Too Much Treatment?
What is most interesting (to me anyway) about this article from The Wall Street Journal is that it was sent around by a radiologist at BIDMC. His short comments suggested that we might all be interested in seeing what the public is reading. Since he is a radiologist, he is very well informed about the benefits and limits of mammography, and I am guessing that he has strong opinions about their use. The questions raised here are about mammography, but also about other treatments delivered to breast cancer patients. If we limit the discussion to radiology, we are thinking about scans and MRIs and x-rays in addition to breast screening exams. Thirty years ago, women were routinely followed by bone scans and x-rays after completing adjuvant treatment. In 1993, when I had completed chemotherapy, the usual annual follow up still included a chest x-ray. I have very clear and painful memories of presenting myself for that exam, feeling very anxious about what might be found. As you know, these tests are not part of standard follow up care now except for the rules of some clinical trials and, surely, if a woman experiences a concern or symptom that needs to be checked.
Here is the start of this article and then a link to read more:
Can There be Too Much Breast Cancer Treatment?
by Melinda Beck
Every few months, another study reports that many breast cancers are being "overdiagnosed"—that is, detected and treated even though they would never cause problems if they were left alone. In one article, epidemiologists in Norway estimated that 15% to 25% of breast cancers found by mammograms were being treated unnecessarily.
A study in Norway fuels the debate over whether breast cancer can be overtreated. Melinda Beck on The News Hub discusses the debate over the concept of too much breast-cancer treatment. Photo: Bloomberg.
The study in the Annals of Internal Medicine in April calculated that for every 2,500 women offered mammograms over 10 years, one breast-cancer death was averted, but six to 10 women were subjected to surgery, radiation and/or chemotherapy unnecessarily.
The researchers in Norway compared breast-cancer rates in counties where a government mammogram program had begun with those without such screening, as well as with past years. They found that detecting and treating many early-stage breast cancers reduced the number of late-stage cancers and deaths only slightly,
prompting them to conclude that much of the treatment was unnecessary—in some cases because the cancers wouldn't have progressed, and in some cases because they were fatal despite being treated early. Other studies have estimated that the overdiagnosis rate falls in a wide range, anywhere from 2% to 52%.