One-Third of Breast Cancer Patients Are Getting Treatment They Don't Need; Many Women with Breast Cancer Detected by a Mammogram Are Treated Unnecessarily, Because Screening Tests Found Slow-Growing Tumors That Are Essentially Harmless

By Szabo, Kaiser | Newsweek, January 27, 2017 | Go to article overview

One-Third of Breast Cancer Patients Are Getting Treatment They Don't Need; Many Women with Breast Cancer Detected by a Mammogram Are Treated Unnecessarily, Because Screening Tests Found Slow-Growing Tumors That Are Essentially Harmless


Szabo, Kaiser, Newsweek


Byline: Liz Szabo, Kaiser Health News

One in three women with breast cancer detected by a mammogram is treated unnecessarily, because screening tests found slow-growing tumors that are essentially harmless. That's according to a Danish study, published in Annals of Internal Medicine, that has renewed debate over the value of early detection.

The study raises the uncomfortable possibility that some women who believe their lives were saved by mammograms were actually harmed by surgery, radiation and even chemotherapy they didn't need, said Dr. Otis Brawley, chief medical officer of the American Cancer Society. He wrote an accompanying editorial but was not involved in the study.

Researchers increasingly recognize that not all breast cancers pose the same risk, even if they look the same under a microscope, Brawley said. While some early tumors turn into deadly monsters, others stop growing or even shrink. But assuming that all small breast lesions have the potential to turn deadly is akin to "racial profiling," Brawley wrote in his editorial.

"By treating all the cancers that we see, we are clearly saving some lives," Brawley said in an interview. "But we're also 'curing' some women who don't need to be cured."

Although experts such as Brawley have long discussed the risks posed by overdiagnosis, relatively few women who undergo cancer screenings are aware of the debate. The American College of Radiology, which strongly supports breast cancer screenings, acknowledges that mammograms lead some women to be treated unnecessarily, but said the problem is much less common than the new study suggests. Another study from Denmark--where the national health program keeps detailed records--estimated the overdiagnosis rate at only 2.3 percent. Brawley notes that most estimates of overdiagnosis put the rate between 15 percent and 25 percent of breast cancers.

"The amount of overdiagnosis really is small," said Dr. Debra Monticciolo, chairwoman of the American College of Radiology's Commission on Breast Imaging. "Articles like this aren't very helpful," she added, because they leave women confused about how and whether to be screened for breast cancer.

But treating women for cancer unnecessarily can endanger their health, said Fran Visco, president of the National Breast Cancer Coalition, an advocacy group. Radiation can damage the heart or even cause new cancers. Visco notes that breast cancer activist Carolina Hinestrosa, a vice president at the coalition, died at age 50 from soft-tissue sarcoma, a tumor caused by radiation used to treat an early breast cancer. Women should understand these risks, Visco said. Instead, women often hear only about mammograms' benefits. "Women have been inundated with the early-detection message for decades," she said.

The risks of overdiagnosis and false positives, which can lead women with benign growths to undergo biopsies and other follow-up tests, have caused some experts to re-evaluate breast cancer screenings. Although mammograms don't find all tumors, they reduce the risk of dying from breast cancer by 25 percent to 31 percent for women ages 40 to 69, according to the Agency for Healthcare Research and Quality, part of the Department of Health and Human Services.

Medical groups now offer differing advice on mammograms. …

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