Mammograms for millennials

According to Rep. Debbie Wasserman Schultz (D-FL), DNC Chair:

You know, for millennials, young adults in particular, because they have an opportunity to stay on their parents' insurance until they're 26 years old, many of them need to be aware they can do that. That's going to give them comprehensive coverage that so many of them don't have now. And the focus needs to be on making sure that we can get young people who are often healthier into the pool so that it lowers the overall cost of health insurance. Whether it's making sure they get access to preventive care like mammograms...

(Source)

1. Okay, so it sounds like Schultz thinks it's a good idea for all women in their 20s to use mammograms.

2. On the face of it, it might seem like a good idea for all young women to get a mammogram to screen for breast cancer. (I doubt Schultz is referring to using mammography diagnostically, which would be an even more thorny issue to discuss.) Who doesn't want to take every precaution and make use of every possible resource to detect breast cancer early?

3. Indeed, mammograms could be a good idea for women under 40 if the woman is at significant risk for developing breast cancer (e.g. if the woman carries the BRCA1 and BRCA2 genes). But that's not what it sounds like Schultz is getting at. No, it sounds like Schultz is addressing all young Americans, including young women, which includes young women who don't have a significant risk for developing breast cancer.

4. What's more, call me cynical, but it sounds like Schultz is using mammograms as one of the ways to sell ObamaCare to "millennials," particularly young "millennial" women.

5. In any case, it's quite arguable whether it's beneficial to use mammograms to detect breast cancer in women under 40.

a. For instance, according to a reliable medical resource widely used by physicians called UpToDate:

Performance characteristics of mammography are poor for women younger than 40. In a review of results of 73,335 initial screening mammograms in women aged 35 to 39 years, the recall rate was 12.7 percent and positive predictive value was 1.3 percent [93].

b. Moreover, according to the Mayo Clinic:

When to begin screening mammography

Experts and medical organizations don't agree on when women should begin regular mammograms or how often the tests should be performed. Talk with your doctor about your risk factors, your preferences, and the benefits and risks of screening. Together, you can decide what screening mammography schedule is best for you.

Some general guidelines for when to begin screening mammography include:

Women with an average risk of breast cancer. Many women begin mammograms at age 40 and have them every one to two years. Professional groups differ on their recommendations, with most, including the American Cancer Society, advising women with an average risk to begin mammograms at age 40 and the U.S. Preventive Services Task Force recommending women wait until age 50 to begin regular mammograms.

Women with a high risk of breast cancer. Women with a high risk of breast cancer may benefit by beginning screening mammograms before age 40. Talk to your doctor for an individualized program. Your risk factors, such as a family history of breast cancer, may lead your doctor to recommend magnetic resonance imaging (MRI) in combination with mammograms.

In addition, the Mayo Clinic notes risks associated with mammography. Here are some of the risks and limitations (I'd especially note the third point about difficulty in interpretation):

Mammograms expose you to low-dose radiation. The dose is very low, though, and for most women the benefits of regular mammograms outweigh the risks posed by this amount of radiation.

Mammograms aren't always accurate. The accuracy of the procedure depends in part on the technique used and the experience and skill of the radiologist. Other factors — such as your age and breast density — may result in false-negative or false-positive mammograms.

Mammograms in younger women can be difficult to interpret. The breasts of younger women contain more glands and ligaments than do those of older women, resulting in dense breast tissue that can obscure signs of cancer. With age, breast tissue becomes fattier and has fewer glands, making it easier to interpret and detect changes on mammograms.

Read the rest here.

c. Similarly, the National Cancer Institute lists benefits and harms of mammography screening here. Note the benefit best applies to women above age 40 since the study was conducted among women aged 40-74, while the harms can apply to all women who undertake mammography screening.

I'll simply list the headings, and suggest people click on the link to read the entire page:

Benefits

• Decrease in breast cancer mortality

Harms

• Overdiagnosis and Resulting Treatment of Insignificant Cancers

• False-Positives with Additional Testing and Anxiety

• False-Negatives with False Sense of Security and Potential Delay in Cancer Diagnosis

• Radiation-Induced Breast Cancer

6. This post is not at all to denigrate mammography as a screening tool. Mammography is highly useful. But in the right context. And that's something a woman (or man) should discuss with their physician.

Obviously no one should take the word of a blog post such as this one. After all, who knows how trustworthy any of this truly is? By the same token, neither should they take the word of the Chair of the Democratic National Convention on this topic.