Breast Cancer "Overdiagnosis" is a Dangerous Misnomer

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[1] to getting mammograms every year starting at age 45 and then every other year starting at age 54[2] to getting mammograms every other year between the ages of 50 and 74.[3] 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.

  

 

 

 

 

[1] https://www.acr.org/About-Us/Media-Center/Press-Releases/2015-Press-Releases/20151020-ACR-SBI-Recommend-Mammography-at-Age-40
[2] http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-acs-recs
[3] https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening

A Physician's Perspective on Volunteering for the Brem Foundation

 

I am a Brem Breast Imaging Fellow. I spend my days learning the most cutting-edge techniques in breast cancer diagnosis and understanding how to be a compassionate physician. Part of my role includes reaching out to communities by volunteering to support the Brem Foundation’s life-saving work. This year I had the privilege of doing so – but in an unconventional way – at the Redskins’ annual breast cancer awareness game.

The Redskins Foundation chose the Brem Foundation as its breast cancer charity of choice in 2016. Part of this partnership included donating proceeds of Redskins’ breast cancer t-shirt sales to support the Brem Foundation’s B-Fund, a fund that helps underinsured patients get critical diagnostic tests after an abnormal mammogram.

My volunteer experience while selling breast cancer awareness t-shirts at the Redskins game was impactful – and one that I knew was going to further the Brem Foundation’s mission of maximizing every woman’s chances of finding an early, curable breast cancer. It was also uplifting. I am used to seeing the patient side of breast care. Here I saw that many people were willing to buy these t-shirts just because the proceeds were supporting breast cancer work. Many of these people were either breast cancer survivors themselves or had a family member who was a breast cancer survivor.

But I didn’t just sell t-shirts. I had the opportunity to educate and give handouts to people about breast cancer, its prevention, and early diagnosis. Along with teaching others about breast cancer I, myself, learned how to effectively attract people to this worthy cause.

I volunteered with my husband and 13-year old daughter. Our booth was located at one of the main entrances to FedEx Field. Everyone who walked into that entrance was met with our pom-poms and breast cancer awareness signs. I volunteered for a total of four and a half hours, from 11:00 am to 3:30 pm. We had to reach the stadium at 10:00 am. During that one-hour time frame, we set-up our booth. At 11:00 am the Redskins fans rushed in to get their seats. The Redskins Foundation staff gave us Redskins breast awareness cancer t-shirts to wear. Wearing those t-shirts helped us show our customers how beautiful they looked. Being a part of the Brem Foundation made me proud to be wearing that t-shirt as it symbolized my support for breast cancer.

Overall volunteering for the Brem Foundation was an incredibly rewarding experience for me. It opened my eyes to a side of breast cancer work that I do not see everyday. I loved educating people about breast cancer. I felt blessed that my family was able to be a part of this mission with me. I never realized how rewarding volunteering for the Brem Foundation could be for me and my family. I encourage everyone – with kids or without – to consider volunteering for the Brem Foundation. It changed my life, and the lives of so many others, for the better. 

Dr. Gauri Khorjekar graduated from Terna Medical College in Mumbai, India. She completed her Nuclear Medicine Residency at the Washington Hospital Center in Washington, D.C. and received her board certification in Nuclear Medicine in 2013. She also completed her Radiology Residency at the George Washington University in 2016. Dr. Khorjekar lives in Maryland with her husband and daughter.