The British Medical Journal published a monumental study on screening mammography this week. It’s garnered a ton of media coverage because the findings provocatively question the sacrosanct idea that early detection of breast cancer saves lives. Imagine that…Imagine if the entire pink machine was misguided. Of course, for people who have been willing to squint hard and look through the haze of hype, this news does not surprise.
In two sentences, this is the story: Detecting disease earlier prolongs survival from that disease (you have it longer), but it may not improve the death rate. That’s because many of the early detections may not transform to severe disease, and because treating more people with potentially toxic interventions exposes many to potential harm.
Note that I specifically used the word disease, and not breast cancer. That’s because the same principle applies to other cancers, especially prostate cancer, but also heart disease as well.
Rather than go on with my words, let me link a few articles and then you decide. Keep this Tweet in mind as you decide. Think past the emotionally charged issue of mammograms. Think about the larger issue of over-diagnosis and over-treatment.
Dr James Hamblin, an Indiana University trained doctor, who is now the health editor of the Atlantic wrote this crystal-clear analysis of the BMJ trial. In Dr Hamblin’s article is a video from another Indiana University doc that explains (in John Green style) how improving survival may not equate to improving death rates. The bonus from that video is that it also explains how the Fox news dribble about British cancer care being substandard to ours may not be based in evidence.
The second article worth reading is this one from Dr Gilbert Welch. In it, he explains the limits of breast cancer screening and what we still don’t know.
The third and fourth works focus on one of the many dangers of early detection and treatment of cancer. Namely, the cardiac toxicity of cancer treatments. Over the past decade or so, as the pink campaign gathered steam, effectively squashing any voices of skepticism, an entire branch of cardiology came to be.
The field of cardio-oncology emerged to deal with the effects of radiation and chemotherapy. An article from CardioVascular Business (how apropos) chronicles the costs of surviving cancer.
And then there is this sobering review article in Circulation entitled, Cancer Therapyâ€“Induced Cardiac Toxicity in Early Breast Cancer Addressing the Unresolved Issues. The vastness of that review article, and the fact that we have created an entire branch of cardiology to deal with medically-induced heart disease, makes you think hard about early treatment of anything.
This is important stuff. It’s not intended as anti-mammography or anti-chemotherapy.
It’s intended to make us all think about the tradeoffs of doing stuff.