Today is a snow day in our neighborhood. Overnight, about a foot of snow fell, so after helping my husband clear our driveway I came inside to warm up and noticed an email from the Lown Institute advising us that Shannon Brownlee would be speaking on the Diane Rehm show on NPR in just a few minutes. Earlier this week, the BMJ released a study that shows that although annual mammograms for women lead to more diagnoses of breast cancer they do not reduce the number of deaths from this disease, and there’s been a lot of debate about this study in the media. I’ve spent most of my snow day reading and listening to some of this debate and I thought I’d share some of my resources and observations with you.
The Diane Rehm show
New Research On The Value Of Mammograms
You can click on the link above to listen to the show and read the comments.
The speakers included:
• Dr. Anthony Miller – professor emeritus at the University of Toronto, and the lead author of the study on mammogram screening being discussed.
• Shannon Brownlee – senior vice president, Lown Institute, Boston, and author of Overtreated
• Dr. Daniel Kopans – professor of radiology, Harvard Medical School.
• Dr. Ranit Mishori – associate professor of family medicine, Georgetown University School of Medicine.
It’s membership drive week on NPR so the show was shorter than it otherwise would have been. I hope that they discuss this topic further because there is so much more they could have talked about.
Dr. Miller stated that too many mammography screenings are being done and that abnormalities are being found that would never harm the women and should never have been treated.
Shannon Brownlee talked about how we think about cancer and how we believe all cancers start small, then grow and eventually result in death. She noted that as a result of mammography screening many cancers are being found that are not harmful and that the harm comes from treating them. There are similarities between PSA screening and breast cancer screening but the difference is that the belief that PSA screening is beneficial in preventing death from prostate cancer was addressed before it became too deeply embedded, unlike with breast cancer where there the belief that breast cancer screening saves lives is already ingrained.
Dr. Kopans’ opinion was that the study was flawed but I’ve since read that he helped develop a 3D mammogram device, also known as tomosynthesis, so it strikes me that his opinion may not have been all that objective.
Dr. Mishori described how stressful a false positive mammography result is to women because it can take weeks before they find out that there is no cancer.
I really wish there had been more time for this show because the guests made some great points that I would have liked to hear in more detail.
Debating the value and effectiveness of mammograms
You can click on the link above to watch the interview and read the transcript.
Dr. Gilbert Welch of the Dartmouth Institute and author of Overdiagnosed was one of two guests on this show and he began by clarifying that the study was about screening mammography and not diagnostic mammography.
The other guest, Dr. Carol Lee of the Memorial Sloan-Kettering Cancer Center, criticized the study by saying there were several other large studies that show decreased deaths from breast cancer as a result of screening and this one was an outlier, a term I’ve heard a few times today by critics of the study.
In Dr. Welch’s reply to criticisms about how the study was conducted, he noted that this study was unique because it focused on screening mammography as well as a careful physical exam.
I really liked Dr. Welch’s comment at the end of the interview:
The professional disagreement tells you that this is a really close call. And I’m not suggesting women shouldn’t have mammograms. They should just have the choice. It’s a genuine choice. It’s a close call. It has probably some benefits, but it also has some harms.
It’s in line with the point I’m making with this blog. I want to point you toward the information so you can make your choice.
See also Study Casts Doubt on Mammograms for a summary of other interviews with Dr. Welch.
There are legitimate reasons for having mammograms but screening everyone has not resulted in preventing deaths from breast cancer. The author of this article, Kevin Drum, wrote, “. . . the answers are changing, and we need to change along with them.”
I realize that I have a bias because I believe that we are being encouraged to be screened for cancers and that as a result healthy people are becoming patients because of overdiagnosing and overtreatment. I believe that the people that impress me, the ones that are working on showing us that there are harms to this screening, don’t have a financial interest driving them, and I am concerned that their critics often do have a vested interest.
Patients are people, too!
I’m not a fan of studies because the results can be interpreted in different ways by the authors, their critics and the media. As Dr. Welch commented, we should have a choice, so we need to educate ourselves so we can decide for ourselves.