New Study Points to Problems with Breast Cancer Screening

by Barbara A. Brenner

MammographyIn a ground-breaking article published in the Journal of the American Medical Association in October, researchers concluded that mammography screening for breast cancer has not had the impact that effective screening programs should have. They recommended pursuing new approaches for screening, early detection, and prevention. (“Rethinking Screening for Breast Cancer and Prostate Cancer,” JAMA, October 21, 2009, Vol. 302, No. 15, pp. 1685–1692).

In breast cancer, while the death rate has declined, the number of women and men dying of the disease has not. That’s because screening isn’t working the way it should.

As the article points out, the most successful screening programs should result in an increase in the number of early breast cancers found, followed by a decrease in the number of late-stage cancers, while the overall rate of cancer detection remains the same. This is because, if it’s working, a screening program would find earlier cancers that, without screening, would be found later at a more advanced stage.

On the other hand, an ineffective screening program leads to an increase in local disease detection without a corresponding decrease in the detection of cases of late-stage disease. When this happens, screening leads to unnecessary treatment of non-life-threatening cancers. As the graph shows, breast cancer screening results indicate that, while late-stage breast cancers have been reduced, that reduction is small, particularly in light of the substantial increase in the discovery of local disease.

The graph below appeared in the New York Times on October 21, 2009.

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Incidence Graph

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Clearly, breast cancer mammography screening is not as effective as it could be.

Ideally, a screening program for a disease results in a reduction in the number of people dying from it. In breast cancer, while the death rate has declined, the number of women and men dying of the disease has not. That’s because screening isn’t working the way it should.

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