The Mammogram Melee: How Much Screening Is Best?

Even doctors are not always mindful of the risks of overscreening. Busy physicians often prescribe routine screening as a substitute for in-depth discussions with patients about their individual risk of developing cancer and the relative benefit a yearly mammography would offer. "These are hard conversations," says Dr. Eric Winer, director of breast oncology at the Dana-Farber Cancer Institute and chief scientific adviser to Susan G. Komen for the Cure. "So it's easier to tell women to get a mammogram beginning at age 40. But simple isn't always what's best."

The Calculus of Risk

So is there any way to reconcile the weight of evidence about screening with patients' natural impulse to take every available precaution? Science may ultimately provide a way out. A better understanding of what triggers abnormal growth of breast tissue, for example, would lead to more effective and targeted therapies, rather than the treat-one-treat-all approach in place today. Current screening can pick up only suspicious growths; smarter technology could help doctors know exactly what to do with them. "The goal is not finding cancer; the goal is reducing death and suffering," says Dr. Lisa Schwartz, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.

In the future, that may help reduce the risks to women from screening, says Dr. Stephen Taplin, program director for the Breast Cancer Surveillance Consortium at the National Cancer Institute, which is reviewing its guidelines that now advise biennial mammography for women in their 40s. But that will also require women to come to grips with the full range of risks associated with being proactive. Taplin says the oft-cited statistic that 1 in 8 women will eventually develop breast cancer requires doctors and patients to be vigilant but judicious about using mammography. Says Taplin: "We need to think about the seven who don't get breast cancer as well as the one who will."