The world’s leading medical journal has published yet another skewed analysis of mammography, overdiagnosis and breast cancer trends. I’m disappointed that the New England Journal of Medicine would promote such an estimate-loaded piece to dissuade readers of screening’s value. So I’ll restate my three go-to points on why this mammography “news” should not influence any woman’s decision:
- The overdiagnosis campaign reflects a lack of respect for women's capacity to make rational choices about their health. If a woman learns she has a breast tumor, she can weigh the information and consult with her doctor about the best plan forward.
- The report rates old technology. The most recent mammograms in this “ecological” study would be from 2002. Mammography equipment has since shifted to digital, among other leaps forward.
- The paper ignores differences among radiologists, and the potential to improve screening outcomes in the U.S. population by assuring that all breast imaging is done by doctors who do only that.
I’ll add three points that pertain to the broader issue of breast cancer screening in 2016:
- The article skips over advances in pathology. Doctors have tools now in everyday use to evaluate biopsies and distinguish aggressive tumors from slow-growing ones, to avoid overtreatment.
- The study doesn’t consider alternative and new screening methods: breast ultrasound to evaluate dense breasts, 3D mammography, MRI or molecular breast imaging.
- The authors fail to address the price of not screening women for breast cancer. Delayed diagnosis leads to more women needing more treatment for large tumors and later-stage disease.
There is no doubt that advanced breast cancer causes disability and death. Medications are expensive. Yet the financial and physical costs of treating stage 4, metastatic breast cancer, which remains incurable and requires treatment until life's end, go unstated here and in other anti-screening screeds. Why not mention the harms of late detection?
Of course no woman should get screened for breast cancer if she doesn’t want to get screened. To make an informed decision, she and her doctor need access to information about modern mammography, ultrasound, MRI and current methods. I look forward to the Journal publishing that kind of breast cancer screening update.
