Is Breast Cancer Overdiagnosed?

mimikitty

My husband wondered if breast cancer is overdiagnosed so I googled it and found these articles. The Norway study is very recent. Has anyone else ever thought about this? I'm going to ask my oncologist if she thinks I might fall into the "overdiagnosed" category referred to in these articles based on my type of cancer and get her opinion. I think I'm driving her crazy, but this is just part of my quest to be as informed as possible about this diagnosis.

http://en.wikipedia.org/wiki/Overdiagnosis

http://www.npr.org/blogs/health/2012/04/03/149920647/mammograms-may-lead-to-breast-cancer-over-diagnosis-study-finds

joannstar

IMO I'm glad
that my onc was proactive and caught my Stage 1 TNBC early!
I didn't like the article about the Norweigen study--might be fine for the statistics but when it concerns me, not so much.
Until "they" know which cancers can be ignored due to them being "slow growing" I would prefer the overdiagnosis.
Just my opinion, of course.
JoAnn

cinnamonsmile

If you read down the
If you read down the article, some of it is referring to the current controversy over how to treat DCIS. Some doctors and researchers are debating whether or not DCIS needs anything done at all. Some think it is fine to leave the DCIS in the milk ducts. Personally, I look at DCIS as a timebomb. You don't know if or when it would or will become invasive. I don't care what kind of statistics they post. For the individual, there is absolutely no way to definitively tell a person whether or not their DCIS will not become invasive. You don't know which percentage you will be in, those that get IDC, or those that don't. Sure a person with a very small amount of DCIS grade 1 may have less of a chance of going invasive than someone with a more aggressive DCIS grade 3, but you never know what cancer will decided to do.
I was ADH with DCIS grade 1, but was spread througout the milk ducts. After the lumpectomy, my breast surgeon drew me a picture of what the ADH and cancer looked like in my breast. She drew it on her whiteboard and my milk ducts were riddled with her black dots. When I found my lump, it was already the size of a breakfast sausage and that was just what I could feel, it didn't include all the other spots riddled with the crap. I am glad that I did not choose to sit back and wait to see IF it became invasive. I had cancer and precancer in me and wanted it out. I did not want to take a chance of it growing and invading other breast tissues.
One of the researchers said in the Norwegian research,"Either the cancers would have grown very slowly or not at all and never caused symptoms, or women would have died from something else before their breast cancer was diagnosed." And just how do they know that? Are they going to biopsy every woman's breast when they die and look for cancer? I thought God was the only all knowing and not everyone believes in him.Ok, if I die from something else, I die from something else. But why die of breast cancer spreading and killing me when I could prevent it. Again, no one knows who's cancer will spread and who's wont, so why leave it in there?
On breastcancer.org there are some women coming forward who are choosing NOT to do anything about their DCIS. It is quite controversial. Although I don't understand why they would choose that, I have to respect their decision.But IF it should turn invasive because they did nothing in the early stages....what a sad outcome. But if nothing should happen and they live out their lives to die of something else, how wonderful. But what a risky thing to gamble on....
Overdiagnosed cancer? I really don't believe in such a thing, no matter what the cancer, be it breast, lung, thyroid, prostate,etc. I tend to believe that if you asked anyone who was diagnosed with a later stage breast cancer if they wished they were diagnosed sooner, I suspect they would say yes. I think the same would be true for any other cancer. I have yet to hear anyone say, boy, I am glad my cancer was overdiagnosed and I didn't do anything and it turned to a later stage or boy, am I glad that my cancer wasn't found til a later stage.
Personally, I wonder if this research is all backed by insurance companies and governments looking for a way to cut costs.

ksf56

Yikes!
Please - these articles scare me! Women have died because they were told to wait awhile because they felt a small lump. I was a nurse in the times when this was happening. This kind of thinking will put us back 25+ years in breast cancer care. I personally, couldn't feel my tumor - it was in an unusual place. I not only had TNBC invasive ductal but also DCIS upon pathological examination. We have fought for early detection and women are surviving BC - there are more of us out there because they're removing these tumors and treating these women. Though I'm not happy to have had BC, I'm glad I have it now rather than the days when docs patted women on the back and said "Don't worry dear".

