BREAST CANCER SCREENINGS
GOOD or BAD?
Mammograms increase the incidence of diagnosed cancer in the following two ways.
- By detecting tumors earlier than they would have been otherwise found.
- By detecting tumors that would never have been clinically apparent in the woman's life.
Seven years ago, Norwegian women ages 50 to 69, were allowed to have a mammogram every other year
Using public health data from their government-run health system, Kalager and colleagues and his team looked at the statistics. They determined that Norway's over-diagnosis rate was a whopping one in four (25%). After looking at the data in a different manner, they still estimated the overdiagonisis to be as high as 20%.
When the rate of breast cancer diagnosis is added to the rate of breast cancer over-diagnosis (and the subsequent over-treatment, and mortality / morbidity associated with this process), their stats showed that one breast cancer death per 2,500 women was prevented.
This led experts Drs. Joann Elmore, MD, of the University of Washington, and Suzanne Fletcher, MD, of Harvard Medical School to publish their own research in the very same journal. These two well-respected breast cancer experts wrote in the Annals of Internal Medicine that, "Evaluating strategies for observing change in some lesions over time instead of recommending an immediate biopsy has been suggested. Unless serious efforts are made to reduce the frequency of overdiagnosis, the problem will probably increase."
As a side note to this issue, our own State Department's website on Norwegian travel states that, "Healthcare in Norway is very expensive and healthcare providers sometimes require payment at time of service." Norway's tax rate is approaching 50% of their GDP.
- Kalager M, et al "Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian Screening Program" Annals of Internal Medicine 2012; 156: 491-499.
- Elmore JG, Fletcher SW "Overdiagnosis in breast cancer screening: time to tackle an underappreciated harm" Annals of Internal Medicine 2012; 156: 536-537.
WHAT ABOUT SELF BREAST EXAMS?
Let me say that none of these people are telling women not to do self examinations. They are simply telling them that self examinations do not prevent breast cancer like they have been led to believe. Rather than belabor this issue, I will let you read this short paper by the National Breast Cancer Coalition (HERE).