Health News Review

You judge.Two significantly different frames were used to tell the story of a paper in The Lancet.

The Associated Press (AP) headlined it: Mammograms: For 1 life saved, 3 overdiagnosed.  Excerpt:

“It’s clear that screening saves lives,” said Harpal Kumar, chief executive of Cancer Research U.K. “But some cancers will be treated that would never have caused any harm and unfortunately, we can’t yet tell which cancers are harmful and which are not.”

Each year, more than 300,000 women aged 50 to 52 are offered a mammogram through the British program. During the next 20 years of screening every three years, 1 percent of them will get unnecessary treatment such as chemotherapy, surgery or radiation for a breast cancer that wouldn’t ever be dangerous. The review was published online Tuesday in the Lancet journal.

Some critics said the review was a step in the right direction.

“Cancer charities and public-health authorities have been misleading women for the past two decades by giving too rosy a picture of the benefits,” said Karsten Jorgensen, a researcher at the Nordic Cochrane Centre in Copenhagen who has previously published papers on overdiagnosis.

“It’s important they have at least acknowledged screening causes substantial harms,” he said, adding that countries should now re-evaluate their own programs.

In the United States, a government-appointed task force recommends women at average risk of cancer get mammograms every two years starting at age 50. But the American Cancer Society and other groups advise women to get annual mammograms starting at age 40.

In recent years, the British program has been slammed for focusing on the benefits of mammograms and downplaying the risks.

Maggie Wilcox, a breast-cancer survivor and member of the expert panel, said the current information on mammograms given to British women was inadequate.

“I went into (screening) blindly without knowing about the possibility of overdiagnosis,” said Wilcox, 70, who had a mastectomy several years ago. “I just thought, ‘It’s good for you, so you do it.’ ”

Knowing what she knows now about the problem of overtreatment, Wilcox says she still would have chosen to get screened. “But I would have wanted to know enough to make an informed choice for myself.”

But the French news agency Agence France-Presse (AFP) reported, “Breast cancer screening saves lives, says study.” It’s lead line:

“The benefits of preemptive breast cancer screening outweigh the risks, a study said Tuesday, insisting the practice saves thousands of lives.”

And the final line in the AFP story:

Its work, said The Lancet, “should begin to lay the benefits versus harm controversy to rest”.

Really?  Let’s see.

Addendum on Oct. 31:  Dr. Otis Brawley of the American Cancer Society reacted to the study on the ACS blog. Excerpt:

“We have overwhelming evidence showing that mammography starting at age 40 saves lives and is even more effective in older populations. The data also suggests screening has harms. That’s a part of the message that has often been lost in vigorous efforts to encourage screening.”

Comments

Gary Fradin posted on November 5, 2012 at 11:43 am

Interestingly, we no longer buy cars just because they get ‘good’ gas mileage. Rather, we ask ‘exactly how many miles per gallon?’

We’re only just starting to ask the ‘exactly how many lives saved’ questions about medicine.

I, for one, view a test differently if it saves 1 life per 10,000 people screened over 10 years or 3,000 lives per 10,000 people screened over 10 years.

Ditto for harm.

Here’s hoping that one day medicine will actually become a science.