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[docorion]

An essay in this month's Health Affairs is compelling reading, at least for folks like me. In brief, the author describes the reasons why she, despite a positive family history, does not get an annual mammogram.

The following paragraphs encapsulate the argument nicely, I think:

"If 2,000 women are screened regularly for ten years, one will

Comments

[docorion]

That's a diagnostic mammogram, and needs doing. The discussion which is generating all the heat is about *screening* mammograms. You had a diagnostic mammogram, which is a different beast. (Difference: you had an obvious lump or other reason to get a mammogram; this gives you a higher probability of disease right out of the gate. And "probability of disease" is a factor in the equation which governs the predictive value of a test (any test, not just mammograms).

And as for testing-true, they don't operate or radiate without testing-but you assume (as do most people, including physicians) that the tests are infallible. They are not. *No* test is infallible; they all have a sensitivity, a specificity, and a positive and negative predictive value.

And there is some question, especially for breast cancer, whether the test is even as good as we think it is. The volume of testing done mandates a high volume methoidology, and when you move to that, something tends to suffer. (Consider: would you like McDonalds, or a burger made by hand at a nicer place than McDonalds? Both are beef patties fried on a griddle, but one is almost certain to be better than the other. So with testing; high volume has certain tradeoffs, and we're not sure what we've traded away is worth it).

So had you asked my advice at the time (and likely we didn't know one another), I'd've recommended you stay in the Koningkrijk der Nederlanden, which has talented doctors who know what they're doing, and had your workup done there.