Associated Press discussed a recent article in the BMJ which found that 1 out of 3 breast cancers were overtreated based on review of breast cancer screening programs in Britian, Canada, Austrailia, Norway, and Sweden. Specifically that screening tests are unable to tell which breast cancers are potentially more deadly and which ones are less so.
The study's results are troubling not because of the screening tests inability to differentiate between aggressive cancers compared to more slow growing. The problem with this report is what the public hears and does.
Specifically, women might not get screened.
Note that the countries listed all have better healthcare outcomes than the United States. There levels of screening are far better than in the United States. We already are the worst among industrialized countries on doing basic things like vaccinations, cholesterol, blood pressure control, and screening tests like mammograms, colon tests, and prostate exams. As a country, there is probably a lot more we must do before we have the issue of "overtreatment".
If both men and women hear that screening causes cancers to be overtreated that they won't get screened. There will be too many preventable deaths and major costs to families which are bankrupting.
What the report could have said was screening in fact detects potentially fatal cancers 2 out of 3 times.
From the article -
Study: 1 in 3 breast cancer patients overtreated
By MARIA CHENG – 21 hours ago
LONDON (AP) — One in three breast cancer patients identified in public screening programs may be treated unnecessarily, a new study says. Karsten Jorgensen and Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen analyzed breast cancer trends at least seven years before and after government-run screening programs for breast cancer started in parts of Australia, Britain, Canada, Norway and Sweden.
The research was published Friday in the BMJ, formerly known as the British Medical Journal. Jorgensen and Gotzsche did not cite any funding for their study.
Once screening programs began, more cases of breast cancer were inevitably picked up, the study showed. If a screening program is working, there should also be a drop in the number of advanced cancer cases detected in older women, since their cancers should theoretically have been caught earlier when they were screened.
However, Jorgensen and Gotzsche found the national breast cancer screening systems, which usually test women aged between 50 and 69, simply reported thousands more cases than previously identified.
Overall, Jorgensen and Gotzsche found that one third of the women identified as having breast cancer didn't actually need to be treated.
Some cancers never cause symptoms or death, and can grow too slowly to ever affect patients. As it is impossible to distinguish between those and deadly cancers, any identified cancer is treated. But the treatments can have harmful side-effects and be psychologically scarring.
"This information needs to get to women so they can make an informed choice," Jorgensen said. "There is a significant harm in making women cancer patients without good reason."
Jorgensen said that for years, women were urged to undergo breast cancer screening without them being informed of the risks involved, such as having to endure unnecessary treatment if a cancer was identified, even if it might never threaten their health.
Doctors and patients have long debated the merits of prostate cancer screening out of similar concerns that it overdiagnoses patients. A study in the Netherlands found that as many as two out of every five men whose prostate cancer was caught through a screening test had tumors too slow-growing to ever be a threat.
"Mammography is one of medicine's 'close calls,' ... where different people in the same situation might reasonably make different choices," wrote H. Gilbert Welch of VA Outcomes Group and the Dartmouth Institute for Health Policy and Research, in an accompanying editorial in the BMJ. "Mammography undoubtedly helps some women but hurts others."
Experts said overtreatment occurs wherever there is widespread cancer screening, including the U.S.
Britain's national health system recently ditched its pamphlet inviting women to get screened for breast cancer, after critics complained it did not explain the overtreatment problem.
Laura Bell of Cancer Research UK said Britain's breast cancer screening program was partly responsible for the country's reduced breast cancer cases.
"We still urge women to go for screening when invited," she said, though she acknowledged it was crucial for women to be informed of the potential benefits and harms of screening.
On the Net:
http://www.bmj.com
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