On Mammography and Hormone Replacement Therapy

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On Mammography and Hormone Replacement Therapy

Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2017, Vol 1, Issue 1

Abstract

About 250 years ago, French philosopher Francois-Marie Arouet Voltaire, wrote: “Doctors prescribe medicine of which they know little, to cure diseases of which they know less, in human beings, of which they know nothing”. Has this state of affairs changed very much since then? I believe so. However, many would argue “hardly”, aside from new technological advances and certain heroic surgical procedures. Our model continues to be population-based (also known as “mass medicalization”) rather than patient-centric. Further, notwithstanding the current dogma on “evidence-based” medicine, meaning that the health care provided is based on solid scientific evidence of utility, a large proportion of tests and prescriptions used frequently have little or no such supportive evidence. Another flaw of today’s “evidence-based” medicine is what has been termed “eminence-based” medicine wherein experts make recommendations or “guidelines” for a large proportion of decisions for which no or minimal data exists. These guidelines have a pronounced impact, as they are believed to represent the standard of care, even though they are based on opinion with a paucity of facts. Actually, even the prestigious U.S. Institute of Medicine concluded that “any valid evidence supports “well below half” of the practice of medicine (!)”. Examples abound such as, statins and statin combinations, prostate specific antigen tests, mammography, hormone replacement therapy, etc., I will discuss here mammography and hormone replacement therapy, which are of particular importance in women’s healthcare. Mammography for breast cancer screening for women parallels the prostate specific antigen (PSA) test in men. This imaging test uses low-energy X-radiation to examine the human (female but also male) breast. It is used both as a screening and a diagnostic test. The goal of any screening procedure is to examine a large population of patients to find that small number most likely to have a serious condition. These patients are then referred for further, usually more invasive, testing. Thus a screening exam is not intended to be definitive, rather to have sufficient sensitivity to detect a useful proportion of cancers. The cost of higher sensitivity is a larger number of results that would be regarded as suspicious in patients without disease. In mammography, the goal is the early detection of breast cancer through the detection of characteristic masses and/or micro-calcifications. Its use as a screening tool for the detection of early breast cancer in otherwise healthy women without symptoms is controversial. Like all X-rays, mammograms use doses of ionizing radiation (lower than those employed in bone radiography) to create images that are subsequently analyzed for any abnormal findings.

Authors and Affiliations

Alain L Fymat

Keywords

EP ID EP567077
DOI 10.32474/IGWHC.2017.01.000101
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