Saving Women From Breast Cancer: Are Mammograms Really the Answer?

EDITOR'S NOTE: Since AlterNet edited this piece, a new study was released by The Journal of the American Medical Association that also raises concerns about the efficacy of screenings to definitively detect breast cancer. The study, taken together with those cited here in Naomi Freundlich's analysis, prompted a stunning shift in thinking at the American Cancer Society.  According to the New York Times, "The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated."

October is National Breast Cancer Awareness Month and the sea of pink has reached tidal-wave proportions. Every conceivable product from yogurt to running shoes to breakfast cereal now sports the ubiquitous pink ribbon. This month some NFL players will wear pink cleats, still more will don helmets festooned with pink ribbons, and legions of supporters are participating in walks, runs and bike rides to raise money for breast cancer causes. The collective spirit has been awakened; the American public wants progress on breast cancer!

But besides being a great marketing tool for selling "things," what, ultimately, is the purpose of National Breast Cancer Awareness Month? The concept was introduced in 1985 by AstraZeneca, the giant international pharmaceutical company that makes the breast cancer drugs tamoxifen and Arimidex. The company's aim was to promote regular mammograms as the most effective weapon in fighting breast cancer. It has since enlisted the support of such venerable groups as the American Cancer Society, the American College of Radiology, the National Cancer Institute and the Center for Disease Control, among others in this campaign.

This mission to promote mammography -- helped by a massive media onslaught that features the likes of Rachael Ray and Dr. Phil—gets more ambitious every year. And the calls for women, from age 40 until they can no longer hobble to an imaging center, to get yearly screenings get more urgent as well.

Here is the American Cancer Society's current clarion call for screening:

Current evidence supporting mammograms is even stronger than in the past. Recent evidence has confirmed that mammograms offer substantial benefit for women starting in their 40s. Women can feel confident about the benefits associated with regular mammograms for finding cancer early.

Wait a minute. Is this really true? In April, I wrote in HealthBeat that researchers at the Nordic Cochrane Centre in Denmark and elsewhere had raised serious questions about the benefits of mammography, especially in women under 50 and over 70. The researchers found that:

"For every 2,000 women [age 50-69] invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.

In July, researchers from this same center published another study in the British Medical Journal that attempted to determine the level of "over-diagnosis" (the detection of cancers that will not cause death or symptoms) that can be attributed to wide-scale screening mammography programs. The researchers studied programs in the United Kingdom, Canada, Australia, Sweden, and Norway. Their findings: one in three breast cancers were "over-diagnosed" in publicly organized mammography screening programs.

What this means is that one out of three cancer diagnoses turned out to be lesions that either went away on their own or otherwise never progressed. In some cases, patients would have died of something else before their symptoms progressed.

Meanwhile, the women who received these diagnoses likely went on to have surgery to remove the lesion or the entire breast, radiation and chemotherapy. This seems a substantial cost—both in terms of a woman's psychological and physical health and in terms of health care dollars -- for questionable gains.

In February, two dozen researchers, physicians and patient advocates signed a letter published in the Times of London, imploring the National Health Service to rewrite its information pamphlet to include the risks of over-diagnosis and over-treatment that women face with mammography. The model is a pamphlet written by Peter C. Gotzsche, the director of the Nordic Cochrane Center and other professionals that also appears in the British Medical Journal.