Breast Cancer….two words which give rise to a lot of concern for most women. We have awareness weeks, funds drives, pink bracelets and even an entire month in which our country turns pink. At the forefront of many discussions is the notion of early detection of breast cancer in the form of mammograms. Several studies in the last few years, some being the largest ever performed on the effectiveness of mammograms, have called into question the frequency, the safety and even the necessity of the performance of breast cancer screening using mammography.
The most recent edition of The British Medical Journal, published February 11, 2014 raises extremely significant questions about the use of such testing. The study’s outcomes lead to the conclusion that mammograms have little to no effectiveness at best and may be harmful at worst. The Canadian Study is one of the largest and most meticulous studies performed to date. Over 90,000 women were involved and followed for a duration of twenty five years. Fundamentally, the research showed once again, that women who received regular mammograms as per current recommendations had no greater survival rate than women who received physical examination only. And, unfortunately, it further showed that one in five women diagnosed did not have a cancer that required any intervention at all and yet they underwent surgeries, chemotherapy and radiation. This overdiagnosis as described by Dr. Otis Webb Brawley, chief medical officer of the American Cancer Society, refers to: “…a tumor that fulfills all laboratory criteria to be called cancer but, if left alone, would never cause harm. This is a tumor that will not continue to grow, spread and kill. It is a tumor that can be cured with treatment but does not need to be treated and/or cured.” (http://www.ncbi.nlm.nih.gov/pubmed/22473436) Summing up the information, the Canadian researchers posed the question, “Does performing mammography and detecting tumors that can’t be detected by feel save lives?” And the fundamental conclusion was no, it does not. To veiw the study, this link will take you there: http://www.bmj.com/content/348/bmj.g366
“The decision to have a mammogram should not be a slam dunk.” said Dr. Russell P. Harris, a screening expert and professor of medicine at the University of North Carolina, Chapel Hill, who was not involved in the study. “It will make women uncomfortable, and they should be uncomfortable,” she noted. So the one size fits all screening is being called into question. Four significant other studies in the last six years have demonstrated nearly identical outcomes. A Cochrane database review which put together the results of many studies prior to 2010 concluded that mammogram screening saved only one life in every 2000 women screened and yet led to 10 women in 2000 being aggressively treated when it wasn’t necessary. One of theses studies, published in the Lancet Onclology in 2011 actually showed women with the most screening actually had a higher incidence of invasive cancers than women undergoing far less screening.
WOW! So where does this leave us? In each person taking personal charge of their own health and making informed decisions with their doctors. So true prevention of cancers, not merely early detection, become the watch words….diminish sugar intake, reduce protein consumption, optimize vitamin D levels, regular exercise, sleep, vegetable and fruit consumption, and others are appreciable action steps that can be taken….and there are even more! To quote Dr. H. Gilbert Welch, a professor of medicine at Dartmouth about this topic, “Wow, times they are a changin'”! So get informed, get involved and make rational health care decisions on your own behalf!