Study: 1 in 3 breast cancer patients overtreated

Jul 10, 2009 By MARIA CHENG , AP Medical Writer

(AP) -- One in three breast cancer patients identified in public screening programs may be treated unnecessarily, a new study says. Karsten Jorgensen and Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen analyzed breast cancer trends at least seven years before and after government-run screening programs for breast cancer started in parts of Australia, Britain, Canada, Norway and Sweden.

The research was published Friday in the BMJ, formerly known as the . Jorgensen and Gotzsche did not cite any funding for their study.

Once screening programs began, more cases of breast cancer were inevitably picked up, the study showed. If a screening program is working, there should also be a drop in the number of advanced cancer cases detected in older , since their cancers should theoretically have been caught earlier when they were screened.

However, Jorgensen and Gotzsche found the national breast cancer screening systems, which usually test women aged between 50 and 69, simply reported thousands more cases than previously identified.

Overall, Jorgensen and Gotzsche found that one third of the women identified as having breast cancer didn't actually need to be treated.

Some cancers never cause symptoms or death, and can grow too slowly to ever affect patients. As it is impossible to distinguish between those and deadly cancers, any identified cancer is treated. But the treatments can have harmful side-effects and be psychologically scarring.

"This information needs to get to women so they can make an informed choice," Jorgensen said. "There is a significant harm in making women cancer patients without good reason."

Jorgensen said that for years, women were urged to undergo breast cancer screening without them being informed of the risks involved, such as having to endure unnecessary treatment if a cancer was identified, even if it might never threaten their health.

Doctors and patients have long debated the merits of screening out of similar concerns that it overdiagnoses patients. A study in the Netherlands found that as many as two out of every five men whose prostate cancer was caught through a screening test had tumors too slow-growing to ever be a threat.

"Mammography is one of medicine's 'close calls,' ... where different people in the same situation might reasonably make different choices," wrote H. Gilbert Welch of VA Outcomes Group and the Dartmouth Institute for Health Policy and Research, in an accompanying editorial in the BMJ. "Mammography undoubtedly helps some women but hurts others."

Experts said overtreatment occurs wherever there is widespread cancer screening, including the U.S.

Britain's national health system recently ditched its pamphlet inviting women to get screened for breast cancer, after critics complained it did not explain the overtreatment problem.

Laura Bell of Cancer Research UK said Britain's breast cancer screening program was partly responsible for the country's reduced cases.

"We still urge women to go for screening when invited," she said, though she acknowledged it was crucial for women to be informed of the potential benefits and harms of screening.

---

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tkjtkj
5 / 5 (1) Jul 10, 2009
This article itself is an example of 'risky business'. Yes, screening can identify more incidents of disease, some of which might be 'over-treated' (although the article is shy about fully explaining that tidbit!) but there also will be more discovery of the 'deadly' versions, too, and this is not even referred to in the article. There does appear admission that there is no way to tell the difference between the 'deadly' and the 'unnecessarily treated' versions of the disease, and logic would dictate then that this matter is moot: Are they suggesting that care-takers wait for a post-mortem exam to decide if they should have or should not have treated the lesion 10 yrs before death?

I sense more than a little 'bean counter' mentality in this matter.
Using England's approach to health care as some sort of 'example' is tantamount to observing that the fox's method of chicken population control benefits the remaining birds.

j.a., md