Breast cancer screening has lead to an over-diagnosis of breast cancer.
Ramona Bates talks about a recent study in the BMJ, showing that there was a “52% over diagnosis of breast cancer in a populations of women who are offered organized mammography screening,” amounting to, “one in three breast cancers being over diagnosed.”
When it comes to cancer screening, it’s hard to accept the consequences of over-diagnosis. But that risk is real. As I recently wrote, “Mammograms detect a number of slow-growing tumors that will never be harmful. But because doctors cannot be sure of which cancers are dangerous, every woman with a suspicious finding is subjected to a biopsy or breast surgery. For every life saved from breast cancer, 10 more lives will be affected by the ensuing procedures.”
Dr. Bates further comments, “Each ‘unnecessary’ surgery for one of the over-diagnosed cancers puts the patient at risk for complications. Not to mention the increased cost to the healthcare system of each country.”
The answer is that we need better screening tests. Something more specific than mammography. And also, an understanding by patients that there are consequences to consider when undergoing cancer screening.
Update:
Orac over at Respectful Insolence also provides his typically thorough take on the issue.
Related posts:
- Do chest x-rays and mammograms increase the risk of breast cancer in young women?
- Is the test that finds the most cancers the best?
- Breast cancer screening: Orac’s take
- The National Consortium of Breast Centers (NCBC) response to the USPSTF breast cancer screening recommendations
- "The great majority of women in the United States should not be getting MRI scans for breast cancer screening"
- Is clinical breast examination, added to mammography, worthwhile?
- Will patients accept the new, evidence-based, breast cancer screening guidelines?
{ 26 comments }
← Previous Comments
Even if the word carcenoma is removed, the NIH consensus statement also notes that
“Mastectomy and local excision with radiotherapy are both effective local therapeutic approaches in patients who have DCIS. A randomized controlled trial comparing mastectomy with local excision and radiation has not been done, but current data demonstrate that long-term survival is similar with either approach. Although survival rates are similar, there is a higher local recurrence risk for DCIS with local excision and radiation therapy (12%, half of whom have invasive cancer) than in patients who choose mastectomy (about 1%).” So the question isn’t whether to treat it but how and that becomes a personal decision — mastectomy and minimum chance of recurrence, no need for radiation or lumpectomy and radiation plus hormonal treatment and increased chance of recurrence (which can then be treated by mastectomy),
Incidentally, Dr. Morrow at MSKCC has just come out with a study showing women are being “scared” into mastectomy nor are they being mislead by their MDs.
Surgeon recommendations and receipt of mastectomy for treatment of breast cancer.
Morrow M, Jagsi R, Alderman AK, Griggs JJ, Hawley ST, Hamilton AS, Graff JJ, Katz SJ.
JAMA. 2009 Oct 14;302(14):1551-6.
PMID: 19826024 [PubMed - in process]
← Previous Comments
Comments on this entry are closed.