Sunday, October 28, 2012

Breast Cancer Screening of Dense Breasts - Dr. Government Prescribes Bad Medicine

This blog is about freedom and personal responsibility.  I have opined that cigarette smokers should not be permitted to transfer total responsibility for the consequences of their choices to the tobacco companies, even if this industry has committed legal and ethical improprieties.  I do not support the politically correct beverage ban in New York City, sure to spread elsewhere, where the government decides the content and dimensions of beverages that the public desires to purchase.  With regard to Obamacare, don’t get me started or I’ll never get to the intended subject of this post.

First, let me refute a point in advance that is sure to be leveled against me by the pro-breast crowd.   I am zealously pro-breast and want all breasts foreign and domestic to remain free of disease. I am against breast cancer and support the goal of striving for early detection of this disease and medical research to prevent it.  Indeed, I am against all cancer and boldly express this controversial view in print for all to see.

Breasts and politics have been intertwined for years.  Many medical advocacy groups admire and envy the huge amount of research money that is garnered for breast cancer research.  Some argue that breast cancer, while worthy, receives a disproportionate share of research dollars at the expense of other crippling and deadly diseases. 

There is no clearer example of the contamination of breast cancer with political interference than Mammogate, when the federal government cowardly rejected the sound and impartial recommendations of its own expert panel for political reasons.

Now, a new scene in the government's Breast Fest has appeared where our elected legislators play doctor.  States are passing laws that require medical facilities to inform patients who have undergone mammograms if they have dense breast tissue and that they should discuss with their physicians if additional testing is necessary. More details are found in the New York Times report on this issue.

I will defer expressing a medical view if women with dense breasts are adequately protected by conventional mammography. If medical professionals, unelected but presumably trained in actual medicine, believe that ultrasound exams or M.R.I. scans are necessary to illuminate dense breast tissue, then brace yourself for an avalanche of unnecessary scans which will generate anxiety, cost a few zillion dollars and identify false positive lesions which are entirely innocent and lead to a breast biopsy bonanza.  This cascade will be fueled also by the medical malpractice system, the raptor present in every mammography suite that is ready to sink talons into its prey.  Am I exaggerating here?  Ask any radiologist why he has stopped reading mammograms.  The guys that still do are scared stiff. These breast images are not sharp iPad images with futuristic resolution.  Instead, they look like grainy collages where it can be agonizing for a doctor to decide if a small smudge is nothing or everything.  Understandably, in today's litigious climate, radiologists join OperationOVERCALL, rather than risk the opportunity to serve as a defendant years later.  

The government are not physicians and should not legislate medical advice.  It’s hard enough for actual doctors to sort through conflicting and controversial medical data and evidence to determine what is best for our patients.  We struggle with this every day.  Will the clumsy axe of government be a helpful player in this effort?   Do we want folks who are beholden to lobbyists and are political animals by definition to force physicians to practice in certain way?

Why stop at breasts?

Pass laws that will require physicians to
  • Obtain a CXR if a patient has a cough and a fever
  • Tell every patient who has a negative cardiac stress test that the patient can drop dead of a heart attack within a week and that a cardiac catheterization should be considered
  • advise patients who are scheduled for surgery to obtain a second opinion in case surgery is silly
  • advise patients to pursue the probiotic promise of a panacea.  
Sure, there's dense breast tissue out there.  But, not nearly as dense as the government.  I suppose we should trust them with our lives and our health judging by the sterling performance they demonstrate as legislators.  Congress' approval rating is now soaring at 21%.  


  1. Thanks awareness about breast cancer informative article for every women

  2. "Understanding this limitation, I performed a screening ultrasound on all women with dense breasts and diagnosed an additional 42 percent of women with cancer who would have been falsely labeled healthy by their mammogram. The false positive rate for ultrasound was only 5 percent, a percentage that I, and almost any woman you would ask, believe is an acceptable tradeoff for finding large numbers of otherwise undetected breast cancer. The AMA gave the study a Scientific Paper of the Year Award for 2002, and during the past 10 years, multiple investigators, including multi-institutional studies, have corroborated these findings."

  3. Kimwhit, thanks for the comment. How do you know that 42% of positive US lesions would have been overlooked by conventional mammography? Did all dense breast pts undergo mammography prior to US? Some experts have argued that some breast cancers may actually be innocent although I would likely agree with you that detecting any cancer today at an early stage is desirable. Nevertheless, when I have reviewed the mortality advantage of screened women, I am struck by what appears to me to be a modest gain.

  4. "Detecting any cancer at an early stage is desirable"? Why would you say that? In other posts, you've reflected an understanding of the fact that many cancers are indolent/never destined to cause any harm to the patient. Detecting these cancers is ALWAYS undesirable, because of the consequent anxiety, unnecessary treatment that is often offered/chosen, and the complications/consequences/costs associated therewith.

    By the way, the process for "proving you aren't a robot" on this webpage is arduous! I was starting to worry after I wasn't able to discern the letters for the 6th straight attempt ;)

  5. Mark, thanks for the comment. I achknowledge your point. I think that early detection is still a reasonable goal as we do not have yet a method to distinguish innocent cancers from those destined to threaten patients. Regarding the arduous 'anti-robot' hassle, hey, take it up with Big Brother Blogger! I hope it won't deter you from commenting. Best, MK