By: Dr. Geoffrey Modest
This editorial is from Eric Topol, and raises concerns about the utility of mammography screening . one issue not addressed by him is primary prevention of breast cancer by decreasing environmental exposure to carcinogens: there are thousands of new chemicals developed in the US each year; historically many of them have estrogenic effects (which may not be the only way that breast cancer is stimulated); they seem to make their way into our air, water, and food supply; and essentially none of them have any significant safety checks prior to being mass-produced and released.
So, I agree with Topol that mammography is a terrible test in many ways, and in particular that it prevents so few breast cancer deaths in the current setting where breast cancer is the second leading cause of cancer deaths in women (in 2013 total of 273K women died of cancer, 72K from lung and 39K from breast). I did post about the new USPSTF recommendations recently, and this and other breast cancer screening blogs can be found here. Topol brings up the intriguing suggestion that maybe we can risk-stratify women, such that low risk women (esp low genetic risk) might not get screening mammograms at all, where the likelihood of a false positive is very high, along with the attendant issues of anxiety, medicalization, followup testing, invasive biopsies, more potentially cancer-causing xrays, and even unnecessary toxic chemo/radiotherapy. and mammograms could be used for more targeted higher risk women. needless to say, this would need to be tested…