October 7, 2015

THE HARM DONE:

 What If Everything Your Doctors Told You About Breast Cancer Was Wrong? (Christie Aschwanden, 10/06/15, Mother Jones)

If she knew then what she knows now, Therese Taylor would have refused the surgery. In fact, she would have canceled the mammogram. Taylor has come to realize that she lost her breast out of fear, not out of caution. She's learned that her mammogram was at least three times more likely to get her diagnosed and treated for a cancer that never would have harmed her than it was to save her life. But perhaps the most infuriating thing she's learned is that scientific evidence for the harms of mammography has been available--published in medicine's most highly regarded journals--for decades.

What scientists know and Taylor didn't is that mammography isn't the infallible tool we wanted it to be. Some things that look like cancer on a mammogram (or the biopsy that comes afterward) don't act like cancer in the body--they don't invade and proliferate in other organs. Some of the abnormalities breast screenings find will never hurt you, but we don't yet have the tools to distinguish the harmless ones from the deadly ones. And so these medical tests provoke doctors to categorize lots of merely suspicious cells in with the most dangerous cancers, which means that while some lives are saved, even more women end up with treatments they don't need. Whether the chance of benefiting from a mammogram is worth the risks of having one is an individual woman's decision, but Taylor believes her doctors owed her a truthful discussion about the potential harms before she made her choice.

Over the last 25 years, mammography has become one of the most contentious issues in medicine. The National Cancer Institute lit a firestorm in 1993 when, after finding sparse evidence of benefits, it dropped its recommendation that women in their 40s get screened. Since then, most of the debate has remained focused on what age women should start getting mammograms, and the number of women mammograms help. Now, after more than 30 years of routine screenings, some experts are raising a different, perhaps less comfortable question: How many women have mammograms harmed?

If you include everything, the answer is: millions. Mammograms do help a small number of women avoid dying from breast cancer each year, and those lives count, but a 2012 study published in the New England Journal of Medicine calculated that over the last 30 years, mammograms have overdiagnosed 1.3 million women in the United States. Millions more women have experienced the anxiety and emotional turmoil of a second battery of tests to investigate what turned out to be a false alarm. Most of the 1.3 million women who were overdiagnosed received some kind of treatment--surgical procedures ranging from lumpectomies to double mastectomies, often with radiation and chemotherapy or hormonal therapy, too--for cancers never destined to bother them. And these treatments pose their own dangers. Though the risk is slight, especially if your life is on the line, a 2013 study found that receiving radiation treatments for breast cancer increases your risk of heart disease, and others have shown it boosts lung cancer risks too. Chemotherapy may damage the heart, and tamoxifen, while a potent treatment for those who need it, doubles the risk of endometrial cancer. In a 2013 paper published in the medical journal BMJ, breast surgeon Michael Baum estimated that for every breast cancer death thwarted by mammography, we can expect an additional one to three deaths from causes, like lung cancer and heart attacks, linked to treatments that women endured.

More and more women are beginning to speak up about this inconvenient reality. Tracy Weitz, a women's health researcher at the Susan Thompson Buffett Foundation, has publicly shared the story of her mother, Diane Olds, who died 10 days after being diagnosed with an aggressive endometrial cancer that Weitz feels may have been caused by tamoxifen treatments for DCIS. In an Elle magazine story in June, Duke University breast surgeon Shelley Hwang described the "terrible feeling" that overcomes her every time she's asked to perform an elective double mastectomy on a woman with DCIS who "almost certainly" would have lived a long life without the procedure. In 2013, journalist Peggy Orenstein, once a staunch defender of mammography, wrote in the New York Times Magazine, "I used to believe that a mammogram saved my life," but 16 years after a breast cancer diagnosis, "my thinking has changed." Having read the latest studies, she wondered, "How much had my mammogram really mattered?"

Posted by at October 7, 2015 1:28 PM
  

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