Introduction
Mammography is a diagnostic procedure for examining women’s breasts to detect cancer and associated disorders. Mammography uses a low dose of X-ray radiations that create images during the process of screening in which radiologists analyze for any anomalous changes in the breasts. Mammogram is a very sensitive diagnostic and screening tool that detects early development of benign and malignant tumors thus enhancing treatment of the breast cancer in women. Increasing incidences of breast cancer in women has prompted medical experts to carry out massive education of women concerning the need of routine breast examination and early diagnosis of breast cancer. According to American Cancer Society (2005), early diagnosis and detection of breast cancer in women is very important in prevention and treatment of malignant tumors, which cause loss of unnecessary lives (p. 4). Thus, early diagnosis of breast cancer and associated disorders has saved many lives that occur due to the breast conditions. Usually, breast cancer and associated disorders affect older women of 40 years and above, but due to nature of diagnosis, many critics have reservations concerning the need to diagnose younger women. However, despite the importance of mammography in diagnosis of breast cancer and associated disorders, it has negative impacts on women.
Uncomfortable Procedure
Mammography procedure is very uncomfortable. This makes many women reluctant to seek the diagnosis. A woman has to prepare herself before undergoing mammography. The preparation involves seeking appointment with the doctor who ascertains varied clinical conditions that warrant examination. The doctor cross-examines the patient’s medical history, use of hormonal drugs, family history, and any current surgical procedure. Although this information is very critical for proper mammography examination according to medical experts, patients feel intimidated and coerced to reveal their secret information and therefore feel uncomfortable. Thompson (2009) argues that the long process of interrogating patients before undergoing mammography is very discouraging as it makes many patients to shy away (p. 5). Statistics have revealed that although about 70% of women are willing to undergo mammography procedure, about 30% are unwilling to proceed because they feel uncomfortable due to the nature of interrogation they receive from physicians. Although medical experts assert that cross-examination of the patients is very critical in establishing the course of diagnosis and subsequent treatment, it does not help in meeting the health care objective of increasing early and routine examination of breast as a measure of preventing breast cancers in women.
Moreover, as part of preparation, the women should not be in their menses nor pregnant. During the time of menses or certain period of pregnancy, women’s breasts are very tender and they will feel quite uncomfortable during mammography examination. To avoid such circumstances arising in the examination room, women need to come for mammography examination a week after their menses. Furthermore, they should consult the doctor on the extent of pregnancy period to qualify for the examination. In addition, women should not apply talcum powder, deodorant and lotion or other cosmetics on their bodies on the day of examination for they affect the integrity of diagnostic results. Performing mammography is the most uncomfortable procedure that requires women to change their clothing to a loose fitting gown for examination. During examination, a technologist positions a mammogram platform on the breast. The technologist compresses the breasts to flatten so that the radiations can penetrate and give the right image. Viewing and handling of breasts by technologists makes women uncomfortable. According to Thompson (2009), since many women have very sensitive breasts, mammography examination inflicts pain during compression (p. 10) Thus, if a woman feels pain or becomes uncomfortable in the first mammography examination, there is a very low probability that she will attend subsequent routine examinations.
In spite of the fact that mammography procedure is very uncomfortable procedure that women undergo during medical examination, medical experts perceive it as a necessary procedure that ensures effective diagnosis and treatment of breast cancers and associated disorders. According to American Cancer Society (2005), medical and family histories are the sources of critical information that are essential in deciding the course of diagnosis and treatment of breast cancers (p. 7). Thus, the patients need not feel intimidated and coerced into revealing personal information for unjustified reason. Regarding the issue of privacy and pain during the procedure, medical experts argue that health condition of a patient is paramount and all other issues should follow. They assert that privacy and minimal pain of compression cannot outweigh the great benefit of diagnosing and treatment of cancer. Hence, uncomfortable procedure of mammography does not warrant women to avoid undergoing breast cancer diagnosis and routine examination.
Harmful Radiations
Routine mammography examination predisposes women to harmful radiations that have detrimental effects on their breasts and health. Although mammography exposes low dose of radiations during examination, cumulative exposure to the same radiation for over long period predisposes women to develop other complicated types of cancers. The ionizing x-rays of mammogram have ability to interfere with the genetic material in the breast, thus triggering abnormal growth of cells, resulting into development of benign and malignant tumors of the breast. Medical experts recommend that x-ray radiations should be minimal but this depends on the size of breast tissue that requires examination because thick breast tissue requires higher dose of radiation as compared to thin breast tissue. Hence, variability in the dose of radiation and the extent of exposure due to routine examination pose great risk of developing other cancers. Brenner, Sawant, and Hande (2002) found that routine mammography exposes women to hazardous radiations because low dose radiations have high per unit dose as compared to high-energy gamma rays or x-rays (p. 1065). This means that regular exposure to low dose x-ray radiation has cumulative effect that eventually leads to mutation of the genetic materials and subsequent development of breast cancer.
