October was long over when the New York Times ran an op-ed about mammography screening and over-diagnosis. The op-ed makes a compelling case for ending
population-based mammography screening for breast cancer, based on the on the numbers of women who will be treated unnecessarily as a result.
This happens because screening mammograms: that is, mammograms given when there is no evidence of a breast lump or any other problem in the breast find cancers that, untreated, will never be life-threatening. In the medical field, this is referred to as over- diagnosis. Women experience it as unnecessary treatment.
Neither the op-ed nor I is talking about the need for diagnostic mammograms, mammograms given when a woman has a lump or another breast condition that needs to be figured out.
I wrote briefly on this topic a year ago in blog called Is October Over Yet? at. In that post, I talk about Komen’s responsibility for push mammography screening, and their refusal to educate people on the risks of screening.
The New York Times op-ed prompted the usually number of outraged letters from members of what I call “A Mammogram Saved My Life” chorus. No one who has undergone surgery, and possibly radiation and drug treatment or chemotherapy wants to believe they didn’t need treatment.
As I explained in the film Pink Ribbons, Inc.at the time of a breast cancer diagnosis, women fall into one of the three categories:
— They have a kind of cancer that, left untreated, will never be life threatening. If they are treated, the treatments will very likely make them feel bad. Cancer won’t.
— They have a kind of cancer that can be effectively treated with currently available treatments. If they get treatment in a timely manner, the treatment may make them feel bad for a while, but it will keep them from dying of breast cancer.
— They have a kind of cancer that is so aggressive, no matter how small the tumor is, that no currently available treatment can stop it. They will be made very sick by the treatments, seriously affecting the quality of their remaining lives.
Of course, everyone diagnosed who is treated wants to believe that they are in the second group. If their cancer comes back after treatment, they will learn that they were in the third group. But people in the first group will never learn that they are in that group: they will continue to believe that are in the second group.
Folks, these realities are about biology, not mammography. Mammograms have always had their problems: they are radiation based, they miss things that might be life threatening and find things that aren’t. We have been promised a better technology for more than 20 years, and we’re not close. What we need are diagnostic tools that can tell us whether a cancer needs treatment. And we need to reduce the amount of over-treatment while not jeopardizing the availability of treatment for cancers that can and should be treated.
We should stop doing population-based mammography screening and focus on screening those at highest risk of breast cancer.
What we know now is that mammograms alone never save a life. If a life is saved, it’s saved by treatment, no matter how the cancer is found. The chorus notwithstanding and Komen are damned.
© Barbara A. Brenner 2012