Increasing use of screening tests lowers death rates for cancers, but the tests themselves and treatments to stop invasive cancers have their own costs by lowering quality of life, increasing risks of other diseases and spiking the medical care budget.
Public Has Difficulty Evaluating Health Risks and Mammogram Screening Benefits
Breast cancer is frightening and women applaud efforts to detect and treat cancer at very early stages. It makes sense that the smaller the tumor and the less breast tissue involved, should mean that treatment is also less invasive and life expectancy is improved. Therefore, more tests should mean better outcomes and costs are of minimal consideration when lives are at stake. Unfortunately, more sensitive tests and earlier detection do not always produce the best results for women.
Breast Cancer Tumors Don’t Develop the Same Way
It is assumed that cancers develop from single cells that proliferate, form tumors that produce their own blood supplies, and then metastasize to new locations. Cancers result from random mutations and breast cancers originate from many different types of genetic changes, following many alternative paths. In most cases, the cancer cells die off. Predicting the behavior of tumors is difficult and even some relatively large tumors spontaneously shrink and disappear.
Twenty Percent of Invasive Breast Cancer Tumors Regress without Treatment
A Norwegian study of breast cancer screening in women over 50 years of age determined that increased screening increased the number of tumors that were detected and treated, but didn’t improve the outcome. The conclusion was that one fifth of the invasive tumors that were detected as a result of more intensive screening spontaneously regressed and would not have required treatment. Unfortunately, there was no way of knowing which of the tumors would disappear without treatment.
More Mammogram Testing Produces Worse Results
Some criticism of the U.S. health care system is based on observations that this system is the most expensive, but it does not provide the best health. Part of the problem is excessive use of increasingly expensive diagnostic tests that provide diminishing returns in health benefits. In some cases these tests may detect cancers that require no treatment, but these false positives cannot be distinguished from others at the same stage, which are deadly. The result is the use of surgery, radiation and chemotherapy that have their own costs in reduced quality of life. It is difficult for doctors to tell patients that surgical interventions might not be needed.
Task Force Recommends Fewer Mammograms for Breast Cancer
The U.S. Preventive Services Task Force came to the conclusion that less was more when they changed the existing recommendations for breast cancer screening. Teaching breast self-exams was found to be ineffective. Routine mammograms for women 40-49 years old were determined to produce more false positives with invasive loss of quality of life than was justified by the number of additional cancers discovered. Mammograms every two years were recommended for women 50-74 years of age and there were no recommendations for women 75 years of age and older. The Task Force also emphasized that these were recommendations and that each woman needs to determine what is best for her by consultation with health care providers.
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