In the following article highlights studies done that indicate the radiation from mammograms (used to detect breast cancer) can lead to a high risk of breast cancer.
After reading the article and thinking about all sides presented, do you think it would be ethically to use mammography to screen for breast cancer in younger, higher risk, patients, even if it meant their chances of getting breast cancer in the future? Why or why not?
[Submitted by Caren Steinway]
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Before making a conclusion, it is important to note that this article is not conclusive and further tests need to be done before drawing a definitive conclusion on mammographs.
ReplyDeleteAs with may high-risk procedures, this screening would have to be evaluated by the patient that would normally go in for the breast cancer procedure testing. If the patient has a relatively low risk of developing breast cancer, then they probably should not get tested at a young age and continuosly. They should wait till they think they are at a high risk and at an age where advancing their possibility of breast cancer isn’t as important as defining the possibility itself.
Individuals with a high risk should consult their doctor because their medical knowledge will probably help in a decision based on scientific information with the patient’s well-beng in mind. It is the doctors duty to do the best procedures for their patients. At the same time, financial gains might have them encourage patients to get more testing done, even though the risk factors might be high. so the patients needs to consider the potential of bias in this stakeholder.
At the end of the day, the patient needs to use their autonomous power and all the resources allocated to them to come to a conclusion based on their health and personal feelings and opinions on their health. This should be evaluated like all high-risk scientific tests. The patient needs to know the facts, have informed consent, and make a researched autonomous decision that they think will benefit them the greatest.
It would not be ethical to deny this test, if it can help a large amount of people (utilitarianism-greatest good for the greatest amount of people) unless an alternative low-risk test was offered that could do the same good. At this point, the harms are not fully known so denying the test would not be ethical,but patients should certainly be made aware of the possibility by their medical care providers and look for more information about the procedure in the future, particularly if they are at risk for developing breast cancer, or get many mammograms done.
Gellena Lukats (blog post 6)
I think it is important to remember that early detection of cancer can improve treatment of cancer and prevent cancer from spreading. Early detection is an important factor in preventing death by breast cancer. Mammograms are the most accurate early detection system that we currently have in place. There may be risk when exposing someone to the radiation of a mammogram, but it has not been definitively proven how dangerous this exposure is. This article is inconclusive on how dangerous mammogram exposure is. Unless the risks of exposure outweigh the benefits of early detection then mammograms should continue. This article may bring some awareness to make sure testing is truly necessary. If someone is not in a very high-risk group than it seems unnecessary to expose that person to radiation before the age of twenty. The article may also bring some thoughts on regulating radiation to space the tests accordingly so women are not being tested more often than necessary and receiving excess exposure. This article brings some attention to a potentially harmful practice but until there is more concrete information, I think it is most useful in encouraging people to make informed decisions when choosing to get screened, but I do not think this is a reason to significantly reduce mammograms overall. Olivia Thomas
ReplyDeleteAfter just listening to a lecture in an epidemiology class from an M.D. who specialized in breast cancer etc, it is clear that there is a huge controversy between early preventative measures before the age of 50, and the possible risks and benefits associated from annual mammography screenings early in age than 50. Although the U.S. Preventative Task force issued "guidelines" suggesting that early screening be kept to an individual case by case basis and for those with a genetic predisposition, their findings should not discourage people from having discussions with their doctor and being proactive with their own preventative health. A staggering 1/3 of the population of women in the US currently never get a mammogram, and what is to say that these new "guidelines" that further push back the suggested age for screening would discourage MORE people from getting screened. Is it ethical to market inconclusive evidence related to early breast exams, when earlier detection means most often a longer life span?
ReplyDeleteAlso, if one was to look at the cost-benefit analysis, discovering breast cancer early on in life would be much less costly than procedures done when dectection was found when the cancer was already stage 4 etc.
However, from the opposing view, one must look at the utalitarian principles of ethics that would agree that the costs to provide these extra tests to women before the age of 50 would be more expensive than it is worth for the sake of catching only 3% more cases.
