A mammography study involving 90,000 women over 25 years has been released. Several stark conclusions:
1) Death rates from breast cancer were the same in women who got mammograms and those who did not.
2) One in five breast cancers found and treated did not pose a threat to women’s health
3) There is no benefit to finding breast cancers before then can be felt.
4) Studies showing a survival benefit for mammograms may lag behind improved treatments and may not follow standards for clinical research.
Dr. Susan Love commented on this article on facebook. “One reason that mammography doesn’t add much is that early detection turns out to be less important than biology ie aggressive tumors are worse than less aggressive tumors!”
For years, the drumbeat has been “early detection saves lives.” Study after study as well as anecdotal evidence from my own life shows this isn’t true. Recently I was involved in a flap on Facebook with someone who said that breast cancer survival rates are soaring.
Are they really soaring, I asked?
Yes, you often hear that 90+% of women diagnosed with breast cancer are still alive in 5 years. How much of that statistic is attributable to improved screening technology? What I mean by that — with improved detection in digital mammography, a radiologist might detect a tumor before it is palpable. A lot of breast cancer grows slowly, so it might be years earlier. She might survive the five years and pump up that statistic, but if the biology is such that our current medicines can’t stop her specific type of breast cancer, she will go on to die eventually. Maybe in 8 years instead of 4 thanks to early detection.
No, that doesn’t mean that early detection bought her four more years. It means that the cancer was discovered four years before it would have been without mammography and without impacting the outcome. You’ll note that this study found no survival benefit to catching the tumor before it’s palpable.
In other words, we can find a cancer years earlier, but if its biology defies our available treatment methods, what good does that do? We need to focus on the biology of the tumor, not on early detection.
The article says this about DCIS:
If the researchers also included a precancerous condition called ductal carcinoma in situ, the overdiagnosis rate would be closer to one in three cancers, said Dr. Anthony B. Miller of the University of Toronto, the lead author of the paper. Ductal carcinoma in situ, or D.C.I.S., is found only with mammography, is confined to the milk duct and may or may not break out into the breast. But it is usually treated with surgery, including mastectomy, or removal of the breast.
We need to focus on the reality of this disease, not on what we want it to be. Yes, I know it’s scarier and means we have far less control over our health than we like to believe we do. But if we really want to change the outcomes, we need to start dealing in facts. One in five is unacceptable. One in three is unacceptable.
The risks of over-treatment are real, folks. Consider just my case: I don’t have routine scans to check for cancer recurrence. Since I was diagnosed at age 41 and treated with every technology possible, my doctor believes that radiation from regular scans over the years could eventually cause another cancer in my body.
And that doesn’t even begin to address the physical, emotional, and spiritual toll that chemotherapy, lymph node removal, a bilateral mastectomy, and 26 doses of radiation took from me. And I needed all that to survive my aggressive Stage III cancer.
As an insider, the idea that women are getting all this treatment without needing it is simply obscene. All because it serves the status quo.
A friend of mine just sent me one of her favorite inspirational quotes: “Do the best you can until you know better. Then when you know better, do better.” – Maya Angelou
Twenty years ago, we started down this path of early detection because we thought it would save lives. Turns out it doesn’t, so now it’s time to do better.
Organizations like Komen, associated most closely with this disease in the public’s mind, need to turn this big pink ship around. This is not to say that their decades of awareness have been a complete waste of time, but it’s time to move on. From the article:
Dr. Kalager, an epidemiologist and screening researcher at the University of Oslo and the Harvard School of Public Health, said there was a reason the results were unlike those of earlier studies. With better treatments, like tamoxifen, it was less important to find cancers early. Also, she said, women in the Canadian study were aware of breast cancer and its dangers, unlike women in earlier studies who were more likely to ignore lumps.
“It might be possible that mammography screening would work if you don’t have any awareness of the disease,” she said.