Avoid harm from excess cancer screenings

I recently reported on the many dangers of “routine” colonoscopies, in my Insiders’ Cures newsletter. But another “routine” cancer screening affects millions more patients. Older women, in particular. And the dangers are just as real.

I’m talking about mammograms.

Data shows they do at lot less than you might think to save actual lives. And they have caused a sweeping epidemic of overdiagnosis and overtreatment. Yet, when you suggest anyone skip this cancer screening, or simply use it less frequently, politically correct zealots act as if you’re mounting a campaign against women’s health.

Of course, this reaction has very little to do with science. Indeed, when it comes to cancer–and breast cancer, in particular–politics, emotion, and fear can completely overwhelm the facts.

You see, 50 years ago, one clinical trial examined mammography as a screening tool for breast cancer. And in the ensuing years, legions of doctors, technicians, medical device makers, public health professionals, and government bureaucrats helped parlay this often-ineffective tool into a multi-billion-dollar enterprise.

Today, tens of millions of women dutifully get annual mammograms. They believe the mantra “early detection saves lives.” But the real data about this approach shows otherwise…

In fact, doctors at the Geisel School of Medicine at Dartmouth University recently gave us some startlingly grim data about mammograms.

According to their estimate, up to 3.2 women, but as few as 0.3 women, out of every 1,000 who get yearly mammograms over a decade will avoid dying of breast cancer. In other words, mammograms, at best, will save three out of every 1,000 women from dying of breast cancer over a decade. At worst, they will save no one.

But up to 67 percent of the women will have at least one false positive during those 10 years. Plus, for every 1,000 women screened over the decade, medical interventions will medically harm as many as 14 women with overdiagnosis and overtreatment.

Think about it this way…

According to this analysis, over a 10-year span, mammograms harm five times, and up to 50 times, as many women as they save. Plus, a majority of all these women will experience at least one traumatic “false-alarm” along the way.

Some doctors think we can do better. A lot better. And they aren’t waiting for the screening industry, the government, or even malpractice lawyers to take action. Instead, they they’re putting tools directly into the hands of the potential victims–the women themselves.

In fact, doctors at the Beth Israel Deaconess Medical Center and Harvard Medical School recently developed a mammogram screening “decision aid.” In other words, they developed a pamphlet. Just a simple booklet. And it describes a woman’s breast cancer risk, her life expectancy, and competing mortality risks. (For example, as you get older, your chance of dying from a non-cancer disease, like heart disease, increases.) The pamphlet also describes the possible outcomes of the breast cancer screening itself.

Simply put, the doctors created a pamphlet that describes the facts about mammograms. Not the politically correct, inaccurate, pink ribbon, rah-rah version of the truth.

Then, the doctors gave the pamphlet to 84 women, 75 years and older. The women had no history of breast cancer. The researchers wanted to see if having this information would help the women feel better informed. And furthermore, would it change their decision about mammograms?

Overall, the doctors found that it did improve the women’s knowledge about the risks and benefits of mammograms. Ninety-three percent of women found the decision aid helpful. And 96 percent said they would recommend it to others.

In particular, the doctors found that significantly fewer women with a life expectancy of 9 years or less chose to continue with their annual mammograms. This makes sense, as these women were least likely to benefit from continued mammograms. And once they understood this fact, they opted out of the screening.

Doctors get similar results when they give older men decision-making aids–or pamphlets–about prostate cancer screenings. My doctor gave me one. And it helped me make an informed decision. Based on the facts.

Maybe more doctors should adopt the mantra, “patient, screen thyself.”

Bottom line?

It’s important to know the facts. Especially when it comes to “routine” screenings for breast cancer, prostate cancer, and colon cancer.

So, keep reading the Daily Dispatch. I’ll continue to separate the facts from the fiction. And I’ll help you stay informed about your health options.

Source:

1. “Quantifying the Benefits and Harms of Screening Mammography,”  JAMA Intern Med (http://archinte.jamanetwork.com/journal.aspx), December 30, 2013

 


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