Doctors critical of mammography study

Medical advances undermine Canadian report, they say
2014-02-24T13:03:00Z Doctors critical of mammography studyISABELLE DILLS Napa Valley Register
February 24, 2014 1:03 pm  • 

Local cancer experts strongly disagree with the findings of a newly published study, which reported that mammograms do not reduce breast cancer death rates, and that the screening tool does more harm than good.

Titled “Too Much Mammography,” the study was published Feb. 11 in The British Medical Journal. The study, which was based in Canada, followed approximately 90,000 women who were assigned to either receive regular mammograms or have no mammograms between the years 1980 and 1985. Researchers followed the participants for about another 25 years.

During the screening period, approximately 660 invasive breast cancers were diagnosed in women who received mammograms, and about 520 cases were diagnosed in those who did not receive the screening. Among the women diagnosed through mammograms, 180 died of breast cancer, and 171 died from the group who were diagnosed without mammography.

According to the findings, mammograms contributed to the ovediagnosis of breast cancer — meaning the screening detected a cancer that was not an actual threat to the woman’s health, but she still underwent chemotherapy, surgery, or radiation.

Dr. Ethan Schram, of St. Helena Hospital’s Martin-O’Neil Cancer Center, said this study would not change his mind about the need for mammography.

“I still recommend screening for the majority of women over the age of 40, and earlier in some women who are at high risk for breast cancer,” Schram said. “While the study was large and detailed, it took place between 1980 and 1985 and many things have changed since then, including how much better we are at evaluating and treating early stage breast cancer.”

Schram said doctors now have more prognostic tests, which can help them decide who needs to receive treatment and how aggressively the cancer should be treated.

“So this study, while interesting, tells us a great deal more about the state of breast health in the early ’80s than it tells us about where we are now in 2014,” Schram said.

In the 1980s, mammograms did overdiagnose many women, Schram added, and treatment options were limited.

“Today, once a cancer is identified through screening, we can discriminate between the low risk cancers, the ones that may not need any or very little treatment, and the high risk cancers that may need aggressive therapies, sparing thousands of women the unnecessary and sometimes harmful treatments they would have been given 25 years ago,” Schram said. “These tests, and there are more coming every year, simply weren't available until about 2004.”

Dr. Marzban Rad, the sub-chief for breast imaging for Kaiser Permanente in the Napa-Solano area, described the Canadian study as “incredibly flawed” because it relied on old equipment and physicians did not use the appropriate “grids,” which makes the mammography picture look more crisp.

“There is absolutely no better screening tool that we have in 2014 than screening mammography,” Rad said.

He added that overdiagnosis can be reduced by using state-of-the art equipment and having a radiologist, who specializes in breast imaging, view the results.

Rad said that he “flatly disagreed” with the study’s finding of mammograms doing more harm than good.

“In the ’80s and early ’90s, breast cancer was the number one killer of women — now it’s heart disease,” said Rad, who credits mammograms and women’s knowledge of the screening tool in reducing breast cancer death rates.

While the Canadian study may leave many women confused — or perhaps, frustrated — both Schram and Rad said women need to be aware of their own risk factors for breast cancer and discuss the need for screening with their doctor.

“I tell (patients) that I still recommend mammograms to my own family, but that ultimately it comes down to a personal decision,” Schram said.

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(1) Comments

  1. skeptic
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    skeptic - February 25, 2014 9:27 am
    surely both dr.s are aware that the journal of the american medical association also made a similar claim about more recent cancer diagnosis. of course, if a similar study to the one reported in the british journal would not be complete for another 25 years if they started today. luckily , we have the jama study based on more recent statistics".for every 2000 women attending mammography screening throughout 10 years, 1 less dies of breast cancer. Concurrently, approximately 10 women with pseudodisease receive a diagnosis of breast cancer and are unnecessarily treated.”
    http://archinte.jamanetwork.com/article.aspx?articleid=1754987http://archinte.jamanetwork.com/article.aspx?articleid=1754987
    this 2013 article states that only 9.5% of physicians inform their patients about the risk of over diagnosis and the fact that surgery ,chemo and radiation may be used when not needed . i’m just a lay person who likes keeping up on journals.
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