Yerramilli: Against mistaken mammogram arguments

On Nov. 9, News staff columnist Leah Libresco ’11 published a direct rebuttal of the views presented in the Yale Herald’s coverage of Breast Cancer Awareness Month, as well as my own opinion editorial on mammogram recommendations. Libresco grossly misrepresented the fundamental claims of my piece. My point was not that we should advocate mammograms at all times. Rather, we should not allow policy changes based on faulty science. Furthermore, we should ensure that patients have access to the information that will facilitate informed decision-making. These issues transcend the specifics of the mammogram debate and are relevant to basic medical and political ethics.

Libresco correctly contends that we should “stop using words like ‘cold-blooded’ and ‘calculating’ to discredit scientists.” Yet the mammogram debate is not, as Libresco suggests, a fight between anecdotal emotion and empirical truth. The questions at the center of the controversy are, in fact, of statistics, ones that do not fall in her favor. Despite several New York Times reporters’ and politicians’ claims, recent scientific studies have merely questioned, not disproven, the efficacy of mammograms. If we are to prioritize the presentation of unbiased facts, as Libresco strongly advocates, then our first target should be those media outlets and public figures that mislead their readers. In an effort to garner attention, media hounds have manipulated science with catchy, oversimplified and controversial headlines that suggest that mammograms are ineffective, regardless of the wealth of scientific evidence to the contrary. This egregious misrepresentation is exemplified by the Times’ article, “Mammograms’ Value in Cancer Fight at Issue.” While the Times piece detailed data that supposedly “prove” the low efficacy of mammograms, the author did not explain that the particular study’s innumerable limitations were mentioned in the original scientific journal article. The mammogram controversy is not derived from a cost-benefit analysis based on knowns, but rather, behavioral recommendations based on a few, unreliable studies.

In her piece, Libresco requests statistics regarding breast cancer misdiagnoses, so I will provide some estimates. According to the Radiological Society of North America, women between the ages of 40-49 have a 30 percent chance of receiving a false-positive mammogram. After an additional mammogram or ultrasound, a misdiagnosed woman has a 7-8 percent chance of having a breast biopsy. Yes, this sounds worrying. But according to several scientific studies, including one conducted by the Baylor University Medical Center, the general misdiagnosis rate for all medical procedures is 40 percent. Approximately 10-12 percent of these cases are significant enough to cause death. Furthermore, the leading misdiagnosed ailment is not cancer, but heart disease. If misdiagnosis is a problem across the spectrum, should the fear of false positives or negatives deter us from obtaining any diagnostic test?

I believe the answer is an emphatic no, but I appreciate that every woman has the right to weigh the costs and benefits of testing. To me, the discomfort or stress of a mammogram, the relatively small radiation exposure, and any biopsy thereafter are worth the prevention of breast-cancer related death. The fear of unwarranted treatment is minimal, as the percentage of women who wrongfully undergo chemotherapy is, at most, less than 2.4 percent of all women who receive mammograms, but is probably substantially lower. The heart-wrenching anecdotes about unwarranted medical bills and days off from work are rare; they should not inform policy decisions any more than the low statistics do. For other women, the trade-offs may not seem as clear as they do to me. The most we can do, therefore, is to ensure that each patient form an educated opinion. This will not happen by discouraging doctors from discussing the options earlier, as the U.S. Preventative Services Task Force recommends.

Libresco does not neutrally represent the science any more than those whom she criticizes. Considering Libresco’s vilifying remarks, which support policy changes that lack grounding in evidence, the title of her piece, “Against action-packed arguments,” is far more appropriate for my Herald op-ed than it is for hers.

Pooja Yerramilli is a junior in Ezra Stiles College and the Advocacy Chair of Yale Colleges Against Cancer.

Comments

  • River Tam

    Libresco fails to grasp that there’s an unbalanced utility curve at work here. High rewards for catching breast cancer; fairly low downside to a false positive.

  • nickss

    A great response to a misguided piece by Libresco, thanks Pooja.