How Mammograms Don’t Save Lives

mammogram

A year ago a New England Journal of Medicine study revealed that mammograms are largely ineffective in preventing deaths from breast cancer. According to Dr H. Gilbert Welch, in a New York Times oped, the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than previously recognized.

According to Welch, one of the co-authors, the outcome of three decades of mammogram screening has been the diagnosis of 1.5 million women with early stage breast cancer. While this number might seem impressive, mammography has only diagnosed 0.1 million women with late-stage (potentially fatal) breast cancer.  This means that nearly a million women underwent unpleasant, invasive and unnecessary treatment (surgery, chemotherapy or radiation) for a non-lethal “cancer.”

Now a second Canadian study, published in the February 11 British Medical Journal, has replicated Welch’s findings. In the Canadian National Breast Screening Study, researchers followed almost 90,000 women for 25 years. Like Welch, they found that annual screening didn’t reduce breast cancer deaths. Instead they tended to lead to over-diagnosis and unnecessary treatment. In other words, cancers were found – and treated – that would have caused no problems during the patients’ lifetime.

In his New York Times editorial, Dr Welch laments misleading statements issued by the Komen Foundation and public health officials that early screening (by mammography) saves lives. The message they should be giving women is that they have a choice. While no one can dismiss the possibility that screening may help a small number of women, there’s no doubt that it leads many more to be treated unnecessarily for non-lethal cancers. Women need to decide for themselves about the potential benefit and risks. One serious potential risk Dr Welch doesn’t mention is the burden of radiation exposure from a lifetime of unnecessary mammograms.

Instead of screening all women with mammography, he recommends that health professionals only target women with a strong family history or genetic predisposition to breast cancer.

photo credit: photo credit: BC Gov Photos via photopin <a

 

9 thoughts on “How Mammograms Don’t Save Lives

  1. Ah this is a debate that I can’t be neutral because I’m right smack in the middle of it. I was diagnosed with stage II breast cancer in 2012 with a fair number of lymph nodes also touched. I got the full meal deal (surgery, chemo, radiotherapy and now drugs) and a long-term subscription at the cancer center.

    Almost everyone I informed when I was diagnosed said, “But, but, but didn’t you get regular mammograms?” Well, no because there was no history of BC in my family and I was well under 50. I still wondered if I had done something terribly wrong – been negligent in some way. And the answer is still no and my oncologist and GP were very emphatic about that.

    What the studies you cite (and there are many BC blogs where they are discussed) make clear is that detection (early or late) does not necessarily mean survival – mammograms just don’t seem to to make that big a difference. In a nutshell, Stage I detection is no guarantee that a woman is going to live.

    This post does a good job of making that point. http://scopeblog.stanford.edu/2014/05/13/breast-cancer-awareness-beneath-the-pink-packaging/

    And funny that you should bring up this topic. It was on my mind because I had my 6 month checkup which turned out to be OK. So far, so good but I still felt the need to sit down and write about it and the space I’m in right now (not “cured” and not necessarily “well” either):

    http://thefranco-americanflophouse.blogspot.fr/2014/05/between-wolf-and-cliff.html

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    • Thanks for your comment, Victoria. Personally I think there is something terribly wrong with our whole approach to diagnosing and treating cancer. Instead of removing/eradicating the cancerous tumor, we should be focus on the defect in the immune system that failed to destroy the cancerous cells.

      From everything I read, the formation of cancerous cells is a normal, protective function in tissues that are deprived of oxygen for some reason. Without the formation of these protective cells, tissue death would occur.

      When the immune system is functioning properly, it destroys the cancerous cells once they have served their purpose.

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  2. ” . . . . This means that nearly a million women underwent unpleasant, invasive and unnecessary treatment (surgery, chemotherapy or radiation) for a non-lethal “cancer.”

    I am wondering about the expression “non-lethal cancer”.
    Would this be the same as benign tumours? I thought if it is “benign”, chemotherapy or radiation is not called for?

    I did have a growth on my tongue which was removed by surgery. Some cancer cells apparently were detected inside the piece that was removed. It was established every bit that could have been dangerous had been properly removed. However I am advised to go for regular check-ups for five years in case a re-growth does occur.

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    • From all the discussions I had with my oncologist this is what I have learned. We say “breast cancer” (or even just “cancer”) as if it was just one thing but it isn’t. So many factors that go into deciding the treatment: the stage, if it’s spread, how fast the cancer cells are dividing and a ton of other things. I was caught at stage II something, fairly slow-growing and estrogen receptive BUT it had already gotten into 4 of my lymph nodes (not good) and the tumors were big (hard to notice though because I had very lumpy breasts). This was clearly “lethal” – it was going to kill me if left untreated. I had already lost motion and sensation in my right arm. That was an easy call. 🙂 But what about a woman I know who had Stage 0 who got radiation treatment (no chemo) “just in case”. Or another woman I know who didn’t want chemo and went only for the radiation and now it’s back…

      If there is a lesson I’ve learned from all this is we (and that means all of us) are not the ultimate deciders of our fates. We just don’t know what is going to happen and the doctor don’t either. All we have to go on is imperfect information and we just have to do the best we can. It happens that something that is caught early and seems relatively benign turns on a dime and suddently the person is stage IV (there is no stage V). Why does this happen? They don’t really know. I do know that I gained a great deal of serenity when I finally understood that I could not control the uncontrollable. It’s not up to me and if the universe wants to take me out, there is absolutely nothing I can do about that. Strangely enough, thinking this way greatly improved my life. 🙂

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      • Auntyuta, they don’t definitely don’t mean benign, as benign tumors don’t spread. Non-lethal cancers don’t metastasize to vital organs.Squamous cell cancer is an example of a very slow growing cancer that doesn’t metastasize.

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