Too risky not to have breast exam

By Dr. Kyle Miller

Special to The Capital-Journal

I am a mammographer, a radiologist whose job in part is to read mammograms. I understand the limitations of the exam and am aware of the terror we not infrequently strike in the hearts of our patients. I know that as many as 10 percent of malignancies are occult --- invisible --- to mammograms. They hurt, they are embarrassing and when detected the cancers are not as easily treated as disease of the thyroid or a basal cell skin cancer.

Neither is melanoma. Or colon cancer. Or cervical cancer. But I do not see the newspaper running half-page diatribes suggesting women stop enduring annual pap smears. I do not see The Capital-Journal standing even "unintentionally" behind a move away from tests for colon cancer. And while many prostate cancers are indolent --- slow growing --- I do not see the editors and writers suggesting they would roll the dice that their elevated PSA is nothing to worry about. Not when (in this season of basketball) the memory of Jimmy Valvano and what he suffered before dying too young is still so vivid.

There is not a perfect test in medicine. Sorry, we wish there was.

No, there is no guarantee in life. But Dr. Lazlo Tabar, a Scandinavian physician dedicated to improving women's chances of surviving breast cancer in a country where nationalized medicine is in place with a focus on the patient and not economics, has years of accumulated data, not a handful of findings that fit someone's preconceived notion.

His findings demonstrate clearly and unquestionably that regular screening mammography reduced mortality in women as a whole. Does that mean an individual will be saved? We hope so. But she certainly won't if she does not have the exam. And the irresponsible fluff that was passed off as fact on the recent Health page gives every woman who is looking for a reason not to endure that exam a little push away from taking care of herself.

There are too many negative messages for women as it is. Telling them the blatant lie that "cancer in your breast may never grow or spread or kill you" is like telling them, "There is only one bullet in this gun. Go ahead, put the barrel to your temple and pull the trigger. Everything might be OK."

To those who suggest the physicians interpreting mammography are pushing the exam because it's lucrative, mammography is the highest malpractice risk in radiologic practice. There is certainly nothing pleasant about giving women bad news --- even only that they must return for additional pictures. And the reimbursement in some cases does not cover the cost of the exam.

It is an ungainly, imperfect exam fraught with difficulties and pitfalls, But it is the best choice available at this time.

Mammography detects cancers before they spread, so they can be removed, and patients can be cured. Those who read the exams and the invaluable technologists who take the images, do so out of concern for their patients.

I wonder if the same can be said of those who want to argue that your wife or mother or daughter --- or you --- should not have the chance to beat a disease that could otherwise take away everything you hold dear.

Kyle Miller, M.D., practices with

Radiology & Nuclear Medicine in Topeka.

Copyright 2002
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