Realization of the fact that mammography radiation predisposes women to breast cancer and other types of cancers, medical experts have recommended that mammography is appropriate to women who are above 40 years; they have high incidences of breast cancer. The breasts of young women who are below 40 years are very sensitive and still very delicate to endure ionizing effects of the low doses of x-ray radiations of mammography. Miller (2010) argues that, since high incidences of breast cancer begin to emerge at the ages of 40s, Preventive Service Task Forces of the United States recommends that routine mammography programs should be available to women of above 40 years, and provided with risk factors association with mammography so that that they can make informed decision (p. 3). Hence, the decision lies on the hands of women for them to weigh whether to risk their lives by undergoing routine examinations or saving themselves from impending threat of breast cancer. In one hand, medical experts are distancing themselves from the harmful effects of radiations, but on the other hand, they are very responsible for the treatment of breast cancer. Thus, harmful radiation due to low doses of x-ray radiations is scaring many women away from complying with routine mammography checkup.
Despite the dangers associated with mammographic radiations, medical experts are still holding that early detection of cancer is very important because it possesses the potential to save many lives of women as compared to meager threat of radiations that have negligible effect on the lives of these women. Proponents of mammography examination argue that mammographic radiations are similar to the dose of radiations received from the sun and therefore they do not pose any significant risk to the body. Thompson (2009) argues that, if a patient has clinical symptoms like mass of tissue or lump in the breast, which suggests presence of breast cancer, the risk of undergoing mammographic examination is very negligible (p. 11). Research studies conducted by the Preventive Service Task Force of the United States have revealed that mammographic diagnosis of breast cancer has helped in prevention and timely treatment of breast conditions. Thus, proponents of mammographic examination argue that mammography is an effective tool of diagnosing breast cancer at early stages of development when chemotherapy still works effectively.
False-Positive Results
Diagnostic results of mammography have about 7% of false positive, which causes unnecessary distress and anxiety among women thus traumatizing them. Given that breast cancer is incurable disease that results into loss of breast through mastectomy or death, positive results given to a woman are very shocking. Normally, when a mammography diagnoses that a woman has breast cancer, it is very hard for a physician to deliver the results to the patient because they are bad and shocking news. Hence, when the results are false positive, the patient has to endure the same shock and distress in response to the bad news of diagnosis. According to Brewer and Lillie (2007), positive results of mammogram have psychological and behavioral effects on women for they will live under traumatic conditions while attending routine screening as well as increasing the frequency of conducting self-examination of their breast (p. 506). As part of the process of accepting the results, patients become distressed and traumatized as they contemplate on the next medical attention necessary, hence forcing them to conduct series of tests in various health institutions whilst seeking medical services from one doctor to another with the hope that they will receive appropriate solution to their conditions.
Moreover, false-positive results of mammograms have serious medical implications as physicians may recommend patients to undergo further invasive medical procedures such as constructive surgery, biopsy, or even mastectomy. These unnecessary medical practices are not only destructive to the lives and breasts of women, but also cost great deal of resources. If about 7% of diagnosed patients are false-positive, it means that many women will undergo unnecessary medical procedures thinking that they are saving themselves yet they will be worsening their health conditions. Due to high rates of false positive in mammography, the physicians will be ironically destroying the lives and breasts of women instead of offering appropriate medical interventions. Brewer and Lillie (2007), argue that over diagnosis of breast cancer has resulted into high rates of false-positive women who undergo medical treatment procedures such as chemotherapy, radiotherapy, surgery, and combined therapies similar with other patients of breast cancer (p. 508). Making healthy women to undergo unnecessary medical procedures due to false positive creates more harm than preventing them from developing breast cancer.
Even though false-positive results have serious psychological, behavioral, and medical consequences due to over diagnosis, some medical experts attribute the results to the high sensitivity of mammogram. They argue that high sensitivity of the mammogram enables it to detect even early forms of cancer that can go undetected if examination procedure is not sensitive. Hence, high rate of false positive results imply that mammogram is very sensitive and thus an effective method of detecting breast cancer. Davidson (2010).argues that the right diagnostic results exist in the balance of false positive results and false negative results and that it is better to have higher false positive results than negative false results for diagnosis to be effective (p. 9). Therefore, sensitivity of mammogram is critical aspect of diagnosis that enables effective screening of population before subjecting them to definitive diagnostic procedures.
