Tuesday, November 25, 2008

Dangerous Nonsense

From Bloomberg News:
Screening for Breast Cancer May Spur Unnecessary Treatment

By Michelle Fay Cortez

Nov. 25 (Bloomberg) -- Mammograms may lead to unneeded treatments for breast cancer that might have regressed naturally, according to new research that revives a debate over frequent screening.

Doctors and public health officials have debated the risks and benefits of regular mammograms for years. While the common assumption is that finding small, easily treated tumors will prevent the development of larger, deadly cancers in the future, studies have yielded mixed results.

The report, published today in the Archives of Internal Medicine, found that the rate of cancer among women who received biannual mammograms over six years in four Norwegian countries was 22 percent higher than those who didn’t. That may mean that tumors in those who weren’t tested regressed without being treated, researchers said.

“Our findings simply provide new insight on what is arguably the major harm associated with mammographic screening, namely, the detection and treatment of cancers that would otherwise regress,” said the researchers led by Per-Henrik Zahl at the Norwegian Institute of Public Health‘s epidemiology department in Oslo.

Breast cancer is the most frequently diagnosed tumor in U.S. women, excluding skin cancer, and is second only to lung cancer in the annual number of deaths. Robert A. Smith, director of cancer screening of the American Cancer Society said the conclusion that more than one in five invasive breast cancers may regress without incident if not detected by mammography “is nothing more than an overreaching leap in logic.”

The study was funded in part by the U.S. Department of Veteran’s Affairs.

Natural Regression

Spontaneous regression has occurred with other tumors, including melanoma, kidney, cervical and colon cancers, the researchers said. While there have been only 32 such reports in breast cancer cases, that doesn’t mean it is rare, they said. The vast majority of breast cancers are treated immediately and aggressively, with few tumors following a natural course.

The cancer society said the authors’ conclusions were flawed. The excess number of cancers found is simply a reflection of the lead time gained with mammograms, alerting women to tumors years before they would normally be detected, Smith said.

There is little evidence that breast cancer can regress, Smith said. Given that many cancers are missed during mammograms, there is plenty of opportunity to compare current to past films, he said in a statement. While there are harms from screening, including false positives and unnecessary biopsies, “the benefits of regular screening far outweigh these limitations.”

Not Life-Threatening

There is growing evidence that a “considerable proportion” of breast cancers aren’t life-threatening, like many cases of prostate cancer, wrote Robert Kaplan, from the University of California at Los Angeles School of Public Health and Franz Porzsolt, from the University of Ulm in Germany, in an editorial that accompanied the study.

If the researchers’ hypothesis about natural regression is correct, 20 percent of women who got biannual mammograms were treated unnecessarily, Kaplan and Porzsolt said. The other possibility is that women who didn’t get the tests had undetected cancer and missed a shot at early treatment, they said.

The spontaneous regression hypothesis is hard to rule out, Kaplan and Porzsolt wrote.

“If the spontaneous remission hypothesis is credible, it should cause a major re-evaluation in the approach to breast cancer research and treatment,” they said. “We must also consider the ethical concerns associated with over-diagnosis and over-treatment.”

If women read this and feel they can skip their next mammo because they might get lucky and have their tumor regress, this article could be one of the most dangerous ever printed.

The line, "The rate of cancer among women who received biannual mammograms over six years in four Norwegian countries was 22 percent higher than those who didn’t. That may mean that tumors in those who weren’t tested regressed without being treated, researchers said."

No, that means that they caught their cancer early and were treated and are now alive and well.

Here are two examples from my own personal experience:

If I did not have a baseline mammogram at age 34 and followed up every year, my cancer would not have been found until I was 40, and that would have been too late. My tumor was a triple negative breast cancer that is very hard to treat successfuly. The only way to beat it is by finding it at its earliest stage, surgery, chemotherapy and radiation. Because my gynecologist insisted on early screening, I survived my highly aggressive cancer.

Five years later, when a new lump was found, my former breast surgeon said it was probably nothing and we shouldn't do any "unnecessary" surgery that would cause scarring and make future mammograms harder to read. We waited a year. I finally got the biopsy and had a 2.5 centimeter tumor with four positive lymph nodes. The mammogram picked up this tumor a year and a half earlier, when it was still tiny, had not become invasive, and had not spread to the lymph nodes.

I am lucky I had a great new surgeon, a top oncologist and the best treatment to fight this second, new cancer. But it wasn't easy. It was a very long year of surgeries, chemo and specialized radiation.

Contrary to what this article states, and ignoring ACS guidelines, women should get screened starting at age 35. African American women should get their baseline at age 30, because they are more likely to get basal, triple negative tumors that must be found early for best survival.

You can be proactive and fight cancer before you are ever diagnosed, or you can hope against hope you have the kind of tumor that magically disappears on its own. There is no middle of the road when dealing with cancer. Those who stay there wind up being run over by a Beast that does not fight fair. Ignore this article and this study and fight.

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