More answers and uncertainty on breast cancer screening: Time for a big change?

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Screen Shot 2013-12-30 at 1.08.50 PMIn recent years a surprising amount of the orthodoxy of modern medicine has been challenged, and this has resulted in some counterintuitive, even surprising findings.

For example, the PSA test for detecting prostate cancer is so flawed that some healthcare professionals are in favor of doing away with it entirely. The primary reason: too many false positives, leading to unnecessary (and very invasive) procedures, with very few lives actually saved.

Annual physicals have been shown to not prolong life, and study after study has shown that taking multivitamins is either useless, or even harmful.

But, there is no more controversial topic than the use of routine mammography for early detection of breast cancer. Once the holy grail of saving lives at risk from breast cancer, a closer look at the data has been, at best, disappointing for proponents of routine screening.

Such is the opinion of H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice and a vocal critic of the overuse of questionable prevention and treatments that are intended to protect us from a variety of conditions.

In a December 30th op-ed in the New York Times, Welch points out that when middle-aged Americans were surveyed about breast and prostate cancer screening, about half said they would not choose to start screening if the test resulted in more than one over treated person per one cancer death averted.

To which he adds, Wow.

Wow, indeed.

Contrary to dogma, millions of American s do not want to be tested for these cancers once they understand that the likelihood of getting a false positive result will then put them into the system, where the next thing they know surgical procedures are being performed on them and much of the time they will cause more harm then good.

Welch refers to his JAMA Internal Medicine perspective piece (which will be published today) in which he estimates that for every one thousand women who undergo mammography, between 470 and 690 (!) of them will have a false alarm. If this sounds bad to you, it sounds even worse to him.

Welch says, A screening program that falsely alarms about half the population is outrageous. Although some women will be reassured that their breasts are healthy from the mammogram, half of them will be scared out of their minds by the possibility that they have breast cancer, when in fact, they do not.

ACSH s Dr. Gilbert Ross has a real problem with this. He says, Any test with a 50 percent false positive rate, especially one that is so devastating to women, should be given a great deal of thought before reflexively getting it done, just because that s the way I ve always been doing it meaning getting a routine annual screening. This is especially true when one considers these details: the JAMA study in question estimates that for every one thousand women who undergo mammography screening, only between 0.3 and 3.2 deaths from breast cancer will be prevented. It is time to take a long hard look at the entire mammography paradigm. The more we learn, the worse current practice seems to look.

Hang on folks. This is far from over.