National Geographic News
Photo of a woman having a mammogram.

Breast cancer is the number one cancer afflicting women. The disease is often found through mammography.

Bizuayehu Tesfaye, College of American Pathologists/AP

Marc Silver

National Geographic

Published February 18, 2014

It was 13 years ago, but I remember it as though it was 13 minutes ago.

My wife, Marsha, had a mammogram. Inconclusive, the report said. So she was called back for a follow-up.

I was at my office when the phone rang. In a shaky voice, Marsha repeated what the radiologist told her after the second screening: "Sure looks like cancer to me."

I thought of that moment when I saw the headline in this week's New York Times: "Vast Study Casts Doubts on Value of Mammograms." Many other media outlets picked up the story. The Daily Kos gave it this spin: "Vast Study, Mammograms Do More Harm Than Good?" CNN asserted: "Study: Mammograms Do Not Save Lives."

Marsha and I are neither scientists nor statisticians. But we both know that for her, the mammogram had tremendous value.

Because of the mammogram finding, she was diagnosed with stage II bilateral breast cancer: a tumor in each breast, one lymph node affected but no evidence of spread to other organs. She had lumpectomies, followed by six sessions of chemotherapy and a month of radiation.

Today, she is in good health.

The new study is impressive in scope: 90,000 Canadian women, followed for 25 years, with the results published in the BMJ, which summed it up this way: "Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when ... therapy for breast cancer is freely available."

The findings seem solid. Until you talk to some of the country's cancer experts.

"Everyone assumes it must be a good study. But it's the worst study ever done," says Daniel Kopans, a professor in the department of radiology at Harvard Medical School. In 1990, the doctors in charge of the Canadian study asked him to review the quality of mammography. "They had a lot of outdated machines," he reports. What's more, he says, the technologists who would perform the breast scans were not properly trained.

Kopans also claims that the study investigators gave breast exams to all participants before they were assigned to either the group that was to have mammograms or the control group. The study organizers likely "loaded the sides" by placing more women with advanced cancer in the screening group, he says. That would have boosted the survival rate for the women who did not have mammograms as part of the study.

Lead study author Anthony Miller vigorously rebuts Kopan's criticisms. Miller, a professor emeritus of cancer epidemiology at the University of Toronto's Dalla Lana School of Public Health, says the mammogram machines were "high quality." He defends the technique of the screeners and said an official assessment of study records "exonerated us" of the charge of stacking the deck.

It's all very confusing, especially because other studies have shown a reduction in deaths from breast cancer as a result of mammography. A 29-year research project in Sweden showed a 30 percent drop in mortality in women who were screened.

The continuing debate over the science of mammography—and the recent spate of screaming headlines that disparage mammograms—isn't merely academic. It has an impact on people's lives. Marisa Weiss, a breast oncologist in the Philadelphia area and founder of breastcancer.org, says the overburdened 21st-century woman, juggling work and family responsibilities, is definitely receptive to news that mammograms may not be necessary.

"Getting a mammogram every year is a pain in the ass. People would love not to get it. It's scary. Woman are saying, 'If [the medical profession] isn't so sure it's important, then I'm not going to go get it." In her practice, she's seen people "letting mammograms slip—instead of every year, every year and a half, every two years." Injecting doubt about diagnostic tools "can cloud people's thinking."

Breast cancer is the number one cancer afflicting women. And one of the "most common ways" breast cancer is found is through mammography, says Weiss. "It doesn't magically get treated without being found."

Then there is the study's claim that mammograms uncover small cancers that would not prove life threatening and would not require treatment. "My point of view is that you never want to miss a diagnosis," she says. "Missing a diagnosis of breast cancer is unacceptable because someone's life is at stake, and we don't yet know how to say it's okay to miss this cancer because it's not going to kill her."

Behind the raging debate and the blizzard of numbers in this and other studies, there are individuals like Marsha. Her dense breasts make it difficult if not impossible for her to find a lump by touch; doctors, too, rely on mammograms to assess her breasts. In fact, Anthony Miller told me that for women with "lumpy breasts," mammograms are a critical tool—a message that was not included in media coverage of his study.

I wondered what Marsha would make of all this, so I asked her. "From my perspective," she told me, "the mammogram saved my life."

Marc Silver is an editor at National Geographic and the author of Breast Cancer Husband: How to Help Your Wife (and Yourself) Through Diagnosis, Treatment, and Beyond and, with his daughter, Maya, My Parent Has Cancer and It Really Sucks: Real-Life Advice from Real-Life Teens.

12 comments
Diana Lane
Diana Lane

This is why screening by mammography must come down to a personal decision based on individual values. Each woman must decide for herself whether the risks of overdiagnosis (which are not trivial) are outweighed by the chance of finding a cancer that would otherwise be (or become) life-threatening, if not found by screening mammography. For myself, the benefits do not outweigh the risks of overdiagnosis. Many other women feel differently. 

Dorothy Head
Dorothy Head

Right now I'll always get my mammogram because that is how my breast cancer was discovered almost 15 years ago, no lump just a change from the year before. I was overweight didn't exercise or eat right but I got my mammogram and well woman check up every year, thank goodness. We need to find a better and more accurate way to diagnose breast cancer way earlier. maybe something that doesn't rely on sight, more like a way to check cells or find a protein that we know is present in breast cancer patients. Plus we need to find a way to know who needs a biopsy  or other surgery. Until we do, then I'm sticking with my annual mammogram. I was a breast cancer patient navigator and I was amazed at how many women's cancer was found on their mammogram.

