Is Susan G. Komen wrong about mammograms?

Is Susan G. Komen wrong about mammograms? The world’s largest breast cancer charity used misleading statistics and deceptive statements about mammography to promote breast cancer awareness and screening, authors of an opinion piece asserted.

In promotional material for the 2011 Breast Cancer Awareness Month, Susan G. Komen for the Cure suggested large differences in breast cancer survival among women who undergo screening mammography and those who do not. Specifically, the advertisement stated a 5-year survival of 98% when breast cancer is caught early and 23% when it is not.

In doing so, the organization ignored “a growing and increasingly accepted body of evidence [showing] that although screening may reduce a woman’s chance of dying from breast cancer by a small amount, it also causes major harms.”

“This benefit of mammography looks so big that it is hard to imagine why any one would forgo screening. She’d have to be crazy,” Steven Woloshin, MD, and Lisa M. Schwartz, MD, of the Department of Veterans Affairs Medical Center in White River Junction, Vt. and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., wrote in an article published online in BMJ.

“But it’s the advertisement that is crazy,” they added.

In response to the BMJ article, Susan G. Komen for the Cure issued a statement from Chandini Portteus, vice president of research, evaluation, and scientific programs.

“Everyone agrees that mammography isn’t perfect, but it’s the best widely available detection tool that we have today,” said Portteus. “We’ve said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start, through biomarkers, for example.”

But Woloshin and Schwartz argued that the timing of breast cancer diagnosis has minimal impact on long-term survival, citing evidence that mammography reduces a 50-year-old woman’s 10-year risk of dying of breast cancer from 0.53% to 0.46%.

“Five-year survival is all about what happens from the time of diagnosis,” Woloshin and Schwartz wrote. “It is the proportion of women who are alive 5 years after diagnosis. Because screening finds cancers earlier, comparing survival between screened and unscreened women is hopelessly biased.”

The authors also faulted Komen’s deception for emphasizing the benefits of mammography but making no mention of the possible risks. Woloshin and Schwartz cited evidence indicating that 20% to 50% of women screened annually for a decade will have at least one “false alarm” that leads to a biopsy.

For every life saved by mammography, the imaging leads to overdiagnosis of two to 10 women, many of whom receive unnecessary interventions and treatment, they added.

With regard to the need for balanced information about mammography, Komen’s Portteus said, “We have long advocated for women to be informed about the benefits and risks of early detection and treatment. We encourage women to work with their healthcare providers to find out what’s right for them.

“At the same time, Komen is funding millions of dollars in community health programs that educate, screen, and provide financial and social support for low-income and uninsured women through treatment,” she added.

“Women need much more than marketing slogans about screening,” Woloshin and Schwartz concluded. “They need — and deserve — the facts. The Komen advertisement campaign failed to provide the facts.

“Worse, it undermined decision making by misusing statistics to generate false hope about the benefit of mammography screening. That kind of behavior is not very charitable.”

Charles Bankhead is a staff writer at MedPage Todaywhere this article was originally published.

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  • carolynthomas

    “For every life saved by mammography, the imaging leads to overdiagnosis
    of two to 10 women, many of whom receive unnecessary interventions and
    treatment”

    Several years ago, I became one of those women after a mammogram turned up a suspicious “mass” in my right breast.

    The surgeon performed a quadrant resection to remove this mass, along with a sizeable chunk of breast tissue – a terrifying, invasive and permanently disfiguring procedure. The good news: the mass was not cancer, and for that news I was expected to feel relieved and grateful to my wonderful surgeon. The bad news: I became yet another statistic, an example of those “two to 10 women who received unnecessary interventions and treatment”.

    Alas, we rarely hear from women like me, drowned out by the noise of marketing slogans about screening from organizations like Komen.

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      Carolyn, thank you for sharing your experience. While I am glad that the mass was not cancer, it’s too bad that you ended up becoming another statistic.

    • LKMA

      Carolyn, I am a breast cancer survivor. Mine was picked up early by mammogram. What I do not understand is why your surgeon went straight for the quadrant resection without doing a needle biopsy or some preliminary procedure to determine if your mass was benign or truly cancerous prior to the cut down procedure. Mammograms are for SCREENING. Back up methods for diagnosis must be used. I would lay your disfigurement and stress at the feet of the surgeon and NOT put it on the mammogram procedure.

    • drjoekosterich

      Well put Carolyn. we need to hear more stories like yours.

  • http://www.dental-management.net/ DentalAccountant

    This is quite an enlightening read. A big company like Komen has great influence on the people that believes them, which is why every statement that they make truly matters and creates an impact on their choices. What do you think is the best way to detect breast cancer? Is it wholly mammogram screenings?

