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No debate: Breast cancer screening saves lives

November 4, 2012 12:10 am

CHARLESTON, W.Va.

--I was dismayed, disappointed, and to a degree disgusted by the article on the front page of your paper on Oct. 30: "Study shows breast cancer may be overdiagnosed." The statements quoted are misleading at best and simply untrue at worst.

Read the words! Harpal Kumar says: "[S]ome cancers are treated that would never have caused any harm and unfortunately, we can't yet tell which cancers are harmful and which are not." We can do what is happening now and treat all cancers, or we could treat none of them and then we would know which ones were harmful because those patients would all be dead!

Then, pray tell, just how in the world does anyone draw the conclusion and make the statement that "1 percent of them will get unnecessary treatment such as chemotherapy, surgery, or radiation for a breast cancer that wouldn't ever be dangerous"? Even if that were true--and I do not believe it--in that scenario 99 percent of the patients who needed treatment received the treatment appropriate for their diagnosis. Please explain the problem!

Kumar says: "It's clear that screening saves lives." Karsten Jorgensen says: "It's important they have at least acknowledged screening causes substantial harms." Once again it is mind-boggling that anyone publishes such a broad condemnation of a process that is acknowledged over and over in the same article as being successful at saving lives. What are the examples and what is the proof of "substantial harm"?

I challenge you to find one patient in this country who has undergone any of those treatments without a pathologic diagnosis of malignancy. Biopsies are performed and pathologic evaluations are completed to obtain a tissue diagnosis. If there is a malignancy then it is classified by cell type and additional tests may be performed--estrogen receptor status, PET scan, etc. On the basis of that information treatment options are discussed with the patient and a treatment program defined.

Repeated statements of "overdiagnosis" are, very simply, lies. A tissue diagnosis is exactly that: These are the cell types present, period, the end. They may run the gamut from normal to neoplastic but there is a specific diagnosis made. Overdiagnosis doesn't just imply a problem, it indicts the process and suggests that the pathological information obtained is somehow wrong, that noncancerous lesions are being called cancer.

Screening for breast cancer is exactly that, screening. That means that repeated exams at appropriate intervals are necessary because one mammogram is a snapshot in time and, while it has significant diagnostic value, it has little to no prognostic value. A normal mammogram today does not imply, much less guarantee, normal mammograms in the future.

Breast cancer became more of a political disease than a medical one years ago, and we adapted to those demands in an effort to continue to care for our patients. Even so, I am constantly amazed and frightened by the manner in which ill-informed, often ignorant people draw concrete conclusions from conflicting information and data. It is then dismaying to see the media publish those conclusions with absolutely no effort to verify them. Reference to a journal article hardly suffices for actual verification.

The bottom line remains the same: Screening mammography saves lives!

George Butler Wilson, M.D., is a radiologist in West Virginia.





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