Dorothy Head
Dorothy Head

Right now I'll always get my mammogram because that is how my breast cancer was discovered almost 15 years ago, no lump just a change from the year before. I was overweight didn't exercise or eat right but I got my mammogram and well woman check up every year, thank goodness. We need to find a better and more accurate way to diagnose breast cancer way earlier. maybe something that doesn't rely on sight, more like a way to check cells or find a protein that we know is present in breast cancer patients. Plus we need to find a way to know who needs a biopsy  or other surgery. Until we do, then I'm sticking with my annual mammogram. I was a breast cancer patient navigator and I was amazed at how many women's cancer was found on their mammogram.

Dai Davies
Dai Davies

Yeah, why be swayed by personal experience, it's not as if a mammogram saved the author's wife's life. Oh wait, it did. Just because it doesn't reduce your chances of dying, doesn't mean that it has no value. Mammograms clearly work or there would have been no need for the technology and clearly they work because people have been saved by them... Why suggest that it's not useful if people are being saved by it? Why put more peoples' lives at risk? This is like with the whole inoculation scare, and now there are increased rates of all the diseases that were previously better under control...

Gary Weiner
Gary Weiner

Let me paraphrase Mr Silver, if I may, "I don't care what the science says, I know what the truth is based on my personal experiences".  Well, thanks for that.


What's extra sad is that this is the way we do medicine in the US. More often than not, medical professionals will make treatment recommendations based on the subjective interpretation of their personal experiences. 


http://theincidentaleconomist.com/wordpress/horribly-depressing-news-about-mammograms-ctd/


I leave you with one final thought. If you’re not going to be swayed at all by a randomized controlled trial of 90,000 women with 25 year follow up, excellent compliance, and damn good methods, it might be time to consider that there’s really no study at all that will make you change your mind.


Deb Solen
Deb Solen

I am a 4 year SURVIVOR of breast cancer.... I was diagnosed at 39 years old with no family history and no symptoms...  I am here alive and well due to my Dr. writing a script for s mammogram and telling me "Its time to start getting mammograms".  When she said this to me I was kind of confused at why she was sending me.  I'm a healthy almost 40 yr old woman.......Then it hit me I'm 40 I need to do these things now..    I chuckled then told my husband.  We got a good laugh till I went in for my "routine base line mammogram."  The tech told me to get dressed and wait in the waiting room.   Very irritated three hours later and no answer why I was still there, it never entered my mind I had breast cancer the radiologist calls me back and quickly tells me I have breast cancer and need to see a breast surgeon right away then sent me on my way. Two weeks later I was having a Bi -lateral mastectomy at 39.  My Oncologist told me that Ductuial breast cancer would have been stage 4 before I had ever detected a lump because of its location.  Mammogram saved my life when I didn't even know I was at risk.

J. Brooker
J. Brooker

So the radiologist quoted believes that the study organizers "likely" loaded the sides by placing more women with advanced cancer in the screening group. How the hell does he know that? 


That's a serious charge to make against scientists writing in a peer-reviewed journal such as the British Medical Journal. For me to take his criticism seriously, he's going to have to come up with something better than just spouting off that the the study was "likely" fixed. 


Until then, I'll just conclude that he "likely" has his own bias as a radiologist kept busy, at least currently, reading all those yearly mammograms. 


And the author of this piece should have challenged him on that, instead of allowing him to make unsubstantiated charges. 

Betty Muir
Betty Muir

Relatively few people, including conventional doctors, have a good grasp on the topic of mammography. Almost everybody repeats the same type of platitudes the medical culture has taught them, such that "mammograms save lives" or that "early detection of breast cancer leads to fewer treatments" or the low dose of radiation from a mammogram is "harmless," etc, etc. All of it is either misleading or simply false.


The new study is merely one important piece of good evidence in a vast arena of solid scientific data against the general use of this medical procedure (read "The Mammogram Myth" by Rolf Hefti). Virtually all pro-mammogram studies are/were conducted or promoted and defended by people with massive vested interests,  such as radiologists (like the here cited Kopans), oncologists (like the here cited Weiss), surgeons, and other profiteers.


The general confusion among women about mammography, or the debate around it, is the outcome of a continuous concentrated effort of the mammogram industry, and its defenders, to ridicule, overlook, deny, obscure, or hide the real but for-their-big-business-inconvenient evidence. Responses by the Komen charity, the American Cancer Society, and other authoritative bodies are instructive of these ongoing shenanigans to obfuscate and ameliorate the truth about mammography.

Phil Fakczs
Phil Fakczs

@Larry Hawley & others: preventing unnecessary treatment is ABSOLUTELY essential. Consider the health risks of even just being hospitalised and add to that the risks associated with (potentially uneecessary) surgery, anesthesia and possibly devastating side-effects of medication. The equation "more treatment = better health" is plain wrong and has many variables that must be considered.

It finally boils down to: find a GOOD doctor who's capable of using all his skills to give you the RIGHT treatment - with the RIGHT diagnosis.

Dinakantha Kumararatne
Dinakantha Kumararatne

I would completely agree with you. My wife had the same experience in 2001. THE FALLACY OF THE ARGUMENT that cancers that don't matter may be found and lead to unnecessary treatment is that by the time you find otherwise it would be too late. The rational way to proceed is to find all cancers early but design research to to use the properties of the cancer to predict outcome. Not short term research but at least this way in 10-15 years the discipline would have advanced. 

Larry Hawley
Larry Hawley

Who are these idiot Doctors ? I want my wife with me as long as possible and if i can at least know she doesn't have breast cancer by having a mammogram its a good way to be forewarned if it develops ! What else don't these Doctors believe in ? 

Dai Davies
Dai Davies

THIS is why scientists need to get training in Anthropology or some of the other social sciences because they don't realise the real problematic implications of their studies! Science does not exist in a vacuum and is not apolitical. Studies like this that will put women's lives at risk are dangerous.

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