Tuesday, August 11, 2009

Mammography May Mean Over-Diagnosis Of Breast Cancer

Mammography May Mean Over-Diagnosis Of Breast Cancer

Dear Reader,

Today breast cancer is the second leading cause of death in women, after lung cancer.

As a result, a yearly mammogram has become common for women over 40, or anyone at high risk of developing this dangerous, disfiguring disease.

Now that programs like this are in place, experts had expected that the number of cases of advanced breast cancer would drop off, but that's not happening.

Instead the incidence of breast cancer seems to have gone up since widespread screening became part of our yearly exams. Why?

Women know that early detection of breast cancer can save lives, but that doesn't make going for that yearly mammogram any less nerve wracking or uncomfortable.

We endure the testing because we've been told we need to find lumps when they're too small to feel or bring symptoms, before they have a chance to grow and cause trouble.

But do all cancers cause problems?

Late last year a large Norwegian study of mammography screening for breast cancer found that some invasive cancers might spontaneously regress over time, leaving no sign that they were ever present in a woman's body.

The study authors pointed out, "This raises the possibility that the natural course of some screen-detected invasive breast cancers is to spontaneously regress."

Makes you wonder, now that we can screen for it, if breast cancer isn't over diagnosed or over treated.

This latest BMJ report citing an over-diagnosis rate for invasive breast cancer of 35% could truly have you re-thinking that yearly mammogram.

Besides breast cancer, over-diagnosis has also been mentioned for cancer of the prostate as well as neuroblastoma, melanoma, thyroid cancer and lung cancer.

The latest work on over-diagnosis comes from researchers out of the Nordic Cochrane Centre in Copenhagen.

The team looked at the findings of studies that spanned a 14-year period. 7 years before public mammography screenings were available, and 7 years after government run mammography-screening programs were in place in five different countries (United Kingdom, Canada, New South Wales, Australia, Manitoba, Sweden and areas in Norway)

They found an over-diagnosis rate of 52% for all cancers, 35% for invasive breast cancer.

The data shows a jump in breast cancer incidence just after the screening programs were put in place.

What this work suggests, as did the Norwegian study before it, that perhaps not all cancers need to be treated, some might grow too slowly to affect a patient and others may resolve on their own.

It's important to know that no doctor or current screening technique can tell the difference between a cancer that's dangerous and one that might not be.

In a BMJ editorial that's published along with the research, professor of medicine Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Research recognizes the problem of over-diagnosis, understanding the trauma and terror a woman endures after being given such news by her doctor.

Surgery and chemotherapy bring their own set of difficulties that are physically demanding and emotionally draining, and a terrible trial for patients and families. Especially those whose cancers might not have needed to be treated at all.

While this latest study is still not an excuse, or recommendation, to put off your yearly mammogram, it does raise some rather nagging questions.

Until we know more, each woman has to decide for herself, keeping in mind the words of breast cancer experts.

"We do know that breast cancer survival has increased, and we do know that screening increases survival," points out Dr. Richard J. Bleicher, a breast cancer surgeon with Fox Chase Cancer Center in Philadelphia. "Some of that screening has let us detect earlier cancers."

To your good health and replace your hormones that mimic a healthy, fertile, cycling, female!

Call my office to set up an appointment or email me 815-476-5210 or jones.gretchen@gmail.com


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