February 14, 2012

THE PINK RIBBON STANDS FOR SUPPORTING VIOLENCE AGAINST WOMEN:

Komen for the Cure's Biggest Mistake Is About Science, Not Politics (Christie Aschwanden, 2/10/12, Discovery)

But these problems are minuscule compared to Komen's biggest failing--its near outright denial of tumor biology. The pink arrow ads they ran in magazines a few months back provide a prime example. "What's key to surviving breast cancer? YOU. Get screened now," the ad says. The takeaway? It's your responsibility to prevent cancer in your body. [...]

Years of research have led scientists to discover that breast tumors are not all alike. Some are fast moving and aggressive, others are never fated to metastasize. The problem is that right now we don't have a surefire way to predict in advance whether a cancer will spread or how aggressive it might become. (Scientists are working on the problem though.)

Some breast cancers will never become invasive and don't need treatment. These are the ones most apt to be found on a screening mammogram, and they're the ones that make people such devoted advocates of mammography. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, calls this the overdiagnosis paradox. Overdiagnosis is what happens when a mammogram finds an indolent cancer. A healthy person whose life was never threatened by breast cancer is suddenly turned into a cancer survivor. She thinks the mammogram saved her life, and so she becomes an advocate of the test.
Some cancers behave just the opposite of these slow-growing, indolent ones. Researchers now know that some cancers are extremely aggressive from the start. There's simply no such thing as "early" detection for these cancers. By the time they're detectable by any of our existing methods, they've already metastasized. These are the really awful, most deadly cancers, and screening mammograms* will not stop them.

Then there are cancers that fall somewhere in between the two extremes. These are the ones most likely to be helped by screening mammography, and they're the lives that mammography saves. How many? For women age 50 to 70, routine screening mammography decreases mortality by 15 to 20% (numbers are lower for younger women). One thousand women in their 50′s have to be screened for 10 years for a single life to be saved.

So let's recap. Getting "screened now," as the Komen ad instructs can lead to three possible outcomes. One, it finds a cancer than never needed finding. You go from being a healthy person to a cancer survivor, and if you got the mammogram because of Komen's prodding, you probably become a Komen supporter. Perhaps a staunch one, because hey--they saved your life and now you have a happy story to share with other supporters. Another possibility is that the mammogram finds a cancer that's the really bad kind, but you die anyway. You probably don't die later than you would have without the mammogram, but it might look that way because of a problem called "lead time bias." The third possibility is that you find a cancer that's amenable to treatment and instead of dying like you would without treatment, your life is saved. Here again, you're grateful to Komen, and in this case, your life truly was saved.

Right now, breast cancer screening sucks. It's not very effective, and if you measure it solely based on the number of lives saved versus healthy people unnecessarily subjected to cancer treatments, it seems to cause more harm than good. For every life saved, about 10 more lives are unnecessarily turned upside down by a cancer diagnosis that will only harm them. In a study published online in November, Danish researchers concluded that, "Avoiding getting screening mammograms reduces the risk of becoming a breast cancer patient by one-third."



Enhanced by Zemanta

Posted by at February 14, 2012 6:23 AM
  

blog comments powered by Disqus
« THAT WOULD BE BENJAMIN FRANKLIN ELEMENTARY SCHOOL...: | Main | THE PURSUIT OF THE HIRSUTE: »