Many of us have heard that routine breast
cancer screenings help detect cancers at earlier stages, make them easier to
treat, and save people’s lives. However, recent studies have proven otherwise,
mammography may not be the infallible tool it was thought to be, and routine screenings
may be more harmful than beneficial.
Even with today’s medical knowledge,
doctors are unable to fully discern whether abnormal mammogram readings or
biopsies are actually harmless or deadly. The large majority of abnormal findings
have the possibility of becoming cancer but are low-risk and most of the time will
never harm or bother the patient. To err on the side of caution, doctors are inclined
to overdiagnose and categorize merely suspicious cells with dangerous cancer
cells (Aschw & en, n.d.).
While some women’s lives are saved
(1 in 1,000), even more women are overdiagnosed (6 in 1,000) and receive
treatments they don’t actually need.
A 2012 study found that over the past 30 years, 1.3 million women in the United
States were overdiagnosed with some form of breast cancer (Bleyer & Welch, 2012). These women
received unnecessary treatments such as radiation, chemotherapy and mastectomies for
harmless cancers that instead posed greater health risks. Overdiagnosed patients
and their families also face an array of unnecessary psychosocial issues
including financial losses, emotional turmoil, anxiety and loss of faith in the
medical profession (Aschw & en, n.d.). With this
in mind, do the risks associated with overdiagnoses outweigh the benefits of curing
cancer in a small number of patients? Should providers make more of an effort to
educate patients to facts and statistics of breast cancer risk?
Furthermore, recent studies have
shown that when examining rates of cancer diagnoses and deaths in the United States,
areas with higher rates of screening had more cancer diagnoses but no decreases
in mortality (Jin, 2014). Is
mammography causing more malfeasance than beneficence? Will you still consider getting
a mammogram?
Citations:
Aschw, C., & en. (n.d.). What
If Everything Your Doctors Told You About Breast Cancer Was Wrong? Retrieved
December 5, 2018, from
https://www.motherjones.com/politics/2015/10/faulty-research-behind-mammograms-breast-cancer/
Bleyer,
A., & Welch, H. G. (2012). Effect of Three Decades of Screening Mammography
on Breast-Cancer Incidence. New England Journal of Medicine, 367(21),
1998–2005.
https://doi.org/10.1056/NEJMoa1206809
https://doi.org/10.1056/NEJMoa1206809
Jin,
J. (2014). Breast Cancer Screening: Benefits and Harms. JAMA, 312(23),
2585–2585. https://doi.org/10.1001/jama.2014.13195
Hi Dana! I think that your post raises some interesting questions about the potential dangers that mammograms present, especially since they're recommended annually for women over the age of 45 (https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html).
ReplyDeleteOne thing that I find interesting is that the use of a clinical exam to screen and detect cancer is declining and the use of mammograms for detection is increasing, but in one study, scientists found that a significant number of cancer diagnoses would be missed had a clinical examination not been performed. In their study, they looked at over 6,000 women diagnosed with breast cancer and how it was detected. 36% was detected through a mammogram, 55% were detected using a mammogram and a clinical exam, and 9% were detected just by a clinical exam. Those cancers that had more aggressive features were more often detected on a clinical exam than using a mammogram alone (Provencher et al., 2016).
While this doesn't address the problem of false positive diagnoses when looking at mammograms, a clinical exam is a low-cost and zero-radiation way to detect breast cancer. Perhaps the way to address this is to provide female patients with more information on how to do a breast self-exam as well as how frequently to do it to potentially catch an early cancer diagnosis. Maybe the false positive rate would decrease if female patients had to get a clinical exam first and be referred to get a mammogram from there if there was a suspicious finding, rather than just getting an annual mailer saying it's time for another mamogram. However, I do think that they're still important as a detection tool (especially given the results of the above study), but maybe the false positive rate would decrease if it was recommended that female patients only get a mammogram every two or three years to decrease the amount of radiation they are exposed to.
Provencher, L., Hogue, J. C., Desbiens, C., Poirier, B., Poirier, E., Boudreau, D., Joyal, M., Diorio, C., Duchesne, N., … Chiquette, J. (2016). Is clinical breast examination important for breast cancer detection?. Current oncology (Toronto, Ont.), 23(4), e332-9.