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This month’s Narrative Matters in Health Affairs (Why I Don’t Get Mammograms) is among the best I’ve read. Author Veneta Mason is a late 50s nurse practitioner whose sister died from breast cancer. Yet she’s consciously decided not to get mammograms anymore because she doesn’t believe early detection makes successful treatment more likely or extends life. To summarize her arguments:

• Cancer is horrible but metastatic breast cancer is just as treatable and deadly whether or not a patient undergoes routine screening. Even though she accepts her risk may be significantly higher due to her sister’s illness, it doesn’t matter if screening doesn’t make her treatment better or life longer
• It’s important to have a primary care physician who accepts her reasoning about screening
• Breast self-exams aren’t worthwhile, but if she happens to discover something she’s not opposed to following up and having a diagnostic mammogram
• It’s important to get multiple opinions if one is told there’s a cancerous lump. A second opinion is good and a third is better
• It’s a good idea not to rush into treatment
• If there are changes in medicine that make early detection more worthwhile, she’ll change her view
• She expects to die of something –and it could be breast cancer
• She won’t think less of someone who gets screening, especially since most professional and public opinion support screening
• She relies on the Nordic Cochrane Centre for guidance

I’m not a clinician and make no judgment about the specific medical perspective she provides. However, I worry about the strong embrace of excessive screening and diagnostic testing because of the negative consequences it brings, such as unnecessary –and in some cases damaging– treatments and fear.

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