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Really? Article in today's paper

sbmly53
Posts: 1482
Joined: Jan 2010

States mammograms lead to over treatment of cancers that might not have needed to be treated. The article is by Marilynn Marchione Associated Press.

Arrrggghhh!

Sue

cinnamonsmile
Posts: 1049
Joined: Dec 2010

There is a movement that for SOME DCIS which is Stage 0 (breast cancer ONLY in the milk ducts) to do a watch and wait, which I am assuming would be for Grade 1, with no comedo necrosis. I bet that is what they are referring to (I haven't read the article yet).

My thoughts about this are: 1. What are you waiting for? Til the cancer is a bigger tumor? 2. That maybe it will not grow (I have seen this posted on breastcancer.org) 3. Wait until it becomes invasive?

My personal opinion is that why leave cancer even if it is DCIS, Grade 1, small amount,etc? To me, it is like leaving a ticking time bomb of cancer. Who know when or if it will explode. I am going to google this article tomorrow (it is Thanksgiving and I don't want to get myself really worked up).

SIROD's picture
SIROD
Posts: 2198
Joined: Jun 2010

http://www.southcoasttoday.com/apps/pbcs.dll/article?AID=/20121122/NEWS/211220378/-1/NEWSMAP

Study finds breast exams spur unneeded treatment

By MARILYNN MARCHIONE
The Associated Press

November 22, 2012 2:35 AM

Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.

Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don't need treatment, the study suggests.

It's the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.

But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call "cancer" are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don't really need.

Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it's relatively new to the debate over breast cancer screening.

"We're coming to learn that some cancers — many cancers, depending on the organ — weren't destined to cause death," said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, "once a woman is diagnosed, it's hard to say treatment is not necessary."

He had no role in the study, which was led by Dr. H. Gilbert Welch of Dartmouth Medical School and Dr. Archie Bleyer of St. Charles Health System and Oregon Health & Science University. Results are in Thursday's New England Journal of Medicine.

Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Other countries screen less aggressively than the U.S. does. In Britain, for example, mammograms are usually offered only every three years and a recent review there found similar signs of overtreatment.

The dogma has been that screening finds cancer early, when it's most curable. But screening is only worthwhile if it finds cancers destined to cause death, and if treating them early improves survival versus treating when or if they cause symptoms.

Mammograms also are an imperfect screening tool — they often give false alarms, spurring biopsies and other tests that ultimately show no cancer was present. The new study looks at a different risk: Overdiagnosis, or finding cancer that is present but does not need treatment.

Researchers used federal surveys on mammography and cancer registry statistics from 1976 through 2008 to track how many cancers were found early, while still confined to the breast, versus later, when they had spread to lymph nodes or more widely.

The scientists assumed that the actual amount of disease — how many true cases exist — did not change or grew only a little during those three decades. Yet they found a big difference in the number and stage of cases discovered over time, as mammograms came into wide use.

Mammograms more than doubled the number of early-stage cancers detected — from 112 to 234 cases per 100,000 women. But late-stage cancers dropped just 8 percent, from 102 to 94 cases per 100,000 women.

The imbalance suggests a lot of overdiagnosis from mammograms, which now account for 60 percent of cases that are found, Bleyer said. If screening were working, there should be one less patient diagnosed with late-stage cancer for every additional patient whose cancer was found at an earlier stage, he explained.
"Instead, we're diagnosing a lot of something else — not cancer" in that early stage, Bleyer said. "And the worst cancer is still going on, just like it always was."

Researchers also looked at death rates for breast cancer, which declined 28 percent during that time in women 40 and older — the group targeted for screening. Mortality dropped even more — 41 percent — in women under 40, who presumably were not getting mammograms.

"We are left to conclude, as others have, that the good news in breast cancer — decreasing mortality — must largely be the result of improved treatment, not screening," the authors write.

The study was paid for by the study authors' universities.

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York. Doctors already are debating whether DCIS, a type of early tumor confined to a milk duct, should even be called cancer, she said.

Another expert, Dr. Linda Vahdat, director of the breast cancer research program at Weill Cornell Medical College in New York, said the study's leaders made many assumptions to reach a conclusion about overdiagnosis that "may or may not be correct."

