As a breast cancer survivor who was originally diagnosed ten days before my 31st birthday, I can attest that the only thing, short of my fingers intuition, that found out that that I had cancer was a breast MRI. For many young women who already have to push their doctors because they are "too young for breast cancer," this tends to be the case. I have since had an recurrence that was again, only determined to be cancerous through an MRI. I'm sorry that these are expensive and perhaps for the majority of women, MRI's are not appropriate. But as a young woman who's been through it twice & still standing (and yet still fights with my PPO to pay for it), we have to be careful that we don't dismiss a diagnostic tool that is truly lifesaving for some women.

Perhaps the focus should be on identifying a small percentage of the popultion who would likely benefit, better doctor training on how to read them (they are notoriously difficult to read) and technological advances to make them more affordable.

I had a mammogram at 29 because I was high risk. It came back "clean", only for me to manually find a lump a few months after. Granted, this problem could have been avoided with better mammogram reading, and improving that should be the first action we take. Still, while an MRI would of course have been expensive, it would have been a heck of a lot cheaper than the additional treatment that I needed thanks to the months the tumor grew unchecked (the difference of about 2 months of treatment vs. my almost 2 years).

Besides, even though the "right" and "wrong" kind of cancer can not be determined from the test, the point remains to find it. We as individuals should be aware when there's "something" there that needs to be watched. That way we can help discover that it's "bad" as soon as possible.

People should not loose sight of the fact that these MRIs are being proposed for "high risk" women, not everyone. Unfortunately, chances are, in the group we're talking about, the tests will be well worth it in the long run.

That won't get paid for. My Dr recommended that I get a mammogram next year. I had one at 34, he wants me to have one at 37 and then again at 40. The insurance I had when I was 34 paid for them when recommended by a Dr, no matter your age. The insurance I have now won't pay for one until I'm 40, no matter what my doctor recommends or demands.

Yes, I'm welcome to pay for any treatment *I* deem necessary. But if I wanted to (or could afford) to pay for any treatment, why would I need insurance??

What, pray tell, is "overdiagnosis" of breast cancer? There are four cases to consider: Case A - breast cancer is detected and in fact, present; Case B - breast cancer is not detected but present (a "false negative"); Case C - breast cancer is detected but not present (a "false positive"); and Case D - breast cancer is not detected and not present.

The effect of doing more testing has two effects - it moves some people from Case D to Case C (increases false positives), and moves some people from Case B to Case A (decreases false negatives). I can see the argument that doing the additional testing is not worthwhile because the increase in false negatives outweighs the value of the missed detections... but that doesn't seem to be the argument here. In fact, I'm not really sure WHAT the argument is.

Are you trying to say that we'd be better off not detecting some cancers, because there's a chance that they wouldn't need treatment anyway? That's not going to be very well received by women whose cancers DID need treatment. This quote is telling:

In general, early detection is "a strategy that turns many more people into patients. Its effect on how many people die is relatively small, at best."

It's hard see how this isn't an argument in terms of cost. The reason we don't want to turn too many people into patients is that doing so costs money. This is exactly the claim that the Dartmouth doctors claim it isn't - that we're not doing these tests because it costs too much. And maybe it does, but let's not pretend that it isn't a cost issue.

Either in a way that does not need to be treated that way or does not need to be treated at all. There are such things as slow growing tumors. The rush to eliminate every single possible cell cluster will invariably lead to too much surgery and chemo and you will be the first people in line to lobby the medical profession for more humane treatment.