Ineffectiveness of Mammography
Critics of mammography argue that mammography is not an effective diagnostic tool because it has high rates of false negative and false positive results, hence unreliable in carrying out definitive diagnosis of breast cancer and associated disorders. By use of mammography alone, physicians are not confident in mammographic results for they have doubts that there may be false positive or negative results, hence forcing them to demand for other confirmatory tests that are more reliable. According to Bolton (2007), mammographic images do not give sufficient evidence for radiologists or physicians to confirm with certainty the existence of benign and malignant tumors in the breasts because mammography cannot detect all types of breast cancers and associated disorders (p. 17). Therefore, mammography is inefficient and unreliable tool of diagnosis because it is highly dependent on other confirmatory techniques in screening and diagnosis of breast cancer. Usually, a good diagnostic tool should be reliable and very effective to avoid unnecessary confirmatory tests that do not only make diagnostic procedures expensive, but also cumbersome for patients and physicians to follow.
In contrast, medical experts argue that mammography is primarily for screening purposes to reduce the number of women who will undergo further medical procedures. They argue that it is very complex and expensive for health care system to conduct comprehensive diagnosis of all women yet it is quite economical to screen using mammography. Since, the objective of mammography is early detection of cancer to enhance treatment at those stages and prevent development of malignant and benign tumors; mammography is appropriate tool for screening large population of women before subjecting them to definitive diagnostic techniques. Murphy and Walter (2010) argue that mammography is an indispensable diagnostic and screening technique that contributes significantly to early detection of breast cancer in women (p. 3). In combination with other diagnostic and screening techniques, mammography becomes effective and reliable medical procedure.
Cost of Mammogram
Mammogram examination is very expensive in that over half of women who are majorly in middle and lower classes cannot afford and thus will not be able to comply with the requirement of routine examination of breast. Health care system recommends that regular self-examination of the breasts and routine mammographic diagnosis for women who are 40 years and above will significantly reduce the increasing incidence rates of breast cancer. Routine mammographic diagnosis is important for it enhances early diagnosis of breast cancer at the stage when chemotherapy is very effective, thus preventing performance of invasive medical procedures that are costly in terms of heath and resources. Although mammography is very critical in early diagnosis of breast cancer, the negative aspect of it is that it is not only expensive to the patients but also to health care institutions. Wagner (2009) argues that installation of mammography is very expensive as it entails high cost of installation, operation, and maintenance, which cumulatively reflect on the high cost of diagnosis making it an expensive medical procedure (p. 4). Hence, many poor women cannot afford to perform routine mammography examination as recommended, thus becoming a great setback in the fight against breast cancer.
Despite the fact that mammography is very expensive and unaffordable to many poor women, medical experts argue that the cost of diagnosis is very negligible as compared to health benefits of reducing mortality rates of breast cancer. They argue that early diagnosis of malignant or benign tumors in the breast can help in treatment or management of the breast cancers thus help in prolonging the lives of many patients. Bryan, Brown, and Warren (1995), argue that the costs of routine mammography examination to detect early development of cancer is very little as compared to the cost of treating advanced forms of breast cancer due to late diagnosis (p. 74). This means that mammography is a preventive form of diagnosis that is preferable as compared to curative measures that are very expensive. Thus, it is much cheaper for women to perform routine mammography examination than to wait and treat advanced breast cancers and associated disorders.
Recommendations
Due to uncomfortable procedure of mammography, many women do shy away from performing routine mammography examination as recommended. To increase the number of women who are undergoing routine examination of breasts, comprehensive education regarding the mammographic procedure is imperative. Given that mammography has harmful radiations, radiologists need to be cautious and reduce the amount of radiation they expose to women during mammography examination. Murphy and Walter (2010) recommend that young women who are at their early 40s and have family history of cancer have high risk of developing breast cancer due to radiations hence they should not undergo routine examination as other women (p. 5). Concerning high false positive results and ineffectiveness of mammography, incorporation of other screening and diagnostic techniques is essential to increase accuracy of the results and save the patients from developing needless trauma and undergoing unnecessary medical procedures. Finally, since mammography is expensive and inaccessible to many poor women, the government should subsidize the cost of screening breast and save the lives of many women who have no alternative.
Conclusion
Mammography is an appropriate medical procedure of diagnosis that women of 40 years and above should undergo; they are at risk of developing breast cancer. It is very important in early detection of cancer at early stages of development when noninvasive medical interventions effectively work in prevention and treatment of benign and malignant tumors. However, mammography has some negative aspects for it is uncomfortable procedure, exposes women to harmful radiations, has high false positive results, ineffective screening techniques, and is a very expensive medical procedure that prevents many women from accessing essential routine examinations. To overcome these negative aspects of mammography, medical experts need to enhance awareness of medical procedures, reduce the amount of radiations exposed to women and incorporate other accurate diagnostic and screening techniques into mammography examination. In addition, the government should subsidize the cost of mammography for poor women to afford.
References
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