In general, it should be the individual's autonomous decision whether or not to pursue a mammogram screening at an earlier age, but understand that there is a chance for false positives or false negatives that is increased with younger age groups. As long as women are given informed consent about the benefits and drawbacks, and are not coerced by doctors based on review articles that have inadequate data or insurance companies that refuse to cover screenings, it will be ethical to maintain the previous governmental guidelines for breast health. -Alex Pitkin
I think this article is all about options. A patient, who happens to be in the more at risk category of breast cancer should have the option of getting tested earlier than the recommended age. However, this patient should be aware of the suspected radiation drawbacks of this mammogram. This article does not state how dangerous or how bad the effects can be. A patient should be presented with all the information when making a decision, without any physician interference.
ReplyDeleteEarly detection plays such an important role in the long run of a patients health. If a patient does not appear to be in a high risk category then possibly they should refrain from exposing themselves to radiation. But they should also be able to pose the option of being tested early, if this is something they want. As long as a patient is aware and able to comprehend all aspects of the mammogram, she should be able to receive a mammogram early disregarding the ethical implication of the 'radiation' effects.
I think there are two sides to this argument. As of now mammograms are the best screening tool that we have to screen for breast cancer. I think that before there is any replacement or improved screening test that women should continue to get mammograms at the currently recommended age rather than waiting. In the case of cancer, the benefits of the mammogram greatly outweigh the small possibility of misinformation or potential risks of the procedure. That being said, however, women must understand that mammograms are just a SCREENING test not a DIAGNOSTIC test. Because the test is highly sensitive it often picks up cysts or other non-malignant tumors or tissue growth in the breast. If a woman is screened and told that her mammogram results were troubling this would obviously cause anxiety to her when in reality the test could just have shown a false positive. The woman should be informed of this fact so as to lessen the anxiety that she may feel. However, doesn't this small anxiety outweigh the risk of not catching cancer earlier and treating it? Who is to decide whether a woman should get a test just because it could cause a false positive. If a woman is informed about the procedure and knowns that the test results are not always accurate then it should be her decision as to whether she wants the screening test or not. Of course it is the doctors obligation to give advice as to whether he or she recommends the test but I think that the decision as to when to start having mammograms is up to the woman. It violates a woman's autonomy to tell her that she can not have an available screening test that could potentially catch a fatal cancer.
ReplyDeleteAlso, there is the question as to whether it is ethical to have these suggestions about screening tests all over the news before experts have made a conclusive decision. The recent news articles may turn many women away from having a test when it could actually benefit them and then later they find out that they have a cancer that can no longer be treated when it could have been treated at an earlier stage because they were advised not to get a screening test. I think that until we have a better solution that women should continue to get these screens and should not be scared away by media with information that they probably do not understand. The media is telling people to speak with their physicians about whether they need early detection or not or if they are high risk or not. However, not all women have PCPs who know their history or have PCPs at all.
Finally, insurance companies may now use this so called data or evidence to stop paying for mammographies before a woman reaches a certain age. This again violates her autonomy as she can not get a test that is available and could potentially save her life.
Sarah Puklin
After reading the article one of the most important facts is that these are high risk patients that we are talking about. They are patients that are more likely to get breast cancer than the rest of the population. Although the article may talk about the risks of getting such frequent mammograms, I think that one of the things the article fails to mention is how important early detection is in fighting breast cancer. Having high risk patients have more mammograms may increase their chance of getting breast cancer, but since they are high risk patients who is to say they won't get breast cancer anyway? If these patients do get breast cancer, how important is early detection? Because if early detection is very important, then I find it hard to argue that these patients should stop having such frequent mammograms. These tests could provide early detection which could be the best chance to beat breast cancer. And I think that will continue to make these tests important, even if they are potentially risky. -Joyce Ganas
ReplyDeleteI think it would be very premature to call off mammograms in younger, high risk patients based off this article. As other people have pointed out, the results are not conclusive and further studies would be necessary to make a strong argument for not performing mammograms on this population. Screening tests are not perfect and mammograms are no exception, with both false positives and false negatives occurring. These results can be damaging to the patient, just as the radiation from the mammograms can be damaging. However, the benefits of screening out weight these possible downfalls. There is always the possibility to improve on current technology, so I am sure screening for breast cancer will continue to evolve over the years. However, at this point in time mammograms are the best screening tool, even when considering any cons, and as such must be used appropriately.
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