Controversial Dr Essermann on screening/treatment, WISDOM study

I had my first mammo at 38, strictly as a baseline. My PCP at the time had heard that Ashkenazi Jewish women seemed to develop breast and ovarian cancers at much higher rates than other ethnic groups. I had no relatives with either disease. but she wasn't taking any chances. In all the years I've had mammos, I've never had a false positive. Just for spits & giggles, I took that "Gail Model" risk assessment mentioned in the Prevention article. (It failed to mention age at menopause, number of children, breastfeeding, or sub-ethnicity for women who chose “white" as their race). It calculated my risk at 64 of developing breast cancer as 2.7%. Yet here I am.

And Esserman's assertions about disappearing breast cancers, as well as those that may never progress, pertain only to DCIS (or LCIS, which Dr. Susan Love doesn't even consider to be cancer). To say a woman should wait until she notices a lump or anomaly visible to the naked eye is simply reckless. Most women here diagnosed with Stage IA invasive ductal carcinoma (far & away the most common) were diagnosed after a mammogram picked up a non-palpable anomaly. A lump, if it turns out to be malignant, is likelier to be larger and have spread to at least one lymph node than is a non-palpable IDC, and requires more extensive and riskier treatment. I'm pretty sure that article misinterpreted Dr. Esserman's and Dr. Otis Brawley's theories and advice (reported verbatim and at length in scholarly journals--which Prevention is NOT--and the N.Y. Times).

Between making the appointment for the spot-compression diagnostic mammo/ultrasound and getting that followup imaging done, Esserman's recommendations (backed up with some caution by Dr. Brawley) on DCIS came out, and I read the Times article as well as Kolata’s sidebar elaborating on it. Because the previous year's screening mammo was clean as a whistle (as were those a year and two years before that), I assumed that my worst case scenario was DCIS (visible w/o biopsy--how naive was that?); and I was ready to go all-in on “watchful waiting" and perhaps an AI for prevention. Even after I got that BIRADS-4 classification (with the added words “suspicious for malignancy," “ill-defined hypoechoic mass" and “malignancy is within the differential diagnosis" and had my core-needle biopsy, I'd suspected DCIS at worst. But when the path report came in as not only IDC but Grade 2 (not exactly inert), I knew that doing nothing was not an option. I may be wrong, and Esserman may have written subsequent articles asserting invasive tumors may not warrant treatment, but I wouldn't bet on it.

Do I sometimes kick myself for getting my annual mammogram and acting on the report it generated? Yeah, for maybe five seconds; and then I shudder to think what would have happened were I among the 80% of women whose cancers DON"T “disappear" spontaneously? There are three kinds of untruths, according to an old saying: lies, damned lies and statistics. Just as “the Devil may cite Scripture for his purpose" (per Shakespeare), statistics can be sliced, diced, massaged and run though the cognitive dissonance mill to “prove" any agenda an author might have in mind. (I ought to know--at the beginning of my legal career, I often found myself asked by my bosses to take the same set of facts and case law and come up with memoranda arguing two opposite conclusions).