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New Guidelines Reflect Knowledge On Positives, Risks Of Mammograms


Now, for women out there, we know that you have a lot of questions - what does this mean for me? Should I or shouldn't I get a yearly mammogram? Well, to help us sort through some of the confusion, we've called on Dr. Kenny Lin. He's associate professor of family medicine at Georgetown University's School of Medicine. Welcome to the program.

KENNY LIN: Nice to be here.

CORNISH: So we heard in our report that the American Cancer Society still wants every women to talk to her doctor to figure out what makes the most sense. How do you interpret all this?

LIN: So I think what you've just said is probably the best way to describe it, that women should be talking to their doctors about mammography. It shouldn't be automatic. It shouldn't be reflexive. It shouldn't be like the experience of many of my friends who are in their early 40s and they show up at their doctors and they get a slip and they say go get your mammogram. We instead should be raising the topic saying, look, we have this test. It could prevent you from either dying or having a serious illness from breast cancer. But it's not perfect. It has, you know, many harms as well, including false positives, diagnosis of a breast cancer that may not ultimately be true cancer but something that we might have to act on. So it's basically, I think, best viewed as an invitation to both patients and physicians to have that conversation if they haven't been having it before.

CORNISH: There have been several studies that have shown that doctors really don't talk all that much about the risks of cancer screenings. They don't give numbers for how many people actually do benefit from the screenings. Do you think these guidelines will change that?

LIN: I hope they do. Now in defense of those doctors, it is a challenging conversation. There are a lot of numbers. There's a lot of uncertainty about some of the numbers. I think that it can be helpful to present patients with either a handout or some sort of visual aid where you can show what the numbers really are for the benefits and the harms. And it's something that I've been doing, but I think a lot of doctors haven't been doing that and I'm hoping the new guidelines encourage them to because I think it's really difficult to have this conversation without something to look at to really visually illustrate those numbers.

CORNISH: If your doctor doesn't really initiate this discussion, what kinds of questions should you ask, right? I mean, this kind of relies on women thinking of their own family history, race or whatever and somehow divining risk factors. I mean, what should patients be thinking about?

LIN: Well, so the guideline that the ACS released was a guideline for average risk women who are defined as not having one of the breast cancer genes or not having a family history where you have several family members with breast cancer or a single member at a young age. So the rest of women are kind of lumped into this average risk category. And certainly there are things that may not be accounted for in risk assessment tools that may be important to someone. So I think a patient should go to their doctor and say, look, this is - you know, this is how I feel about mammography. This is, you know, my experience with cancer, my family history. Perhaps they don't like having to go for repeated tests. You know, I'm worried about false positives. I think they should also ask their doctor, well, you know, what are really downsides to this test? I mean, that's really I think the first question, you know, the doctors are always - we always volunteer the upsides but I think you have to ask specifically what are the downsides. And hopefully that will spark a conversation if your doctor seems otherwise inclined to gloss over it.

CORNISH: Well, what do you say to women who today are are frustrated, maybe even angry or upset, right, women who have had, like, annual mammograms for many years who've gone ahead with procedures that turned out to be unnecessary? I mean, was that a waste?

LIN: Well, it's probably not a large consolation, but, you know, unfortunately in science this is kind of the way that things progress. We do the best we can with the information we have at a given time. And the same thing sort of happened for prostate cancer screening in men. It used to be something that you started at age 50, you do it every year, and now there's organizations that say you don't do it at all, or if you do it, you have to be aware of the downsides. So it's something where it - I understand it can be frustrating to patients. But the greater error I think is to cling to an old guideline to say, well, we're going to dig in our heels and keep starting at age 40 and doing it every year and ignore the new guideline because that would be, I think, a worse mistake. Look, we have to operate with the knowledge that we have. And I think the ACS has very comprehensively summarized what we know about mammography at the present time and their guidelines reflect that knowledge.

CORNISH: Kenny Lin is an associate professor of family medicine at Georgetown University's School of Medicine. Dr. Lin, thanks so much for speaking with us.

LIN: You're welcome. Transcript provided by NPR, Copyright NPR.