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When to get screened depends on your risks
When to get a mammogram is a decision women should make with their doctors

Date published: 12/6/2009

IF YOU HEARD a collective "Doh!" on Nov. 16, it was the physician community responding to the new recommendations of the U.S. Preventive Services Task Force against routine mammograms for women ages 40-49 years.

Whether you realize it or not, cancer screening in "healthy" individuals is not settled science and remains a conundrum. What tests are most beneficial is still highly debatable and subject to interpretation.

We have all heard anecdotes of people's lives being saved by screening tests. But science, not anecdotes, should drive our decision.

WHO NEEDS AN EXAM

"To screen, or not to screen?" is not an easy question to answer. Hindsight alone will determine for a given person whether screening turns out to be a success or tragedy.

Isn't screening good, and cancer bad?

Ah, sound bites I wish it were that easy. "Cancer" has become a very frightening word in our society, for understandable reasons. Many people have been scarred by cancer--either by personal experience or through a loved one.

We are bombarded fairly regularly with messages that we need to be screened for cancer--Katie Couric's remarkable on-air colonoscopy is one vivid example.

But knowing when to screen is about your personal risk. Not all screening tests are helpful, and many in the past have proved harmful.

We will need to depend on the evolving science, because careful, rigorous analysis alone should guide our decision making.

MAMMOGRAMS

It is the job of advisory bodies such as the USPSTF to scientifically examine the evidence for the utility of broad screening tests applied to the entire population.

Public health is dependent on rigorous statistical analysis of mass screening programs. However, keep in mind that the USPSTF does not make decisions about your mammogram. That decision is between you and your personal doctor. The USPSTF recommendation applies to individuals with average or low risk of breast cancer.

In the future, genetic tests and more-targeted screening tests--that identify aggressive cancers through biologic markers, as opposed to the blunt mammogram--will lead to improved screening strategies.

For now, if you're wondering whether to get a mammogram, talk to your doctor and make a decision that is right for you.

In the meantime, don't let cancer scare you to death!

PUT FEAR IN PERSPECTIVE


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If this column left you wondering what to do about your personal breast cancer screening decisions, I would recommend reading some selected references and speaking with your doctor.

To see the case for mammograms, read the American Cancer Society's rebuttal to the USPFTF mammogram recommendations, at cancer.org.

To read a compelling case against mammograms, read Chapter 6 in Dr. Nortin Hadler's book "Worried Sick."

But above all, calculate your personal risk for breast cancer using the online tool at cancer.gov/bcrisktool, then discuss the results with your doctor.

More references:

The USPSTF 2009 update for breast cancer screening: ahrq.gov/clinic/uspstf/uspsbrca.htm

Breast cancer in perspective: cdc.gov/cancer/breast/statistics/

Better understanding screening tests: cancer .gov/cancertopics/pdq/screening/overview/HealthProfessional

U.S. causes of deaths: cdc.gov/nchs/FASTATS/lcod.htm

Dr. Christopher Lillis is an internist with Chancellor Internal Medicine in Fredericksburg.