast cancer before it can
be felt -- which can only be done using mammography, practically
speaking -- FAR outweighs the risk for populations of women. As to a
lump which can be felt, as you describe: one can often get definative
information from the nearly painless five second procedure of
inserting a needle: if it's a cyst, fluid comes out and it's gone. If
it's not a cyst, a bit of tissue in the needle can be analyzed.
Ultrasound is usually not needed for something that can be felt. There
is something referred to as the "triple test:" if a lump feels BENIGN,
and a recent mammogram was BENIGN, and a needle sample is BENIGN, the
chance that a lump is cancer is nearly zero. Likewise, in most cases
if a lump feels ok, and the woman prefers recheck without further
testing, that may be ok as well; nothing replaces good judgement.

PS: if there were an "edit" option, I'd have done a better job of
spelling spectra, definitive, and, in one instance, radiation.

Thank you, surgeon-ga, for your professional perspective on the
question.  Are you by any chance a GA researcher?  I have a couple of
questions to follow up on your comments, but don't expect you to
answer them via the comments section is you are in fact entitled to
answer them for $.  Yreka.

I'm not a paid researcher; but I'm happy to answer questions based on
my knowledge. Fire away; I'll help if I can

Thank you...the results are back by mail from the radiologist:
"Probably benign.   Recommend ultrasound followup in 6 months."  I was
already interested in your comment that ultrasound would not be a
usual recommendation for a lump that could be felt, so this latest
recommendation is of particular interest to me.  I have very small
breasts, and have wondered for years how in the world a mammogram
could be effective when there's hardly anything to compress; could
that be why an ultrasound would be ordered...to pick up on something
that is just not "seeable" by the mammogram?  I'll ask my doctor about
it when she calls next week, but wondered what you would say, too. 
Thanks again.  Yreka

I guess it matters where the process starts: in the evaluation of a
palpable lump, ultrasound is of much less benefit than is the
inserting of a needle (if it's palpable, it's poke-able!). Sometimes a
mammogram is done, and something shows up which is not necessarily
feelable, and about which further info can be gained by doing
ultrasound.  Then, when the ultrasound is done, some other area may
show on ultrasound which may neither be feelable or correlatable to
the original mammogram....and around and around it goes...The most
reliable info from ultrasound of the breast is to say whether a
finding is liquid or solid; ie, a cyst or not. If a cyst, it's nearly
certainly benign. When solid, then it may or may not be a tumor, and
further investigation may or may not be needed. It's hard to say, from
your info, where the findings lie among those possibilites. If the
ultrasound found an area not otherwise detectible, and if it's got
what are considered benign (but not cystic) characteristics, then
repeat ultrasound over time is a sensible option. One can also do
ultrasound guided biopsies, if preferred. Bottom line: if the area in
question is not palpable, then various options of followup are
available. If it is palpable, then in my opinion it makes more sense
and is more definitive simply to sample it with the same sort of small
needle used for blood-drawing -- quick, easy, over. (Parenthetically,
smallness of breasts does not typically degrade the usefulness of the
image.)

Thanks, surgeon-ga, for that explanation.  I appreciate your taking
the time with this.  Next I'll ask my doctor about her rationale for
ordering ultrasound and not the needle sample.  Over and out.  Yreka