"As part of breast cancer awareness month, a 40-year-old anchorhad her first mammogram on morning television. And last week the anchor, Amy Robach, underwent a double mastectomy after announcing she had cancer, and saying -- in front of 5 million viewers -- that "having a mammogram saved my life."
And I feel the obligation to point out that other possibilities are more likely.
To understand why, you need to know how doctors now think about cancer: in terms of turtles, rabbits and birds. The goal is not to let any of the animals escape the barnyard pen to become deadly. But the turtles aren't going anywhere anyway. They are the indolent, nonlethal cancers. The rabbits are ready to hop out at any time. They are the potentially lethal cancers, cancers that might be stopped by early detection and treatment. Then there are the birds. Quite simply, they are already gone. They are the most aggressive cancers, the ones that have already spread by the time they are detectable, the ones that are beyond cure.
Before I go through the other possibilities, let me be clear about something: I know Robach has been through an emotionally gut-wrenching month. I know she is worried about her children. I know her parents are worried about her. And I truly hope the mammogram served a purpose -- that it saved her life.
It is understandable that any woman with a screening-detected cancer would want to believe this. But all women contemplating mammography should understand the other possibilities.
One possibility is that it could not save a life, that the woman will ultimately die from her disease. Thankfully this possibility is the least likely. Yet in every trial of screening, some women die from breast cancer despite its being detected early. It's not the mammogram's fault, it's the bird's fault. The birds are the reason why the rate at which women present with metastatic breast cancer in the United States remains unchanged, despite three decades of widespread screening mammography.
Another possibility is that early detection was unnecessary -- that she could have done just as well had her cancer progressed to the point she noticed a breast lump. Doctors are getting pretty good at dealing with rabbits. While the news media tends to focus on screening, the bigger story in breast cancer is the dramatic improvement in treatment over the last 20 years. Ironically, the better we are at treating breast cancer -- the less important it is to screen for it.