Skipping mammogram?

What is the difference between a screening mammo and a diagnostic mammo?

ICAN... You ask a great question!  However, there is NO right answer.  Depending on how high your recurrence risk should guide how often you need to be screened. H. Gilbert Welch, MD and others have argued that while screening mammos save lives, they believe they don't save as many lives as we are led to believe.  Diagnostic mammos do save a lot more lives. According to the US Preventitive Task Force, screening mammos save the most lives in the over 50 and I think, under 70 age range. Many countries, including Canada recommend screening for that age range, every two years.  But here's the catch, those of us who have already been diagnosed,  are not included in the recommendation. 

In February I will be 4 years out from my initial diagnosis and several months ago, my radiologist told me I could resume annual screening mammos.  I was THRILLED to hear that. I trust my doctor, so I am VERY comfortable with his recommendation.

Likewise, I have an 88 year old mom who until recently went for annual screening mammos. I spoke to several of her doctors and they all insisted that she continue getting mammos until her health deteriorated. Mom, who is a retired nurse, sister who is also a nurse and I discussed it together and we all agreed that she would no longer continue being screened.  Mom is very comfortable with the decision after we spoke about all the pros and cons.

So, what I'm saying is that you need to figure out what is your future risk and match that to your comfort level. If you trust your physician and trust their recommendation and are comfortable, then you've arrived at what's right for you!

http://m.annonc.oxfordjournals.org/content/early/2013/08/22/annonc.mdt284.full

"follow-up and long-term implications

The aims of follow-up are to detect early local recurrences or contralateral breast cancer, to evaluate and treat therapy-related complications (such as menopausal symptoms, osteoporosis and second cancers), to motivate patients continuing ET and to provide psychological support and information in order to enable a return to normal life after breast cancer...

...Despite the fact that no randomised data exist to support any particular follow-up sequence or protocol, balancing patient needs and follow-up costs, we recommend regular visits every 3 to 4 months in the first 2 years, every 6 months from years 3–5 and annually thereafter [V, A]..."

VR: here's your guy Welch in the NYT op ed opining more about mammograms, and whether they are good or bad, in essence.  It really must come down to one word for the masses, for public policy. The grays, the splitting hairs, the conflicting data…well, that's just anathema to the screening 'movement'.  It discourages people, muddies the 'message'.

http://www.nytimes.com/2013/12/30/opinion/breast-cancer-screenings-what-we-still-dont-know.html?ref=opinion&_r=0

Jessica, if you read  the  late Handel Reynold, MD's book, The Big Squeeze, he explains why there will never be a study like the one Dr. Welch suggests.  And regarding public policy, there IS a public policy that was recommended by the Preventative Task Force that was rejected by  radiologists and advocacy groups.  

Yes, farmer...Dr. Handel Reynold's book, The Big Squeeze is a MUST read.  Made my head spin for days!  I love reading books that shake up my brain cells!

I have not read Dr Reynold's book but I am confused. DCIS was not a dx before mammograms?  Then what did I have?

I was a year out from my last clean mammogram when I noticed a bloody discharge from my nipple. After a  diagnostic mammogram, ultrasound, stereotactic biopsy and other punch biopsies and an MRI, I was diagnosed with multi-focal and multi-centric DCIS and told I needed an MX given how extensive the DCIS was throughout three quadrants of my breast. I was told I'd only had the DCIS for about 6 months. Nothing showed on the mammogram of a year ago. And, given the current recommendation for a mammogram every other year and no family history of BC, I would have gone another year without one, but for the nipple discharge. 

I was treated at a top national comprehensive cancer center. When I met with my surgeon to get my post surgery pathology report, he told me there was a "surprise" in my report that no one expected based on all the pre-surgery diagnostic tools -- a 3mm IDC triple negative tumor and numerous microinvasions.  My surgeon is confident that I only had DCIS for 6 months, and yet it became invasive in that short amount of time. So, far from an over diagnosed and innocuous condition, I had triple negative IDC. Suddenly, the option of chemo was under serious discussion. 

Despite all of the diagnostic tools, rather than having a benign condition that was over treated, I had an invasive and dangerous type of cancer that would have progressed for another year until my next mammogram but for the nipple discharge. Yet no one knew it was IDC until after my MX for DCIS. Based on much current commentary, my well documented Stage 0 DCIS did not require a rush to treatment and perhaps did not need to be treated at all!  And yet . . . .

I don't think we should overlook the fact that everyone writing on the topic these days has an agenda and that cost containment is at the heart of much of what is currently being written and recommended.  And I am horrified by those who suggest that, because BC treatments have improved, we don't need to worry so much about catching it early because it is more treatable now than it used to be. So, let's stop with all this scaring and over treating women with DCIS. Instead, let's have the disease progress in the unlucky few like me to a stage where we can feel it. Of course, at that point a woman will need a much more intensive, extensive and expensive course of treatment. But, she will probably survive. And, sacrificing her is fine because overall it will be less expensive for society to stop over treating DCIS. We realize some women will be sacrificed on the altar of cost savings, but that's okay  (unless you're that woman, of course). 

IMO, until we know for certain which cases of DCIS will become invasive or already have become invasive, all of the talk about over treatment is just that -- talk. 

JaneB1, eloquently and concisely stated.  You got to the heart of the matter, cost containment.  Thanks goodness you had the doctors that you had.