"Women Deserve to Know the Truth About Mammograms"
Fueled by good intentions, and economic conflicts
of interest with the multi-billion dollar mammogram industry,
many women are being given diagnoses of breast cancer unnecessarily,
producing unwarranted fear and stress
and exposing them to treatment they don't need.
This is the overdiagnosis problem I've been talking about,
the detection of pseudodisease— mammogram-detected abnormalities
that look like cancer under a microscope,
and so you're diagnosed with cancer, you're treated for cancer,
but it was just pseudodisease
and would have never progressed to actually cause symptoms.
The human costs include mastectomies and even deaths.
The chance that a woman will benefit from mammograms may be small,
in fact maybe ten times smaller than the risk that she may experience
serious harm in terms of this overdiagnosis.
How many would elect to go in for a mammogram if they knew
that for every one woman who is notionally saved by early detection,
anywhere from 2 to 10 otherwise healthy women
are being turned into breast cancer patients unnecessarily?
Well, first of all, are patients even told
about the possibility of overdiagnosis by their physicians?
I mean it is, after all, now recognized as
the most serious downside of mammogram screening.
Well, hundreds were asked, and less than 1 out of 10 said
that they had been informed about it.
And when they were told about it, a little more than half said
they wouldn't agree to screening if it resulted
in more than 1 over treated person per life saved.
Wow! That implies that millions of Americans might not choose
to be screened if they knew the whole story; however, 90% do not.
Most women are aware about false-positives
and tend to view them as an acceptable consequence of mammograms.
But in contrast, most women were unaware that screening
could detect cancers that may never progress,
and what they don't know could potentially even kill them.
So when considering the pros and cons of mammograms,
it would be good to consider total mortality.
Can it actually help you live longer, on average?
And mammograms have not been shown to do that,
and it is therefore misleading to claim that "screening saves lives."
Theoretically, a routine mammogram should increase
a 50-year-old nonsmoking woman's overall survival chance
from around 96.3% to 97.1% over 10 years.
But these statistics disregard deaths from overdiagnosis,
deaths from the unnecessary radiation and chemo,
and thus increased mortality from heart disease and other cancers
that may entirely outweigh the benefit in terms of reduced breast cancer mortality.
You can't irradiate the breast without exposing
the rest of your chest to radiation— your heart, your lungs—
explaining why breast cancer survivors can end up with significant
and marked impairment in cardiopulmonary
(heart/lung) function.
Radiation treatments increase deaths from heart disease
by more than 25% and from lung cancer by nearly 80%.
Now we would accept that risk if we were beating back some deadly cancer,
but the main effect of screening is to produce patients with breast cancer
for which treatment offers zero benefit, since they would have remained
free of breast disease for the rest of their lives without it,
since compelling data suggest that most overdiagnosed tumors
would have regressed spontaneously without treatment.
Still, women who have had a cancer detected and then removed
are likely to feel that their life was saved, but perhaps 10 times more likely
their lives were actually seriously harmed, not saved.
Ten times more likely you were told you had a cancer that could kill you
but you really didn't;
corralled into the operating room for surgery you didn't need.
Every doctor's appointment, every sleepless night,
all completely unnecessary,
yet you come out as mammograms' greatest advocate: it saved your life.
That's the crazy thing about mammograms, about PSA testing for prostate cancer:
the people who are the most harmed are the ones who claim the greatest benefit.
So overdiagnosis creates this vicious cycle for more overdiagnosis
because more and more people know someone, a friend, a family member,
a celebrity, who "owes their life" to early cancer detection.
So the worse the test is, the more overdiagnosis it causes,
the more popular it becomes.
The more mammograms harm women, the better they seem to work.
The more breasts that are surgically removed completely unnecessarily,
the more women swear by it.
Yeah, it's maybe billions of dollars wasted for nothing
that could be spent on doing more for women's health.
But it's the human costs: the harms from breast cancer screening
may outweigh the benefits if death caused by treatment is included.
Based on some best- and worst-case scenario estimates,
for every 10,000 women invited for 10 years of mammogram screening,
3 to 4 breast cancer deaths may be avoided
at the cost of around 2 to 9 deaths
from the long-term toxicity of unnecessary radiation treatments.
Yet only 1 in 10 women undergoing mammography
said they were ever told about overdiagnosis,
even though 9 out of 10 thought they had the right to know.
Now overdiagnosis is not easy to talk about.
It's a sensitive issue, but just because communicating with patients
can be difficult doesn't mean that we shouldn't do it.
Informed women deserve no less.
We have an ethical responsibility to let them know.