The Downside of Breast Cancer Screening

Excerpt:

“A 17-year study has concluded that screening mammography — in which all women in certain age groups are routinely screened for breast cancer — does not reduce the incidence of advanced tumors, but does increase the diagnosis of lesions that would never have led to health problems.

“In Denmark, screening was implemented in different regions at different times, so researchers there were able to compare groups of women who were screened with those who were not.”

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Retesting Breast Cancer Axioms

“American women face conflicting advice about whether to be screened for breast cancer, at what age and how often. The decisions they make are often more strongly influenced by fear or a friend’s experience than by a thorough understanding of the benefits and risks of mammography.

“In 2009, the United States Preventive Services Task Force recommended that women 50 to 74 be screened with mammography every two years and that biennial screening of women younger than 50 be considered case by case. There is no good evidence on whether women older than 75 should be screened, the task force said.

“Yet, screening rates have not declined. Under the Affordable Care Act, free screening mammography is available to all women every one to two years.

“But is this really free, in the fullest sense of the word? Many experts cite hidden costs — financial, medical and emotional.”


Questioning Medicine: Breast Cancer Screening (CME/CE)

Joe Weatherly, DO, and Andrew Buelt, DO, are family medicine residents in St. Petersburg, Fla. Together, they co-produce the podcast Questioning Medicine, where they deconstruct issues confronting today’s clinicians. In this guest blog, Weatherly gives his take on breast cancer screening

“In 2014, there will be an estimated 1,665,540 cancer diagnoses, and approximately 585,720 deaths from cancer or complications from the treatment of cancer. Estimates are that 3% to 35% of cancer patients avoid premature death by screening alone.

“This sounds wonderful. Those individuals and their stories are the poster children for preventive medicine. The cost and collateral impact on their lives is well worth it to those who prolong life and obtain ‘remission.’

“What we don’t talk about are the potential harms false positives can have on the majority of those screened. The Susan G. Komen foundation website states ‘…. goal is to find cancer, not to avoid false- positive results.’ But false positives have consequences.

“The screening machine spits out false positives, false negatives, and identifies positive cancer diagnoses that will not benefit from treatment.

“We have sold America on the notion that breast cancer screening will reduce the risk of breast cancer death by more than 50%. And it will prevent death in more than 8% of the participants.

“But according to Biller-Andorno et al., the screening process on its best day can provide a relative risk reduction of 20% and, in absolute terms, one breast cancer death per 1,000 women.”