Breast intentions

I have treated so many cancer patients in my career. And the ones who take total control over their disease–rather than the other way around–are the ones who survive.

That’s why I’m so eager to share this interesting piece of information.

A couple of weeks ago, I told you about some new findings on the risk of “over-diagnosis” that accompanies current breast cancer screening protocols in the UK.

And it seems the problem on our side of the pond is even worse. At least, according to a new report published in the New England Journal of Medicine.

In this study, researchers tracked trends in breast cancer diagnoses–both early stage (ductal carcinoma in situ, or DCIS) and late stage–in women over 40. The data spanned from 1976 to 2008.

Researchers found that the rate of late-stage diagnoses dropped from 102 cases to 94 cases for every 100,000 women screened. Meanwhile, screening doubled the rate of early breast cancer detection.

Early-stage breast cancer diagnoses jumped from 112 to 234 per every 100,000 women screened. Again, that sounds like good news. But in reality, only eight of these cases were likely to progress to advanced disease over time.

When you look at the bottom line, the benefit here is shockingly small. The cost, however, is anything but.

Ultimately, more than one million American women have been over-diagnosed over the past 30 years, due to US breast cancer screening protocols.

In fact, almost 31 percent of all breast cancers diagnosed in 2008 fell into this category–affecting more than 70,000 women. In other words, one third of all women diagnosed with breast cancer that year were unnecessarily treated.

And their lives were ruined… for nothing.

In response to these stats, the report’s authors conclude that “mammography has largely not met the first prerequisite for screening to reduce cancer-specific mortality–a reduction in the number of women who present with late-stage cancer.”

This is something I have been saying for years. Early and aggressive screening may find cancer sooner. But more often than not, it doesn’t really change anything.

In fact, DCIS–which doesn’t cause symptoms and in many cases won’t progress into a life-threatening case of cancer–doesn’t even require treatment. And yet, guess how conventional wisdom suggests we deal with it?

Bilateral mastectomy.

What is this, the dark ages? Since every man who lives long enough will wind up with prostate cancer, should we advocate castration?

One day in the future, we’re going to look back at this era of medicine and realize how barbaric it all is. Not to mention how inefficient and wasteful.

In the age of less care and cost-cutting, we have to look seriously at everything we do. And we have to remember that just because we can do something, it doesn’t mean we should.

I have had this discussion many times with my patients in recent weeks. Health care costs are going to have to come down. And the easiest way to do it is to stop doing things that are unnecessary.

Things like over-diagnosing breast cancer through excessive screening practices.

I’m not saying mammography doesn’t save lives. It most certainly does. All I’m saying, once again, is that we tend towards overdoing things in this country.

And this is a particular problem when you consider mammography’s controversial risks.

Only now do we own up to the fact that CT scanning causes up to 2 percent of all cancers in this country. How many breast cancers are caused by the mammography itself? And how many women have to suffer for us to start reconsidering our approach to diagnosis?

There are other, safer methods to detect breast cancer. And there are smarter strategies for screening.

Isn’t it about time we started putting them to good use?

“Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence” N Engl J Med. 2012 Nov 22;367(21):1998-2005. doi: 10.1056/NEJMoa1206809.