by Lisa Garber
Researchers of a new study published in the New England Journal of Medicine claim that the push for breast cancer exams in the past 30 years has caused 1.3 million American women to be overdiagnosed. Dr. H. Gilbert Welch of Dartmouth College’s Geisel School of Medicine argues that the decrease in breast cancer mortality rates is owed more to improved treatment than screenings, which detect even small, possibly benign and temporary abnormalities that resolve themselves.
Many breast imaging specialists, like Dr. Danial B. Kopans of Massachusetts General Hospital in Boson, railed against the findings, calling it “malicious nonsense” designed to deny women access to screening to reduce healthcare costs.
Early Screenings and False Positives
While the study authors agree that screening has detected early-stage cancers, it must also by this reasoning reduce the incidence of late-stage cancers (because the tumors would have been removed sooner). But they haven’t, the authors say.
After analyzing data between 1976 and 2008 from the National Cancer Institute and the Centers for Disease Control and Prevention, they found that early-stage cancers doubled (per 100,000 women) from 112 to 234, but late-stage cancers fell by only 8 cases, from 102 to 94.
“We hear the word ‘cancer,’” says Welch, “and we all assume the definition that’s in my medical dictionary—it’s a tumor that, left untreated, will inexorably grow and cause death. But now, as we look for really early forms of the disease, we realized the pathologic definition of cancer includes abnormalities that may come and go.” (Welch clarified that although he is not telling women to resist screenings, they should be conscious of the technology’s limitations.)
Stamatia Destounis, a Rochester breast imager, was dubious on the matter. “There is no way for us to know which early-stage breast cancer would not progress and which one would…. How would we tell a patient, ‘Chances are this is early and it’s probably not going to progress for a long time, if ever’?”
Dangerously High Screening Rates
This isn’t the first time breast imaging has come under attack; in 2009, the US Preventative Services Task Force concluded that current levels of testing put women under unnecessary financial and emotional duress. They also noted that false positives and unhealthy exposure to radiation were a growing concern. Several Harvard Medical School academics also echo Welch’s opinion that screening rates are unnecessarily high, and even mainstream health officials like Danish scientist Peter Gotzshe admit that screening isn’t always all it’s cracked up to be.
It can also be argued that the very organizations advocating aggressive screenings—like Susan G. Komen—are engaged in fraud for using misleading statistics to promote screening, offering free screenings that may or may not raise the risk of future development of cancer, and by skirting scientifically relevant issues to breast cancer, like its link to BPA.
Unfortunately women are driven by massive amounts of fear of breast cancer, so much so that some individuals are actually cutting off their breasts in order to be risk-free.