I could write a book on what’s wrong with today’s breast cancer screening “news.”
What I’m wondering is how to bring mainstream health journalists and women who are, lately, choosing not to have mammograms, to their senses about a persuasive but flawed argument put forth by a Dartmouth epidemiologist and others in a crew of seemingly like-minded, hopefully well-intentioned, some perhaps tenure-seeking and others grant-needing, circulatory bias-confirming academics who meet and discuss and write about the so-called dangers of mammography.
Maybe some doctors and journalists think they’re doing the right thing by informing a naïve body of women who, in the words of an LA Times writer today, presumes that we think only correlative and simple thoughts.
From Screening mammograms save fewer lives than you think:
If you or someone you know discovered she had breast cancer thanks to routine mammography screening, and if you or that friend with breast cancer got treatment and today is cancer–free, it’s natural to assume that the mammogram was a life-saver.
But odds are, it wasn’t.
More likely, the cancer that was picked up by that mammogram would have been just as treatable even if it hadn’t been caught until you or your friend felt a lump in the breast. It’s also entirely possible that the cancer wouldn’t have killed you (or your friend) if it had been left alone, untreated.
More than 75% of women who found out they had breast cancer from a screening mammogram fell into one of these two categories, and no more than 25% of them can give the test credit for saving their lives.
In the 5th paragraph of this news item:
So says a study published online Monday by Archives of Internal. The authors – Dr. H. Gilbert Welch and Brittney A. Frankel of the Dartmouth Institute for Health Policy and Clinical Practice – used data from the National Cancer Institute to arrive at this conclusion… <italics added, ES>
First things first: the title makes an assumption about what I, or you, or any reader, thinks.
Next this high-profile piece tells readers that, sometimes, people incorrectly draw inferences based on their personal experiences rather than from science. (Really? Do we need a nominally straight news story from the LA Times to explain this?)
We’re given two factoids: first — that over 75% of women diagnosed with BC by screening mammography wouldn’t have died from the cancer if they hadn’t had mammography; and second — that no more than 25% of those same women can rightly credit a mammogram for saving their lives.
But this is just one stat, or falsehood, based on the true, assumption-free relationship between 75% and 25%.
Dr. H. Gilbert Welch, who recently likened mammography-taking to gambling, plays freely with impressive-sounding information sources. He and his coauthor used data from the NCI. Seemingly hard to argue with those kinds of numbers. But they used old data, again, and employ numerous assumptions (what the authors call generous, but I wouldn’t) to render calculations and “prove” their point published in the Archives of Internal Medicine.
The manipulative tone is set in the paper’s abstract:
“…We created a simple method to estimate the probability that a woman with screen-detected breast cancer has had her life saved…
Simple? Don’t you believe it.
There’s a Well post in the New York Times today covering the same Archives of Internal Medicine article. Not surprisingly, this draws positive feedback in the comments and Twitter-chatter. Some of the more understandable discussion comes from women with metastatic disease whose tumors were missed by screening mammography. Notably, neither paper quotes an oncologist.
Here in the U.S. where we do spend too much on health care, we all know women whose breast tumors were missed by screening mammograms. This happens, and it’s awful, but it doesn’t and certainly shouldn’t happen so often as some doctors seem to think. Extrapolating from personal observations to draw conclusions about a procedure’s value is flawed reasoning, either way.
I agree with many of Dr. Susan Love’s school, and most of the NBCC agenda, and others that say breast cancer prevention would be better than treatment. How could I not?
But until there’s a prevention for BC, which I’m sorry to report is unlikely to happen before 2020, especially because it’s really 15 or 20 or maybe even more diseases that would, presumably, need distinct methods of prevention, and until there are better, less damaging and less costly remedies, mammography may be the best way for middle-aged women to avoid the debilitating and lethal effects of late-stage disease. And for society to avoid the costs of that condition and its treatments, which are huge.
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Dr. Schattner:
You comment that “mammography may be the best way for middle aged women to avoid the debilitating and lethal effects of late stage disease”. I agree and so does the article which sites the guidelines for mammograms every other year for those middle aged women 50–74 years of age.
The point is that mammograms have been oversold, and the message of early detection-awareness has hijacked a broader, more realistic discussion of the issues of a breast cancer “cure”. Early screening is not the cure and more money needs to go to finding treatments for those unlucky enough to have a “bad” cancer (undiscovered or identified too late by mammograms) and more to investigating the process of metastases, which is, after all, what causes death.
Any effort to refocus the breast cancer discussion and dispel some of the mythology surrounding it is welcome.
Ginny,
I appreciate your comment. But I don’t think awareness campaigns should “hijack” other discussions.
The tension between screening proponents and others isn’t essential.Until there is a good preventive method, or an easy cure, why can’t we benefit from high-quality screening? In my view, we should be pushing for universal mammography standards (e.g. digital for young women, specialized radiologists, etc.) while we press for prevention, better science, and cures for each BC subtype.
[…] Medical Lessons, who’s none too pleased with recent anti-mammogram rhetoric. “Mammography may be the best way for middle-aged women to avoid the debilitating and lethal effects of late-stage disease” […]
[…] Schattner, M.D. at Medical Lessons blog, is concerned about one-sided reporting on the downsides of mammograms. She reminds us that epidemiologists are not oncologists, and that […]