I assume many of you have heard by now of the Canadian randomized controlled mammography study that found that 25 years later, there was no difference in breast cancer death rates between 40-59 year-old women who had mammograms vs. those who did not. I won’t go into a lot of further details and analysis, but provide links a few other perspectives.
This topic was discussed on NPR’s Diane Riehm show. Shannon Brownlee of the Lown Institute and Ranit Mishori, MD from the Family Medicine department at Georgetown University medical school did a great job explaining the harms of mammography in a way that was easy to understand. They were certainly more polite and respectful than the Harvard radi-ologist who of course supported continued mammogram screening.
This topic has been covered around the world since the study was made available online. Here is one example from the Guardian. This article mentions that Switzerland is reacting to the findings. I dug around and found a statement from Switzerland’s medical board that currently only 10 of 26 canons (kind of like states) provide screening mammograms. The Board said that the non-mammogram canons cannot add the service. It was more vague about what to do with the 10 canons that provide the screening currently, though I read their statements as saying that the intent is for this service to eventually go away.
As Gilbert Welch, MD was quoted in the Guardian article as saying, “The times, they are a changin’.” It’s about time.
However, realistically, I feel trapped between what is in my heart and what is prudent. I will continue to tell my residents to have conversations with their patients about the issue. I don’t want them getting into medico-legal risk. And mammography is one of the federal EMR meaningless use measures. I’m afraid we’re stuck in this medical Twilight Zone for decades.