For 30 years, the mantra of the mainstream breast cancer movement has been “early detection saves lives” and “early detection is your best protection.” This mantra is so popular that for decades now challenging it is tantamount to heresy.
The controversy really heated up in 2009 when one of the leading health policy organizations—the U.S. Preventive Services Task Force (USPSTF)—issued new screening recommendations for women who were asymptomatic and who were not at an elevated risk of breast cancer. In addition to calling for an end to routine mammography screening for women 40 to 49, the 2009 USPSTF encouraged a shift away from annual mammograms for postmenopausal women, and toward biannual (every two years) screening. This recommendation was consistent with the practice in most other countries with screening programs, countries that have no worse outcomes in terms of breast cancer mortality than the United States. No sooner had the guidelines been published than backlash conversations turned to healthcare rationing and cost cutting. And the issue has been hotly debated ever since.
A new randomized controlled study from Canada, one of the largest (with 90,000 women) and longest (25 years) ever conducted, shows that routine mammography screening does not reduce deaths from breast cancer in women aged 40 to 59. It should be noted that without examining the raw data to examine who is and is not included in this study, a majority of Canadians (about 77%) are white. The study sought to determine whether there was any advantage to finding breast cancers for women at average risk when they were “too small to feel,” and the answer is no. The study also documents harms from routine mammography screening; researchers estimated that the rate of overdiagnosis (finding and treating cancers that would not have killed women if left untreated) was 1 in 5 women and as high as 1 in 3 if you include ductal carcinoma in situ (DCIS) diagnoses.
But the science is clear: if we’re going to get to the best place in terms of both reducing deaths from breast cancer and minimizing the harms that occur when we do mammography screening, we need to change our practices of business as usual. And that means recognizing that mainstream narratives about “early detection” are not true and do not reflect an understanding of the biology of breast cancer.
We have suffered from the oversimplification of the “early detection” message for far too long. When a study of this magnitude emerges, a study grounded in clear, evidence based research, and challenges the perpetuated but ill-founded advantages of early detection, we must move forward.
The information that we have seen from this study does not let us draw conclusions for specific communities, many of which are most affected by higher morbidity rates. Given the unequal burden that women of color bear when it comes to breast cancer morbidity and mortality, questions remain as to whether there are different findings for different communities. Absent this evidence, there are no clear answers for women of color. The growing body of evidence, of which this study is part, continues challenge long-standing and commonplace assertions that mammograms are a driving factor in reducing death rates.
At the end of the day, we have to ask why mainstream breast cancer organizations, medical professionals and practitioners, and health organizations across the U.S. have for so long so willingly bought into, and peddled, such a flawed message. Could it be that too much of our health industry, and too many mainstream breast cancer organizations, are bank rolled by big pharma and corporations with a vested interest in the success of mammography?
For more information, check out our webinar “The Oversimplification of Early Detection: Screening Mammography and Breast Cancer Overdiagnosis” and Breast Cancer Action’s comments submitted to the U.S. Preventive Services Taskforce (USPSTF) about mammography screening guidelines and inequities in breast cancer.