Mammography Screening Debate Reignites

Cheryl Clark, for HealthLeaders Media , August 29, 2011

Jorgensen and colleagues say that far too many women are receiving false positive results from mammograms. In fact, the risk of a false positive after 10 mammograms is 49%, they wrote. That means "19% of women who do not have breast cancer would have undergone biopsy after 10 mammograms." 

They continued, "Substantial overdiagnosis and overtreatment increases mortality (e.g., from heart disease and lung cancer caused by radiation therapy). The net effect of screening on all-cause mortality, if any, must be minimal, even if screening still had some effect on breast cancer mortality today (which is doubtful.)"

In defense of the Swedish study's conclusions, however, Daniel B. Kopans, MD, of the Department of Radiology at Massachusetts General Hospital, Robert A. Smith of the American Cancer Society and Duffy wrote a rebuttal.

"The latest challenge to screening mammography has been the argument that screening leads to the diagnosis of a large number of breast cancers that, if left undiscovered, would never become clinically evident and thus would never become potentially lethal," Kopans and colleagues wrote.

They "recognize that there are almost certainly some breast cancers that will never be lethal," and that many women will be treated with systemic therapy without clinicians knowing specifically who will benefit and who won't.

But in conclusion, they wrote, "early detection, although not perfect, has been repeatedly demonstrated to reduce deaths from breast cancer and that the risk of overdiagnosis is small compared with this benefit."

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3 comments on "Mammography Screening Debate Reignites"

John D. Keen MD (9/7/2011 at 8:57 AM)
Dr. Destounis: Please read our article more carefully in Radiology. You are misrepresenting our position. Overdiagnosis turns healthy women into cancer patients, because all detected cancers are treated. We are not advocating watchful waiting as you imply-we advocate that women be told the truth about the problem of overdiagnosis. Let us have an honest debate. John D. Keen, MD

mbrandt2977 (8/29/2011 at 2:27 PM)
My mother was recently diagnosed with Breast Cancer through a mamogram that was clear last year. The cancer is the size of a pea and would not have been felt until it is much more advanced. At 45, I will continue to get my annual mammogram!

linda (8/29/2011 at 9:16 AM)
As a 13 year breast cancer survivor I attribute my survival to early detection and mammography. Many of the women in my Breast Cancer Support group would not have survived if mammograms were not available. I believe the benefit far outweighs the risk. Ask any of us who have survived the horrible disease.




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