Recently, I was part of a team that was caring for a woman with breast cancer. “Would I have fared better had I undergone mammography when I turned 50?”, she asked me. She is right because a neighbouring medical school is offering mammography on wheels—bringing technology to the doorsteps of rural women who cannot access healthcare. Over the years, the mammography team has picked up many early cancers. These women had their cancers cut and radiated, and they completed chemotherapy. Everyone—the mammogram team, the surgeons, the radiotherapists, the oncologists, the patients and their loved ones—seemed happy. After all, but for the technology, their cancers would have taken longer to be detected.
I am not a cancer doctor. I know little of what, when, how, where and why of breast cancer. Women believe—a belief fostered by doctors—that regular mammography screening may reduce their chances of dying from breast cancer. The logic is simple. Mammograms detect cancer when they are small—too small to be detected by palpation. Thus, if we pick up small cancers, hit them early and hit them hard, they might go. And women would have a higher chance of living longer compared to those whose cancers are chance detected.
Epidemiologists tell us that this logic is flawed. They use three terms to explain this. Lead time bias, length bias, and over-diagnosis. Put simply, the technology might not help women fulfil their wish list—living longer and living better.
I stumbled on an amazing infographic when I began to read the benefits and harms of mammography. It made me understand the pluses and minuses of mammography. Also, it answered the question: Do women with screen-detected breast cancer survive longer compared to those whose cancers are picked up randomly? Please have a good look at the numbers and decide for yourself if this indeed is the case.
Visualise a hypothetical scenario. I got this infographic translated in Marathi. I have it pasted in the waiting hall of the Radiology department equipped with a mammography machine. We ask a social worker to explain the picture to women referred for mammography. We simplify the jargon. We present the evidence visually. We put faces to these numbers. Women are given plenty of time to decide—should they, or shouldn’t they. And after they are truly informed, we count the number of women willing to endure mammography.
I am not sure. But I would like to test this idea on a small sample in my setting.