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Komen Blasted For Pro-mammography Claims

August 6, 2012
Written by: , Filed in: Breast Imaging, Medical Ethics
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A commentary published last week in the British Medical Journal accuses Susan G. Komen for the Cure of using misleading statements to oversell the benefits of mammography.

The breast cancer–fighting organization responded that “mammography isn’t perfect,” but, “The numbers are not in question. Early detection allows for early treatment, which gives women the best chance of surviving breast cancer.” However, the Komen statement, from Chandini Portteus, vice president of research, evaluation, and scientific programs, did not directly address the BMJ article’s criticisms.

Article authors Lisa M. Schwartz, MD, and Steven Woloshin, MD, both of the Center for Medicine and the Media at The Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire, contend that the numbers are very much in question.

Specifically, they quarrel with Komen ads saying that five-year survival for breast cancer is 98 percent when the cancer is caught early and 23 percent when it is not. If a mammogram detects a tiny tumor that would take more than five years to grow to the point of causing death, then early detection has nothing to do with the five-year survival rate from such a tumor, Drs. Schwartz and Woloshin say. So the “98 percent” claim misleadingly gives mammography credit for some five-year survivals that would have occurred even with no detection or treatment at all.

Drs. Schwartz and Woloshin say:

There is no correlation between changes in survival and what really matters, changes in how many people die.

They calculate that screening mammography brings “a reduction in the chance that a woman in her 50s will die from breast cancer over the next 10 years from 0.53 percent to 0.46 percent, a difference of 0.07 percentage points.”

Drs. Schwartz and Woloshin also say Komen ignores the problem of overdiagnosis. Mammography detects some tumors that, left untreated, will remain relatively harmless and never cause any symptoms. The identification and unnecessary treatment of such tumors lead to emotional turmoil, pain, side effects, and wasted expenditures, the doctors say.

The problem with that argument from the point of view of the patient is that medical science can’t tell which of the tumors it detects will go on to be harmful and which ones won’t. Suppose you were told, “It’s cancer, but it may never really bother you. We can wait and see whether it’s the kind that grows, metastasizes, and kills you, or we can treat it now.” What would you do?

It’s a complex subject. Both Komen and Drs. Schwartz and Woloshin do at least agree that, as the Komen statement says, women should be “informed about the benefits and risks of early detection and treatment” and should “work with their healthcare providers to find out what’s right for them.”

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