Breast screening risks – article in Nature

Alexandra Barrett, an epidemiologist at the University of Sydney, Australia, explains her view of breast screening in an article in Nature this month. ‘Because a screening mammogram is a snapshot in time, it is more likely to catch a slow growing cancer’, she writes. ‘Estimates vary, but I’m more likely to be over-diagnosed than to have my life saved — three to ten times more likely’. 1, 2.

This is because mammograms find small changes that would never affect a woman in her lifetime, even though these are called ‘cancers’. However, regular screening is far less likely to find the fast growing, dangerous cancers – which tend to become noticeable between screenings.

Perhaps incredibly, over-diagnosis leads to over-treatment; doctors do not know which of the ‘changes/cancers’ will cause a problem so they tend to treat them all, often with mastectomy. The physical and psychological effects of cancer treatments can be profound (including a lifelong risk of lymphoedema, a fairly common side effect not mentioned in this article) and a ‘cancer’ diagnosis can also label a family.

The Risks of Overdiagnosis, Barrett A. S104, Nature Vol 527, 19 November 2015.
http://www.nature.com/nature/journal/v527/n7578_supp/full/527S104a.html

1Marmot, M. G. et al. Lancet 380, 1778–1786 (2012).
2. Gøtzsche, P. C. & Jørgensen, K. J. Cochrane Database Syst. Rev. 2013,
CD001877 (2013).

Here are the remaining useful references given in the article:
Carter, J. L., Coletti, R. J. & Harris, R. P. Br. Med. J. 350, g7773 (2015).
Esserman, L., Shieh, Y. & Thompson, I. J. Am. Med. Assoc. 302, 1685–1692
(2009).
Welch, H. G. & Black, W. C. J. Natl Cancer Inst. 102, 605–613 (2010).
Welch, H. G. & Passow, H. J. JAMA Intern. Med. 174, 448–454 (2014).
Hersch, J. et al. Lancet 385, 1642–1652 (2015).

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About bmitzi

Medical writer, author, artist. Cancer campaigner. Aiming always to improve health services and bring compassion into health care.
This entry was posted in Breast Cancer, breast screening, Campaigns, harms, healthcare modernisation, mastectomy, Screening Mammography, Uncategorized and tagged , , , , . Bookmark the permalink.

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