How Much is Too Much?
Sep 13, 2013 01:43PM ● Published by Cate Reynolds
By Sarah Hagerty
In a dramatic revelation in the November 2012 issue of the New England Journal of Medicine, authors Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H., questioned the efficacy of the current mammography testing standards. The report stated: “Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer.” The report continued: “After excluding the transient excess incidence associated with hormone-replacement therapy and adjusting for trends in the incidence of breast cancer among women younger than 40 years of age, we estimated that breast cancer was over diagnosed (i.e., tumors were detected on screening that would never had lead to clinical symptoms) in 1.3 million U.S. women in the past 30 years. We estimate that in 2008, breast cancer was over diagnosed in more than 70,000 women; this accounts for 31 percent of all breast cancers diagnosed.” *(Editor’s Note: Bolding emphasis ours.)
This is nothing short of stop-you-in-your-tracks information. In laymen’s terms, they were saying that almost one-third of the breast cancer found was never going to be life-threatening.
In the same vein, three years ago, the U.S. Preventive Services Task Force (USPSTF), an independent panel that reviews a range of preventive services, issued controversial guidelines saying that most women age 40 to 49 should no longer get routine mammograms. This started an understandable uproar. But, in the end, it didn’t seem to make much of a difference.
According to the National Health Interview Surveys, we’ve been unaffected—mammography rates actually increased slightly between 2008 and 2011. That’s not really surprising. The data can be confusing—we hear from friends and acquaintances that a mammogram saved their mother, sister, themselves. Health news seems to change almost daily—“this is good for you; that is bad for you; no, sorry, it’s the other way around.” “You must have this test.” “This is a test to be avoided.” Etc. And what, we wonder, is the harm in getting a mammogram every year anyway?
The National Cancer Institute (NCI) says there may be some harm—or at least fallout from annual mammography. It cites:
• Finding cancer early does not always reduce a woman’s chance of dying from breast cancer
• False-negative results
• False-positive results
• Over diagnosis and over-treatment
• Radiation exposure [although the levels are very low] Nonetheless, the NCI recommends that women age 40 or older have screening mammograms every one to two years.
The Mayo Clinic has a more well-rounded approach as it suggests talking to your doctor for those concerned about screening mammograms. Discuss your personal risk of breast cancer (family history, age, the geographic area in which you live); the benefits, risks and limitations of screenings; the role self-exams play in identifying abnormalities or changes; and the role of clinical breast exams.
Breast cancer screening, however, isn’t the only procedure facing new scrutiny. The American Urology Association has reassessed its longtime solid support of prostate cancer screening, now saying that the testing should be considered primarily for men age 55 to 69. The new guidelines issued in May state that routine screening is no longer recommended for men age 40 to 54 who are at average risk of getting prostate cancer. Screening is also not recommended for men 70 and older.
The American Cancer Society may have the last word on the subject of cancer testing by suggesting we reduce our overall risk of getting cancer. They recommend:
• Stay away from tobacco
• Stay at a healthy weight
• Get moving with regular physical activity
• Eat healthy with plenty of fruits and vegetables
• Limit how much alcohol you drink (if you drink at all)
• Protect your skin
• Know yourself, your family history, and your risks
And, of course, the American Cancer Society recommends “regular check-ups and cancer screening tests.” Looks like we’re back where we started.
What’s Up? does not give medical advice. This material is simply a discussion of current information, trends, and topics. Please seek the advice of a physician before making any changes to your lifestyle or routine.