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Can mammograms do more harm than good?

A study just published in the prestigious BMJ (formerly the British Medical Journal), questions the widespread claim that early detection is the best way to reduce breast cancer related deaths.

It was carried out on Dutch data. Since widespread mammographic screening began in Holland in 1989, breast cancer deaths have declined markedly. It’s been the same story in Australia and other Western countries.

At first glance we might assume that this is because mammograms have picked up more cancers.

In fact, that’s exactly what’s happened. But more than half of those cancers were harmless. They’re stage 0 (also called ‘ductal carcinoma in situ’ or DCIS) or stage 1 cancers. 

Many people argue that DCIS shouldn’t be called cancer at all, and had women not had mammograms, many of them would have gone unnoticed and never caused a problem.

In other words, we’re both over-diagnosing and over-treating.

Meanwhile, the incidence of more serious cancers — stages 2, 3 and 4 — hasn’t changed much in Holland or Australia.

So why has the incidence of breast cancer deaths fallen? Because of better treatment for stage 2-4 cancers.

The researchers argue that not only are mammograms not saving lives, they may be causing a lot of women a lot of stress by putting them through unnecessary surgery and radiation. 

Bear in mind that this study looked at the statistical big picture, not individual circumstances. Obviously, if you have a later-stage cancer that’s detected with a mammogram you’ll regard mammograms as a lifesaver.

No one is suggesting that we should ditch breast screening, though I’d love to see a focus on breast health rather than cancer detection, and on the use of screening technologies other than just mammography. 

But too much has been invested in mammography for anything to change in the short-to-medium term.

What you can take away from this study is that if you’re diagnosed with an ‘early-stage cancer’ the wise course of action would be to take a few deep breaths then get a second or third opinion. 

Photo Source: Bigstock 

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Tuesday, December 19, 2017 | Rhonda Anderson