Mammography Dilemma: Breast cancer is woman’s number one   disease

“I’ll do everything I can to end breast cancer! “ The tear is rolling on her cheeks as she is promises to her dying sister who is yet to see the world of the elderly.

Being diagnosed as having monstrous breast cancer at the age of 33, the Illinois-born bright young lady, Susan was forced to leave this era sooner than her family. She was only able to make it to 36. The grief caused by this poor incident was felt not only by her family, but heart-breaking to those who heard the story

It was in 1982, the Susan G. Komen Breast Cancer Foundation was founded in memory of Susan. Her family strongly believed  Susan’s outcome might have been better if the patient knew more about the cancer and its treatment.

Nowadays in 2015, the Komen is the most widely known, largest and best-funded breast cancer organization in the United States.  Millions of campaigns have been done to raise awareness among women on breast cancer. Even in Malaysia, there is such thing as subsidized mammography in order to promote early screening, thus allowing better prognosis among patients.

Statistically speaking, hundreds of new cases have been discovered each year over the past decade. This may be solely contributed by increased availability of mammography and increased awareness among the women. However, the shocking truth is that almost half of them are false-positive. A lot of them are also found to be in dormant state, needing no intervention.

As time passes, many issues arise. Lots of scientists and even medical practitioners begin questioning the gold standard. Be it logically speaking, statistically speaking referring to data from numerous studies, the effectiveness of mammography seems to be hype. Not more than that.

“They are staring at me as if I have committed murder,” A woman in her mid-thirty complaints about the nurses as she undergoes screening mammography.

As a matter of fact, mammograms do not prevent breast cancer, but help saving lives by finding the cancer as early as possible. However, the result may vary, from false negative to false positive.

For there is bright side of mammograms, there is darker aspect of mammograms that should be made publicly known. Finding breast cancer  does not improve health or help a woman lives longer – cruel, but true.  Screening will be of no benefit if it is a fast growing one, or already metastasize to other parts of the body. Overdiagnosis too, is such a common thing. When cancer with no risk is found, any treatment given will not help you live any longer and may instead cause serious side effects. Being able to identify which one of the two will be of great importance, which is unattainable with the current technology!

“What is the number one killer of woman?” A practitioner asked her middle-ages female patient, who is having high blood pressure and elevated blood lipids.

“I know the right answer is heart disease, but I’m still going to say breast cancer.” The patient told the practitioner.

‘Misfearing’- our human nature to fear instinctively rather than factually, is the best dubbing to describe this psychological phenomenon. Sometimes they are fearful in the absence of significant danger, and sometimes they neglect serious risk. In other word, it is just the stigma of the community that women are very close to breast cancer. They become so occupied with the cancer and forget cardiovascular problems and metabolic diseases which have been ruining lives for centuries! It is hard to overcome conditioned fear with just facts.

Mammography proponents are surely right that mammography has saved some lives. However, it is more important to wonder whether this gold standard test has helped more women than those who are harmed, and the current studies propose, NO.

cancer“So, what are people like you trying to do?” A reporter asked as cited in Los Angeles Times, referring to practitioners who suggest that mammogram may, actually cause more harm than good.

To answer such question, it is important to be clear about things we are not trying to do. First, stop women from getting screened. Women who want to be screened should be.  Second, prompt insurance companies to stop covering screening. Health insurance already covers a lot of services, and there is no reason it should not cover this one.

The first thing that we are trying to achieve is that women should have the opportunity to make the choice. In order to make the choice, women should be provided with enough and accurate information about the benefits and harms. While this sounds applicable, the current practice is generally one-sided. The women are subjected to lots  of persuasive messages that overstate the benefits while ignoring the harms completely. Such reminder as ‘Get screened. Screening saves lives’. The second thing is to have mammography community that acknowledges the harms.

Simply speaking, detection of any abnormalities that meet the criteria to be called ‘cancer’, but are not destined to cause problems, is the main issue. The increased number of mammography screening has ridiculously increased the incidence of overdiagnosis.

“Anything called ‘cancer’ is treated  by surgery, radiation, and chemotherapy!” These sorts of things will bring nightmare to any patient for the serious side effects, and it is not really worth it if your ‘cancer’ is actually doing no harm. You are just making good things worse.

Frankly, there will always be overdiagnosis, or false positive as a consequence to catch cancer early. It is the paradigm of conventional cancer screening, ‘Look harder and harder to find smaller and smaller abnormalities’.

To be honest, the real one who can benefit from mammography is the women who would die if their breast cancer were not detected and treated. Since the current approach will make it impossible to discriminate the real patient from those who does not require any intervention, it is important to minimize the collateral damage. We should always preserve all sorts of benefits present in mammography screening, and always try our best to reduce the harms.

COLUMNIST PAGE | MEDICINE

Muhammad Aiman bin Azhari
5th Year
Faculty of Medicine
Ain Shams University

Karya Unit
Publications and Information Bureau
PERUBATAN Ain Shams Chapter

The author has also written several articles for mediaPERUBATAN such as ASUzen and our PERUBATANOnline. He is very well known person to be regarded as one of our legendary in KARYAWAN PCS and he believes that art of writing has a power to change our world to a better place. Let’s continue to give support to him guys!

STATEMENT
This article is the personal opinion of the author and do not necessarily represent the opinion of PERUBATAN Online.