Mammography Cost Versus Benefit

December 17, 2015

Mammography is in the news again.  I can’t comment on arbitrary studies, especially ones that contradict the overwhelming evidence that mammograms find early breast cancer. Early detection is key to a better outcome.  I repeat my mantra - Mammography isn’t as good as some reports claim and it isn’t as bad as some reports claim.  Even the critical reports concede that mammography will save individual lives.  How many lives becomes the bottom line for evaluating cost vs. benefit in health care.  If your life is saved, or the life of someone you love, it’s worth the cost.
 
Mammography is still the best modality for early detection of breast cancer.  It is not perfect.  Mammograms are less sensitive in patients with dense breast tissue.  I have appeared before federal and state government bodies to testify in support of legislation that requires women to be notified when their mammograms reveal that they have dense tissue.   This legislation, passed in several states now, but stalled in New Jersey, also advises women with dense tissue to ask their doctors about adding another imaging modality such as Ultrasound, MRI, or Molecular Imaging. 
 
I do not agree with the argument that the radiation from mammography might lead to an increased cancer risk; I have not seen persuasive evidence that radiation from mammography is harmful.  I also do not agree with the position that mammograms can cause psychological stress when they produce false positives requiring a biopsy.   I know from my own patients, as well as national surveys, that most women are more afraid of a cancer being missed than having a biopsy that proves cancer is not present.
 
While most studies focus on whether or not mammography results in lower mortality rates for breast cancer patients, they ignore the benefit of early detection on morbidity, complications from disease.  When breast cancer is found early, treatment is less invasive – and less expensive.  The costs – financial, physical and psychological - of early detection are much lower than for treatment of advanced breast cancer.   Thank mammography for that.
 

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