Mammograms: For 1 life saved, 3 women overtreated
LONDON (AP) - Breast cancer screening for women over 50 saves lives, an independent panel in Britain has concluded, confirming findings in U.S. and other studies.
But that screening comes with a cost: The review found that for every life saved, roughly three other women were overdiagnosed, meaning they were unnecessarily treated for a cancer that would never have threatened their lives.
The expert panel was commissioned by Cancer Research U.K. and Britain's department of health and analyzed evidence from 11 trials in Canada, Sweden, the U.K. and the U.S.
In Britain, mammograms are usually offered to women aged 50 to 70 every three years as part of the state-funded breast cancer screening program.
Scientists said the British program saves about 1,300 women every year from dying of breast cancer while about 4,000 women are overdiagnosed. By that term, experts mean women treated for cancers that grow too slowly to ever put their lives at risk. This is different from another screening problem: false alarms, which occur when suspicious mammograms lead to biopsies and follow-up tests to rule out cancers that were not present. The study did not look at the false alarm rate.
"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 breast cancer programs.
In the U.S., a government-appointed task force of experts 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 breast screening 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 that screening comes with a cost: The review found that for every life saved, roughly three other women were overdiagnosed, meaning they were unnecessarily treated for a cancer that would never have threatened their lives.
The expert panel was commissioned by Cancer Research U.K. and Britain's department of health and analyzed evidence from 11 trials in Canada, Sweden, the U.K. and the U.S.
In Britain, mammograms are usually offered to women aged 50 to 70 every three years as part of the state-funded breast cancer screening program.
Scientists said the British program saves about 1,300 women every year from dying of breast cancer while about 4,000 women are overdiagnosed. By that term, experts mean women treated for cancers that grow too slowly to ever put their lives at risk. This is different from another screening problem: false alarms, which occur when suspicious mammograms lead to biopsies and follow-up tests to rule out cancers that were not present. The study did not look at the false alarm rate.
"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 breast cancer programs.
In the U.S., a government-appointed task force of experts 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 breast screening 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."
I personally hate feeling pancaked by this process. Wishing there was another way of diagnosis other than a mammogram.Â
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Given that - I've had several where they are totally unreadable, due to the dense tissue. The insurance company will pay for the mammogram, but now not the ultrasounds. That's really unfair, if we leave it in Obama's care.Â
@washcomom This has effing NOTHING to do with the Affordable Care Act. The ACA is the only thing reigning in the insurance companies. They are the true Death Panels.
 @Mechanic It has EVERYTHING to do with the ACA, as they have taken things out of my affordability and made them UNAFFORDABLE. I'd like to see you pay for my ultrasound, when my insurance won't and I CANNOT afford it.Â
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Do you not get it??? The ACA is an absolute disgrace to the fact that what was allowable no longer is under Obama's guidelines, and we have the Federal Government telling us what will be paid for, and what won't be, and there is no recourse to it. It is giving a blanket diagnosis when everyone doesn't go under that particular blanket.
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I thought this country was made up of individuals and their rights to pursue their life, liberty and happiness. NO! Not so! The country has to stymie that action, so that everyone has the same blue blanket with the same twinkle stars on it. There are many who want pink with ribbons on them.
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Put yourself in waffle iron, and tell me how it feels, then come back to me with your spouting off. It bears NOTHING here. Â
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Thank you, @badcat , for your analogy. AWESOME!
@Mechanic I wish the ACA had addressed the costs hospitals and providers are billing to the insurance companies. In rural areas, where there is one hospital, they pretty much have a monopoly and charge exhorbitant fees - these fees need to be addressed. Insurance companies react and respond to those fees, they cannot absorb all of those outrageous fees without raising our premiums. This is a no win situation for all of us.
@washcomom In my area, it seems that most insurance companies have negotiated a price for well-woman care that provides for an annual mammogram for women over a certain age. It's amazing how all of a sudden, they "see" something on the mammogram, or they can't see through the dense tissue. Now, a no-cost mammogram has turned into a required ultrasound, bringing in additional money to the hospital or provider. The incidence for a follow up ultrasound is over 90%, what are the odds of that happening, really? They use scare tactics to ensure themselves of the ultrasound fee.
 @Kachina  @washcomom I think it depends on the provider. I've got Kaiser and in over 10 years of annual mammograms, I've only been asked to do an ultrasound once and that was for a mass that even I could see on my mammogram that wasn't there the year before. I was thankful for the ultrasound option (it thankfully turned out to be a cyst) and hope I don't have to ever be told again I need one.Â
 @washcomom If the screening process for testicular cancer involved putting them in a waffle iron, you can be guaranteed they'd come up with something better, and no matter how expensive, it would be covered!
Absolutely!
I really don't like this article. I get the point that it's trying to make, however, unfortunately, it will be this kind of study program that gets mammogram screenings eliminated from health care coverage for those that truly might have their lives saved from it. I know that aren't saying they are going to stop coverage as it currently exists, but with all the healthcare issues going on right now and insurance companies/government agencies looking for ways to cut costs - this might seem like an "easy" fix for saving $$.Â
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But, then the statistics will swing the opposite direction and for every $$ saved by eliminating coverage for annual mammograms beginning at 40 YOA, there will be 3 women die due to lack of early detection.Â
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Mammograms aren't a miracle detection tool, but it certainly catches a lot of potential issues that could easily become a life-taker in some women.  I hope women will continue to utilize the mammogram tool - along with self exams - regularly. Even if we/you have to pay for it out of pocket, I personally think it's well worth it.
 @Justanother1 I don't think they're advocating less screening. The solution to the problem isn't fewer tests, it's better ones. We need more funds for cancer research. It's criminal that we don't make this a top priority.