Last week’s Baltimore Sun suggested that the United States’ emphasis on early detection of breast cancer through regular mammogram screening is unnecessary, and has led to many women being overtreated.
As a point of reference: in the U.S., the National Institute of Health recommends that women begin mammograms at age 40 and get checked every 1-2 years. In Britain, the National Health Service “invites” women between the ages of 50-70 for screenings every three years.
Writes the Sun:
The July 9 study, by researchers at the Nordic Cochrane Centre in Copenhagen, examined rates of breast cancer in regions of the United Kingdom, Canada, Australia, Sweden and Norway before and after these countries instituted national mammography programs.
The scientists reasoned that if screening mammography were preventing early-stage breast cancers from progressing, these programs should have resulted in a drop in the number of advanced breast cancer cases — those showing signs of spreading — among women who had been screened.
The researchers didn’t find that. Instead, they found that mammography screening programs increased the overall number of breast cancers diagnosed but did not reduce the number of advanced cancers.
The team calculated, based on these results, that for every 2,000 women screened by mammography over 10 years, one will avoid dying from breast cancer and 10 others will receive treatments for a cancer that would have never become life-threatening.
In other words, “screening causes 10 times as many women to become cancer patients unnecessarily as it prevents from dying from breast cancer,” says lead author Karsten Jorgensen, a researcher at the Nordic Cochrane Centre in Copenhagen.
Hopefully this study will not be used as an excuse to reduce women’s access to mammograms in the U.S. – to reduce overdiagnosis statistics, or costs, or anything along those lines.
I take great issue with the government determining at what age and frequency a procedure will be available, particularly for individuals with a family history of cancer. That decision should be up to the patient, as a similarly-themed March 2009 New York Times article concludes:
Ultimately, women have to make their own decision about whether to be screened, said Dr. Lisa M. Schwartz, an associate professor at Dartmouth Medical School, who is co-author of “Know Your Chances” (University of California, 2008), a book about how to interpret health statistics and risk.
“You’re not crazy if you don’t get screened, and you’re not crazy if you do get screened,” said Dr. Schwartz, who also signed the letter to The Times. “People can make their own decision, and we don’t need to coerce people into doing this.
“There is a real trade-off of benefits and harms. Women should know that. There’s no question on one count: if you get screened, it’s more likely you’ll have a diagnosis of breast cancer.”
Screening for cancer is a very personal decision, and one best made by an individual and their doctor based on personal circumstances. Not by a bureaucrat drawing arbitrary lines in the sand.