"I don't think it will change how we view screening mammography," she said.

A government-appointed task force that gives screening advice calls for mammograms every other year starting at age 50 and stopping at 75. The American Cancer Society recommends them every year starting at age 40.

Dr. Len Lichtenfeld, the cancer society's deputy chief medical officer, said the study should not be taken as "a referendum on mammography," and noted that other high-quality studies have affirmed its value. Still, he said overdiagnosis is a problem, and it's not possible to tell an individual woman whether her cancer needs treated.

"Our technology has brought us to the place where we can find a lot of cancer. Our science has to bring us to the point where we can define what treatment people really need," he said.

Margeaux
Posts: 76
Joined: Dec 2011

Read this article in the Houston Chronicle and was quite upset about it. How many women, doctors, and above all insurance companies are going to use this study to skip mammograms? One caveat - all these tests are only as good as the person at the other end intepreting it. I had an abnormal mammogram Sept. 2008, followed by another abnormal mammogram, followed by an ultrasound on the enlarged left axilla lymph node which they called "lymphadenopathy". Their comments - "left axilla demonstrates multiple benign appearing subcentimeter lymph nodes return in one year". Hogwash - it was cancer! The following year I refused to return to this clinic, didn't like them from the get-go. diagnosis in 2009 - IDC, STage IIB HER+. Also, the idea no mammograms are needed after 75, in 2009 I was 76, still working every Saturday, exercising 3x/week, taking care of husband, household, pets, yard, etc. Without that mammogram, top radiologists to interpret it, I'd be long dead. Fortunately, my doctors seem to take these studies with a grain of salt.
Margeaux

SIROD's picture
SIROD
Posts: 2198
Joined: Jun 2010

I read something back in 1996 by Dr. David Plotkin - Good News, Bad News about Breast Cancer which was very similar. It seems to be an ongoing discussion. I remember it as I kept a copy about it. The nurse for the Mammogram Department at my local hospital was very upset with the article. I thought it was well written with food for thought.

Doris.

Gabe N Abby Mom's picture
Gabe N Abby Mom
Posts: 2415
Joined: Sep 2010

I wish this...

"This study is important because what it really highlights is that the biology of the cancer is what we need to understand" in order to know which ones to treat and how, said Dr. Julia A. Smith, director of breast cancer screening at NYU Langone Medical Center in New York.

...received more emphasis, both in the article and in society/research in general.

Thanks Doris for copying the article for us.

Hugs,

Linda

abrub's picture
abrub
Posts: 1537
Joined: Mar 2010

And if some forms of breast cancer are self-resolving without intervention, as indicated by the study, then we would be better off not treating those forms IF THEY CAN BE PROPERLY IDENTIFIED.

I wish we had better visualization and identification that would avoid false positives. My abnormal masses were found because my breast surgeon changed me to the 3D mammogram this year. As a result, I've been through numerous invasive procedures, including 2 surgeries to find out everything is benign. I wish they hadn't found the anomalies in the first place, and saved me the grief (and the insurance company over $25,000 in costs for the diagnostics done.) Oh, and saved me a few hundred dollars in copays as well.

camul's picture
camul
Posts: 2117
Joined: Dec 2010

about this, the research was where they followed groups of women all over the US. All of them received a mammo to start. Then 100 didn't have another one for 5 years, and 100 had yearly. It was like double the amount of women who were diagnosed who had yearly mammograms to those at 5 years. They were really excited about the study because it suggests that many of the breast cancers heal themselves without treatment, they called it a spontaneous regression.

The interesting part was that the numbers were almost identical in all the locations. This was a study that I read off the site for the cancer convention that was held earlier this year in Sacramento.

abrub's picture
abrub
Posts: 1537
Joined: Mar 2010

Fascinating about the spontaneous regression. Heck, I'm ready to go onto biennial mammos at this point. (Note: for those who don't know me, I have not had breast cancer; I had appendix cancer. I've been on this site recently because of all of the diagnostics I recently suffered through because of a questionable mammo. If I'd had breast cancer, I would want to maintain the annual mammos.)

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