The Free Press, Mankato, MN

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December 1, 2009

Your View — Costs of mammograms should be part of discussion

Ron Yezzi, Mankato

Women in their 20s and 30s can die of breast cancer. Yet there aren’t guidelines recommending annual mammograms for every woman from age 20. Why not? Presumably, panels charged with such recommendations decided that, given an assessment of risks, harms outweigh benefits.

Harms would include anxiety about tests, unnecessary tests or treatments — including chemotherapy, radiation or surgery — for non-life-threatening conditions, plus the costs of the screenings, follow up tests and treatments. Benefits would include lives saved. There hasn’t been social turmoil over current practice here.

So why is there such controversy when a panel uses the same considerations to recommend fewer mammograms for women in their 40s and 50s? Their risks, of course, are greater. (Women in their 40s are 3.37 times as likely to be diagnosed with breast cancer as those in their 30s.) Probably nearly all women know someone middle-aged who died of breast cancer or survived because of treatment. Even if the risks are relatively low, it’s still your life at stake.

While these reasons deserve consideration, they need to be balanced by what this panel is saying about risks, harms and benefits. At some point, somebody also has to interject costs into the discussion. According to the panel’s statistics, annually screening 1,904 women through their 40s saves one life. At $100/mammogram, this translates into $1,904,000. That amount does not include any further tests and/or treatments for the women. Maybe these costs are acceptable, whereas the higher costs for women in their 20s and 30s are not. But we should be clear about what choices we’re making.

Finally, we need similar considerations regarding PSA tests for prostate cancer in men.

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