Screening for Breast Cancer
An important report came out in the middle of October that doesn’t seem to have been reported in much detail by the mainstream media in the United States.
It concerns screening for breast cancer. This is a most important issue: breast cancer is the most common form of malignancy in women and it carries a high morbidity and mortality. Though there can be a genetic component, there are also a number of important environmental factors. Some of those for which there is decent evidence include:
- Circulating levels of estrogens and androgens
- Late first pregnancy
- Having no children
- Not breast-feding
- Alcohol consumption
- Post-menopausal weight gain
- Exposure to artificial light
There is an array of other potential risk factors, but the point is that with so many potential risk factors, it is difficult to idenify everyone at high risk of developing the disease.
Therefore mass screening for breast cancer has been the accepted practice for many years now, and it has undoubtedly saved many lives.
But the new research – a review of studies covering half a million women – raises some important questions for women as well as clinicians.
The investigators found that for every 2,000 women who had mammograms, one would have their life prolonged but 10 would have unnecessary treatment due to false positive tests and over-dagnosis.
Dr. Peter Gozsche the director of the Nordic Cochrane Center, who led the research, said that the new research indicated that many women were being treated for slow-growing tumors that might never have affected them if they had not been picked up during the screening.
There remains no question that screening does save lives, but the new research indicates that – if it is replicated – we need to re-think the risk/benefit ratio about screening and the actions that we take if screening turns up an abnormality.
But it also should not scare people away from being screened.
It is also a good reminder that there are many potentially modifiable risk factors for breast cancer, and that is the best place to direct your attention.