I’ve mentioned in several posts that I think screening tests, especially mammograms, are used too widely in this country. Every woman over age 40? Every year? It’s overkill.
Even the US Preventive Services Task Force (USPSTF) only recommends a screening mammogram every other year between the ages of 50 and 75.
But most women still think the yearly mammogram is health care at its finest.
Related post: Screening mammograms—benefits vs harms
The British medical journal, Lancet, recently published a study that shows women who are better informed about the risks and benefits of screening mammograms are less likely to want one every year.
Information on over detection of breast cancer provided within a decision aid increased the number of women making an informed choice about breast screening. Becoming better informed might mean women are less likely to choose screening.
The problem with annual screening mammograms is that they often find benign breast “lumps”, which results in unnecessary anxiety, biopsies and sometimes even cancer treatments.
Scientists are learning that some breast cancers (and prostate and thyroid and other cancers) are at very low risk of ever becoming invasive or life-threatening. Without the mammogram, such small tumors would likely never have been noticed.
This study supports the need for better patient education and shared decision making.
Unfortunately, most women don’t get it. As one physician I talked to said, “Patient education? The reality is we just tell the patient they need a mammogram, end of discussion.”
I get it. There’s no time.
But women should insist their doctors take the time.
Deciding at what age to start screening mammograms, and how often they should be done, needs to be based on your individual risk—age, family history, personal health history—and your level of comfort.
As the lead researcher said in an interview, the study,
…underlines the ethical imperative for women to have clear decision support materials so that they can make more informed decisions about whether they want to have a breast screening mammogram.
A health system centred around the individual should assist decision-making that incorporates a woman’s values and preferences, irrespective of whether her eventual choice is to screen or not.
Therefore, momentum is shifting from uninformative and persuasive approaches to screening communication to clear and balanced information, giving people the opportunity to make informed choices based on their assessment of the trade-offs between potential outcomes.
The study took place in Australia. Can American women hope for more educational, patient-centered conversations about screening mammograms, or are we doomed to continue with the “uninformative and persuasive approaches” that appear to be the norm?