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by Patty Morell Bilhartz, M.D., M.P.H.


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One Big Mistake People Make When It Comes to Their Health


My daughter, a women’s health specialist, sent me an article entitled “Time to End Routine Mammography.” It was published on May 6, 2015, by Eric J. Topol, MD, on Medscape, a clearinghouse of pertinent medical articles for physicians.

The essence of the article is that medical guidelines are often slow to change, even when evidence points to the contrary. This can affect patients and their healthcare providers.  Sometimes for the detriment.

Case in point. Mammography.

If you are a man, please read on. Some men have mammography testing. And, mammography is just one example of healthcare practices that affect both sexes.

The article began by stating that even though the data now points to significant net harm–meaning far more risk than benefit–for routine mammography, we still continue to do it.

Even though a look at all relevant evidence available from 1960-2014 showed that the risks of routine mammography significantly outweigh the benefits, the U.S. Preventive Services Task Force still recently issued recommendations that women aged 50-74 years undergo routine mammography every 2 years.

Mind you, we have no supporting data to demonstrate a reason for this particular recommendation. On the contrary, we have abundant data to show that routine annual mammography screening does more harm than good.

But women (and a few men) are so frightened of breast cancer that they are vulnerable. This makes them more likely to buy into an unproven guideline that routine mammography for women in certain age categories is necessary for optimal health.

The problem with mammography is that the test is incredibly imprecise. According to the article, it boasts a >60% false positive rate. This means that a huge number of women receive a report after their test that tells them that something is abnormal (even if it’s not).  As a result, they feel that they have to continue with further testing. Like a biopsy.

And even biopsy results can be inaccurate or lead to a problem called overdiagnosis. Meaning that in the rare case that the biopsy showed cancer, often the cancer would never cause a problem because it is such an insignificant type of cancer. A type that would contain itself and not contribute to the woman’s death.

In other words, she will die of something else long before the cancer would even cause enough trouble to be harmful.

According to the Medscape article, the bottom line is that “we have come to rely on a test that is notoriously inaccurate but has become a fixed part of American medical practice since it was introduced almost 50 years ago.”

Furthermore, the article states that a Harvard study published in the current issue of Health Affairs demonstrates that the cost to the U.S. healthcare system resulting from frequent false-positive results and overdiagnosis is currently approximately $4 billion per year, plus costs of annual mammography of nearly $10 billion.

Let alone the costs to the patient of pain, disfigurement, worry, and emotional suffering because she was one of the “false-positives” who was subjected to needless additional testing.


Please understand. There are some women who need routine mammograms. They may have a significant family history of breast cancer or present with worrisome symptoms. But, the good news is that genetic testing will likely replace mammograms for many in the near future. In fact, according to the article, for every 1 year of mammography costs in the United States, we could now perform such genetic testing for over 56 million women.

So why would the U.S. Preventive Services Task Force–a group of independent experts who are supposedly working to improve the health of all Americans– continue to recommend a routine screening test that does not have the evidence to support it?

  1. Old habits are difficult to discard. All of us like familiarity.
  2. Fear often drives suboptimal healthcare. Fear of cancer on the part of the patient. Fear of lawsuits on the part of the physician.
  3. There’s probably some politics involved as well.  We’ll save that for another blog.

I’m sure there are some holes in this article, and certainly it will provoke discussion in the medical community. But the point for patients is clear: the One Big Mistake People Make When It Comes to Their Health is we don’t think for ourselves.

I’ll say it again: we need to start thinking more for ourselves, in consult with a physician whom we respect, when it comes to our health.

Instead, we accept an advisory’s board’s recommendation as the gospel truth, without doing a little research to see if this counsel is the best practice for us. If it is a practice that is supported by the best available evidence. If the guidance makes sense, given our family and personal histories. If the test offers more benefit than risk.

We’d like to think that a governing board would have checked all of this out for us. But, it gets complicated. Remember that every person may be different when it comes to healthcare. Your physician may feel some pressure to support suggested guidelines. And, sometimes it is you who may push your physician to order tests that he or she does not really think are necessary, so fear makes the choice instead of reason.

Here’s the nitty gritty. Become your own healthcare advocate.

No one else fully knows your body and medical history quite like you do. Learn your family history. Read up on stuff. Talk to knowledgeable people. Use your physician as a leading resource in your decision-making process. But, don’t allow a healthcare provider, hospital, or pharmaceutical company to sell you a concept that may be out-of-date, rooted in improbable fears, or worse yet, fueled by profit. Especially if there are risks involved in following that advice.

When you take on your own healthcare autonomy, you avoid the One Big Mistake People Make When It Comes to Their Health.  Not taking responsibility for their individual healthcare.

So, it’s up to you. The ball’s in your court. Work with your physician to get the facts that will serve you best. You have many tools to empower yourself to make wise healthcare choices. You just have to use them.

You will be loving yourself to wellness of body, mind and soul when you do!

If you didn’t see my last week’s post on “How to Find the Right Doctor,” please read it now. It goes hand-in-hand with this blog.

What is the scariest thing for you in taking responsibility for your health?

Comments (1)

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    Great encouragement and great way to put it. Amen and amen!


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