By: Andrea Wolf and Dr. Rachel Brem
A swath of mainstream media lapped up a new study published in the Annals of Medicine. This Danish study claims that there has been widespread “overdiagnosis” of breast cancer. This claim is unfounded and dangerous. The cited study makes three inaccurate and damaging implications.
First, the study implies that doctors know which breast tumors are and are not threatening. Promising studies are underway in genomics and molecular medicine seeking proven ways to determine how threatening a breast tumor may be. But scientists cannot yet make those differentiations with certainty. It would be irresponsible and dangerous to base decisions about treating a cancer on unproven science. Even the principal author of the study, Dr. Jorgensen, qualifies his findings by saying that the tumors he classifies as non-threatening were not “likely to progress” and that they “might not be threatening” and “posed no immediate threat” to a woman’s life.
Second, Dr. Jorgensen’s speculation is meant to make women doubt the value of screening for early-stage breast cancer. This study is part of a growing movement to attribute the decline in breast cancer deaths by over 34 percent between 1975 and 2010, with even larger decreases in women under age 50, only to improved treatments rather than to more and better screening. Mammography reduces the risk of dying from breast cancer by 25 to 31 percent for women ages 40-69. Even though these reductions in breast cancer death rates are due to increased and better screening and improved treatments, Dr. Jorgensen’s study fails to address a fundamental, but oft overlooked, factor for breast cancer survivors – intensity of care.
Intensity of care measures the toll of treatment on a breast cancer survivor. That toll is determined by her stage at diagnosis. Failing to consider intensity of care equates the experiences of a woman who had a lumpectomy and went back to work with that of a woman who underwent double mastectomies, chemotherapy, radiation, and reconstructive surgeries – simply because they both survive for five years after diagnosis. The physical, emotional, financial, and psychological toll on the woman who endured chemotherapy, radiation, and multiple surgeries, not to mention its toll on her caregivers and loved ones, is painfully far from that of the woman who had one outpatient procedure. Even Dr. Jorgensen’s study shows that screening finds more smaller cancers – giving those women the opportunity to treat potentially life-threatening tumors with less aggressive, less invasive, and less painful treatments.
Third, the study assumes that “breast cancer screening” is the same as standard mammography. Breast cancer screening is not “one size fits all.” In fact, screening must be based on each woman’s individual risk factors.
We live in a time when a range of technological advancements give doctors the tools to detect breast cancer in women with different risk factors. These include ultrasound, MRI, and molecular breast imaging. By neglecting to utilize these tools, Dr. Jorgensen’s study denies the public critical information about breast cancer. Misrepresenting that breast cancer screening is limited to 2-D mammography does women, especially those at higher risk, a disservice.
Even without Dr. Jorgensen’s study, women are confused by today’s breast cancer screening guidelines. They range from recommending annual mammograms for women beginning at age 40 to getting mammograms every year starting at age 45 and then every other year starting at age 54 to getting mammograms every other year between the ages of 50 and 74. Dr. Jorgensen is not willing to use his data to draw any conclusion about breast cancer screening. Rather he, along with Dr. Otis Brawley, the American Cancer Society’s Chief Medical Officer, unequivocally say that screening is still critical and women should continue to get screened for breast cancer until doctors have the science to differentiate between life-threatening and non-life threatening breast tumors.
Naturally, then, this study begs a question of purpose. Is its purpose to further confuse or scare women? Is it to deter women from getting screened without explicitly recommending less screening? Is it meant to make women more anxious when they do get life-saving screenings for breast cancer? Regardless of purpose, this study does women and their loved ones a life-threatening disservice by placing yet another stumbling block in the path towards having every woman over age 40 screened every year based on her individual risk factors. Only then will we, collectively, maximize every woman’s chances of finding an early, curable breast cancer.