# No mammograms until 50? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [November 18, 2009, 1:41pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024 "2009-11-18T13:41:15Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Marley23](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Marley23](https://boards.straightdope.com/u/Marley23)\ **Post date:** [November 18, 2009, 4:35pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/21 "2009-11-18T16:35:55Z")
> [@aruvqan](#): > > put me down as someone who thinks this is total shite … 15% is not bad. If it was 1% I could see - but I would be willing to bet that if it was a male health issue, there would be no similar recommendation. I disagree completely. Reaction to this move has been completely negative, and breast cancer is a very well known and well funded disease. It gets more attention than some cancers that are more common and more deadly. It’s not like it’s being kept in the dark. > [@irishgirl](#): > > mammograms do not save as many lives as you might believe. And that’s a fact that has been reported for years now. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 18, 2009, 4:45pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/22 "2009-11-18T16:45:35Z")
> [@aruvqan](#): > > put me down as someone who thinks this is total shite … 15% is not bad. If it was 1% I could see - but I would be willing to bet that if it was a male health issue, there would be no similar recommendation. Back when I was in the Health Insurance Empire there was a push to reduce or put off PSA screening for prostate cancer for men, for much the same arguments. So no, it’s not just because it’s a female health issue. Male-specific cancers are getting the same “let’s reduce screening” treatment, even if it’s not as well publicized. ---
**Author:** ![Chopper9760](https://avatars.discourse-cdn.com/v4/letter/c/cdc98d/32.png) [@Chopper9760](https://boards.straightdope.com/u/Chopper9760)\ **Post date:** [November 18, 2009, 4:47pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/23 "2009-11-18T16:47:59Z")
Crappity crap, what is there to argue? You could choose to: A) Have information B) Not have information Why would anyone recommend that I be uninformed about something that could KILL ME. I’m just vexed because a mammogram is a simple, fast procedure. It’s not like I’m suggesting everyone get a full blood panel, MRI, CT scan, and stress test every year. I’m merely suggesting that women 40 and up have good reason to spend 1/2hr at the doctor’s office getting their tits squished to make sure cancer isn’t lurking. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 18, 2009, 4:58pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/24 "2009-11-18T16:58:00Z")
> [@Chopper9760](#): > > My mom had a lump detected via mammogram followed by a needle biopsy and eventually a lumpectomy due to the presence of pre-cancerous cells. At the end of the day it cost our family a fuzz over $5,000 out of pocket - I’m sure insurance covered some, I just know what it cost us. > > So, she didn’t have cancer and it cost us $5,000 not to mention her nervousness and discomfort. I think it was money well spent. My mom is 46 now and the lumpectomy was ~3yrs ago. I’m really glad she didn’t wait until 50 years of age to get a mammogram. > > The only cancer on Ma’s side of the family that I know of was my grandmother’s leukemia. I’m not sure if Mom would have been considered “high risk” or not. In any case, I’m glad she was treated early. I don’t understand why anyone would recommend delaying a simple screening that takes 10-15min to complete when it’s quite literally a matter of life and death. Assuming you had typical medical insurance at the time and you only paid a typical 20% of the cost… Mom’s lump cost _somebody_ around $25,000. I agree, peace of mind is important and if I thought I might have cancer I’d be willing to spend $5,000 out of my own pocket to find out for sure one way or the other. I am in no way disputing the value of either your mother or her treatment. The problem is, the people footing the remainder of that $25k don’t care about your mother as a human being. Society is screaming and protesting the rising cost of healthcare. The bean counters look at overall statistics, not individuals. There will be a _strong_ push to move insurance reimbursement to conform with the new guidelines in the name of “cost-effectiveness”. ---
