Are Mammograms Really Saving Lives? Examining the Evidence and Controversy

The video discusses the complex relationship between mammograms and mortality. Mammograms are a screening tool used to detect breast cancer early, but they may also lead to overdiagnosis and potentially fatal treatment of cancers that would never progress to cause symptoms. Exposure to chemotherapy, radiotherapy, and surgery can potentially lead to new conditions, making mammography a controversial topic.

Decades of evidence reveal a complicated relationship between mammograms and mortality. The paper discusses the history of mammograms and how we came to establish our current mammogram recommendations. The early success in reducing cervical cancer mortality led to the idea that early detection was important, and we expanded it to everything everywhere all the time.

The video shows charts indicating that mammogram usage has increased dramatically since 1987 to 2015, and early stage breast cancers took a tremendous leap up. Overdiagnosis is difficult to identify, and if a mammogram catches an early stage cancer, it is impossible to discern how that cancer would have progressed absent detection, especially for a given individual. Autopsy studies suggest overdiagnosis of thyroid and breast cancer, and time series evidence suggests overdiagnosis of thyroid, melanoma, and kidney cancer as diagnoses have risen dramatically with screening.

The 2016 guidelines for mammography screening from the US Preventive Services Task Force (USPSTF) are based on meta-analysis, and all trials combined include over 600,000 women. The meta-analysis finds no statistically significant reduction in all-cause mortality for women in any age group. Some trials even show imprecise increases in all-cause mortality across all age groups or within an age group.

The video points out that even if there is a decrease in breast cancer deaths, but there is an increase in other deaths from anything, such as the side effects of treating breast cancer, there will be no change in all-cause mortality. Therefore, the difference between disease-specific mortality and all-cause mortality is critical. The video shows that there was zero difference in all-cause mortality. Even in those ages where breast cancer deaths were reduced, women still died at the same percentage rate, just from other things.

The author of the paper suggests that one reason for the controversy surrounding mammography trials is that the idea that finding small treatable cancers will save lives by stopping them from growing into larger malignant cancers is appealingly simple for advocates of mammography. However, the evidence from randomized controlled trials was underwhelming.

In conclusion, while there may be some value in some screening, more screening may not provide additional benefit. The controversy surrounding mammography trials is ongoing, and the political and cultural factors are divorced from the science. Some institutions respond to this by incorporating it into new policies, but the issue of screening older women persists, and many doctors continue to screen older women because of fears of lawsuits, health system bonuses for high screening rates, and because doing less can be perceived as a lack of caring or ageism.