Tag Archives: breast cancer overdiagnosis

Breast Cancer Action Webinar Discusses Screening Mammography and Breast Cancer Overdiagnosis

Photo courtesy of freedigitalphotos.net and stockimages
Photo courtesy of freedigitalphotos.net and stockimages

Breast Cancer Action Webinar

I sat in on a webinar today given by Breast Cancer Action, a group I greatly admire and support for the work they are doing in breast cancer advocacy.  You can find out more about BCA by clicking on the link (above) which will take you to their website, or in the article I wrote last August , “Support Breast Cancer Action – A Good Cause“.

Today’s webinar was titled “The Oversimplification of Early Detection: Screening Mammography and Breast Cancer Overdiagnosis”.  They are running it again on Thursday, March 14, 2013 at 9:00 am PST, 12:00 PM EST.  You can sign up for the webinar by using this link.

Presenting the webinar were Sahru Keiser, BCA’s Education and Mobilization Coordinator; Dr Tracy Weitz, BCA Board Chair and Director of Advancing New Standards in Reproductive Health at UCSF; and Dr H. Gilbert Welch, Professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Research, and co-author of the study “Effect of Three Decades of Screening Mammography on Breast Cancer Incidence.”

They began the webinar with a quotation from Otis Brawley, Chief Medical Officer for the American Cancer Society, who admitted that American medicine has overpromised when it comes to cancer screenings.

Dr Weitz made the point that breast cancer is intensely personal, but also highly political, highly commercialized, and highly confusing.  I was thinking that I couldn’t agree more.

Challenging Old Ways of Looking At Breast Cancer

Dr Weitz said we need to be challenging the old way of thinking about breast cancer, which view has been that breast cancer is a progressive disease that gets more deadly over time.  Based on that old belief, American medicine adopted the approach that early detection is the best way to save lives.

But that approach, and mammography in particular, has not given us the results we have hoped for.  Now we know that:

1.   Not all breast cancers are alike;

2.  Not all breast cancer tumors can be found;

3.  Not all breast cancer can be cured;

4.  The type of tumor matters more than the size;

5.  Not all breast cancers need to be treated;

6.  Screening and treatment for breast cancer comes with its own risks and benefits.

Several times during the webinar it was pointed out that they were primarily discussing breast cancer screening, which refers to the testing of otherwise healthy women with NO breast symptoms.   Diagnostic mammograms still definitely have a role to play when a lump has been perceived and one needs to find out what it is. 

Screening Mammography Benefits and Risks

The greatest benefits of screening mammography are seen in populations with a higher prevalence of disease and with the type of disease that responds to treatments.  The problem, however, is how many false positive tests there are – women who needlessly undergo a battery of tests only to find there is no cancer present.  They also mentioned the associated risks from radiation, because that in itself increases a woman’s chance of getting breast cancer. 

An interesting fact: women in the United States were exposed to SEVEN TIMES more radiation in 2006 than they were in the 1980’s.

Turtles, Bears and Birds

Dr Weitz had an interesting way of classifying breast cancer, she said there were 3 basic types:

Turtles – Those who had non-aggressive, slow moving tumors that would never be life-threatening (which is much of DCIS)

Bears – Those whose tumors lie in hibernation, wake up suddenly and can be deadly

Birds – Those whose tumors fly quickly, were very aggressive, and no matter how small when found, cannot be effectively treated

Apparently screening mammography is better at finding turtles.  If we hadn’t gone looking, we wouldn’t have found them and no harm would be done.  I feel terribly sad for the women in this category who have chosen to have mastectomies out of utter terror of a report that says “cancer”, even though their particular tumor would have stayed localized and not amounted to anything.

1.3 Million Overdiagnosed

Dr Welch noted that in future, screening must advance the time of diagnosis of the cancers that are destined to cause death, that finding these sorts of tumors earlier was absolutely paramount.  He stated that screening mammography has not changed late stage cancer detection but it is finding many more early stage cancers.  He estimated that 1.3 million women in the US have been overdiagnosed and overtreated.

Dr Welch stated that the breast cancer death rate is falling, but that was because it was being treated more effectively, not because of early screening.  He stated that the rates of metastatic breast cancer had not changed, that it appears not to have been affected by early screening at all.

African American Woman At Higher Risk

Sahru Keiser made the point that African American women have a higher risk of dying from breast cancer, that they are 40% more likely to die than white women because of differences in tumor characteristics, because of inability to obtain a good standard of medical care, and that for this group of women, the risk was greater for those who were premenopausal, and that increases in mammography screening had not led to a reduction in mortality.

I think these are shameful statistics.

5 Good Reasons to Rethink Mammograms

All in all, BCA felt that mammograms were not the best screening tool for these reasons:

1.  Mammograms were less effective in premenopausal women

2.  Mammograms were less effective for those with dense breast tissue

3.  Mammography created another set of problems because of the radiation associated with them

4.  Mammography is finding cancers that really should not be found and are nothing to worry about

5.  Mammography isn’t particularly good at finding cancers that really did need to be found.

Here Are 6 Things We CAN Do

1.  BCA advocated being proactive about prevention.  I agree with that and many of the articles on this blog are written with prevention in mind.

2.  Know your body – the shape, the size, the feel of your breasts – so that you will know if something unusual is taking place within the breast.

3.  It was recommended to start having screening mammograms at menopause, and then have them only every other year until the age of 75, at which point your health professionals could made recommendations suitable for your particular health situation. 

4.  It was also recommended that clinical breast exams be performed every year by an experienced health professional – that’s the exam where your doctor has you lie on your back and feels for any notable lumps in the breast.  I would add to that to learn how to do this yourself – there are plenty of websites that teach how to do a breast exam and your doctor will teach you as well.  Do it monthly, after your menstrual cycle if you are premenopausal.  I recommend placing a sticky note reminder on your calendar – or if you have an iPad or smart phone, put that reminder in your calendar to do this monthly.

5.  Read through my site to find out what I recommend for breast health and stress reduction, because I truly believe that stress plays a big role in the development of many cancers.  Sign up for my newsletters, they are free and contain my best recommendations about prevention and healing from breast cancer.

6.  My personal favorite breast screening method is thermography.  If you are lucky enough to have a Thermal Imaging center in your city, I strongly recommend them, I have utilized thermal imaging for myself and found it to be very pleasant, completely safe, and no SQUISH.  For more information, see my page Breast Health – What Is Thermography?  You will find more information in my article titled Breast Screening Without the SQUISH.

BCA recommended two books for further information: Overdiagnosed: Making People Sick In The Pursuit of Health by Dr H. Gilbert Welch, and The Big Squeeze:  A Social and Political History of the Controversial Mammogram by Dr Handel Reynolds.

The bottom line is that if you want to have mammogram screenings, you should continue to do so, but if you don’t want them you should not be coerced into it, and you have every right to do as you wish, it’s your body.

If you would like my help with getting through breast cancer (or avoiding it) in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com).  It is my honor and my goal to help you through this.