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Monday, October 18, 2010

Norwegian Study Casts Doubts of Value of Mammography Screenings

Norwegian researchers cast fresh doubts on the benefits of screening mammography in a recent edition of the New England Journal of Medicine when they reported that screening mammography accounted for a “modest” one-third of the total 10 percent reduction in breast cancer deaths realized during the staggered implementation of a nationwide screening program.

The Norwegian breast-cancer screening program analyzed data from 40,075 women with breast cancer. During the time period of the study, Norway also established multidisciplinary medical teams focused on the treatment of breast cancer. The combined impact of introducing mammography screening and improving treatment was a disappointing 10% reduction in breast cancer mortality. Moreover, an 8% reduction in mortality was noted in women who did not undergo screening but whose cancers were treated by the multidisciplinary teams. These observations suggest that the relative reduction in mortality that can be attributed solely to screening mammograms is a surprisingly low 2%, indicating that the decline in mortality attributed to screening alone may be as few as 2 deaths prevented per 100,000 women screened
Dr. H. Gilbert Welch wrote in an accompanying editorial that since mammograms may have only reduced the cancer death rate by 2 percent, it is an amount so small it may as well be zero.

On the other hand, Andrew Kaunitz at the University of Florida College of Medicine in Jacksonville told MedScape: “Although some will view these Norwegian data with confusion or even hostility, I see the findings of this study as good news. We have improved our treatment of breast cancer so dramatically over the last several decades that the benefits of early diagnosis are not as great as they once were.”

Dr. Grout’s comment:

Let’s see if I get that last comment right: we are so much better at managing your later-stage cancers (and making money from it) that it doesn’t matter if the screening isn’t that great (and it makes money too). That may be a somewhat callous way of interpreting Kaunitz’ comments, but that’s basically what it boils down to. It matters less that we diagnose you early, because we can treat you better once you actually have breast cancer. The concept of prevention is completely absent in that paradigm.

Past research has already demonstrated that adding an annual mammogram to a careful physical examination of the breasts does not improve breast cancer survival rates over getting the examination alone. And that 2 percent gain is offset by the dangers of mammography.

The day is coming when women will not put up with the annual mammogram lecture anymore. The word is getting out that this screening is ineffective, and every time you X-ray your breasts, you subject yourself to cancer-causing radiation which can lead to later cancers. Also, the compression is dangerous – squeezing breast tissue that does contain cancer is an open invitation to spreading cancerous cells.

Thermography is by far the better screening technique – no radiation, no compression, and it can pick up the signs of tumor formation years before you feel a lump.

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