Yikes again!

mimikitty

ksf56 said:

Yikes!
Please - these articles scare me! Women have died because they were told to wait awhile because they felt a small lump. I was a nurse in the times when this was happening. This kind of thinking will put us back 25+ years in breast cancer care. I personally, couldn't feel my tumor - it was in an unusual place. I not only had TNBC invasive ductal but also DCIS upon pathological examination. We have fought for early detection and women are surviving BC - there are more of us out there because they're removing these tumors and treating these women. Though I'm not happy to have had BC, I'm glad I have it now rather than the days when docs patted women on the back and said "Don't worry dear".

Yikes again!

Thanks for Your Thoughtful Answers
I will make my husband read them.

SIROD

It's An Old Story....
Sixteen years ago in an article written by Dr. David Plotkin titled "Good News and Bad News About Breast Cancer" in what was then called The Atlantic Monthly Magazine. It was argued that some cancers grow to slowly to be treated and therefore are "over treated". Amazingly enough, I found the article still online, printed in June 1996.

http://www.theatlantic.com/magazine/archive/1996/06/good-news-and-bad-news-about-breast-cancer/7788/

Here is the part in the article that I am referring to:

Among the most important varieties of the new breast cancer is the in situ tumor--the small, localized, almost nongrowing tumor that at the time of diagnosis has seemingly neither become invasive nor developed the capacity to metastasize. Prior to mammography, as noted earlier, in situ tumors accounted for only one to two percent of all breast-cancer diagnoses, whereas today in communities where people see doctors often and have lots of tests, in situ tumors account for at least 10 percent of all breast-cancer diagnoses. After lumpectomy and radiation, only one out of ten in situ malignancies recurs in the next five to eight years.

Most of my colleagues celebrate this as a triumph, because it appears that we are catching cancers earlier than ever and curing more of them. They may be right. But consider this--if one out of ten in situ cancers recurs after treatment, nine out of ten do not. If my view is correct, even without treatment many or most in situ cancers would never have grown big enough to be detected by palpation, let alone to pose a threat to life. They might even have become invasive and metastasized, but the metastases would also be too small to be detectable and would never be lethal--rendering the recurrence rate and thus the question of treatment ultimately unimportant to survival. As a result, mammography is only leading physicians to diagnose an ever-larger number of harmless tumors. Patients who otherwise would never have known they have cancer may needlessly suffer through the unique pain, anxiety, disfigurement, and expense associated with modern medicine and cancer. For all we know, the chief effect of mammography has been to disguise our inability to cure the old cancer, by burying it in cases of new cancer.


Not a new story, however if my cancer had been "in situ" I would have chosen to be treated. Breast Cancer is to sneaky a disease to ever just stand by an watch it. My opinion.

Best,

Doris

EveningStar2

one in ten
Apparently I'm the one. I have had a reoccurance of DCIS. When I was first diagnosed in 2009, I was aware of the controversy surrounding DCIS treatment. I wanted the lumpectomy, maybe would have passed on the radiation but DH was not buying off on that! Since I now have DCIS again, I am opting for bilateral mastectomy. I plan on dying from something other than breast cancer.

Maureen

mimikitty

SIROD said:

It's An Old Story....
Sixteen years ago in an article written by Dr. David Plotkin titled "Good News and Bad News About Breast Cancer" in what was then called The Atlantic Monthly Magazine. It was argued that some cancers grow to slowly to be treated and therefore are "over treated". Amazingly enough, I found the article still online, printed in June 1996.

http://www.theatlantic.com/magazine/archive/1996/06/good-news-and-bad-news-about-breast-cancer/7788/

Here is the part in the article that I am referring to:

Among the most important varieties of the new breast cancer is the in situ tumor--the small, localized, almost nongrowing tumor that at the time of diagnosis has seemingly neither become invasive nor developed the capacity to metastasize. Prior to mammography, as noted earlier, in situ tumors accounted for only one to two percent of all breast-cancer diagnoses, whereas today in communities where people see doctors often and have lots of tests, in situ tumors account for at least 10 percent of all breast-cancer diagnoses. After lumpectomy and radiation, only one out of ten in situ malignancies recurs in the next five to eight years.

