For years, women have been urged to get screened for breast cancer because the earlier it’s found, the better. Now researchers are reporting more evidence suggesting that’s not always the case.
A study in Norway estimates that between 15 and 25 percent of breast cancers found by mammograms wouldn’t have caused any problems during a woman’s lifetime, but these tumors were being treated anyway. Once detected, early tumors are surgically removed and sometimes treated with radiation or chemotherapy because there’s no certain way to figure out which ones may be dangerous and which are harmless.
“When you look for cancer early and you look really hard, you find forms that are ultimately never going to bother the patient,” said Dr. H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, who was not part of the research. “It’s a side effect of early diagnosis.”
The study is the latest to explore overdiagnosis from routine mammograms — finding tumors that grow so slowly or not at all and that would not have caused symptoms or death. Previous estimates of the problem have varied.
Interventional radiologist Dr. Steven Charney, the medical director of Banner Boswell Medical Center’s medical imaging department, said the study isn’t enough to bring about changes in the current process.
“This is one of the moral and ethical conundrums that’s never going to be solved,” Charney said. “Right now, I think this is one of those reports that is going to stir up a lot of controversy.
The central issue with the study, he said, is it doesn’t take into account that doctors have no way of knowing whether a tumor is deadly until it has been biopsied. It would be very difficult to tell a patient that they have a tumor, but it might not need treatment.
“Until I see other numbers and other studies, I doubt there will be any major changes,” Charney said, adding he’s waiting for more concrete evidence. “There’s not enough out there.”
Overall, Charney said, the study may be more of a disservice than a positive.
The researchers took advantage of the staggered decade-long introduction of a screening program in Norway, starting in 1996. That allowed them to compare the number of breast cancers in counties where screening was offered with those in areas that didn’t yet have the program. Their analysis also included a decade before mammograms were offered.
They estimated that for every 2,500 women offered screening, one death from breast cancer will be prevented but six to 10 women will be overdiagnosed and treated.