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The Mammogram Debate: Two Doctors Discuss Why It’s So Complicated

Dr. Avrum Bluming is a medical oncologist and clinical professor of medicine at the University of Southern California. He is also a dear friend, scientist, and careful analyzer of data. I asked him to help me understand the current mammogram guidelines debate, and what women (now faced with conflicting recommendations) should do about breast cancer screening. Please listen to his fascinating discussion captured here:

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What I learned is that the guidelines must be tailored to each woman’s unique situation. The variables that must be considered are incredibly complex, as breast cancer risk factors include everything from when and if one has given birth, to a history of smoking, drinking, overweight, breast cancer in the family and even the age of your parents when you were born. Beyond risk factors, new research suggests that some breast cancers spontaneously resolve without treatment, but our technology is not advanced enough to distinguish those from others that will go on to become life-threatening tumors – so we treat all cancers the same.

Dr. Bluming did reassure me that the radiation exposure of mammograms is very low – about the equivalent of what one would get from about the equivalent of the cosmic radiation experienced during a round trip airflight across the U.S., and that having surgery (for a false positive biopsy) is quite rare.

When I suggested that the USPSTF guidelines more closely resemble European breast cancer screening strategies, so that maybe the US has been over-testing all along, Dr. Bluming simply responded that cancer death rates in the US are much lower than in Europe, probably because of more aggressive early detection.

He concludes: “I support healthcare reform, because the current situation is untenable. However with universal healthcare systems, cost cutting becomes the focus and screening tests are limited by necessity.”

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