**Author:** ![gonzomax](https://avatars.discourse-cdn.com/v4/letter/g/e8c25b/32.png) [@gonzomax](https://boards.straightdope.com/u/gonzomax)\ **Post date:** [November 18, 2009, 5:03pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/25 "2009-11-18T17:03:42Z")
The panel says they get a large percentage of false positives. Screening is not all that dependable. A lot of women go through a great scare . Many get invasive treatment they did not need. It has a great expense. They apparently balanced that with the occasional finding of a young person who had breast cancer and ruled against the screening. ---
**Author:** ![Cat\_Fight](https://avatars.discourse-cdn.com/v4/letter/c/90ced4/32.png) [@Cat\_Fight](https://boards.straightdope.com/u/Cat_Fight)\ **Post date:** [November 18, 2009, 5:10pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/26 "2009-11-18T17:10:45Z")
> [@Broomstick](#): > > Also - I’m _assuming_ they’re referring to screening the general population. Women at _known high risk_ might well still be considered for earlier screening. Women with many relatives with breast cancer, history of early breast cancer in the family, or with known breast cancer gene susceptibility. I’m ignorant (not being sarcastic, I really am). If insurers don’t have to cover mammograms for the general population, could a history of breast cancer be considered a pre-existing condition? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 18, 2009, 5:13pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/27 "2009-11-18T17:13:44Z")
Potentially, yes. So, in that case if a policy covered pre-existing conditions screening shouldn’t be an issue. If the policy didn’t cover pre-existing conditions then conceivably screening may not be covered _at all_. Other factors influencing this would be legislation that mandated a certain level of coverage in all policies. ---
**Author:** ![control-z](https://avatars.discourse-cdn.com/v4/letter/c/eada6e/32.png) [@control-z](https://boards.straightdope.com/u/control-z)\ **Post date:** [November 18, 2009, 5:23pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/28 "2009-11-18T17:23:22Z")
This sounds like accounting rather than medicine. And why in the world would you not do self-exams? They cost absolutely nothing and certainly the good they could potentially do would outweigh the negatives of a few overly-nervous women. ---
**Author:** ![ivylass](https://avatars.discourse-cdn.com/v4/letter/i/9de053/32.png) [@ivylass](https://boards.straightdope.com/u/ivylass)\ **Post date:** [November 18, 2009, 5:30pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/29 "2009-11-18T17:30:54Z")
They’re saying women who do self exams have more biopsies. Um, isn’t that sort of the point? Find a lump, go find out if it’s something to worry about? ---
**Author:** ![MsRobyn](https://avatars.discourse-cdn.com/v4/letter/m/90ced4/32.png) [@MsRobyn](https://boards.straightdope.com/u/MsRobyn)\ **Post date:** [November 18, 2009, 5:31pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/30 "2009-11-18T17:31:35Z")
> [@Really\_Not\_All\_That\_Bright](#): > > What rubbish. Screening for breast cancer has nothing to do with _treating_ breast cancer. If women are undergoing unnecessarily aggressive treatment regimens, that’s because oncologists are using shitty treatment guidelines. > > You might as well say that testing schoolchildren on material they’re supposed to know is dangerous because you might find out that they don’t know anything. Even if women with a lump revealed on a mammogram isn’t treated for cancer itself, there are still consequences. I’ve seen many, many $150 screening mammograms turn into thousands of dollars’ worth of diagnostic testing between more intensive mammography, ultrasounds and biopsies. Some of it may be covered, some not. With each procedure, that also means lost time from work, which may or may not be paid. There’s the stress of a false positive and a non-screening diagnostic code in the record, which can lead to an impact on the dreaded “pre-existing condition.” I recently had a discussion with a friend about health care reform. He claims that one of the reasons why women get slapped with a “pre-existing condition” is because we tend to have more screenings that start at an earlier age, which means more opportunities for something potentially abnormal to be found and referred for further testing and diagnosis. Whether the abnormal condition is truly a disease that requires treatment is irrelevant; once you’ve got the “abnormal” label, you’ve got it for a while. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 18, 2009, 5:44pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/31 "2009-11-18T17:44:31Z")
