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This week’s Health Report on Radio National uncovered evidence which suggests Australia’s national program for the early detection of breast cancer is over-diagnosing the disease, subjecting healthy women to unnecessary breast cancer treatments that do them more harm than good.
Now known as BreastScreen Australia, the national program for the early detection of breast cancer has been offering free breast cancer screening since 1991. The program is largely credited for a 28% drop in breast cancer mortality in this country. However, some researchers believe the program has been given too much credit and that advances in treatments and breast cancer awareness has saved just as many lives as screening mammography. But while the expects argue over who and what has saved more lives, a much more pressing issue has come to light.
While early detection of breast cancer can save lives, screening mammography can also detect breast abnormalities that contain cancer cells that might “never matter, either because the cancer will never grow, or it grows so slowly that the patient dies from something else before the cancer ever has a chance to appear”.
This quote is taken from a conversation ABC reporter Joel Werner had with Gilbert Welch, a professor at the Dartmouth Institute for Health Policy and Clinical Practice in the United States, where screening mammography has been around since the early 1970s.
What concerns researchers most about screening mammography, is that some women are undergoing aggressive cancer treatments like surgery, chemotherapy and radiation they don’t actually need.
Professor Robin Bell of Monash University’s School of Public Health and Preventive Medicine says breast abnormalities are treated the same as a malignant breast lump. “They will have the same patterns of surgery, radiotherapy, chemotherapy, endocrine therapy and so forth, as someone who has a cancer which would have gone on to threaten their life.”
“If you have a life-threatening disease, weighing up the harms and benefits of these treatments is one thing, but if you do not have a condition which is going to affect you clinically in your lifetime, all of these interventions actually represent harm,” said Professor Bell.
But women also need to be aware that there is a big difference between screening mammography and diagnostic mammography.
“Diagnostic mammography is the test that doctors order when women become aware of a new breast lump. That’s something we all agree is an important diagnostic test,” said Professor Welch. “Screening mammography is different, it’s about inviting women who have no sense of anything wrong, to come in so we can look hard to see if we can find any early abnormality.”
So what we can conclude from this is that not all ‘breast abnormalities’ from screening mammography require treatment. But since there is currently no way of identifying who is being over-diagnosed, the only advice researchers like Professor Welch can offer to women is this: “I think the truth is it’s a close call, and there is no single right answer.”
“I think the debate is less about whether we should tell women to do X or Y, and more about whether we should provide women with some balanced information about the benefits and harms in screening so they can make their own choice,” said Professor Welch.
But the problem with this picture is that greater awareness of the disease has got so many women scared of dying, that most would rather undergo unnecessary cancer treatments, than risk their lives by taking a let’s just wait and see approach.
Case on point, actress Angelina Jolie, who elected to have a double mastectomy last year, not because she had breast cancer or any breast abnormalities, but because she was scared of getting breast cancer after it claimed the life of her mother.