Breast cancer screening a waste of time? Not so fast

2014-02-12 16:01
Radiology experts challenge the notion that breast cancer screening is a waste of time

A new study published in the British Medical Journal (BMJ) suggests mammogram screening is a waste of time and may add fuel to breast cancer screening controversies. The newest report showed annual breast cancer screening leads to high rates of false positive results that in turn can precipitate unnecessary biopsies and stress for women. A previous finding from the same study showed mammography performed yearly did not reduce death rates from the disease for women age 40 to 59, compared to physical exam or usual health care. But there may be more to the story, suggest radiology experts.

Authors for the study found 22 percent of breast cancers were overdiagnosed. In response to the finding, the American College of Radiology (ACR) and Society of Breast Imaging warn women that foregoing yearly breast cancer screening would put them at unnecessary risk for dying. There may indeed be more to the story that women should know.

Is the study flawed?

According to the ACR and Society for Breast Imaging, the Canadian researchers who conducted the study extracted data from women whose breast cancer screening was performed with “second-hand mammography machines” that makes it difficult to detect breast cancer and produces “cloudy” images.

One of the contentions of the new study is that mammograms are a waste of time and cost money.

They also point out the technical quality of the screening was poor due to improper positioning of the women being screened. The ACR also states physician interpreting those mammograms had no special training, which would mean lower detection rates.

Women investigated were part of the Canadian National Breast Screening Study (CNBSS) that is a 25-year follow up from previous 11 and 16 years of tracking the value of breast cancer screening. The new study reports the number of false positive results from mammography, found to be 22 percent and is published for the first time.

The study authors, Anthony B Miller and colleagues, concluded: “Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were overdiagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.”

Substandard techniques used in study

The ACR says the reason breast cancer wasn't detected is poor quality screening that was confirmed by experts called on to review the CNBSS finding. The techniques used were even substandard considering the time of the study, which was in the early 1980s.

Another study flaw cited by the ACR is that the women studied were not randomly chosen, which violates the rules of protocol when conducting a randomized controlled trial (RCT). All of the women had a physical exam prior to being assigned to either a control or screening group. The researchers already knew which women had large tumors and incurable breast cancer prior to carrying out the investigation. But the study authors say the women were assigned randomly without regard to physical findings on breast examination. The ACR thinks it’s likely that a large number of women who already had breast cancer could have been assigned to the group receiving regular breast cancer screening.

The BMJ study authors stated annual mammograms failed to lower mortality rate. the ACR contends mortality rates would indeed be higher given the number of women who already had incurable cancer and were screened.

The ACR is advising against making any policy changes about mammography screening based on the BMJ study. The finding, and the ACR statements could again make breast cancer screening confusing for women. Speak with your doctor, know your risk factors, and for now at least, continue getting your mammograms and breast exams. Most women would agree screening for breast cancer is worthwhile - especially those whose lives were saved by early detection. What do you think?

As an update, MedPageToday interviewed healthcare professionals about their thoughts on the study and whether it would change how they recommend mammography. Most clinicians said they would continue to follow current guidelines for breast cancer screening, also citing study flaws. Another well made point is that most women will survive breast cancer, regardless of the type of screening used because treatments are so effective.

Updated February 16, 2014

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Comments

You have to consider the overall picture. The most reliable data has shown that mammography does more harm than good to most women, and only seriously flawed pro-mammogram studies, huge vested interests, medical dogma, and big egos support and assert the perspective in favor of mammography (read "The Mammogram Myth" by Rolf Hefti).
George - Sorry, but I am not forgoing my own mammogram. I am old enough to remember how very young women died all too commonly from lack of screening. Think of our own grandparents. How many women in your family's history might have died unnecessarily from the disease? I don't suppose Rolf Hefti is making any money on "The Mammogram Myth", right? Nor is he selling supplements. But I do think each woman has to choose for herself and there are many things to consider. I dont like them...I had a "almost" false positive - it didn't feel good. I also know they have limitations. But I think until we have something better I'll stick with it. I guess I'm too afraid not to. Thanks for your comment too!
With all due respect, your recall of who or how many people have died in your grandparents' time may be less convincing than what the research data on large numbers of people tell. More than one study reported that mammography does not significantly reduce mortality from breast cancer. Also, George referred to "huge" vested interests pushing the mammogram agenda by an industry that earns billions of dollars from the test, whereas Hefti, in comparison, probably hardly earns a dime from his book.
Interesting. I don't think any studies have been conclusive. I wish for a better test - but again - that's what we have and it should be a personal decision.