The alternative is _not knowing_, which is in no way better. If you want radiologists to interpret mammograms conservatively, fine. ---
**Author:** ![Marley23](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Marley23](https://boards.straightdope.com/u/Marley23)\ **Post date:** [November 18, 2009, 5:45pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/32 "2009-11-18T17:45:12Z")
> [@control-z](#): > > And why in the world would you not do self-exams? They cost absolutely nothing and certainly the good they could potentially do would outweigh the negatives of a few overly-nervous women. “Adequate evidence suggests that teaching BSE does not reduce breast cancer mortality.” Again, I’m of two minds on the issue, and I think first and foremost, rather than testing the hell out of everyone, we need to know more about whose cancers are likely to become dangerous and whose are not. But I think people are not getting some of the distinctions in the recommendations here. There are always negatives associated with testing and with treatment. It is not free information, and even a positive cancer diagnosis and treatment does not mean a life has been saved. Remember, it’s been established in the past that the U.S. has higher rates of cancer detection, but survival isn’t better - and the goal is saving lives, not diagnosing the most cancers. Even if you are diagnosed with cancer, that does not mean the cancer is going to kill you, or that the tumor is going to do more harm than the treatment could. You often see this calculation made with prostate cancer or with cancers or other diseases that affect older people. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [November 18, 2009, 7:57pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/33 "2009-11-18T19:57:34Z")
From what I’ve read, these early screenings are of limited value. The types of cancers that strike pre-menopausal women tend to be fast-growing, which means that yearly screenings don’t generally do much. Rates of false positives are sky high and an enormous drain on the system. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [November 18, 2009, 8:17pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/34 "2009-11-18T20:17:08Z")
> [@ivylass](#): > > They’re saying women who do self exams have more biopsies. > > Um, isn’t that sort of the point? Find a lump, go find out if it’s something to worry about? The vast majority of lumps are benign, though. What you really want to find are the _dangerous_ lumps and leave the safe lumps alone. More and more biopsies is not inherently better, especially as they can lead to scarring that might make detection of future tumors more difficult (though that doesn’t always happen). ---
**Author:** ![ThirdOne](https://avatars.discourse-cdn.com/v4/letter/t/53a042/32.png) [@ThirdOne](https://boards.straightdope.com/u/ThirdOne)\ **Post date:** [November 18, 2009, 9:40pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/35 "2009-11-18T21:40:10Z")
I’ve no history of breast cancer in my family. At 50, I had my routine mammo and the dr. saw a spot the size of a pin-head and had it enlarged. Turns out, it was non-invasive (yet) cancer. There is no way I would have found something that small. By the time it was large enough to feel, it would have been regular ol’ invasive cancer. So, at the time, that “lump” was “safe,” but eventually, it wouldn’t be. I think it’s better to have it removed while small, than wait until it invades and, who knows, spreads to other parts of the body. Besides life-saving, what about breast-saving? Mastectomies aren’t exactly a walk in the park. That’s removing a large portion of a woman’s chest. Then, if she’s lucky, she’s get reconstruction. My surgeon actually presented this as an option, because some women would prefer to just have it done and over with. Did you know, once you’ve had radiation in an area, you can never have radiation again? I didn’t, but I do now! I had a lumpectomy and 6 weeks of radiation. If I have another cancer show up in that breast, my only choice is mastectomy. I was willing to take that chance. I had mammos every 6 months for 3 years, and thankfully, have been cancer free, so am now back to every year (or who knows, now). So, I’m on the fence about this. Each woman’s experience is going to be different. I happen to think my breast center and hospital are exceptional, but that doesn’t mean all hospitals and breast centers will be. Oh, and I forgot to mention. Broomstick, when a biopsy is done, it is tagged with a small metal clip to mark it, so even if there’s scarring, they know where the spot was. ---
