Measuring the worth of mammograms for women under 50

January 13, 1994|By SUSAN REIMER

If men were plagued by a cancer of mysterious origin that assailed the organ that most basically defined them, and if the only way to diagnose that cancer was to strip a man naked, take that organ and smash it flat between two plates of glass and then shoot it with radiation that they feared might feed that cancer or create another one -- well, my guess is men would find another way.

That is mammography. That is a woman's best defense against breast cancer, and it isn't all that great.

A mammogram is only as good as the technician reading the X-ray, and it takes a lot of skill to recognize the tiny, light spots that could easily be dismissed as dust spots or flaws in the film. And, until recently, there weren't even any standards for evaluating this kind of screening.

So, mammograms are a barbaric, imprecise method of detecting a disease that is killing twice as many women as it did 30 years ago, a method fraught with the possibility of human error -- and now medical science can't even agree on when a woman should have one.

The National Cancer Institute recently announced it will no longer recommend routine mammograms for women in their 40s. And get this. The reason is early detection through mammograms doesn't appear to reduce the death rates for women that age. Cancer among women under 50 tends to be so aggressive the survival rates are not improved by mammography.

Am I reading this right? Breast cancer in women in their 40s is more likely to kill them, so the NCI can't in good conscience recommend that you look for it?

What are they saying here? If the early detection via mammography isn't necessarily going to increase a woman's chance of survival, why go to the trouble?

There are other reasons why the NCI no longer recommends annual mammograms for women under 50. Breast tissue in young women is dense and lumpy, and may hide a small tumor. What does that mean? You might miss the tumor, so don't go looking?

The X-rays are also more likely to pick up harmless lesions in a younger woman's breast that still have to be pursued and, as one doctor says, a breast biopsy, even one that is negative, "is not a benign experience" for a woman. Hey, neither is dying.

The NCI is not saying younger women should not have regular mammograms. It is saying experts cannot agree on their worthiness.

Just what women need, a mixed message about perhaps their darkest fear.

"I'm angry," says a woman friend. "I am convinced this is what I am going to die from. And these doctors can't decide and tell me what to do."

Her doctor told her not to have a baseline mammogram at age 38 when she asked if she should. Then, when a suspicious lump appeared at age 40, he criticized her for not having a baseline X-ray he could use for comparison.

"Typical," says another friend. "They tell you they can't recommend that you have one. Then, five years down the road, you have breast cancer and you get a lecture about how early detection might have saved you."

What the NCI's equivocation on mammography means to women in their 40s is this: Insurance companies will stop paying for them. That means the women who don't have $75 to pay for a screening, or who just need one more reason not to have a test they fear, won't have them.

I'm in my 40s, and breast cancer scares me more than just about anything else. The statistics tell me it is going to strike me or someone I know and devastate her, her husband and her children. When these dark thoughts come over me, I wonder: Who will mother my kids, my sister's kids, my friend's kids?

If mammography is the only shot we have of staying around for an extra few years of a child's life, we have to take it. No matter what the experts say.

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