Most of my colleagues celebrate this as a triumph, because it appears that we are catching cancers earlier than ever and curing more of them. They may be right. But consider this--if one out of ten in situ cancers recurs after treatment, nine out of ten do not. If my view is correct, even without treatment many or most in situ cancers would never have grown big enough to be detected by palpation, let alone to pose a threat to life. They might even have become invasive and metastasized, but the metastases would also be too small to be detectable and would never be lethal--rendering the recurrence rate and thus the question of treatment ultimately unimportant to survival. As a result, mammography is only leading physicians to diagnose an ever-larger number of harmless tumors. Patients who otherwise would never have known they have cancer may needlessly suffer through the unique pain, anxiety, disfigurement, and expense associated with modern medicine and cancer. For all we know, the chief effect of mammography has been to disguise our inability to cure the old cancer, by burying it in cases of new cancer.


Not a new story, however if my cancer had been "in situ" I would have chosen to be treated. Breast Cancer is to sneaky a disease to ever just stand by an watch it. My opinion.

Best,

Doris

Thanks for the Article
I felt the article you posted was intelligently written and very thorough. I read it in its entirety. It gave me a lot to ponder. BTW...I am 41 and recently diagnosed with Stage 1A invasive breast cancer. The tumor was 1.7 cm largest width. No lymph node involvement and just had a lumpectomy with clean but close margins. Other characteristics of the tumor look good ER+/PR+/HER2-. Thanks again.

carkris

EveningStar2 said:

one in ten
Apparently I'm the one. I have had a reoccurance of DCIS. When I was first diagnosed in 2009, I was aware of the controversy surrounding DCIS treatment. I wanted the lumpectomy, maybe would have passed on the radiation but DH was not buying off on that! Since I now have DCIS again, I am opting for bilateral mastectomy. I plan on dying from something other than breast cancer.

Maureen

it is interesting because
it is interesting because some prostate cancers are xconsidered like this. I wish they could figure out what cancers would lie dormant but how can they know? I know mine didnt choose to behave that way LOL

AngieD

carkris said:

it is interesting because
it is interesting because some prostate cancers are xconsidered like this. I wish they could figure out what cancers would lie dormant but how can they know? I know mine didnt choose to behave that way LOL

Mine is not DCIS, but I have
Mine is not DCIS, but I have to think:
BETTER SAFE THAN SORRY!

Angie

laughs_a_lot

AngieD said:

Mine is not DCIS, but I have
Mine is not DCIS, but I have to think:
BETTER SAFE THAN SORRY!

Angie

Russian Roulette
Would the insruance companies be content to let a case of DCIS go untreated in thier mothers, daughters, sisters? I think not. Everyone wants to hedge thier bets on the side of living.

camul

I dont think so
6-10 out of 2500. That doesn't seem like too many to me, and this is just an educated guess. There is no way to really know, as the one doctor says. They can't really do 2 study groups, one gets treated one does not. This percentage is extremely low, and just knowing that the numbers of men and women dying from the disease is so much lower, is enuf to tell me to keep on doing the mammo's and treating for dcis.


I saw an MO while mine was moving to private practice who told me my MO was too aggressive. He treated me aggressively because of HRT, and large doses of Estrogen and Premarin.
She went on to tell me that my chances for a recurrence were no more than anyone who had not had bc. I politely disagreed and told her I was very happy with my choices. Never saw her again, but she is the expert at our big cancer center on determining this for bc patients.

8 1/2 years later I was stage iv. Now if I had listened to her, there is no way I would have seen ned for 8 1/2 years. I would rather be treated, than play Russian Roulette with my life!

sweetvickid

This reminded me of a story.
This reminded me of a story. Friend of mine that was nurse said a Dr. she worked with 10 years ago thought BC was over diagnosed and treated. Especially DCIS. But when his wife was diagnosed with DCIS I think stage 0 he changed his tune. He took her to Barnes Hospital in St. Louis for a mastectomy and chemo. When she questioned him he was a tad pissed at her and said this was different it was his wife!