Finding Breast Cancer Early Doesn’t Save Lives????
In yesterday's New York Times, Gina Kolata tells us that the American Cancer society is re-thinking its message on the importance of screening mammograms in saving lives. (Click here to see the article.) The new thinking is partially based on a research article published this week in the Journal of the American Medical Society in which Kolata reports that researchers found,"a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body."
The promise of breast cancer screening was that mammograms would find cancers at an earlier and more curable stage and thus reduce mortality or save lives. What appears to have happened is that screening has been finding "cancers that do not need to be found because they would never spread and kill or even be noticed if left alone. That has led to a huge increase in cancer diagnoses because, without screening, those innocuous cancers would go undetected."
While screening has vastly increased the incidence rate of breast cancers that may not be dangerous, it has not led to a large reduction in the number of dangerous cancers found early enough to save lives.
We have been taught that all cancers are dangerous and must be promptly treated. We are now openly told that this premise is not true. Some cancers are not deadly. Some may even go away on their own. Finding these cancers and treating them is overdiagnosis. Kolata quotes Dr. Barnett Kramer, Associate Director for Disease Prevention at the National Institutes of Health as saying, "Overdiagnosis is pure, unadulterated harm."
This is not news to breast cancer advocates. We have been debating the benefits and harms of screening mammograms for years. However, for the debate to have reached the level where the American Cancer Society is re-thinking its message about screening is news.
Where does this leave us? To screen or not to screen -- is that the question? Or perhaps, the question now is: How do we screen more wisely?
Posted October 22, 2009.
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As advocates know, mammograms also have the problem of underdiagnosis. Studies have shown that mammograms miss about 20% of breast cancers. Mammograms are also not very effective for women with dense breasts, which includes most young women, which is why screening begins at age forty in the US and fifty in most European countries. Very aggressive breast cancers can show up at any time and may have spread beyond the breast before a woman finds a lump or gets her annual screening mammogram, and some forms of breast cancer such as inflammatory breast cancer look more like a skin infection than a tumor.
So what's the message here? I think it's that regardless of mammograms, all women need regular medical care, with breast exams, that women (and men) need to be aware of changes in their breasts, and that doctors need to take patients' concerns seriously, regardless of how young or old (or insured) they may be.
— Ilene Winkler, SHARE Director of Metastatic Programs