Let sleeping lumps lie

Mammography… as you know by now, I’m not a big fan of the technology.

Well, let me take that back–at least, partially. Mammograms have saved countless lives. And that is fantastic.

But I do disagree with the number of mammograms that we recommend to women. And with the age at which we recommend them.

I also think ultrasound and MRI can probably do a better job of finding tumors, with a lot less risk. I mean, we’re talking about radiation here… and it comes with inherent risks. Not least among them, a higher risk of cancer.

And then of course, there’s the additional risk of over-diagnosis and overtreatment.

I talk about this problem a lot. And it’s a big reason why I’m happy to see that the powers-that-be are at least starting to look at the pitfalls of routine mammography.

Finally, they’re admitting that over-diagnosis is unavoidable under current screening practices. And they’re urging healthcare providers to inform patients of this risk prior to screening.

Ha! That’s something that is very unlikely to happen.

But at least someone’s saying something. Because even under more sensible European breast cancer screening practices–which only require mammography every two years starting at the age of 50–about 1 percent of women will be over-diagnosed.

That may not sound like a big deal. But it is. Because it means that women on the wrong side of the statistics are receiving diagnoses for cancers that never would have surfaced during their lifetime otherwise.

And that means surgery, chemotherapy, and all of the devastating consequences that come with a cancer diagnosis. For nothing.

This is starting to look more and more like the ongoing prostate cancer debacle. So I want to take a moment to talk about when your screening results require treatment… and more importantly, when they don’t.

Recent research looking at 30-year trends in European breast cancer incidence revealed a rise in the incidence of ductal carcinoma in situ (DCIS) of about 20 to 25 percent.

This may sound like a positive development. But here’s the thing: In most cases, DCIS is a pretty benign condition.

Figures suggest that DCIS will progress into a more dangerous, invasive form of breast cancer about half the time. But this development can take decades–much like the trends we see with prostate cancer.

In fact, when I was in medical school, DCIS wasn’t even considered a cancer. But now, women are undergoing life-altering surgeries and aggressive treatments for a “cancer” that may or may not (most likely not) cause a real danger to their health.

On the other hand, this same research also found an increase in diagnosis of invasive breast cancer. (Most likely due to the conventional practice of prescribing hormone replacement therapy made from horse urine.)

And as it turns out, almost two-thirds of the women in this dataset who were “over-diagnosed” with DCIS also had an invasive form of breast cancer. And in cases like these, early detection can be life-saving.

Unfortunately, there’s no clinically proven way to say which women with DCIS need treatment and which don’t. Which is why, in the end, they all end up with treatment–for better or worse.

But there’s a better way to handle this–and it’s time all doctors started addressing this problem with some changes.

These European researchers recommend that any woman diagnosed with DCIS also receives an MRI, which can rule out more invasive forms of cancer. Then, just like men with prostate cancer, you’re better off watching and waiting.

In other words, don’t rush into unnecessary interventions. Because they won’t prolong your life. They will only chip away at its quality.

I realize that this is a confusing topic–especially for women facing the stress of a potential cancer diagnosis. But it’s absolutely worth talking about, because one in eight women will be diagnosed with breast cancer in their lifetimes.

DCIS is just the medical industry’s new way to make money. Should your next mammogram reveal DCIS, remember that there’s a good chance you don’t need to worry after all.

And make sure your doctor is willing to explore all of the treatment options available to you. Even–and maybe especially–if that means no treatment at all.

Overdiagnosis on Screening Mammography ‘Unavoidable’. Medscape. Mar 19, 2013.