In Shift, Cancer Society Has Concerns on Screenings

[azurnoir]

Source: NYT

The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

Prostate cancer screening has long been problematic. The cancer society, which with more than two million volunteers is one of the nation’s largest voluntary health agencies, does not advocate testing for all men. And many researchers point out that the PSA prostate cancer screening test has not been shown to prevent prostate cancer deaths.

There has been much less public debate about mammograms. Studies from the 1960s to the 1980s found that they reduced the death rate from breast cancer by up to 20 percent.

The cancer society’s decision to reconsider its message about the risks as well as potential benefits of screening was spurred in part by an analysis published Wednesday in The Journal of the American Medical Association, Dr. Brawley said.



Read more: http://www.nytimes.com/2009/10/21/health/21cancer.html?partner=rss&emc=rss

[Demeter]

1. No Kidding!

But there's these horribly expensive, pain-inflicting machines to pay for!

[sicksicksick_N_tired]

27. Less expensive semi-annual full screen blood tests are more practical for detection.

I don't know what else to say.

[ccinamon]

2. Good article...hopefully doctors & screeners will get on board!

I always thought it was strange that there was more diagnoses, but no significant change in the death rates....I knew they were looking at the whole cancer thing wrong. I'm glad someone is finally thinking outside the box!

quote: "But finding those insignificant cancers is the reason the breast and prostate cancer rates soared when screening was introduced, Dr. Kramer said. And those cancers, he said, are the reason screening has the problem called overdiagnosis — labeling innocuous tumors cancer and treating them as though they could be lethal when in fact they are not dangerous.

“Overdiagnosis is pure, unadulterated harm,” he said."

[JenniferJuniper]

3. Over-diagnosis is a huge problem

particularly with breast cancer, primarily because of the irrational obsession with mammography.

"They are finding cancers that do not need to be found because they would never spread and kill or even be noticed if left alone. That has led to a huge increase in cancer diagnoses because, without screening, those innocuous cancers would go undetected."

But the Cancer Industry, I mean, Cancer Society, has been lying about that "'20% lower death rate" due to mammograms for decades. Why even a hint of a shift now?

[Berry Cool]

4. Thank you, thank you, thank you.

Each year during this month, we get beaten over the head with the "Women, get your mammograms!" message. We get told that "early detection" is the most important key to successful treatment of breast cancer. We get ever newer and more obnoxious versions of that message ("Get your boobies squished," "Examine your titties," etc.), designed to appeal to the 12-year-old boy in all of us. And we get exhorted to do what we can to help poor women get free mammograms.

What we don't get is the truth, as you stated it above...or recognition of the fact that each mammogram a woman gets re-subjects her breasts to radiation...and radiation is a cause of cancer.

We need a better form of screening for breast cancer than we now have. Even more, we need a greater focus on prevention rather than just "early detection." Early detection is not prevention; it is not protection; it is not cure. It does offer more time and more treatment options, but the sad fact is that some cancers cannot be stopped no matter how early they are detected, while others will never be that dangerous no matter how late they are detected and, thus, we may be wasting unnecessary time and health-care dollars treating them. It doesn't mean mammograms are useless, but it does mean they are not the be-all and end-all. Nor does a cancer found early via a free mammogram mean anything to a woman who can't afford to have it treated.

Many people mean well when it comes to cancer, but mindlessly reciting mantras about the importance of breast self-exams, mammograms and early detection is not making all that much of a positive difference in women's health and lives.

[JenniferJuniper]

5. I hear ya.

The real issue is that we don't have a handle on the true nature of many cancers, and this is clearly true for breast and prostate cancers.

We've been brainwashed into believing that all breast malignancies will be fatal if not treated. (you'll note this is not as much the case with prostate cancer.) This would only be true if we had the capacity to live to 125 or older. But we don't; our bodies will very likely give out from something completely unrelated before that ever happens. (and then there's the evidence that some tumors actually regress on their own without treatment.)

Asymptomatic breast cancer screening as it currently works cannot differentiate between those malignancies that will indeed kill and those that would do no harm ever in the remaining life span of the individual. And before anyone says "better safe than sorry!", they need to read up on the dangers of cancer treatment. It can do serious damage, even kill. Radiation. Shudder.

My daughter's former babysitter was just diagnosed with breast cancer via an asymptomatic mammogram two weeks ago. She's 83, hadn't had a mammogram and 10 years, and her new primary doctor insisted she consider one. So she had one, lo and behold it found cancer, she's now in a complete panic and her surgery and treatment schedule are all planned. 83. Would she be better off never knowing about this and not going through this ordeal? I can't say for sure, of course, but the statistics would seem to indicate she would have been better off without that mammogram.

[still_one]

7. Where are you coming up with that "finding cancers that do not need to be found"?

How do you determine that?

