Benefits, Risks Of Cancer Screenings 'Not Always Clear,' NYTColumnist Says

Main Category: Cancer / Oncology
Also Included In: Preventive Medicine;  Public Health
Article Date: 26 Oct 2009 - 1:00 PDT

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Although "[m]ost people believe that finding cancer early is a certain way to save lives," the "reality of cancer screening is far more complicated," New York Times columnist Tara Parker-Pope writes. "Studies suggest that some patients are enduring aggressive treatments for cancers that could have gone undetected for a lifetime without hurting them," while "[a]t the same time, some cancers found through screening and treated in the earliest stages still end up being deadly," according to Parker-Pope. "It is estimated that for every 100 women who are told they have breast cancer, as many as 30 have cancers that are so slow-growing they are unlikely to be life-threatening," she adds. Figures like these and other studies have prompted the American Cancer Society to say that some benefits of early detection have been overstated. The group issued a press release Wednesday standing by its current recommendations of mammograms for women ages 40 and older. However, ACS also says that women should be aware of the limitations of screenings, and it "will continue to revise its public messages about cancer screening as new information becomes available," Parker-Pope says.

Otis Brawley, chief medical officer for ACS, feels the group's "goal is to update public health messages to better reflect the benefits, risk and limits of various forms of cancer screening," Parker-Pope writes. She adds, "Nobody is suggesting that women stop getting mammograms or that men stop discussing prostate cancer screening with their doctor."

Cancer screenings can be useful, but they are "not the answer for every kind of cancer, and it's not going to fix all the problems," explained Laura Esserman, a professor of surgery and radiology at the University of California-San Francisco and co-author of a recent analysis in the Journal of the American Medical Association about the risks and benefits of cancer screenings. She added, "If you get screened, there's a chance you're going to find a cancer that might not be dangerous, and you want to make sure you understand that so you don't get overtreated."

Parker-Pope continues, "It is a commonly cited fact that mammography screening for breast cancer lowers a woman's risk of dying from the disease by 20%, compared with women who do not get screened." She adds, "That sounds like a big benefit, but it does not fully communicate the extent to which an individual woman is helped by screening." According to Parker-Pope, "Another way to describe the benefits of mammography screening is this: You would have to screen 1,000 women ages 50 and older for 10 years in order to avert one additional death from breast cancer, compared to a similar number of women who are not screened." False-positives are also an issue. "(F)or every 1,000 healthy women who undergo annual mammograms, about half will have a stressful false positive within 10 years, and 180 of them will undergo a biopsy," Parker-Pope says (Parker-Pope, New York Times, 10/22).

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