Editorial

Risks vs. Benefits in Breast Cancer Diagnosis

From the moment of birth we faceinnumerable risks that not only threatenour existence, but also carry the potential of temporary or even permanentinfirmity.

To avoid most risks one would haveto take to the bed—a considerable circulatory risk in itself—and shun normalactivities.

We eat to survive, yet run the riskof aspiration pneumonia with everyswallow. We ride in automobiles to ourplaces of work, thereby running the riskof collision. We play at games to giveus much needed exercise, risking asimple fracture or even quadriplegia.Thousands of other examples readilycome to mind, confirming the fact thatone cannot live without risk.

Of course, we must decide to acceptor reject these risks in determining theconduct of our lives. Some are ofquestionable benefit and requirethorough evaluation; some are so obviously foolhardy that they warrant nomention.

Recently, concern has been expressed about the carcinogenic risk ofradiation exposure secondary to diagnostic mammography. Unfortunately, apremature distribution of information toa widely read syndicated columnistsuggested that periodic mammography

will produce, in the next 30 years orso, as many breast cancers as it willsave. This report has already discouraged some women from undergoing notonly annual screening mammograms,but has also kept women from havingmammography when clinical findingsdictate the need. It has even unintentionally frightened some women awayfrom centers where mammography isused. At a time when continuing emphasis on early diagnosis of breastcancer is essential to improve survivalrates, too many are joining the bandwagon crying doom and disaster, but accomplishing nothing.

Regarding the report and the suddenfanfare, let it be known that the concernnow being expressed is based on athree-year-old evaluation of data soscanty and conclusions so tentative thatextrapolation into uncertain, futurepredictions is simply not warranted.Why has it taken three years to bringforth these predictions? Why has somuch confidence been placed in a document which merely points out the needfor further study?

This is not meant to demean theimportance of reducing even further theradiation exposure used in diagnosticexaminations. We have all seen theunfortunate results of poorly controlled

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radiation exposure in the past. However, the radiologists and radiationphysicists of today are vigilant aboutunnecessary exposure to ionizing radiation and are doing everything possibleto keep dosage to the minimum required for accurate diagNosis.

The risk of mammography in experthands may well have been overstated,sensationalized and misunderstood bynot emphasizing the lack of concreteinformation. We can only hope that nottoo much damage has been done tothose women who, in fear, are neglecting to have examinations which diagnose bseast cancers in a readily curablestage.

We cannot easily lay. aside theknowledge that in the United Statestoday one of every 15 women will get

cancer of the breast, or that every. 15minutes three women develop breastcanoer and one woman dies of thisdisease, or that breast cancer is-Sthenumber one cancer killer of Americanwomen. We are just beginning to demonstrate at the community level thatmammography is capable of detectingextremely early, nonpalpable breastcancers in older women, and even inthose under 50 years of age. The useof mammography in conjunction withother methods now offers the promiseof significantly improving what hasbeen a relatively constant mortalityrate.

Surely we all agree that it is important to avoid needless risks. Let us alsoagree to avoid needless deaths due todelayed diagnosis.

4/L4 i.4i/d0 M.D.

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