HealthManagement, Volume 18 - Issue 2, 2018
No refunds or returns for advanced disease
Without a shift to a personalised breast cancer screening programme, participation rates in mammography screening may further decline.
As i said goodbye to another Christmas season and headed to the mall and
my local post office to exchange a gift with one that fits or is more
apropos to my personal needs, I was reminded of my more than a
decade-old desire to exchange the term ‘mammography’ screening with‘breast
cancer’ screening—after all we do not screen for mammography but screen
for breast cancer. I want a breast cancer screening programme that is
personalised, based on the unique risks and personal preferences of
women who choose to participate in
screening. Without a shift to a personalised breast cancer screening programme, Participation rates in mammography screening may further decline.
In
the last decade, there is increasing news about the overdiagnosis of
mammography screening and its harms compared to its benefits. This month
another headline greeted women across the globe about the overdiagnosis
and ineffectiveness of mammography screening from a study published in
the BMJ (Autier et al. 2017). the study, which analysed the mammography screening programme in the Netherlands from 1989 to 2012
concluded that the Dutch programme had little impact on the burden of reducing advanced disease, suggesting a marginal effect on mortality.
Additionally, the authors concluded that half of screening detected
cancers represent overdiagnosis.
Radiologists and supporters of
mammography screening are yet again tasked with counteracting the
growing trend of studies in peer-reviewed journals touting the harms
of mammography. often criticising the faulty analysis of the most
recent study and fiercely questioning the elaborate claims of
overdiagnosis, the cheerleaders of mammography screening defend the
importance of its role in finding early cancers and at the same time
acknowledging an insignificant rate of overdiagnosis.
Overdiagnosis
is defined as the detection of tumours at screening that might never
have progressed to become symptomatic or life-threatening in the
absence of screening. the challenge that currently exists is that we
cannot discriminate between which cancers are progressive and
potentially deadly.
Since my advanced stage breast cancer diagnosis in 2004, after never
missing my mammography screening, I have studied the research of mammography screening and its impact on mortality. given my significant
diagnosis and that my faithful mammography screening did not benefit
me but caused me harm and still may cost me my life, I should be the
least enamoured advocate of mammography screening. However, the impact
of early detection by screening mammography, although not perfect, is
beneficial to many women with its impact to reduce mortality from breast
cancer. Coincidentally, a 2015 study from the Netherlands found that
even in light of new treatments, the size of the cancer and how far it
spread remains vital to surviving the disease (Saadatmand et al. 2015).
I
am personally aware that mammography is not an equal opportunity
technology for access to an early diagnosis for many women with dense
breast tissue. When a woman’s cancer is not detected at an early stage, even after faithfully participating in mammography
screening, there are no refunds or returns. the benefits of early
detection by mammography have failed these women. They are left with
the harms of a later stage diagnosis, aggressive treatment options,
quality of life issues and a greater likelihood of dying from breast
cancer. In our state advocacy efforts, we still encounter
physician-trade organisations that are neutral or opposed to dense
breast tissue reporting legislation with the goal of initiating dialogue
with healthcare providers leading to personalised screening. I have
worked with women across this country, who were harmed in the worst way
by dying from breast cancer, not from overdiagnosis but from
underdiagnosis.
It’s time for the breast health community to exchange the term ‘mammography’ screening with‘breast
cancer’ screening. While most women, unless they have a genetic
mutation or are at high risk of the disease, would begin their personal
screening programme with a mammogram, women with dense breast tissue
could alternate in-between years with a different screening tool which
fits their personal breast health needs, giving them a greater
likelihood of reducing advanced cancers.
Despite
decades of mammography screening, breast cancer remains one of the
major causes of cancer deaths in women. Research concludes that early
detection by screening reduces mortality from breast cancer by detecting
cancer early, leading to a decline in the rate at which women present
with late-stage breast cancer when a refund or a return has expired.
Reprinted by permission from Nancy’s Chalkboard - areyoudense.org/blog.
The Are you dense? Handy patient guide to screening options for dense breasts is available at https://www.areyoudense.org/resources/ patient-friendly-tools/handy-patient-guide- screening-options-dense-breasts
References:
Saadatmand S et al. (2015) Influence of tumour stage at breast cancer detec- tion on survival in modern times: population based study in 173,797 patients. BMJ 351:h4901.