Is Breast Cancer Overdiagnosed?

Yikes is the word. Writing at Jezebel Laura Beck has found just the right word to describe the latest research on the value of mammograms.

Americans believe in mammograms. They believe in preventative testing. They believe that the sooner you catch an incipient tumor the better the chances for effective treatment.

Americans believe so strongly in mammograms that President Obama made a campaign issue out of the Republican proposal to defund Planned Parenthood. He claimed that Republicans would thereby deprive countless women of their access to mammograms.

Of course, Planned Parenthood does not perform mammograms, but why let reality get in the way of a good story line.

Anyway, most of what we think we know about mammograms turns out to be questionable.

Allow Laura Beck to summarize the new research:

Roughly one third of tumors found in routine mammography screenings are "unlikely to result in illness, according to a new study that says 30 years of the breast cancer exams have resulted in the overdiagnosis of 1.3 million American women."

The study, published in the New England Journal of Medicine, claims that the increase in breast cancer survival rates over the last few decades is because of improved therapies and not screenings, and not because of the widespread use of mammograms. In fact, the widespread mammogram usage resulted in overdiagnosis of breast cancer in roughly 70,000 women a year. Which is a problem as being diagnosed with breast cancer is a big fucking deal — think about the cost, anxiety, radiation exposure, false positives, and overtreatment. Yikes.

"Our study raises serious questions about the value of screening mammography," wrote Dr. H. Gilbert Welch, an epidemiology and biostatistics professor at Dartmouth College's Geisel School of Medicine. "It clarifies that the benefit of mortality reduction is probably smaller, and the harm of overdiagnosis probably larger, than has been previously recognized."

Breast cancer screening are often unnecessary. In many cases they cause harm. 

1,300,000 women have been overdiagnosed because the tumors discovered by mammograms will probably not become illness.

And then, Beck adds, think of how much this overdiagnosis costs in emotional well-being and in aggressive cancer treatment.

As for the idea that screening has helped increase the survival rate of breast cancer victims, Dr. Welsh asserted that the improved results derive from improved treatments, not from early detection.

He concludes that women who are at higher risk for breast cancer should receive mammograms but that the test is not necessarily appropriate for everyone.

Naturally, the research is controversial. Beck adds the opinion of a physician who believes that Welsh’s research is bunk.