Society and medicine are very slow to adapt and change. This may be fine in some situations, but when it comes to mammography and breast cancer, the consequences are extreme.
The story needs to start with what exactly constitutes “breast cancer.” The two most common types are lobular and ductal carcinomas. Both of these have invasive and is-situ versions. There is no doubt that the invasive forms of both are scary situations. With the in-situ types, the abnormal cells have not penetrated beyond the surface of the cells.
You’ll notice I did NOT call this cancer.
In-situ is a precancerous state. It is NOT cancer, although it does indicate that your current state of health is in jeopardy and that the risk of developing invasive cancer in the future is high. Overall, though, only a small percentage of women with DCIS will progress to invasive ductal carcinoma. Some 15% of women have DCIS found at autopsy; meaning that these women died WITH DCIS not FROM DCIS.
But what happens when you get diagnosed with DCIS? All the scary things that you think about—the worry, the discussions with family, the surgery, the chemo, the radiation and the lifelong damage that you carry from this pattern of treatment.
Let’s put this in perspective.
- You have an abnormal PAP screen. Your doctor immediately gets you in for a surgical removal of your uterus and ovaries, followed by chemo and radiation.
- Your dermatologist removes a small lesion on your skin by burning it off, just to be safe. But, just to be REAL safe, you undergo PET scans and biopsies to make sure nothing has spread followed by chemo and radiation.
- You come out of your colonoscopy and your GI doc said they took out a small polyp. He then immediately schedules you for a colon resection with follow up chemo and radiation.
Of course these 3 scenarios sound like massive overkill a ridiculous approach to treatment. But they are NO different then what we do with ductal carcinoma in situ. When women are told that this is cancer (which it is NOT, it is precancerous) the entire psychological impact of the “C” word comes into play.
Every statistic related to DCIS will tell you that it accounts for about 20% of breast cancer cases and that the incidence of DCIS has been increasing over the past few decades. This increase mirrors the increase in the public health recommendations to increase mammogram screenings.
Here’s the rub. Despite this increase in DCIS and the increased number of women undergoing breast cancer treatment, the overall mortality rate from breast cancer has not changed. Should raise some questions, don’t you think?
Should we be aggressively treating DCIS that, in most cases, will never create a problem?
Some women would prefer the aggressive treatment just on the off-chance that the aggressive treatment will save them in the future. Think Angelina Jolie.
Just in case you are in this camp of taking the aggressive treatment, this particular article really helps put everything in perspective. In it, researchers looked at the substantial harms associated with overdiagnosis associated with mammography and the medical and societal costs from this overdiagnosis.
The researchers looked at the cost data from a major healthcare insurance carrier covering some 700,000 women 40 to 59 years old, who had undergone routine mammograms from 2011 to 2013. Here’s what they found:
- 11% of the routine screening mammograms resulted in false positives.
- The translates to 3.2 million receiving false positive mammograms each year, at a cost of $2.8 billion annually (yes—with a “B”).
- Of the true cancers detected, with an accepted overdiagnosis rate of 22% (based on previous studies), 20,116 women would be overdiagnosed with invasive breast cancer, at a cost of $1 billion each year.
- For DCIS, the rate of overdiagnosis is a shocking 86%. With these numbers for DCIS the estimated the cost of DCIS overdiagnosis nationwide to be $243 million.
- Put together, they estimated costs of $1.2 billion in overdiagnoses for both invasive breast cancer and DCIS and another $2.8 billion for the workup and treatment costs associated with false positives.
These are serious numbers. This may help you understand why so many groups were against the recommendations to stop routine screening women under age 50. There’s a LOT of money to be lost. These groups continue to shout from the mountaintops that routine screening should be done and the mounting evidence demonstrating significant harm from routine mammography is all hogwash.
No one seems to be taking you, the female patient, into consideration.
The best discussion between you and your doctor would be one that discusses the very real and very likely chance that you will be diagnosed with a condition that will never harm you. This should take into account your family history, lifestyle factors and age. This discussion should then naturally steer towards what lifestyle choices you should choose to dramatically lower your personal risk of breast cancer.
If this is NOT the discussion you are having with your primary care physician, then maybe it’s time to find a new one.