ADAM RUINS EVERYTHING
-I’m Dr.Elmore.-I’m Rachel.
Nice to meet you. How can I help you today?
I don’t want to think pushing,
but I need a mammogram now.
Can you tell me a little bit more about why?
I haven’t found a lump or anything.
I just need to get screened,
so I know I don’t have cancer.
Okay, let me sit down,
let’s talk about this.
Cancer screening is a complicated topic.
I looked at your medical record before I came in
and it says that you’re 35 years old
you don’t have any family history of breast cancer
no risk factor, correct?
Then I would not recommend a screening mammogram today.
Why on earth not?
Breast cancer is something that many of us fear.
Many of us have loved ones who’ve suffered from it.
But the truth about screening mammograms is that
the benefit is less than we had hoped
and they are real harms more than people think.
It sounds like that human internet comment.
Oh, you must need Adam.
We were just talking with Adam about this at book club.
Dr Elmore, is it you? How’s the family?
好的 ADAM 进来吧
Fine, Adam, you can come in.
I’m not looking. Very respectful.
Rachel 这位是Joann Elmore
Rachel, this is Joann Elmore.
She is a doctor professor university Washington
and an expert on breast cancer screenings.
Adam, I’m over here.
I don’t understand.
I thought every woman needed screenings like constantly.
Yeah, that’s what doctors and advocacy groups have told us for decades.
In the 80s, the American Cancer Society even ran an ad that said
if you haven’t had a mammogram
you need more than your breast examined.
Wow! That’s insulting.
Par for the course for the 80s.
But in the last few years, new research has caused
some of the recommendations to change.
The American Cancer Society, the US Preventive Services Task Force
and the American College of Physicians have all recommended
getting mammogram screenings less frequently and begining them later in life.
Most screening mammogram can and do save lives.
The actual number of life saved
is much smaller than most people think.
Based on randomized clinical trails,
if you took 10,000 women in their forties,
here is how many might died of breast cancer
if they didn’t get any mammograms for a dacade.
And here is how many of those same women might die
if they did get those mammogram screenings.
Take off your blindfold.
They both look the same.
的确 妇女中做了乳腺扫描的和控制组 两组数据
Exactly, there was no statisticly significant difference between
the women who got the mammograms and the control group.
How can that be?
Mammograms find cancer.
I have many pamphlets that say that.
Well they definitely find cancer
but not all cancer is the same.
How do you think cancer works?
Well, it starts with one bad cell
it multiplies and spreads and
if you catch it early enough then you survive
and if you don’t, then your friends and family
run a 5K every year.
That’s what a lot of people think
but the truth is a lot more complicated.
Some cancer grows so fast that mammogram can’t catch it in time.
This is an awesome thing to win!
But some cancers start growing but then stop before they kill you.
Another cancers grow so slowly
they would never have the chance to kill you.
Finally there’s the kind of cancer you were thinking of
the kind you hope to catch early.
Yeah, that one hasn’t reached the finish line yet.
A mammogram could stop it in time.
The problem is mammograms can’t tell the difference between these types of cancer.
Ah… I can’t tell you apart.
You all look deadly to me.
I’m gonna treat you all the same.
You are so sexy when you did that to cancer.
That is less helpful than I thought.
But if there’s even a tiny chance, it’ll save my life.
It does seem worth it for a harmless test.
Unfortunately, mammograms aren’t harmless.
There’s a chance the x-ray will show something suspicious
when the woman doesn’t even have cancer.
That’s called a false positive.
This happens to about one out of ten women
and it can be very stressful.
And the more often you get mammograms
the more likely you are to get a false positive.
Over a half of women in the US who receive annual mammograms
will experience a false positive within a decade.
But… okay, sometimes they do find cancer, right?
In a small percentage of women yes
But remember the screening could just find one of those
harmless cancers that would never kill you.
That’s what we call over diagnosis.
Estimates are that about one in five cancers might be over diagnosed.
That’s really high!
Consider the emotional and psychological stress
of thinking you have a deadly disease when you don’t
or having to tell your loved ones
those are real harms.
And overdiagnosis can lead to over treatment.
Since mammograms can’t tell the difference between these types of cancers,
we recommend serious treatments for all of them and
that can result in women getting treatments they don’t need.
Some like chemotherapy, radiation therapy and mastectomy
take a serious toll on the body.
So you’re telling me I could have that lazy cancer
that would never have hurt me
but still be told to get chemo.
Yeah, it’s entirely possible.
Taken together, given the false positives over diagnosis,
over treatment instead of rushing in to get screening.
I want women to weigh all of the data
and make an informed choice.
Prostate and thyroid cancer screenings have the same issue by the way.
You know, I used to get my prostate checked
twice a week before I found this out.
So, what should I do?
If you do feel a lump or unnormality,
please go to your doctor.
And if they recommend a mammogram, get one at that time.
Apart from that the US Preventive Services Task Force recommends talking to
your doctor in your forties about whether you want to start screenings
then and otherwise they suggest getting them
every two years starting in your fifties.
That’s when the benefit is more and the harms are less.
I guess I… I won’t get one today then…
There is some good news our treatment of breast cancer
is so much better than it used to be.
The mortality has dropped significantly and
we’re able to cure most women with breast cancer regardless of
whether the cancer was detected on a screening exam or not.
Thanks, Dr. Elmore.
你好 我是ADAM 如果你喜欢这些
Hey, Adam being here. If you like that,
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be sure to watch all new episodes of ADAM RUINS EVERYTHING
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