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Healthcare Humility
Mammogram Study Exposes Medical Naiveté

Everything you thought you knew about mammograms is wrong. A new gold-standard study out of Canada looked at the effect of mammograms by randomly assigning women to two different groups: one who got mammograms and one who didn’t. The results call into question the entire value mammograms for women today. The NYT has the story:

[The study] found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation […]

In the United States, about 37 million mammograms are performed annually at a cost of about $100 per mammogram. Nearly three-quarters of women age 40 and over say they had a mammogram in the past year. More than 90 percent of women ages 50 to 69 in several European countries have had at least one mammogram.

Mammograms not only are no longer helpful in catching breast cancer: they actually have positive harms and cost US healthcare important time and money. This new experiment dovetails nicely with other recent studies—such as in Oregon—showing that expanded insurance does not have a direct or clear relationship to health. The fundamental truth emerging from much recent work on the US health care system is that health, health care, and health insurance are all three different things. They bear important relationships, of course. But those connections are complex and understudied. We do know that neither health care nor health insurance as we currently use them always improve health. We also know that health is a multifaceted phenomenon that has as much to do with environmental factors or your relationships to other people as to the treatment you receive. But there’s a lot we still don’t know, and that makes policies based on the folk notion of a direct progression from health insurance to health care to health outcomes problematic.

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  • Maynerd

    Your post is overly negative. There are two positive reasons screening mammography is not worthwhile in 2014:
    1 – Breast cancer treatments are so effective that women are often cured even when presenting with an advanced stage of disease. Catching the cancer early is no longer critically important.
    2 – Many of the cancers successfully detected by screening mammography turn out to be medically irrelevant and do not ultimately harm the patient.

    Ironically the common sense notion of detecting cancer early is no longer useful for breast carcinoma.

    I hope your other blog post aren’t equally superficial.

    • Andrew Allison

      Dear Doc, your comment, while understandable, is ridiculous on its face. First, what the study shows is that mammograms are no better at catching malignancies than palpitation. Second, while the biopsies and treatment resulting from false positives may be medically irrelevant, they are hardly irrelevant to the patient. I hope your future comments will not be equally superficial [grin]

      • Maynerd

        You don’t get it. But that’s OK. Carry on.

        • Andrew Allison

          You are correct. I misread your comment. My apologies.

  • AGoyAndHisBlog

    “…health, health care, and health insurance are all three different things.”

    That this self-evident fact comes as a revelation to most people is a testament to the success of the federal government’s relentless efforts to conflate and, thereby, politicize them.

    • Andrew Allison

      Much as I despise the federal government’s abysmal failure to deal rationally with both health care and health insurance, I think you do it an injustice. The problem, IMO, is that it is commentators (including until today’s Eureka moment TAI) which conflate the issues. As I have commented more than once here, we need as a society to reach a consensus as to what minimum level of health care we owe all members and then how we’re going to pay for it.

      • AGoyAndHisBlog

        The only “rational” manner in which the federal government could possibly “deal” with health care or health care insurance is to butt out of the market entirely. The federal government has absolutely no constitutional authority whatsoever to manipulate the manner in which health care is funded, much less run an insurance ponzi scheme using Taxpayers’ wealth.

        And pardon me, but No One in society “owes” anyone else any level of health care – minimum or otherwise – any more than anyone is “owed” food, water, shelter, heat, clothing, electricity or any other necessity of life. Individual liberty means individual responsibility.

        If you as a segment of society decide that you owe someone else some minimum level of sustenance – whether it be health care or anything else – there’s a social construct available that’s been around for centuries, which will provides you with the every opportunity to pursue it.

        It’s called charity. No one’s stopping you.

        • Andrew Allison

          Where to begin? With the fact that I wrote that we as a society (not as individuals) should decide what (if any) minimal level of healthcare we owe to its members and how it should be paid for? With the fact that every OECD country except the US has figured out the answer? With the fact that the government is in the health insurance, and not the health care business? With the fact that the federal government is engaging in all sorts of things for which it has no constitutional authority? And last, but by no means least, the reason that I am so adamantly opposed to ACA, namely that I want to decide how to make my charitable contributions, not have them required of me because my family has an AGI of very slightly more that 4X than the so-called “poverty” level.

          • AGoyAndHisBlog

            “we as a society”

            We “as a society” don’t make decisions like this. History shows that wannabe dictators make those decisions FOR society, by offering false choices promoted by appeal to authority, appeal to majority and appeal to emotion fallacies.

            “every OECD country except the US”

            Every OECD country has amassed unsustainable levels of debt pretending that “society” can decide to function as a welfare state.

            “government is in the health insurance, and not the health care business?”

            Government has no constitutional authority to be in either business. Presently, it manipulates one in order to control the other and, with it, the people who need it.

            ACA is a symptom of open-loop, unaccountable government that is exercising control in areas where it has no constitutional authority to meddle.

          • Andrew Allison

            Sadly, you couldn’t be more mistaken. Our elected reprehensatives are empowered to pass any old law they choose on our collective behalf. Thanks to their efforts the US has, among other things, both unsustainable debt and (on a per capita basis) third-world health care.
            You are also mistaken about ACA: however misbegotten it is, as he who must be obeyed famously announced before he started unconstitutionally changing it, the law of the land.
            Now, if we might return to the sub-topic, the question I posed is who should have what sort of health care and how can it be paid for.

          • AGoyAndHisBlog

            “Our elected reprehensatives are empowered by the constitution to pass any old law they choose on our collective behalf.”

