Mammography. What’s a woman to do?

I am often asked about my thoughts on mammography. There is controversy in terms of it’s use as a screening tool and when used, how often and at what age to begin screening. There is no doubt as a diagnostic tool—when a mass is found and needs to be evaluated, it is effective. The question is how effective is it as a screening tool with the goal of early cancer detection with the subsequent assumption of a resultant longer lifespan.

In October 2015 the Journal of the American Medical Association published a large meta analysis of research. This was not a new study, rather an analysis of existing research-a study of studies. It shows an association of mammography (MMG) with a decrease in breast cancer mortality. The decreases in mortality increase with the age of the women screened, the largest decrease of breast cancer related mortality is with women aged 60-69 (because breast cancer frequency increases as you get older). The article acknowledges the issues of over diagnosis but unfortunately notes there are no studies with reliable data on this, nor on the impact of treatment for the over diagnosed. So this very important variable is still unclear.

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