According to the New York Times, The American Cancer Society is planning to restate its claims about the benefits of early cancer detection. That these claims are questionable is not new information, in fact I wrote about it in 2005 (see below for excerpt) and again last year. What is new is that we will no longer be told that mammograms absolutely save lives because the truth is a lot more complicated than that. As the NYT reports,
While the limits of cancer screening have long been known in the prevention community, the debate is new and confusing to many patients who have been told repeatedly to undergo screening.
Indeed it is, but while I am profoundly pleased that the ACS is finally acknowledging this, what is disturbing is that it has taken so long for them to do this because as the NYT notes, this issue isn’t new.
As for individuals trying to decide what they should do regarding their own health, the first thing is make sure you understand what is and isn’t known about early detection. The NYT has a second piece on the subject here which you should also read. I’m sure others will weigh in on this in the coming days as well.
But lets go back to the issue of why it has taken so long for this change of policy which brings me to the piece that I wrote in 2005, The Booby Trap: Does Breast Cancer Awareness Save Lives? A Call to Re-think the Pink. In that piece I pointed out that,
ACS and Komen are both big supporters of annual mammography for women over the age of 40. Over and over, both organizations tout early detection as a lifesaver. They both also receive substantial funding from makers of mammography equipment such as GE and DuPont.
Unfortunately, the truth about mammography and early detection is not so cut and dry. Mammograms may detect cancer earlier (although the majority of women detect their own cancers) but they do not prevent cancer or protect women from cancer and early detection does not necessarily translate into longer survival.
Many women whose cancer is detected by mammograms have slow-growing cancers that will never be life threatening while others are very aggressive and would be lethal no matter when they are detected. Early detection does not appear to impact the life expectancy of either of these groups of women. In addition, because breast tissue in pre-menopausal women tends to be denser, mammograms may miss suspicious masses. The breast tissue of younger women is also more susceptible to damage from radiation.
It is interesting to note that no nation other than the U.S. routinely screens pre-menopausal women by mammography. According to activist Jennifer Drew, in England the practice is for “women aged between 50 and 64 who are registered with a General Practitioner (to) receive a letter inviting them to attend a Breast Screening scan. The age is being raised to 70 years from 2004. Women between these ages can have free mammograms every 3 years. The Government here in the UK believes once every 3 years is sufficient based on medical research.” In contrast with the United States, only one in nine women are stricken with breast cancer in the UK, a statistic also true in Canada. Routine screening guidelines for Canadian women are to be screened every two years after the age of 40. Only one in eleven women in Australia are stricken with breast cancer and women there are advised to get mammograms every two years between the ages of 50-69.
What is perhaps the most important to understand is that survival rates are counted from when a woman is diagnosed. So if a woman is diagnosed in 2000 and lives for 15 years, this is no different than if she was diagnosed in 2005 and lived for 10 years. She would still die in 2015. In other words, a woman may live longer past a diagnosis that occurs earlier, but not necessarily longer overall.
Now if there is anything we’ve learned lately, it is that women’s bodies are a healthcare commodity. The U.S. has the highest c-section rate in the world, but at the same time we deny a woman who has had a c-section health insurance. Women are routinely charged more for health insurance if they can get it, but they can’t if they’ve been raped and take anti-virals to guard against HIV or if they’ve been a victim of domestic violence. In the case of breast cancer, some of the same companies that sell chemicals to cure this disease also sell chemicals that cause it. In this case, it has been known that mammograms were being misleadingly portrayed but GE, Which makes mammography equipment also owns NBC News, and it would not be in their best interests to publicize this information because while it might be good for our health to know this, it would not be good for their bottom line. The company has also provided support to both ACS and Komen. I’m not saying these vested interests were a determining factor in ACS’s policy, but they need to be considered.
Like any situation where there aren’t definitive answers, it is hard to make decisions and there aren’t necessarily right or wrong ones. But is wrong is that it has taken so long for this change to be made because whatever choices we make, we have the human right to honest and accurate information about the medical tests and treatments that are recommended to us without having to worry about corporate vested interests trumping our lives.