The podcast episode discusses the controversy surrounding breast cancer screenings, specifically mammograms. The guest, Dr. Elmore, an expert on breast cancer screenings, argues that while mammograms can detect cancer, the benefits are less than previously thought and there are real harms associated with them.
The American Cancer Society, US Preventive Services Task Force, and the American College of Physicians have all recommended giving mammogram screenings less frequently and beginning them later in life. This is because the number of lives saved by mammograms is much smaller than most people think.
Dr. Elmore explains that while mammograms can detect cancer, they can't tell the difference between types of cancer. Some cancers grow so fast that mammograms can't catch them in time, while others grow slowly and would never kill you. This means that mammograms can sometimes lead to unnecessary treatments, including chemotherapy, radiation therapy, and mastectomy.
Dr. Elmore also discusses the issue of false positives, which occur when a mammogram shows something suspicious when the woman doesn't even have cancer. This can be very stressful and can lead to overdiagnosis.
The US Preventive Services Task Force recommends talking to your doctor in your 40s about whether you want to start screenings. They suggest getting them every two years starting in your fifties, when the benefit is more and the harms are less.
Despite the controversy, Dr. Elmore emphasizes that the treatment of breast cancer has significantly improved over the years, with the mortality rate dropping significantly. Most women with breast cancer can now be cured regardless of whether the cancer was detected on a screening exam or not.
1. The conversation is between a doctor named Dr. Elmore and a woman named Rachel.
2. Rachel has a lump and seems concerned about having cancer.
3. Dr. Elmore reviews Rachel's medical records, which indicate she is 35 years old, has no family history of breast cancer, and no risk factors.
4. Based on this information, Dr. Elmore does not recommend a mammogram screening for Rachel.
5. Dr. Elmore is joined in the conversation by Adam, a professor at the University of Washington and an expert on breast cancer screenings.
6. The conversation touches on the changing recommendations for breast cancer screenings over the past few years, with organizations like the American Cancer Society, the US Preventive Services Task Force, and the American College of Physicians now recommending less frequent screenings and starting them later in life.
7. The discussion highlights the potential benefits and harms of mammogram screenings, including false positives and overdiagnosis.
8. The conversation concludes with the suggestion that if Rachel does feel a lump or notice any changes, she should go to her doctor for advice.
9. The US Preventive Services Task Force recommends discussing the decision to start screenings in the 40s and then getting them every two years starting in the fifties.
10. The conversation ends with a positive note on the improved treatment of breast cancer.