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Mammograms Identify DCIS But Lead to Over-diagnosis, Over-treatment?

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Breast cancer screening was not associated with any reduction in the incidence of advanced cancer, and overdiagnosis of invasive tumors and ductal carcinoma in situ is a common problem…”

Articles and studies debating overdiagnosis and over treatment of DCIS are not new. What is new is a study that puts a real number on what overtreatment costs the U.S. in dollars.

Before the invention of the mammogram, there probably were breast cancers that could have been diagnosed at an earlier stage but were not. As we all know, finding cancers early results in better outcomes. By identifying breast cancers earlier,  mammography improved the outcomes for many women.

In fact, a good friend of mine discovered her invasive breast cancer through a routine mammogram. Maribeth swears to me that mammorgrams save lives.

At the same time, mammograms find problems that either are not cancer or cause treatment that is not necessary, aka overdiagnosis and overtreatment.

Owing to the widespread adoption of screening for breast cancer and improvements in the sensitivity of mammography, the diagnosis of ductal carcinoma in situ (DCIS) has increased dramatically over the past few decades. Historically, DCIS accounted for only 1% to 2% of all breast cancer diagnoses, but now it accounts for over 20%.

According to a recent Medscape article, the number of DCIS diagnoses in 2014 was 35,591. Many cancer experts debate if DCIS should even be classified as cancer or perhaps cancer stage 0.

I am a cancer survivor and cancer coach. If you have been diagnosed with DCIS consider evidenced-based, non-toxic therapies to reduce your risk of progressing to breast cancer.

Nutrition, supplementation and lifestyle therapies shown to reduce the risk of a breast cancer diagnosis. 

To learn more about DCIS and the evidence-based therapies that can help you prevent its spread into invasive breast cancer, please watch the video below:

 

For more information on both conventional and non-conventional therapies for breast cancer, scroll down the page, post a question or a comment and I will reply ASAP.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:

 


1 in 7 Breast Cancers ‘Overdiagnosed’ in Women 50-74

“About 15% of screen-detected breast cancers among women ages 50-74 would not have caused symptoms or signs in a woman’s remaining lifetime, which is less than previously thought, a modeling study suggests.

Identification of those cancers on screening is considered to be overdiagnosis..”

Study finds breast cancer overtreatment costs US $4B per year

“Sharpening a medical debate about the costs and benefits of cancer screening, a new report estimates that the U.S. spends $4 billion a year on unnecessary medical costs due to mammograms that generate false alarms, and on treatment of certain breast tumors unlikely to cause problems…

The cost estimates cover women ages 40-59…

Study authors Mei-Sing Ong and Kenneth Mandl say their findings indicate that the cost of breast cancer overtreatment appears to be much higher than previously estimated. Their $4 billion figure is the midpoint of a range that depends upon assumptions about the rates of false-positive mammograms and breast cancer overdiagnosis…

Apart from the financial cost of screening tests and treatment, false positives and overdiagnosis expose women to risks from additional medical procedures, not to mention psychological distress. It’s not uncommon for mammograms to turn up some apparent abnormality that has to be resolved with more imaging tests or a biopsy…

Study: Mammography Results in Overdiagnosis, No Reduction in Advanced Disease

Breast cancer screening was not associated with any reduction in the incidence of advanced cancer, and overdiagnosis of invasive tumors and ductal carcinoma in situ is a common problem, according to a new study conducted in Denmark…

“Effective breast cancer screening should reduce the incidence of advanced tumors,” wrote study authors led by Karsten Juhl Jørgensen, MD, of the Nordic Cochrane Centre in Copenhagen. “Screening mammography detects many small tumors that would not have become clinically evident in the remaining lifetime without screening.”

Denmark provides an ideal setting for testing overdiagnosis and screening efficacy, because only 20% of the population aged 50 to 69 years was invited to participate in a mammography screening program over a 17-year period. The researchers compared breast cancer rates and estimated overdiagnosis in this large population; the results were published in Annals of Oncology.

Overall, they found that the incidence of nonadvanced tumors increased in screening periods compared with prescreening periods, with an incidence rate ratio of 1.49 (95% CI, 1.43–1.54). Instituting screening was not, however, associated with any decrease in the incidence of advanced tumors.

They estimated that in 2010, 271 invasive breast tumors and 180 DCIS cases were overdiagnosed each year. When DCIS was included, they found an overdiagnosis rate of 24.4%, compared with the incidence observed in 50- to 69-year-old women in non–screening areas of the country; without DCIS, the rate was 14.7%. In other words, approximately one in every five women in that age group diagnosed with breast cancer was overdiagnosed in areas where screening was used.

“Seventeen years of organized breast screening in Denmark has not measurably reduced the incidence of advanced tumors, but has markedly increased the incidence of nonadvanced tumors and DCIS,” the authors wrote. “These findings support that screening has not accomplished the promise of a reduction in invasive therapy or disease-specific mortality.”

In an accompanying editorial, Otis W. Brawley, MD, of the American Cancer Society in Atlanta, wrote that “acknowledging the existence of breast cancer overdiagnosis challenges the value of screening: it means that the benefits of breast screening have been overstated, and that some women who have been ‘cured’ were harmed because they received unnecessary treatment.”

He noted that routine mammography should be advocated for women at significant risk, and that in the future it may become easier to separate those at very low or very high risk in order to stratify for screening purposes.”

 

 

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Mammograms Identify Small Breast Cancers But do They Save Lives? - PeopleBeatingCancer says a couple of years ago

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