Friday, June 22, 2012

Watch this TEDTalk

NY Breast Density Inform Law Heads to Governor Cuomo's Desk.

If you have not seen it yet, you really should take a few minutes watch this TEDTalk by Deborah Rhodes that is like a crash course on the subject of breast density and the politics surrounding it.

The actual topic of her talk is a new diagnostic tool called Molecular Breast Imaging (MBI) that is far better than mammography in detecting cancers in women with dense breasts--it finds three times more tumors. But a lot of what she discusses is very pertinent to the breast density legislation that is on Cuomo's desk.

Will the MBI replace the mammogram someday? It's too early to say. Breast imaging specialists point out its limitations:  you can't biopsy from an MBI, but Rhodes counters that radiologists have always been able to localize the area with another technique once it is identified.  Regarding radiation, the effective MBI radiation dose to the body is about twice as high as the mammogram dose, but the MBI dose to the breast is actually less than the radiation dose from a mammogram. Dr. Rhodes says: "What that means for long-term breast cancer risk associated with this radiation is not known."

Dr. Rhodes advocates this tool over the ultrasound for women with dense breasts, while another hero of mine, Dr. Tom Kolb, prefers the ultrasound. What they both agree on, however, is honesty. Right now, what is important is that women with dense breasts get some form of supplementary imaging beyond the mammogram, be it ultrasound, MRI, or MBI. As we know, supplementary screening in Connecticut has doubled detection of invasive cancers. As Dr. Rhodes says, of course we should be telling women their density.

Doctors' orgs actually argue that being honest with women with dense breasts about the limitations of mammograms will discourage women from getting mammograms, and therefore should not be done. This is highly unethical, and denies women informed consent. (It's also insulting to women.) Doctors should not withhold material medical information from women for marketing reasons, or any other reason.

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