The issue of potential harms from mammography has been aired again, this time in a New York Times op-ed piece declaring that the false alarms in breast cancer screening “are a problem that needs to be fixed.”
The op-ed article was based (and broke the embargo by a few hours) on a commentary published online December 30 in JAMA Internal Medicine, which accompanied a small prospective study of a decision aid to help women to get a better handle on the benefits and risks.
The Study: Women 75 years and older, who were given a decision aid pamphlet outlining the risks and benefits of breast cancer screening. They reported being better informed about the potential tradeoffs and appeared to feel less conflicted about their ultimate choices, report Mara A. Schonberg, MD, MPH, and colleagues from Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts.
In the commentary, H. Gilbert Welch, MD, MPH, and Honor J. Passow, PhD, from the Geisel School of Medicine at Dartmouth University in Hanover, New Hampshire, estimate that of 1000 US women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will be spared from dying of breast cancer, 490 to 670 will have at least 1 false-positive result, and 3 to 14 will be overdiagnosed and overtreated.
Is that acceptable? Read the response of the authors to these findings:
Dr. Welch says that a “screening program that falsely alarms about half the population is outrageous” and that “[w]hether you blame the doctors or the system or the malpractice lawyers, it’s a problem that needs to be fixed.”
So what can we do?
“Our suspicion is that the top priority for most women would be to have a more precise estimate of the benefit in the current treatment era. It has been 50 years since a randomized trial of screening mammography has been done in the United States. Given the exposure of tens of millions American women to this intervention, perhaps we are due for a second look,” they write.
My Take: 42 of the 45 women said that they found the decision aid helpful, and 43 said they would recommend it to others. This is a step forward. Looking ahead, we need to do a better job of individualizing screening recommendations to the individual, optimally with some input from the person regarding their tolerance for risk (unnecessary biopsies, for example versus cancer risk). I’m Dr. Michael Hunter.
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Reference: JAMA Intern Med. Published online December 30, 2013.