To screen or not to screen: Mammo overdiagnosis finding adds fuel to heated debate

A recently released report out of the U.K. finds that while mammographic screening certainly saves lives, it also results in more cases of overdiagnosis.

It's a report that's bound to add kindling to a fire that's been burning ever since the U.S. Preventive Services Task Force's 2009 recommendations suggesting that women at normal risk of breast cancer can delay mammography screening until they reach the age of 50.

In September 2011, for example, the authors of an article in the journal Radiology were quite clear with their answer when they asked whether mammographic screening is justifiable. "The truth is that the benefit is doubtful, that overdiagnosis is substantial and certain, and that screening increases the number of mastectomies performed," wrote Karsten Juhl Jorgenson, M.D., and his colleagues.

Yet, a European study published just this past September in the Journal of Medical Screening concluded that the chance of saving a woman's life through population-based mammographic screening is greater than that of overdiagnosis. For every 1,000 women between the ages of 50 and 70 who get mammograms every two years, there would be four cases of overdiagnosis, but between seven and nine lives would be saved

So, does the report out of the U.K.--which finds that for every life saved through mammographic screening, three patients are overdiagnosed--confuse the subject even more?

In an article published in June in Radiology Today, Rulla M. Tamimi, an associate professor of medicine at Harvard Medical School and a co-author of a study on overdiagnosis that appeared in the Annals of Internal Medicine, said that these kinds of studies can help patients and doctors communicate more effectively.

If, as it has been suggested, some women go through the process of mammographic screening totally unaware that overdiagnosis exists, giving them as much information as possible about the potential benefits and disadvantages of screening is critical.

Which is the point made by Harpal Kumar, chief executive of Cancer Research U.K., in summing up the U.K. study.

"We think it's vitally important for women to have access to clear information about breast screening, the balance of benefits and harms and the fact that they could be diagnosed with and treated for a cancer that might not cause them harm," Kumar said. - Mike


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