            You couldn’t be more mistaken. And it’s clear that any attempt to explain this to you would be pointless.

            “what sort of health care and how can it be paid for.”

            Same as with every other necessity: whatever sort of health care you like, as long as you make arrangements to pay for it. Society’s involvement in that process has only one purpose: to ensure that the market isn’t manipulated by overreaching government.

          • Andrew Allison

            Well at leat try and explain it, starting with ACA, a law passed by Congress and signed into law by the law-changer-in-chief.

            You continue to confuse what our constitutional government decides is good for us with what is actually good for us.

          • AGoyAndHisBlog

            I’m not the one who’s confused.

  • Corlyss

    While I wouldn’t be surprised if it becomes true because of newer treatment protocols for breast cancer, like aromatase inhibitors and genetically targeted treatments, I ain’t buying that report for a nanosecond. If I believed in coincidence, I’d think “How timely! Now that we know health care costs are incredibly hard to control once the Feds get involved unless they just refuse to pay rightfully owed bills, cut insured pools, and reduce coverage that was once liberally available thru employers, this is a boon that should help to save money.”
    But I don’t believe in coincidence. Canada is hardly paradigm of honesty in this regard. Neither is Britain’s NHS. They both have been lying about wait-times and treatment results for decades. In fact, they lie like rugs to change the public’s perception of the latter’s needs and the former’s ability to deliver services, thereby controlling what’s demanded of them. My first reaction is, “find another bunch of suckers to sell this proposition to, say, for instance, the NYT.” As a breast cancer survivor, I will continue to get my mammograms yearly.

    • Andrew Allison

      Corlyss, the rationale for including “deaths from all causes” in a study of mammogram effectiveness is that it answers the question of whether, in addition to being a waste of money, they have other consequences. You are, of course, entitled to continue the annual mammograms for which I trust you, rather than your insurance company and hence the rest of the insured are paying for, but most of those having them are not survivors. In short, it’s an early warning system which has been shown to be not just ineffective but to result in unnecessary treatment for 20% of those “diagnosed”.

      • Bruce271

        Sadly, mammogram advocates often dismiss the figures on total mortality probably because studies found mammograms increase it. But self-serving conduct is a matter of routine for the mammogram lobby, they’ve seem to be also behind the censorship of information relating to this Canadian study (google/bing “A Mammogram Letter The British Medical Journal Censored”).

        • Andrew Allison

          Sadly, it’s not just the mammogram lobby, but the entire so-called “medical profession”, which demonstrably has no interest in anything which challenges their preconceptions or exposes them to the slightest risk of malpractice suits. A physician who recommends unnecessary tests (or drugs) which have been shown to do more harm than good is both violating the Hippocratic Oath and as despicable as the Trial Bar.

  • Andrew Allison

    Eureka! “The fundamental truth emerging from much recent work on the US health
    care system is that health, health care, and health insurance are all three different things.”

  • TommyTwo

    I’ll reserve judgement until I study the study. Which won’t prevent me from supplying the snark to my adoring public:

    Shouldn’t the headline be: “Canada joins GOP in pernicious War on Women”?

    • Andrew Allison

      You are utterly shameless, not just in suggesting that appreciation is the same thing as adoration, but in misinterpreting the results of the study. Surely what the Canadian study is suggesting is that it is the recommendation for annual mammograms which is an assault on the fair sex?

      • TommyTwo

        I am shameless indeed, for having provided the preceding snark solely for the benefit of my adoring public, and not the merely appreciative one. But I am magnanimous enough to allow the latter access to it.

        “No mammograms please, we’re Canadian.”

        • Andrew Allison


  • Mark Michael

    I think the recent release of this study is just a minor update on research done starting in the early 1970s and ending in the early 1990s (perhaps late 1980s). The PBS Jim Lehrer NewsHour had a long segment on this past week. Judy Woodruff moderated the discussion. They had on two experts, one pro and one con. I forget the two doctors’ names, but it came across to me (a naive layman, admittedly) as not super clear cut with respect to just buying the recommendations of the study “as is.” IMO, if we had a more free-market health care insurance system, each woman (and her doctor & family) would decide how to proceed. Unfortunately, with so many 3rd-party payers today, rationing somewhere is needed or costs will spiral out of control – as they have. (But that’s so obvious, I shouldn’t bother to repeat it.)

  • rheddles

    the folk notion of a direct progression from health insurance to health care to health outcomes

    What a crock of . That is an elite notion from silverspooners like you who get theri healthcare on a platter and do not have the common sense of the folk.The elite have been jamming the conflation down the folk’s throat for generations in an effort to gain more control over the folk. And some of the folk are stupid enough to believe you. The rest are called the TEA Party.

  • free_agent

    All true… but what causes more money to be spent on doctors and hospitals? I’d say it’s yearly mammograms.

  • LadyBingham

    Mammogram screenings have always been a controversial topic. Many doctors claim it’s not helpful to detect breast cancer and cause harm to the body. While other say it’s important to do mammogram screening for early detection of breast cancer. These days there are more powerful options present than a regular mammogram. A new technology known as 3D mammography, whose information present at recnac has improved the detection rate of breast cancer. It reduces false positive or false negative results and necessity of biopsies after this screening.

  • JoelMonk

    Since its inception, mammogram screening has been in debate due to its false alarm/result and harmful effect. As far as I have read, conventional mammogram has some issues, however, after the introduction of 3D mammography technique bring by Hologic several issues are solved and catching breast cancer become effective.

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