Cancer Death Rates Are Down, but Watch Out if Breast Cancer Screening Falls Off

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Izzy, mammograms have never been proven to cause breast cancer. There is speculation, but that's as far as it goes. An annual mammogram equates to about one airplane ride per year.
When an analysis, in plain numbers, shows a reduced risk of dying with the use of screening, but an unquantifiable level of "harm" from the procedure is what is emphasized (too many false positives, extra biopsies, added anxiety), you do wonder what the motivation is. I'd like to see a study done on the "harm" women experience if they were told they were completely on their own, with no screening at all, and left to find their own breast cancers. If my logic is correct, that would include even GREATER anxiety, more radical cancer treatments and surgeries, and ummmm....MORE DEATHS!!!!!!!!!!

Jonathan R. of DC 1:47PM March 23, 2010

Regarding "Don't be Fooled's" and "Izzy of MA's" comments
It is impossible to compare 1900 statistics to 2010's. There are so many variables that affect this data that cannot be controlled for: access to modern technology to diagnose cancer, accuracy and reliability of data being collected, recent advances made in health and safety regulations, etc.. . And yes, modern medicine has made advances. I would have lost both my mother and my aunt if they would have lived in 1900.
To Izzy of MA:
The American Cancer Society states:
"Strict guidelines ensure that mammography equipment is safe and uses the lowest dose of radiation possible. Many people are concerned about the exposure to x-rays, but the level of radiation from mammography today does not significantly increase the breast cancer risk for a woman who gets regular mammograms."
"The dose of radiation that she gets during a screening mammogram is about the same amount of radiation from her natural surroundings (background radiation) she would average over about 3 months."
Taken from: http://www.cancer.org/docroot/cri/content/cri_2_6x_mammography_and_other_breast_imaging_procedures_5.asp

A Benson of IL 5:37PM March 11, 2010

Dr. Healy:
Yes, the full story must be told. The full story is that the evidence review and findings from simulation modeling that the USPSTF conducted suggested that routine mammography was of questionable benefit for anyone under age 60, let alone 50. And the full story? Are the consequences of false positives limited to inconvenience, worry, and anxiety? No, they include unnecessary radiation exposure, and repeated radiation exposure poses a risk of...cancer. Yes, cancer. The impact of radiation is not well understood, but let's say such exposure poses a 1% lifetime risk. There are currently about 23 million women in the US aged 40-49. So, over a lifetime, roughly 230,000 of these women will get cancer from mammography exposure. If we assume that only 10% of these cancers will ever be fatal, that is still over 20,000 deaths averted by not screening. The story is different but similar for prostate cancer -- early detection by PSA leads to many more unnecessary treatments for cancer that will never cause a single problem than aggressive cases missed -- it is harm to patients that is the reason why most European countries don't do routine PSA screening, not saving money. Dr. Healy, as a columnist for a respected magazine, you need to decide what is most important -- objective analysis, or political leanings.

Izzy of MA 2:17PM January 26, 2010

And the naysayers said there would be no death panels in ObamaCare.

allen of MS 3:03PM December 12, 2009

Cancer death rates only SEEM to be down because today we have earlier detection. The truth is cancer death rates are where they have always been because except for a handful of cancers, modern medicine has made ZERO progress. The industry doesn't want you to know this however.
What is always not stated that in 1900 roughly 1 out of 30 Americans got cancer. Today is is 1 in 3. Yet the cancer industry talks about progress ...

Dirk of GA 10:18PM December 09, 2009

There is no question that mammograms at 40 save some small number of lives. And there is no question that there is a cost for these saved lives, both financial and in terms of the iatrogenic effects of radiation and unnecessary biopsies. The new standards make the case that the costs outweigh the benefits. That seems to be a well reasoned and fair position that is in the interests of patients, not just payers.
We make these cost benefit decisions all the time. Mammograms starting at age 20 or 30 would save lives as well but we believe that the costs outweighs the benefits. No intervention is free, ether in terms of financial cost or in terms of side effects. There are limits to all health care. At least this recommendation is based on solid cost-benefit analysis that takes the financial, human, and emotional costs into account. I wish that we did a better job of making these recommendations in all parts of medicine. Research based decision making in medicine is making progress but is still pretty poor in many ways. We need to do a far better job of recommending the best that we have, balanced by what makes good, rational sense. This kind of reasoned approach ultimately is best both for patients and for the economics of health care.

Tony Zipple of IL 5:26PM December 09, 2009

Dr. Healy claims, "But U.S. breast-cancer screening policies are a big part of why America has among the lowest breast-cancer death rates of developed countries..."
The OECD publishes cancer stats for developed countries. The average Breast Cancer Mortality Rate for OECD countries in 2004 (latest stats I found) was 22.0 deaths per 100,000 age-standardized women. The US average was... 22.0 deaths. What does Dr. Healy know that the OECD doesn't? What makes her think the way the US handles breast cancer is superior?

SteveH of MD 4:33PM December 09, 2009

The study under discussion didn't compare financial cost versus lives saved but heath costs versus lives saved. No where in this article is mentioned the costs of false positives: women who undergo mastectomies and/or radiation treatment needlessly. With real costs to their life expectancies. If you save one life at the cost of taking a year off the life of 1000 women, is that preferable? That was the calculus of the study. This article completely omits this point and falsely says it was an analysis of saving money versus lives. I agree it is a grey area and debate should take place, but one should not distort what was being said.

john of MA 10:19AM December 09, 2009