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 What Doctors Don't Tell You: QUESTION FROM READER - MAMMOGRAMS 
 
What Doctors Don't Tell You © (Volume 5, Issue 4)
Q:I am 47. My doctor is pressing me to have mammograms every other year. What evidence is there that it can help prevent cancer? M S, Hitchin.

A:Absolutely none as medicine embarassingly admits in its own literature while stepping up screening for all ages sharply. As the number two killer of women in the West after smoking, breast cancer has become a political football, with breast cancer activists on both sides of the Atlantic demanding government action. In America, Congress responded to pressure by breast cancer activists by ordering the National Institutes of Health to increase spending on breast cancer by nearly 50 per cent to some $132.7 million. Lately, the American Cancer Society has begun employing tactics like designating October 19 as National Mammography Day ("Be sure she makes the appointment that could save her life," says the ad in the medical literature, sponsored by the ZENECA HealthCare Foundation); or offering individually tailored letters and telephone calls.

In the UK, the government launched its National Breast Screening Programme in 1990, offering mammography to women aged 50-64, and in its first year exceeded its target of screening 70 per cent of the million women invited to participate every three years.

During a recent international conference on breast screening Dr Laszlo Tabar, a Swedish radiologist, said this isn't good enough. He took issue with the British health department policy of recommending screening for women over 50 once every three years. In his view, women should be screened every 18 months and women between 40 and 49, every year (Doctor, April 1993). The American College of Obstetricians and Gynecologists also has called for more mammograms among women over 50.

All this activity may comfort those who wish to see a government seen to be doing something. However, nobody is quite sure exactly who should be screened and how often. Wide variations exist between countries (and even between different governmental bodies) as to which groups of women would most benefit from screening.

Following the results of a Swedish overview, which pooled results from five studies conducted from five to 13 years on some 300,000 women, most members of establishment medicine have adopted as gospel its results that for women 50 and over,regular screening can reduce breast cancer mortality by 30 per cent (The Lancet, 12 June 1993). However, from the results of this test and others it is also generally agreed that no studies have shown a benefit for women younger than 50.

That apparently hasn't prevented the American Cancer Society and the American College of Radiology from urging all women over 40 which of course includes this limbo group between 40 and 49 to have annual mammograms. In early 1994, the National Cancer Institute broke ranks by reversing its recommendations dating back to 1987 advising all women over 40 to have routine mammograms. The reason for this volte face, it said, was that randomized clinical trials of routine screening mammography "have not shown a statistically significant reduction in mortality in women under the age of 50." (JAMA, 1994:271;2: 96).

This decision was followed by a similar move by the government of New Zealand. Top breast cancer specialists Ismail Jatoi and Michael Baum from London's Royal Marsden Hospital wrote a special feature labelling American doctors giving mammograms to the under 50s "negligent" because it can often do more harm than good (BMJ, 4 December 1993).

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What Doctors Don't Tell You What Doctors Don’t Tell You is one of the few publications in the world that can justifiably claim to solve people's health problems - and even save lives. Our monthly newsletter gives you the facts you won't......more
 
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