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Mammograms not end-all

Mammograms have reduced the mortality rate of breast cancer patients by 30 to 40 percent, which is noteworthy. Yet, this method of screening is far from perfect. Mammograms can miss up to a third of breast cancers and have an even worse record among women who have dense breast tissue.

Mammograms are fairly inexpensive and remain the most common option for early detection. But many women require more expensive imaging options, and their insurance won't pay for it as initial breast screening in asymptomatic women. We hope ongoing research that compares traditional mammograms to ultrasound, and other studies that compare digital mammography to analog mammography, will encourage insurance companies to give women more options for initial screening.

Women 40 and older should have a mammogram each year. Despite its limitations, mammography often detects the earliest and most treatable form of breast cancer, ductal carcinoma in situ. Interestingly, this is a cancer that ultrasound often misses. This suggests there is an ongoing need for mammography, but it could be easily argued that patients have different imaging needs for initial screening, and that insurance companies should not be so rigid that they strictly limit patients' and caregivers' choices.

This is particularly important because of great strides in breast cancer diagnosis and treatment during the past 25 years. In the mid-1970s, breast cancer usually meant removal of the entire breast, underarm lymph nodes and skin and muscles underneath the breast. Now, many women are candidates for lumpectomies and can reduce the risk of breast cancer with therapies such as tamoxifen, and with lifestyle changes.

Although heart disease kills more women than breast cancer, more than 200,000 American women are diagnosed with breast cancer each year. Nearly 40,000 women annually die from it.

Obviously, women would like to have every diagnostic tool at their disposal. However, health insurance coverage cannot be a free-for-all. But as research documents the benefits of various forms of diagnostic tools, patients deserve the benefit of those tools that can detect cancers early, when they are more easily treated.