A recent three-decade long study from the New England Journal of Medicine points to the possible over-diagnosis of breast cancer, and yes, the idea that the sacred mammogram may be barely making a dent in the fight against the disease.
Peggy Orenstein, A New York Times Best Selling Author and breast cancer survivor, turned her analytic eye on pink-ribbon mania, the possible over-diagnosis of breast cancer, and yes, and the idea that the sacred mammogram may be barely making a dent in the fight against the disease.
When bringing up the subject she asks, how many lives, exactly, are being ‘saved,’ under what circumstances and at what cost?”
Mammograms and other radiation related intrusive treatments and detective procedures (cat scans, M.R.I.’s, etc…) doctors use are known to cause even more damage the original problems detected, even causing a second or third cause for cancer growth. Why Suggest to use this technique so frequently. It appears fear wins in the argument that you cannot be to careful.
• Mammograms may not make much difference. Yes, there has been about a 25 percent drop in breast-cancer death rates since 1990. But some researchers point to treatment—not mammograms—as being mainly responsible for the decline. Evidence comes from a study of three pairs of European countries: In each pair, mammograms were introduced in one country 10 to 15 years earlier than in the other. Yet mortality rates are virtually identical, indicating mammography hadn’t made a difference. Further, mammograms, are not so great at detecting the most lethal forms of disease—a “triple negative,” for example—at a treatable phase. Aggressive tumors also tend to progress too quickly, cropping up between screenings.
• Unnecessary treatments can be harmful. “According to a survey of randomized clinical trials involving 600,000 women around the world, for every 2,000 women screened annually over 10 years, 1 life is prolonged but 10 healthy women are given diagnoses of breast cancer and unnecessarily treated, often with therapies that themselves have life-threatening side effects,” Orenstein reports. Those treatments include Tamoxifen, which carries risks of stroke, blood clots and uterine cancer, while radiation and chemotherapy weaken the heart.
• Newer diagnosis is on the rise. Many women today are told they have ductal carcinoma in situ (D.C.I.S.), or “Stage Zero” cancer, in which abnormal cells are found in the lining of the breast’s milk ducts. The diagnosis of D.C.I.S., in fact, now accounts for about a quarter of new breast-cancer cases, totaling some 60,000 a year. These are oftentimes the women we see celebrated at pink-ribbon events as “triumphs of early detection.” But D.C.I.S. does not spread; “in situ” means “in place.” The only danger is if it develops into an invasive cancer, and right now, there’s no way to know that, which is one of the major things in this fight that needs to change, say researchers. In the mean time, says Laura Esserman, director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco: “D.C.I.S. is not cancer. It’s a risk factor. …We don’t do heart surgery when someone comes in with high cholesterol. What are we doing to these people?”
The new study also found that, while mammography does reduce, by a slight margin, the number of women who develop late-stage cancer, it is is far more likely to result in over diagnosis and unnecessary treatment, including the use of potentially toxic drugs.
Preemptive mastectomies are on the rise, and not because of medical advice. According to Todd Tuttle, chief of the division of surgical oncology at the University of Minnesota and lead author of a study on the topic, there was a 188 percent jump between 1998 and 2005 among women given new diagnoses of D.C.I.S. in one breast who opted to have both breasts removed just in case. “You could attribute the rise in mastectomies to a better understanding of genetics or better reconstruction techniques,” Tuttle said, “but those are available in Europe, and you don’t see that mastectomy craze there. There is so much ‘awareness’ about breast cancer in the U.S. I’ve called it breast-cancer overawareness. It’s everywhere. There are pink garbage trucks. Women are petrified.”
The conclusion of the study
Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer. Although it is not certain which women have been affected, the imbalance suggests that there is substantial overdiagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer.
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