Will cancer screening actually save your life?

By Julia Belluz - Friday, May 25, 2012 at 9:00 AM - 0 Comments

(Bruce Powell/AP Photo/University of Chicago Medical Center)

“There is a powerful narrative among support groups and cancer survivors: Screening saves lives. . .  For the most part, it’s wishful thinking. And it demonstrates the growing gap between what screening (and science more generally) can offer, and what the risk-averse public wants it to be.”—Globe and Mail, May 21, 2012

A recent recommendation by a U.S. government advisory panel to ditch the PSA test for prostate cancer has reignited the call for a cancer screening rethink. It’s no longer okay to abide by the “screen early, screen everybody” maxim, the conversation goes, echoing the one that emerged when the frequency of routine screening for breast cancer was scaled back last year.

Now, it’s good to be having these discussions: We do need to change how we think about cancer screening. In recent years, with the advent of incredible technologies that detect diseases before we feel sick, we’ve seen the emergence of “overdiagnosis.” The term describes cancer that is diagnosed but would not necessarily cause death or even symptoms because the cancer never grows, it regresses, or it spreads so slowly, the person dies before knowing any harm. That’s right, not all cancers are deadly or even harmful. As well, every single body displays at least a couple of benign abnormalities that can be seen as trouble. This is why mass screening has the potential to “rapidly turn perfectly healthy people into patients,” says the Canadian health policy researcher and author of Seeking Sickness, Alan Cassels.

Science-ish, though, wondered whether PSA testing and mammograms—usually the inspirations for the anti-screening cri de coeur because they can lead to overdiagnosis and unnecessary surgeries—are the exceptions in cancer screening or the rule.

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Routine mammograms: evil, necessary, or both?

By Anne Kingston - Friday, November 25, 2011 at 7:12 PM - 5 Comments

Last week, the Canadian Task Force on Preventive Health Care issued new breast cancer-screening guidelines that have raised questions and stoked debate. The task force recommended women under 50 who are not at high risk of breast cancer forego routine mammograms. It also recommended that the interval time between mammograms for women aged 50 to 69 be extended from every one to two years to every two to three years—unless their doctors suggest otherwise. And, contrary to what women have been told for decades, it concluded women should no longer conduct regular breast self-examinations.

To sort through the confusion, Anne Kingston spoke with Eileen Rakovitch, a radiation oncologist and chair of the breast cancer program at Toronto’s Sunnybrook hospital.

Q: It seems this debate never ends. Let’s start with mammograms. Radiologists in the U.S. and Canada have disagreed on this in the past: in the U.S., the recommendation is that women over age 40 should have regular mammograms; in Canada, the thinking has been that women at average risk should begin screening at age 50. Continue…

How do you know when to get screened for breast cancer?

By Julia Belluz - Monday, July 18, 2011 at 2:22 PM - 14 Comments

The Statement: “The benefits of mammography are going to depend a lot on what your underlying risk is, and the current guidelines look only at age… I think that, other things being equal, it’s reasonable for a patient and their doctor at that point to say, ‘we’re going to put off the next mammogram until age 50.’” (Dr. John Schousboe, 07/06/2011)

Dr. John Schousboe, of the Park Nicollet Clinic in Minnesota, is speaking here about a new health- and cost-effectiveness analysis of mammography (breast x-rays) he co-authored, which was published in the Annals of Internal Medicine. The study suggests that risk factors other than age—breast density, family history, and history of breast biopsy—should also be taken into account when determining who should be screened regularly. Continue…

The mammography debate rages on

By Kate Lunau - Thursday, September 30, 2010 at 6:12 PM - 0 Comments

A new study, published in the journal Cancer, claims to prove that annual mammography for women in their forties reduces the death rate from breast cancer in this group by almost 30 per cent. This is sure to throw more fuel on the fire as experts hotly debate at which age women should begin a regular screening program for breast cancer—and even whether awareness and treatment were more important tools than regular mammograms.

The most recent study was authored by Dr. Stephen Duffy of the University of London, and Dr. Laszlo Tabar of the University of Uppsala School of Medicine in Sweden, well-known advocates of mammography, the New York Times reports. It followed over 600,000 women for 16 years, and found that the number of breast cancer deaths among women who didn’t receive mammograms was twice as high as those who did. “It is now time to stop confusing women with conflicting information. Mammography is a lifesaver for women in their forties,” Dr. Gail Lebovic of the American Society of Breast Disease said, commenting on the study.

Still, other research has claimed differently. Just last week, another widely reported study suggested that increased awareness and better treatment—and not necessarily mammograms—were the best way to reduce death rates from breast cancer, the most common cancer in women worldwide. (See Canadian statistics on breast cancer here.) Timely care and “the widespread use of adjuvant therapy have probably combined to make screening now less important, said Dr. Gilbert Welch of Dartmouth Medical School in an editorial accompanying the study, according to ABC News.

This follows even more conflicting advice. In January, two U.S. groups (the American College of Radiology and the Society of Breast Imaging) recommended that women begin getting regular annual mammograms at age 40, just two months or so after the U.S. Preventive Services Task Force recommended against routine mammograms at that age, causing an uproar among some health care professionals and patients alike.

Screening mammograms are meant to detect any signs of cancer tumours in apparently healthy women, but some argue they can do more harm than good, especially at a younger age. The disease is less common in younger women (the annual risk of developing it at age 40 is half what it is at 50), so they’re more likely to get false positive results, which can lead to everything from unnecessary biopsies to stress. That’s one reason medical bodies offer widely conflicting advice, as Maclean’s reported earlier this year. The Canadian Cancer Society says women aged 50 to 69 should get a mammogram every two years and those in their forties should talk to a doctor; both groups should get clinical breast exams. The American Cancer Society, meanwhile, recommends yearly mammograms beginning at 40.

Anyone could be forgiven to feeling confused. Until some sort of consensus on mammography emerges, one position almost every medical expert can agree on is that individual women should discuss the benefits of mammography with their doctors.

Location, location, location

By Kate Lunau - Thursday, January 21, 2010 at 10:30 AM - 2 Comments

YAKABUSKI had an unofficial 'screening program'

Concerned about an aunt who’d been diagnosed with breast cancer, Vicky Yakabuski—then in her thirties—got a referral from her doctor for a mammogram, a habit she got into keeping each year. At age 46, Yakabuski learned she had breast cancer. “It was a treacherous time,” says the homemaker, now 48, who lives in Stouffville, Ont., and it was hard on her husband and two daughters. After a mastectomy and chemotherapy, she’s doing better; she and supporters (dubbed “Team Victorious”) raised $15,200 in October’s Canadian Breast Cancer Foundation CIBC Run for the Cure. As for the mammogram, she says, “it saved my life.”

Breast cancer is the most commonly diagnosed cancer among Canadian women, yet for those under 50, the benefits of regular mammograms remain controversial. Because it’s less common in younger women—the annual risk of developing it at 40 is half what it is at 50—experts warn that regular testing can actually do more harm than good. (Women in their forties, who have denser breast tissue, are more likely to get false positive results.) Others insist it saves lives: one B.C. study showed that providing women in their forties with regular mammograms reduced deaths from breast cancer by 25 per cent. Even so, medical bodies offer conflicting advice, and screening programs vary between provinces. This “creates confusion,” says Beth Easton of the Canadian Breast Cancer Foundation (CBCF), and can put women at risk.

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