Health News Review

The New York Times Sunday magazine piece, “Our Feel-Good War on Breast Cancer,” is by Peggy Orenstein who begins:

“I used to believe that a mammogram saved my life. I even wrote that in the pages of this magazine. It was 1996, and I had just turned 35 when my doctor sent me for an initial screening — a relatively common practice at the time — that would serve as a base line when I began annual mammograms at 40. I had no family history of breast cancer, no particular risk factors for the disease.

So when the radiologist found an odd, bicycle-spoke-like pattern on the film — not even a lump — and sent me for a biopsy, I wasn’t worried. After all, who got breast cancer at 35?

It turns out I did.”

But a few paragraphs later, she updates readers:

“Sixteen years later, my thinking has changed. As study after study revealed the limits of screening — and the dangers of overtreatment — a thought niggled at my consciousness. How much had my mammogram really mattered? Would the outcome have been the same had I bumped into the cancer on my own years later? It’s hard to argue with a good result. After all, I am alive and grateful to be here. But I’ve watched friends whose breast cancers were detected “early” die anyway. I’ve sweated out what blessedly turned out to be false alarms with many others.”

And she concludes the long piece:

“It has been four decades since the former first lady Betty Ford went public with her breast-cancer diagnosis, shattering the stigma of the disease. It has been three decades since the founding of Komen. Two decades since the introduction of the pink ribbon. Yet all that well-meaning awareness has ultimately made women less conscious of the facts: obscuring the limits of screening, conflating risk with disease, compromising our decisions about health care, celebrating “cancer survivors” who may have never required treating. And ultimately, it has come at the expense of those whose lives are most at risk.”

Read the entire piece.

Then read the Reuters story, “New guidelines did not change mammography rates,” which explains:

“The proportion of women undergoing screening for breast cancer every year did not change after a government-backed panel said women in their 40s shouldn’t have routine mammograms, according to a new study.

“It would be optimistic to think the lack of change reflects the decision by many women in their 40s to go ahead and proceed with mammography with a clear understanding of the benefits as well as the risks,” (Dr. Michael LeFevre, co-vice chair of the US Preventive Services Task Force) told Reuters Health.

“I think it is a bit more likely that physicians continue to recommend mammography without necessarily discussing the specifics of what the science tells us,” said LeFevre, who wasn’t involved in the new study. “It’s always easier to do than to discuss.”



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Katherine OBrien posted on April 27, 2013 at 8:44 am

Hi Gary
Orenstein’s article is well done and certain to elicit a lot of commentary. One thing she didn’t write about, however, is our crummy data.

Meaningful statistics on metastatic breast cancer recurrence are elusive. US cancer registry data captures data at the time of diagnosis and death. The registries don’t track what happens in between.

As Orenstein notes, 30% of those originally diagnosed with early stage breast cancer will have a metastatic recurrence. But this information is not tracked–until people die:

NCI and SEER database record incidence, initial treatment and mortality data. Most people do NOT present with metastatic diagnosis. The cancer registry does not track recurrence—which is how the majority of people are thrust into the metastatic breast cancer ranks.
We say that there are 150,000 US people currently living with metastatic breast cancer, but that’s basically a guess.
We know for sure that 40,000 US people die from breast cancer every year. We know that 5 to10 percent of those with metastatic breast cancer were Stage IV from their first diagnosis. So what about the 90 to 95% of those 150,000 currently living with metastatic breast cancer who were previously treated for early stage breast cancer? The cancer registry does not track them—until they die.

See more here: