October 24, 2011

SMOKE SCREEN AND MIRRORS:

Mammogram's Role as Savior Is Tested (TARA PARKER-POPE, 10/24/11, NY Times)

A new analysis published Monday in Archives of Internal Medicine offers a stark reality check about the value of mammography screening. Despite numerous testimonials from women who believe "a mammogram saved my life," the truth is that most women who find breast cancer as a result of regular screening have not had their lives saved by the test, conclude two Dartmouth researchers, Dr. H. Gilbert Welch and Brittney A. Frankel.

Dr. Welch notes that clearly some women are helped by mammography screening, but the numbers are lower than most people think. The Dartmouth researchers conducted a series of calculations estimating a woman's 10-year risk of developing breast cancer and her 20-year risk of death, factoring in the added value of early detection based on data from various mammography screening trials as well as the benefits of improvements in treatment. Among the 60 percent of women with breast cancer who detected the disease by screening, only about 3 percent to 13 percent of them were actually helped by the test, the analysis concluded.

Translated into real numbers, that means screening mammography helps 4,000 to 18,000 women each year. Although those numbers are not inconsequential, they represent just a small portion of the 230,000 women given a breast cancer diagnosis each year, and a fraction of the 39 million women who undergo mammograms each year in the United States.

Dr. Welch says it's important to remember that of the 138,000 women found to have breast cancer each year as a result of mammography screening, 120,000 to 134,000 are not helped by the test.

"The presumption often is that anyone who has had cancer detected has survived because of the test, but that's not true," Dr. Welch said. "In fact, and I hate to have to say this, in screen-detected breast and prostate cancer, survivors are more likely to have been overdiagnosed than actually helped by the test."

How is it possible that finding cancer early isn't always better? One way to look at it is to think of four different categories of breast cancer found during screening tests. [...]

The notion that screening mammograms aren't helping large numbers of women can be hard for many women and breast cancer advocates to accept. It also raises questions about whether there are better uses for the hundreds of millions of dollars spent on awareness campaigns and the $5 billion spent annually on mammography screening.

Posted by at October 24, 2011 9:05 PM
  

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