(March 11, 2014) - Controversy over screening mammography continues to grab headlines in the Savannah Morning News and national media.
The most recent news concerns an update of a large Canadian study of mammography that demonstrates no advantage to screening women for breast cancer. There have been eight large studies done on the value of testing women for breast cancer using annual breast x-rays (mammograms), and this is the only trial that failed to show a benefit.
The flaws in the Canadian study are significant, including the design of the study and the mammography equipment used.
Not mentioned in the discussion of the Canadian study is the fact that the other seven mammogram studies, which involved nearly 500,000 women, demonstrated a benefit to screening mammograms. Cancer researchers have demonstrated that 50 extra breast cancers will be diagnosed and five lives saved by screening 10,000 women every year. That translates to about 35 deaths and 350 breast cancer diagnoses in the Savannah area each year.
One can debate the fact that all cancer screening efforts are expensive and may lead to false positives (abnormal test results but no evidence of cancer) or false negatives (when cancer is present but does not get diagnosed).
The reality is that no medical test or procedure is perfect, so we use the best test available that helps the most people and causes the least harm. The other reality is that screening for breast cancer leads to 10-48 percent fewer women dying from breast cancer. For women over 40 years of age, mammography detects breast cancer at earlier stages and reduces deaths caused by breast cancer.
It is a statistical fact that one in eight American women will be diagnosed with breast cancer. There were more than 250,000 women diagnosed with breast cancer in the U.S. last year and nearly 40,000 died. We could, and should, be doing better.
The treatment of early breast cancer detected by mammography can be as simple as a lumpectomy (breast conservation surgery) followed by a single dose of intraoperative radiation therapy delivered while the woman is asleep under anesthesia. Delaying a breast cancer diagnosis until it is a more advanced disease may require a woman to undergo more radical surgery, chemotherapy and up to seven weeks of daily radiation therapy.
Deaths due to breast cancer have declined by 30 percent since 1990 because of better treatment and earlier detection from screening tests like the mammogram. Nearly 90 percent of women diagnosed with stage I and II breast cancer are alive five years after treatment, compared to 15-60 percent of women diagnosed when their cancer is more advanced. This shift represents a model that should be embraced and emulated because it demonstrates that earlier detection saves lives and is cost-effective.
The current guidelines proposed by the American Cancer Society are for women to have screening mammograms every year starting at age 40. We will continue to support this recommendation because it has been proven that mammograms save lives.
About the authors:
This article as submitted to the Savannah Morning News by Aaron Pederson, M.D., radiation oncologist, and Ray Rudolph, M.D., MPH, breast surgeon. Both physicians work at the Curtis and Elizabeth Anderson Cancer Institute at Memorial University Medical Center. They can be reached at 800-343-3025.