Is Breast Cancer Screening Causing Overtreatment of Breast Cancer?

Is Breast Cancer Screening Causing Overtreatment of Breast Cancer?


Dr. Harness: Robert, one of the things that
I know Lisa is going to wanna ask you, may be I will jump the gun a little bit. There
have been articles out particularly from the Scandinavian literature that perhaps because
of breast screening, we are actually overtreating breast cancer and I will be real interested
in your comments on that. Dr. Smith: Yeah, so there is really two ways
I think to think about over treatment and I think you can speak to this with much more
authority than I can as a treating clinician. Clearly, we treat breast cancer fairly aggressively
and some women are actually receive more aggressive treatment than they ultimately may need, but
it is what we have to do because we really cannot identify which among these women truly
need that kind of aggressive treatment and which do not and ultimately with better research,
we will be able to distinguish women who could have a moderate course of therapy than those
who may be need really very-very aggressive therapy. The issue of over treatment that
is I guess more predominant now in the context of its harms, is the possibility that mammography
will identify a breast cancer based upon all the criteria that we apply in the pathology
lab, it is a malignancy. It is an invasive breast cancer, but that if that woman had
never been screened, we never would have known about that cancer. That cancer would have
just hung out for the rest of that woman’s life, perhaps it would have progressed, but
ultimately it would never have created symptoms and it never would have threatened her life.
To the degree that we cannot identify those cancers in the lab, the only way we can determine
whether or not overdiagnosis is taking place is statistically, in other words, we look
at incidence rates over long periods of time in women who were exposed to screening and
women who were not and we look for an imbalance and what we might say is the expected rate
and what’s remarkable now in the published literature is how wide those estimates are.
From my perspective, when these studies are done properly, in other words when we address
a number of what we refer to as covariates, challenges, and trends and incidents whether
we overcome the statistically the big increase in incidents, it simply associated with screening
when we find cases earlier than we otherwise would, than those estimates of overdiagnosis
are really very small. They are less than 10% or mostly confined to ductal carcinoma
in situ which means that the likelihood of very-very aggressive treatment associated
with the cancer that would not have ever been a problem is probably very uncommon.

2 thoughts on “Is Breast Cancer Screening Causing Overtreatment of Breast Cancer?

  1. Do you think #breastcancer screening is leading to over-treatment of breast cancer? We asked Dr. Smith of the @American Cancer Society  this question and here's what he said:

  2. Any woman thinking about breast screening should read the brochure prepared by the Nordic Cochrane Institute, an independent medical research group. About 50% of screen detected breast cancers are over-diagnosed, the fall in the death rate is mostly about better treatments, not screening. Also, any benefit of screening is wiped out by those who die from lung cancer and heart attacks after treatments. Risks exceed any benefit. Head over to the NCI's website and make an informed decision.

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