Mammograms and Unnecessary Cancer Treatment

My partner has often written about the diagnosis and treatment of prostate cancer and the decision making process that goes along with them, noting that often the treatment is unnecessary or that it is worse than the disease.  Well, it looks like women should have the same concerns about the diagnosis and treatment of breast cancer.

A recent study published in the Annals of Internal Medicine concluded that mammograms, the leading diagnostic tool for detecting breast cancer, lead to unneeded treatments one-third of the time because the tumors were growing so slowly or were essentially benign.  The study concludes that while treating all breast tumors the same clearly saves lives, many women are subjected to surgery, radiation or chemotherapy who simply don’t need it.  These treatments can cause other problems including heart damage and even different cancers.  Other scholarly articles have reached similar conclusions.

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The study’s findings are not without criticism.  A Denmark study put the overdiagnosis rate at only 2.3%, a significant difference.  Different medical groups also offer different advice regarding mammograms.  The American College of Radiology, for example, recommends the most frequent screening with annual mammograms after age 40.  Some might cynically suggest this recommendation panders to the economic interest of radiologists.  However, there are also plenty of studies which support the position that, consciously or not, financial incentives often drive medical decisions making and the way health care is delivered.  Certainly, there is no reason to believe radiologists are immune from the pull of such forces.

The debate about overdiagnosis of breast cancer, much like the similar debate over prostate cancer, highlights the need for patients to become informed, ask questions and participate more completely in their health care decisions.   Sometimes, there are no right or wrong answers when it comes to breast cancer detection and treatment, but patients should be encouraged to develop an informed assessment of the relative risks and benefits of their care in order to participate fully in decision making process.

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Posted in Breast Cancer, Mammogram |