    • LKMA

      How about analyzing the follow up to a mammogram that indicates a potential cancer. I say “potential” as the mammogram is a screening tool. In my case, needle biopsies were performed PRIOR to a cut down procedure to ensure that it was indeed a malignancy. Because my b/c was found early, I did not need the mastectomy. 13 years after treatment, I remain b/c free. Thanks to God and good medical care….and early detection.

    • LKMA

      Mammograms are a screening test. Follow up with other methods to confirm cancer is a requirement. In my case, needle biopsy. Hardly painful. When confirmed malignant, there was the cut down procedure. Thanks to good treatment, good doctors and a benevolent God, I have been cancer free for 13 years.

  • http://twitter.com/PatientCommando Patient Commando

    The one thing we don’t get from this study is absolute numbers and the stories behind those numbers. Screening saves 70 lives for every hundred thousand unscreened. Damage is done to 140- 700 per hundred thousand based on the “For every life saved by mammography, the imaging leads to overdiagnosis of two to 10″. If we were told what the numbers actually add up to we’d have a better idea of what the actual cost is to women in terms of physical, social, and emotional damage. Not to mention the cost to their loved ones, their carers, spouses and children who share the experience with them.

    With the large budgets that special interest groups like Komen may have have at their disposal, reasonable discourse on major issues get skewed. No different from politics and other social issues. Ultimately, stories will trump data, and how the patient story and experience is utilized will overcome any rational discussion.

    What this brouhaha exposes is the complete disregard for the real stories of those negatively impacted. They have no voice in this. As interesting an analysis this study is, it gives no insight into the actual impact on the lives of those undergoing unnecessary interventions. This will blow over because this important part of the equation has no champion for its experience.

    I won’t proclaim to be that champion. But any woman – or man who suffered needless consequences of a false PSA test – can let their voice be heard by sharing their personal story on my website http://www.patientcommando.com . And be their own champion of truth.

    Zal Press
    Executive Director
    http://www.patientcommando.com

    • LKMA

      So….it’s all about the bucks for you, Mr. Press? A needle biopsy to confirm the presence or the lack thereof a cancer that mammogram screening may indicate is hardly physical, social, emotional damage. And I am speaking as one who has been through the procedure. Needle biopsies cost loved ones, careers, spouses and children? Tell you what REALLY causes physical, social, emotional damage and REALLY costs loved ones, careers, spouses and children—the suffering and loss of the women in their lives due to under diagnosis of b/c.

  • LKMA

    Ladies, We are being prepped to accept the lower quality of care that is in Obama Care.

    As a breast cancer survivor, health care profession of 30+ years, and published researcher (hematologic oncology field), I tell you that numbers can be spun and interpreted according to agenda. That is what Woloshin and Schwartz are doing.

    Tell any woman who has breast cancer that is detected that waiting another few years for treatment will only reduce her chance of death from b/c by 0.07%. Less than 1%. Does that REALLY make sense to you? Is that what you see in the experiences of your mothers, sisters, friends, and selves? Or is it early detection equals early cure?

    Mammography is a screening test. Screens will have false positives. The idea is NOT to have false negatives. Mammography false positives are a GOOD thing! It means the false negatives are not as likely to occur. Which is worse……suspecting a cancer and getting a needle biopsy that is negative? …..or a TRUE CANCER not being picked up at all and it progresses without diagnosis?

    Do you know that ANNUAL PAP smears are no longer covered? The schedule has been extended. How do the authorities (USPSTF: United States Preventative Services Task Force, a committee of 16 people appointed by the government) justify this? To paraphrase: Cervical cancer is a slow grower and we can catch it next time. Yep. Next time.

    Do you know that PSA testing for the screening of prostatic cancer in men is no longer covered? According to the USPSTF, it is an unreliable test and, though nothing better exists, it has been disallowed from coverage. There was an outcry from the physicians in this nation about this decision but the USPSTF stood their ground. I think that you and I all know of men whose prostatic cancer was picked up with this simple blood screening test.

    What happened to “early detection, early cure”? Obama Care has. And it will continue to modify YOUR care based on cost and not on quality of care. REPEAL OBAMA CARE WHILE YOU CAN!

    • southerndoc1

      “it has been disallowed from coverage”
      It’s not very convincing when you have to lie to make your case.

  • EmilyAnon

    I’m totally confused. If I have a mammogram, and it detects a ‘lump’ the size of a pea, is it prudent to advise me to wait until it’s the size of a lemon before deciding on a course of action? Because even if it’s cancer, the outcome would be the same regardless of the timing? I just can’t wrap my head around that theory.

  • http://www.stephaniefrederick.com Stephanie Frederick, RN, M.Ed.

    I support educating women about breast thermography. Inflammatory breast cancers are not detectable by mammogram, and potential problems can be detected by thermography 8-10 years before they manifest. Why not get some education out to the masses about this? Is it because there’s no money in it??

  • drjoekosterich

    Screening is profitable business. The benefits have been oversold. Those over diagnosed tend not to be concerned because they are so relived not to have whet they never had!