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IFRA SOHAIL
Mammogram is useful for early detection of cancer, but it also has several risks (National Cancer Institute, 2023).
Exposure to Radiations:
Mammography screening uses X-rays of low dose to picture the tissues of the breast in which women are exposed to the ionizing radiation (National Cancer Institute [NCI], 2023). The radiation dose is relatively low in a single use but still doing it multiple times increases the risk of radiation induced breast cancer development commonly in the younger women (NCI, 2023).
In radiation induced breast cancer, cell DNA can be harmed by radiation, particularly ionizing radiation (such as the X-rays used in mammography). Mutations, or alterations in the genetic material of the cell, can result from damage to DNA. Cells may start to grow out of control and develop cancer if enough mutations occur in significant genes that regulate cell development and repair (NCI, 2023).
For women aged 40 and older, the mammogram becomes more useful than harmful. Research shows that for women aged 40 and older, the benefits of mammography outweigh the small risk of radiation-induced breast cancer (Sengwe, 2024). However, for younger women, repeated screenings increase the risk of developing radiation-induced breast cancer (Sengwe, 2024). That’s why it is necessary to balance things such as the advantages of early detection with the risks of exposure to radiation (Sengwe, 2024).
False Positive Test Results:
One of the risks of the mammogram includes false positives and its psychological impact.
False positive test results occur when a doctor observes something that appears to be like cancer, but upon further examination, it is not (Centers for Disease Control and Prevention [CDC], 2024).
This kind of situation leads to having more tests, which results in more time consumption, the use of more money, and inducing anxiety (CDC, 2024).
According to the research, from more than a million women, 77% of them whose results came as false positives went for the follow-up examinations, and 66% of the women with false positive results did follow-up examinations within six months (Higgins, 2024).
The women who experienced the recurrence of the false positives were more likely to show a greater degree of reluctance, and they also showed long-term stress for such findings. False positive test results occur in women who are young, have dense breasts, or have a family history of breast cancer. (Higgins, 2024).
Image Reference: false negative mammogram - Patricia Bowden-Luccardi
False Negatives and Dense Breast Tissue:
False negative test results in mammography screening occur when all the test results seem to be normal and perfect, but the cancer is present there (Abbott, 2024).
False negative test results occur commonly in women who have dense breast tissues. Just like the tumors or malignancies, the dense breast tissue appears to be white in color in mammograms, which results in difficulty finding the abnormalities (Abbott, 2024).
Dense breast tissue is found in nearly half of American women, which makes identification difficult and results in the rising rate of the cancer (Abbott, 2024).
In light of this, the FDA has now made it mandatory to include breast density information in the reports of mammography, advising women with thick breasts to think of getting further screening like ultrasound or MRIs. (Abbott, 2024).
Psychological Impact and Un comfortability:
Being physically uncomfortable is one of the most frequent risks that women suffer during mammograms (Wion, 2024). The psychological and emotional effects of such procedures are likewise negative. You have to remove your clothes and stand next to a machine during a mammographic screening (Wion, 2024). Any kind of jewelry, like earrings or necklaces, must be taken off. Anything like lotion or deodorant that might include metallic particles is restricted (Wion, 2024). You are then told to put one breast onto the machine by the technician (Wion, 2024). After that, the procedure begins, and the breast is pressed for ten to fifteen seconds with the help of a flat plastic plate. For many women, if their breasts are sensitive or bloated, this can cause pain and discomfort (Wion, 2024). Women with a higher risk of having cancer face a lot of mental and emotional stress. They go through repeated screenings without knowing what they are going to find out about them. This results in the increasing cycle of anxiety, which impacts those women psychologically. (Wion, 2024).
Image Reference: Study shows low rates of breast cancer overdiagnosis in mammography
Overdiagnosis:
Overdiagnosis causes the greatest harm.
Even though breast cancer was not previously believed to be life-threatening or to appear as symptoms like a palpable lump, it is today recognized in women and treated with surgery, chemotherapy, and/or radiation therapy (Welch, 2015).
Screening mammography is more likely to lead to overdiagnosis than to save lives (Welch, 2015).
The National Health Service in Britain now warns women that the harm of an overdiagnosis from a mammogram is approximately three times higher than the risk of survival from breast cancer (Welch, 2015).
The United States has been considered to have higher risks of overdiagnosis since the examination of early breast cancer was more thoroughly done there (Welch, 2015).
Overtreatment:
Mammography screening sometimes results in overdiagnosis, which then results in overtreatment (Paci & Duffy, 2005).
There are two common ways that could help overtreatment to occur. First is overdiagnosis. There is no need for treatment when a cancer is over-diagnosed (Paci & Duffy, 2005).
Treatment, particularly surgery, is frequently performed for safety reasons because doctors are not always able to predict whether a diagnosed breast cancer will spread or remain harmless (Paci & Duffy, 2005).
Second, even though they may not require it, some women with actual early-stage tumors undergo too harsh therapies, such as powerful chemotherapy (Paci & Duffy, 2005).
As an example, without treatment, the survival rate for tiny tumors (less than 10 mm) that do not involve lymph nodes is very high. Rather than using a one-size-fits-all strategy, treatment needs to be adjusted to the particular tumors. (Paci & Duffy, 2005).
Image Reference: The Silent Threat: Delayed Diagnoses of Breast Cancer | Blog
Delay In Diagnosis of Breast Cancer:
Delaying the diagnosis of breast cancer can have serious and harmful consequences. It can lead to the development of large-sized tumors and the higher chance of spreading the cancer (Lameijer et al., 2020). For the treatment to be successful, early detection of breast cancer must be done (Lameijer et al., 2020). Researchers have shown focus on the women who already have symptoms of breast cancer, the cause of delays in the diagnosis, but they did not show much attention towards the cause of the delay in the diagnosis of breast cancer that is found because of the routine mammography screenings (Lameijer et al., 2020). Studies have shown that after being diagnosed with an abnormal mammogram, some women wait for two or more years in order to confirm their diagnosis (Lameijer et al., 2020). These delays cause the tumors to grow. Some cancers spread quickly, and in the delaying procedure, the cancer spreads quickly and gets in the state where it becomes untreatable and life-threatening (Lameijer et al., 2020).
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