**Author:** ![ivylass](https://avatars.discourse-cdn.com/v4/letter/i/9de053/32.png) [@ivylass](https://boards.straightdope.com/u/ivylass)\ **Post date:** [November 18, 2009, 9:45pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/36 "2009-11-18T21:45:07Z")
My doctor told me lumpectomies are as effective in preventing the spread of the cancer as mastectomies. Some women opt to have a mastectomy as a preventative measure. Sometimes the doctor goes in to do a lumpectomy and finds the cancer has progressed more than what showed up on scans, and has to do a mastectomy. (That happened to a member of my support group…she went in for a lumpectomy and woke up to find both breasts gone.) ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [November 18, 2009, 9:50pm UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/37 "2009-11-18T21:50:34Z")
> [@ivylass](#): > > My doctor told me lumpectomies are as effective in preventing the spread of the cancer as mastectomies. Some women opt to have a mastectomy as a preventative measure. Sometimes the doctor goes in to do a lumpectomy and finds the cancer has progressed more than what showed up on scans, and has to do a mastectomy. (That happened to a member of my support group…she went in for a lumpectomy and woke up to find both breasts gone.) In some cases as well, there are multiple identified tumors in the breast - that was the case with my sister who had three identified tumors when she had her radical. So at that point, the radical was making a lot more sense. And, in other timely and uplifting news, my friend who was stage IV at diagnosis two years ago died last night. ---
**Author:** ![ivylass](https://avatars.discourse-cdn.com/v4/letter/i/9de053/32.png) [@ivylass](https://boards.straightdope.com/u/ivylass)\ **Post date:** [November 19, 2009, 12:40am UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/38 "2009-11-19T00:40:31Z")
**Dangerosa** , I’m so sorry. ---
**Author:** ![Dangerosa](https://avatars.discourse-cdn.com/v4/letter/d/22d042/32.png) [@Dangerosa](https://boards.straightdope.com/u/Dangerosa)\ **Post date:** [November 19, 2009, 1:06am UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/39 "2009-11-19T01:06:01Z")
She was ready. And there was no pain. She even pre-hosted her own memorial (a girlfriend calls them premorials). We all have to go sometime, though I’d vote for more years than she got. ---
**Author:** ![cerberus](https://avatars.discourse-cdn.com/v4/letter/c/71e660/32.png) [@cerberus](https://boards.straightdope.com/u/cerberus)\ **Post date:** [November 19, 2009, 1:41am UTC](https://boards.straightdope.com/t/no-mammograms-until-50/518024/40 "2009-11-19T01:41:21Z")
It’s a complex issue, and there are at least four levels of “good” operating in screening protocols. 1. The Patient: The patient has an individual gain in this. At one level, there’s a very high cost of a missed opportunity to catch a treatable cancer early. However, noisy screening can lead to false alarms and missed cancers, each having a distinct cost. In terms of screening, there are arguably less treatable cancers and the effect of screening is “stage shifting,” where diagnosis and treatment start earlier, with no real gain. 2. The System (Cost): Cost of early detection of treatable cancers implies better outcomes, and maybe cheaper, more effective early stage treatment with lower recurrence. Cost of early detection of less treatable cancers implies more cost due to longer cycle of treatment with same outcome. Cost associated with effective screening of treatable cancers offset by savings in expensive late stage treatment and recurrence. 3. The System (Practice): Aggressive screening chews up resources by initiating chains of clinical follow-up. Rates of false alarms drive up activity without benefit. Detecting less treatable cancers extends chain of less effective treatment - more activity without concomitant benefit. 4. The Frontier (Research): Screening allows earlier detection of cancers, which allows opportunities to extend the treatment envelope by incorporating the stage shifted less treatable cancer cases in therapeutic research. This research can identify better treatments that can shift the less treatable cases into more treatable categories: research on the less treatable cases leads to better treatment, which expands the classes of more treatable cases. Aggressive screening increases the supply of challenging cases for research. …or something like that… [Previous page](https://boards.straightdope.com/t/no-mammograms-until-50/518024.md?page=1) [Next page](https://boards.straightdope.com/t/no-mammograms-until-50/518024.md?page=3)