If you cannot see that detecting a cancer early before it has spread is life saving, then you are quite naive

[JenniferJuniper]

9. Sorry, but

I'm not going to be your research monkey. See my post below, and for further info search for "breast cancer" and "overdiagnosis". The statistical data has been out there for some time. The American Cancer Society finally has to start dealing with it.

Oh, and I assure you, I am anything but naive.

[still_one]

10. Research monkey, you are the one who made the point. Have a good anti-science life /nt

[JenniferJuniper]

11. Did you not see my post below

as I suggested? You are simply having a knee-jerk, emotional reaction to information that conflicts with what you've been programmed to believe. Anti-science? Hardly.

[dflprincess]

12. Dr. Susan Love has talked about this

she also says one of the problems with current screenings is that they can result in a biopsy that shows benign but atypical cells. There is evidence that women who are diagonised with "atypia" have a higher risk of breast cancer but not enough is really known about these atypical cells to tell which ones are the ones that may become cancerous and which ones are going to stay benign or even be destroyed by the immune system.

[JenniferJuniper]

13. Susan Love is quoted in this article

which is actually a very good summary for laypeople of the mammography/overdiagnosis problem:

http://8.12.42.31/2009/aug/17/health/he-breast-overdiagnosis17

“Screening is really good at finding the slow, ploddy, probably-not-going-to-kill-you cancers, but it’s not so good at finding the fast, aggressive ones,” says Susan Love, president of the Dr. Susan Love Research Foundation and author of “Dr. Susan Love’s Breast Book.”

[Kolesar]

16. "The Cancer Industry"

:eyesroll: Hot words "kind of" take away from your message.

[JenniferJuniper]

17. Perhaps it will for some.

But if you can't see that major, major money is made diagnosing and treating breast cancer, you are not seeing the full picture here.

Mammography is both an essentially useless tool AND a multi-billion dollar industry. You don't have any problem with that?

[Kolesar]

18. I don't have any mamms, so this is all new to me

I read up on this stuff for the sake of those I love.

Did you hear the NPR ATC segment where one town had incredible rates of hysterectomy for some unknown reason? There was a 70% probability that any woman would have a hysterectomy by age 70.

In closing, the NPR writer noted that there is an incentive for doctors to do *more* surgery. It's money.

[JenniferJuniper]

20. Sure. Surgeons don't get paid unless they do surgeries and

given my line of work, I could tell you some absolute horror stories about unnecessary procedures.

But this cancer screening thing is far bigger and broader in scope than rogue doctors who may do some unscrupulous things to make money.

I'll defend the doctors here. Because groups like the American Cancer Society have so effectively brainwashed (and I don't use that word lightly) everyone into believing their mantras about mammograms and "early detection being the best prevention" (that's supposed to be logical?), your typical primary care physician has his or her hands tied when it comes to recommendations. See the LA Times article I linked below for this quote - "The choice is, overbiopsy and overdiagnose – or live through another lawsuit." If a doctor tells a patient there is a high probability that routine screening won't make a damn bit of difference in her life, and she is later diagnosed with cancer, there is always a risk of a lawsuit. Never mind that the doctor WAS right - it wouldn't have mattered, if he goes against the conventional wisdom of the ACS and other such groups, he'll likely run into legal trouble at some point.

We've known forever that mammograms don't really work well at all for pre-menopausal women, yet the screening age was lowered to 40, for no good reason. (well, aside from that money thing :)). Very few doctors will buck this, even those who are not statistically challenged and understand exactly what is going.

Look, I can't undo decades of disinformation in this thread, so I just strongly suggest anyone interested in subject do some independent research. I'd start with the comprehensive Danish study that was released in early 2002. This is where much of this started and information has continued to develop from there. It's taken nearly eight years for the American Cancer Society to even begin to acknowledge those findings. Frankly, I'm surprised they were that quick about it.

[JenniferJuniper]

21. Also, while you may not be getting mammograms

There are some parallel questions regarding routine prostate cancer screening.

[Berry Cool]

25. You don't have any mamms?

Aren't you a mammal? If you're a mammal, you have mamms...and thus the potential for getting breast cancer. Unless you've had a total mastectomy, but cancer can still recur (sadly) in the chest wall.

There's no guarantee for anyone--female or male--to be free of breast cancer risk.

[still_one]

6. bullshit. Detecting breast and prostate cancer early is the best chance against it spreading

where there is less chance for a cure.

Yes, PSA by itself isn't a reliable indicator, but used in conjunction with a digital, and over time, comparing the velocity of the PSA is quite accurate indicator. In addition, new screening tests will be coming out in the next few years.

As for breast cancer there is no question that early detection saves lives, and mammograms can detect cancers that self-exam can't

What about colonoscopy? It is a well know fact that polyps are a risk factor for cancer, and that early detection and removal saves lives

This sounds to me like penny wise pound foolish

What may be an unecessary test for one person, would be a life saver for another

[JenniferJuniper]

8. So we've been told.

Over and over and over again.

