Oddbean

I’m a radiologist. Today was all breast imaging and intervention. Mathematically, it’s by far the most lifesaving thing I do. Almost everything else is salvage work well after shit’s already gone wrong.

FYI: about 1 in 10 screening mammograms will be read as positive. Most of these are false positives. Roughly 1 in 12 women will be diagnosed with breast cancer at some point during life (more if you include died with breast cancer). Mammograms find about 5 out of every 6 cancers. Thus, about 1 in 70 women will feel a cancer we don’t see. About half of these are cancers we will never see regardless of size and the rest are too small to see compared to background. In short, breasts are dangerous and imaging can’t save everyone…self exam matters…things that grow and grow and grow require an answer when the get to be about the size of half you thumb even if we can’t see the problem by mammogram / ultrasound (usually by surgical excisional biopsy or sometimes via MRI).

Wow that’s an incredible scary number! Personally I could do without them if that’s what it takes to be safe. I for the life of me can’t do self exams, usually get my GP to do it(she’s a female), but haven’t felt anything thankfully. But apparently at my age I need to get a scan done, which I’m kinda nervous and putting off, yeah I know I shouldn’t so I’ll have a wine for Dutch courage and get it done.

Mammo ain’t perfect. But that doesn’t mean it’s worthless. A lot of organizations dislike how much gets spent on women and some make slightly bullshitty pussy foot recommendations regarding imaging…like don’t start until age 50 or every other year is just fine…in a mathematical sense, they’re not wrong there just not maximally right. It all depends on how much value you attach to a woman’s life… I also do all the prostate MRI in my county. You’d be amazed at how much gets spent to keep male sexual function intact in comparison to early breast cancer detection (on a per person basis…prostate cancer is more common, but far more common to die with rather than of).

Nobody will know your lumps better than you. Pea size shit we rarely find anything to correlate. But marble size we usually do. Common sense must prevail. But often is lacking clinically…in the modern era, too many clinicians expect more from mammogram than is reasonable and as a consequence make stupid choices for the not rare cancers we can’t see but they could feel if they bothered.