False-Positives Par for Course With Yearly Mammograms

Dear Moderators,

 To quote a paragraph in this article:  "Rather, annual screening picks up more small, non-life-threatening cases, which Autier called overdiagnosis, thus diluting what would otherwise be a similar proportion of advanced cases found, he argued."

Really!!!  The last time I checked,  doctors advocated annual screening PRECISELY to pick up more small, non-life threatening tumors which were easier to treat and had better survival outcomes the earlier they were detected.  Given that medicine cannot currently determine which tumors are non-life threatening and which tumors are - THERE IS NO SUCH THING AS OVERDIAGNOSIS by annual screening beginning at age 40- if not earlier!!!  One of my colleagues missed her annual mammo and had a 2 year gap.  This was the mistake of her life, as the cancer metastasized during that period and her survival chances are now REDUCED!  With all the good research going on in peer-reviewed journals you should have picked another publication to put on these boards.  By the way, the American College of Radiology, the Society of Breast Imaging, Susan B Komen for the Cure, the American College of Obstetrics and Gynecology, the American Cancer Society, and the National Comprehensive Cancer network ALL advocate early screening beginning at age 40 followed by ANNUAL MAMMOGRAMS after that.  The Preventive Task Force never even had one oncologist on board when they made these recommendations!  You owe everyone on these boards an apology for posting this garbage.

I've read many of the press releases about this latest study on mammography.  I haven't read the study itself, which I need to do before I offer a serious comment.  However, I can say this:

1) every8thwoman, I understand and empathize with your anger.  I, too, was fuming when I saw headlines reporting these latest findings... but it's not Breastcancer.org's fault.  You said, "You owe everyone on these boards an apology for posting this garbage," and I could not disagree with you more strongly.  I think BCO is performing an important community service by informing us of reports like this.  We might think the findings are "garbage", but they were published in a peer-reviewed medical journal and have been picked up by all the major news outlets.  Actually, I think it would be irresponsible of BCO to withhold information about studies like this out of concern that the findings might upset us or we might disagree with them.  IMHO, the BCO "expert commentary" that accompanies the article on the BCO website seems to be well-written, and even-handed in its tone.  I think they did a nice job of "spinning" the results so that we would understand them.

2) Although the insurance industry might be happy with results like these, they didn't fund or support this study.  They were not involved in the research.  This was a statistical analysis of data from a large number of studies.  (I need to read the actual report before I can understand how it was done.)

3) Despite everything I've said in #1 and #2, the release of this latest report really p*ssed me off.  I cannot think about these results without developing a knee-jerk reaction that includes lots of fuming and curse words. 

I wonder how a task force or expert panel can presume to know whether I would be more troubled by a false-positive mammogram result, versus the many false-negatives I've received (including one on the day of my biopsy).  On what basis did the group decide a false-positive recall rate of 61.3%* was excessive, but 41.6% was not?  Why did they conclude that it was unacceptable if 7% of mammograms led to a biopsy that turned out to be negative, but it was okay if 4.8% of mammograms led to biopsies that were negative?

Okay... "false-positives are par for the course with yearly mammograms."  So what?

otter

*[ETA: My phrasing is incorrect. It's not a "false-positive recall rate" of 61.3%.  What the press release said is, "Over 10 years of annual screening starting at age 40, the cumulative probability was 61.3% for a false-positive recall and 7% for a false-positive biopsy."  Even that is technically not correct.  What they meant (I think) is that a woman who has annual mammograms for 10 years has a 61.3% chance of being called back for a re-take that turns out to be normal, and a 7% chance of being called in for a biopsy of a suspicious area that turns out to be nothing.  Once in 10 years.]

I guess I am one of the false positives.  I am also one of the ones that was misdiagnosed on biopsy even with a second opinion.  I had a mastectomy in February without reconstruction and found out in July that I never did have cancer.  I am glad that I do not have cancer.  But, it has been much harder to deal with misdiagnosis/no cancer than knowing I had cancer.  I wonder how many women have been misdiagnosed and don't know it.  I met a women last week who had a mastectomy 3 years ago and also found out she did not have cancer.  I was the first person she told.  I read a New York Times article last year that estimates there are between 5,000 and 10,000 women misdiagnosed with early stage breast cancer a year.  Shocking.

Just once I would like to see an article on FALSE NEGATIVES.    A false positve - while scary - never killed anyone.   I had FOUR YEARS of digital mammos that gave me false negatives while a nearly 2 CM tumor was growing inside me.

I totally agree that false negatives are so much more scary than false positives.

Some papers do talk about sensitivity, etc.  I think part of the problem is that the increase in mammography has NOT particularly decreased the amount of advanced breast cancer found, and that in many models of breast cancer, it is thought that *if* a breast cancer does metastasize, it often metastasizes *before* it is large enough to be seen on imaging.

Here's one abstract from Ireland that discusses false negative mammograms. http://www.ncbi.nlm.nih.gov/pubmed/19188311

This from the Netherlandshttp://www.ncbi.nlm.nih.gov/pubmed/19046632

 This from Japan http://www.ncbi.nlm.nih.gov/pubmed/18795941

3 of my mammograms said benign I asked for a biopsy. Where would I be if I waited another 2 years for a mammorgram?  The mammogram showed something, I asked for the biopsy. It turned out to be IDC. I think our insurance companies should pay for thermography breast exams, and mammorgrams, both. We also need to push if we think something is wrong.  We know our bodies better then our doctors.  I also was diagnosed wih CLL last march of 2010. Out of 4 doctors and 1 hospital, none noticed for 8 years that I had  cancer, CLL.  So it may not always be the tests, mammograms, it could be the person reading the tests. Anymore I get all my lab work, learned how to read the blood tests, and push for biopsies if I think something isn't right. Ths is the best I can do.