But it does not appear to be true. Statistics don't lie. But billion dollar industries do. And this is the AMERICAN CANCER SOCIETY that is shifting their position. Not just some researchers in Iceland or Denmark. This is a big deal.

Counterintuitive, I know, but there absolutely IS question that "early detection saves lives". From the International Journal of Epidemiology (and you can find this data elsewhere as well):

"It follows that after 1000 women have been invited to regular screening throughout 10 years, one of them (0.1%) may avoid dying from breast cancer. Since overall mortality was 10%, it means that invitation to screening—most optimistically—may increase survival from 90.2% to 90.3%. Thus, for every 1000 women invited for screening throughout 10 years, at most one—and possibly none, since an effect on overall survival has not been demonstrated–is saved; five additional women will be diagnosed with cancer who would not have got a cancer diagnosis had they not been screened; two additional women will get a mastectomy and three a tumourectomy; and more than 100 women will experience important psychological distress for many months because of false positive findings."

Sure, maybe you'd be that possible "one" that might saved in 10 years of screening. But you're statistically far more likely to be harmed in various possible ways. People have the right to know this. And it seems even the American Cancer Society can't avoid the numbers any longer.

This is primarily about asymptomatic screening for prostate and breast cancers. Colonoscopies are another sort of issue altogether, although there is some debate about them as well.

[dflprincess]

14. I don't think anyone is saying don't get screened

(I'm certainly not going to stop) it's just that some screenings may not be all they've been made out to be.

Another thing Susan Love would like to see is a "pap smear" for breast cancers - and more study of the atypcial cells so they'd know which ones are more dangerous. For example, one of the problems with the current diagnosis of atypia is that it not only may cause more anxiety than it needs to and, with our current system, it make a woman uninsurable because of the presumed increase risk of cancer - and that risk may not be there at all.

[JenniferJuniper]

15. Actually,

I think we're gradually heading in the direction of "don't get routinely screened". At least not until we develop significantly improved screening methods, perhaps along the lines of the cell studies you reference.

The shocking bottom line here is that as a routine screening tool, mammography is, statistically speaking, practically useless when all variables are considered.

And let's face it, the more false security women get from yearly mammograms, the less likely they are to demand better diagnostic tools. This "well, it's the best we've got so we're stuck with it" crap should be causing outrage.

[AngryAmish]

22. You seem to know a lot about this

[llmart]

24. I think I read somewhere......

where most breast cancers are found by the person actually feeling a lump. Also, I've read where most men die WITH prostate cancer rather than FROM prostate cancer.

I have always thought that we are overtesting for many things just because we have the means to. I know too many women who have had breast biopsies and all that encompasses and end up being told it was just a calcification.

[juno jones]

19. K&R! n/t

[kimmerspixelated]

23. Thanks for posting this!

The cancer screening industry probably meant well in the beginning of their billions made, but you're right, it is not statistically sound. The squashing of a healthy boob, can also very likely move any cancerous small cell to becoming a bad tumor just by the very action, especially with so many radiation shots being taken.

Thermography on the other hand, is the cutting edge alternative. It is supposed to be able to detect much more, and be more accurate, all while not giving you any radiation whatsoever. FIRST DO NO HARM!

I won't have another regular mammogram( after educating myself), and when insurance is available, I will screen for it. Trouble is, the thermography clinics are not found everywhere, and one would have to drive a while.

[Berry Cool]

26. Yeah, then the fun will be in trying to get insurance companies to cover the costs of thermography

the same way they do annual mammograms for women over 40. Good luck with that...I wish they would.

There should be more sensible and safer ways to screen breast cancer. You know damn well that if the only way men could be screened for testicular cancer was to put their nuts one by one between two plates and have the plates slowly screwed together in a vise until the testicle was smashed flat, and then someone said "Please hold completely still and don't breathe while we zap it with radiation," some man would come up with an alternative damn quick.

Everyone should also read Dr. Susan Love's Breast Book. It explodes a lot of the common myths about breast cancer, especially the ones we hear during this month in particular.

[goclark]

28. Look closely at all the reports given to you and I always ask for ...

a second opinion.

First time,I was sent to a Specialist at St. Johns Hospital in
Santa Monica. The wonderful Dr.looked at my xray and almost threw it on the floor he was so MAD -- " They misread your xray, you are fine!"

He then advised me never to go to that hospital Lab for any tests - NEVER!

The second time another doctor read the results and had me to schedule an exam with a Specialist. I was so nervous and when I got home, I pulled the report out of my purse and the patient on the report had the same FIRST name but not the LAST!

Then there was the time I had the Needle procedure and during the exam I heard one Dr. say to the other, there is nothing there!

I did have a lump removed many years ago, thankfully everything was OK.

Thank you so much for this important post.