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Is routine screening for breast cancer for asymptomatic women younger than 50 worthwhile?

Dr. Mercola seems pretty confident that mammography not only doesn't improve breast cancer outcomes, but likely causes more cancer than it prevents. See here and here, for typical articles on the subject from his site. Is he right?

Conventional advice, of course, is to get a mammogram every year or two. This is of more than academic concern, because I need to advise the women in my life what to do.

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Joshua Frank
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  • The linked question seems to cover the same ground. – Sklivvz May 08 '12 at 12:35
  • It covers the same topic, yes, but doesn't specifically refute the claims made by Dr. Mercola, which are the ones making me question whether mammograms are safe or useful. Could we leave this open for a little while to give people the chance to weigh in on these specific articles? – Joshua Frank May 08 '12 at 12:42
  • @JoshuaFrank-- I would end up posting the same response, probably :) Dr. Mercola does not seem to remember that the second leading cause of death among women is cancer (http://www.cdc.gov/women/lcod/), and the leading cancer among women is breast cancer (http://www.cdc.gov/cancer/dcpc/data/women.htm). Women who don't get screened die at the rates of women who died prior to the introduction of the mammogram as a screening tool (http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confID=70&abstractID=40559). Mammograms save lives; frequency is up for discussion. – mmr May 08 '12 at 16:59
  • The question here differs in a subtle way to the other question. This question is more specific about the cause of screening failure. There are many more reasons for possible harm as a result of screening and the question might be worth retaining if the focus is to look at the evidence of excess cancer risk only. – matt_black May 08 '12 at 22:32
  • @mmr: You are undoubtedly right, but that doesn't contradict Mercola's argument, which is not that breast cancer doesn't kill women, or even that mammograms don't discover cancers. His point, highly summarized, is that mammograms aren't as good as other existing tools, that they can cause cancer, and that they have other negative side effects (like false positives leading to destructive and unneeded interventions). Is he wrong about that? – Joshua Frank May 09 '12 at 01:35
  • @matt_black: That's also true. – Joshua Frank May 09 '12 at 01:36
  • @mmr: Also, if the "frequency is up for discussion", it's because there is some risk to doing them. Is the risk in the neighborhood that Mercola is claiming, or vastly less? – Joshua Frank May 09 '12 at 01:37
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    @JoshuaFrank-- he is wrong about that. ACRIN 6666 (http://www.acrin.org/Portals/0/Protocols/6666/Protocol-ACRIN%206666%20Admin%20Update%2011.30.07.pdf) showed that ultrasound can augment but cannot replace mammograms, especially when the addition of ultrasound increased the false positive rate by 4x. Since Dr. Mercola is concerned about the effects of false positives (ie, the incorrect need for biopsy, etc), this increase would seem to invalidate his argument that alternative screening methods are more helpful. – mmr May 09 '12 at 03:10
  • @JoshuaFrank-- the frequency of cancer changes with age, so the frequency of screening is up for discussion. The initial assumption of the Task Force, in 2009, was to forgo screening before the age of 50; they've recently revised that based on a variety of factors (http://mississippimedicalnews.com/new-study-guidelines-continue-debate-on-mammography-frequency-cms-1549). Another interesting question is: when do you _stop_ screening for mammograms? Is 74 late enough? 94? What's the latest age where mammograms should be covered? – mmr May 09 '12 at 03:18
  • What to advise the women in your life is to ignore "Dr." Mercola. – Loren Pechtel Mar 03 '17 at 03:14

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