Skip to main content

Mammograms don't help--and the dog that didn't bark in the night

In the short story "Silver Blaze" by Sir Arthur Conan Doyle, Sherlock Holmes remarks that it was very curious that when a race horse disappeared and its trainer appeared to have been murdered, the dog was not heard to bark. Dogs are supposed to bark when odd things happen in the night. If they don't, it means something.

Today Reuters commented upon the most recent article in a series over several years showing evidence that mammograms do not reduce death from breast cancer. Although this is not actually a new finding, it is still big news in the US where the wisdom of having regular mammograms is rarely questioned. In my junk email folder I get commentary on the most influential news from medical meetings and journals from organizations such as Medscape and Internal Medicine News, organizations primarily funded by drug and device manufacturers, but also by other aspects of the business of medicine. These organizations successfully take it upon themselves to educate physicians via email communications and throwaway journals. Most of us would never believe information directly given us by companies that make a profit off of our activities, but we still read the headlines and article links these news services put in front of us. This means that those companies have a powerful influence on what medical news physicians read. There was no mention of this new article by these proprietary news organizations, despite the fact that it was headline news at Reuters and the New York Times.

The Canadian Breast Cancer Research Initiative and 9 other primarily cancer research organizations funded this study, published this week in the British Medical Journal. It looked at nearly 50,000 women ages 40-59, half of them randomized to be offered yearly mammograms and half to clinical breast exams alone. These two groups were followed for 25 years to look for differences in mortality from breast cancer. There was no difference in mortality. If doctors paid attention to this, it would follow that we would not universally recommend mammograms at all. There may be subsets of women who will benefit from mammogram screening, but it may also be that bad breast cancers kill people, and discovering them a little bit earlier by mammograms rather than when they can be felt on a clinical exam, and removing them just that little bit earlier doesn't change this.

So why the spotty news coverage? I saw the Reuters article on Google News, as a top story, then researched the actual study a bit, then went back to find the article on Google News and it was gone. It was replaced by a study that said that removing both breasts if you have the BRCA breast cancer gene mutation saves lives, even if one of those breasts has no cancer. I had to go to my history to find the Reuters article again. It was nowhere on Google News. Suppressing a story like this until people with a stake in the outcome have their official responses polished may have a profound effect on maintaining the multi-billion dollar revenue associated with regular screening mammograms.

Am I being a paranoid conspiracy theorist? Perhaps. But I am hearing a strange lack of anything about how maybe we don't need to be doing mammograms.


Popular posts from this blog

How to make your own ultrasound gel (which is also sterile and edible and environmentally friendly) **UPDATED--NEW RECIPE**

I have been doing lots of bedside ultrasound lately and realized how useful it would be in areas far off the beaten track like Haiti, for instance. With a bedside ultrasound (mine fits in my pocket) I could diagnose heart disease, kidney and gallbladder problems, various cancers as well as lung and intestinal diseases. Then I realized that I would have to take a whole bunch of ultrasound gel with me which would mean that I would have to check luggage, which is a real pain when traveling light to a place where luggage disappears. I heard that you can use water, or spit, in a pinch, or even lotion, though oil based coupling media apparently break down the surface of the transducer. Or, of course, you can just use ultrasound gel.

Ultrasound requires an aqueous interface between the transducer and the skin or else all you see is black. Ultrasound gel is a clear goo, looks like hair gel or aloe vera, and is made by several companies out of various combinations of propylene glycol, glyceri…

Actinic Keratoses and Carac (fluorouracil) cream: why is this so expensive?

First, a disclaimer: I don't know why Carac (0.5% flourouracil cream) is so expensive. I will speculate, though, at the very end of this blog.

Sun and the skin: what happens
If a person reaches a certain age, has very little pigment in her skin, and has spent lots of time in the sun, bad stuff happens. The ultraviolet radiation of the sun does all kinds of great things: it makes us happy, causes us to synthesize vitamin D which strengthens our bones and it gives us this healthy glow until we get old and wrinkled and leathery. And even that can be charming. The skin cells put up with this remarkably well for a long time, partly aided by melanin pigment which absorbs the radiation, which is why we tan and freckle, if we are fair skinned. Eventually, though, we absorb enough radiation that it injures the skin and produces cells which multiply oddly. It also damages the skin's elasticity which creates wrinkles.

The cells which reproduce in odd ways peel, creating dry skin or dry s…

Why do drugs cost so much? Confused and fuming about the unfairness of it all...

Drug prices are a difficult issue to write about because real data about the workings of pharmaceutical companies is very difficult to uncover. Still, last week I came face to face with something that seemed extremely not right and so I feel I should at least make some comment. It started when I prescribed a patient sumatriptan for her recently more frequent migraines. Her cost exceeded my wildest expectations.

Sumatriptan is a nearly magical medicine which was FDA approved in 1991 for treatment of acute migraines.* It is similar to the neurotransmitter serotonin and reduces inflammation of arteries in the brain which is associated with migraine headaches. It does other things as well, and may have a much more complex mechanism of action. Although it has some side effects, it works well for most people, can be given as an injection, pill or nasal spray and doesn't cause drowsiness, constipation or nausea like many other pain medications can. When sumatriptan was first released, u…