Are mammograms really saving lives?
If you have been unaware of pink popping up all around you the last few weeks, you likely haven't been to a supermarket, watched a football game, read philly.com, or opened up Facebook. The little pink ribbon has made its annual appearance, right on time with the leaves turning and weather cooling. Many will participate in events supporting breast cancer awareness and research. But is the attention being generated each fall translating into lives saved?
Are mammograms really saving lives?
If you have been unaware of pink popping up all around you the last few weeks, you likely haven’t been to a supermarket, watched a football game, read philly.com, or opened up Facebook. The little pink ribbon has made its annual appearance, right on time with the leaves turning and the weather cooling. October is Breast Cancer Awareness month, and millions will be reminded to have their mammograms by the NFL’s pink socks, gloves, and penalty flags every Sunday. Many will participate in events supporting breast cancer awareness and research. But is the attention being generated each fall translating into lives saved?
When you look at the numbers, breast, prostate, and lung cancers are the heavyweights — responsible for over 40 percent of all cancer diagnoses in the United States last year. While the other two get their share of support, breast cancer awareness and the pink ribbon is by far the most visible of any awareness, education, and fund-raising campaign. (On a side note: The American Cancer Society publishes a Cancer Awareness Calendar that lists every possible cancer awareness activity, including some that are obscure and even goofy. I mean, "Take A Loved One To the Doctor Day"?? Shouldn’t that be EVERY day a loved one isn’t well? Anyways…)
However, there’s a major problem with the breast cancer campaign – really, two. First, it’s become as much a marketing tool as an awareness movement, at risk of desensitizing us to the cause it represents. Google “pinkwashing” and all sorts of results appear, but in short, it’s a cousin of “greenwashing” – both concepts tailoring their marketing strategies around public perception of assisting a worthy cause. Lurking below the delicate shade are (usually) profit-driven corporations with no governance on their use of all that pink, or what they donate from assumed increases in sales of pink-related items (often, there are caps or pre-determined amounts donated). Incredibly, some companies who splash pink in their marketing actually use cancer-causing agents in the very same products wrapped nice and neatly in that pretty pink bow — how hypocritical of them.
Second, and much more importantly, the breast cancer awareness campagin is likely not saving lives. In 2011, Dartmouth researchers concluded just that; “Most women with screen-detected breast cancer have not had their life saved by screening. They are instead either diagnosed early (with no effect on their mortality) or overdiagnosed.” This observational study shows that while the rate of detection of early-stage breast cancer has more than doubled since 1976, the rate of late-stage breast cancer has decreased just slightly and there is, at best, a small effect on breast cancer mortality rates.
The also notes that 31 percent of all breast cancers are over-diagnosed. In other words, the medical community is being overly cautious/aggressive in determining if a woman has breast cancer (leading to increased diagnoses), but this has NOT led to a reduction in the percentage of women with advanced disease or dying from breast cancer. That conclusion is supported by multiple controlled scientific studies (an excellent New York Times post from last year offers insight and links) showing women assigned to mammogram screening were just as likely to die from breast cancer as those who were given no screening.
There are several difficult questions here – ones women should consider and discuss with their doctor before their annual checkup:
- Are mammograms doing anything besides increasing unneeded treatments in women? False positives can often incur additional procedures and, in some cases, significant medical treatment for cases that do not require it.
- Do mammograms extend the life of those with breast cancer (and with what quality of life)? I could not find much in my limited research on this subject, but the question perplexed me well into the evening Wednesday night. As someone who is trying to extend his own life just as much as “cure” himself, long-term survival certainly requires more attention than this posting has given it.
- Does the harm done by excessive screenings, treatments, and surgeries outweigh the gain of a few lives potentially saved? This study will make all but the most dedicated statistician cross-eyed; its conclusions are that there are “live-saving absolute benefits” that increase with age, but that there is a “less than 5 percent chance that a mammogram will save [the] life” of a woman with mammography-detectable breast cancer. Obviously, if you are in the 5 percent, the answer is “yes”, but at what cost to the other 95 percent? There are also better options available, like thermography, which has both supporters and its own issues.
- Are external factors (like toxins in the environment) increasing overall cancer rates? Or have breast cancer rates ‘increased’ only because detection is now more prevalent, and screenings have no bearing on eventual mortality? (Remember – mammograms are NOT prevention; they are early detection of cancer, much the same way a dermatologist visit can’t prevent melanoma, it only confirms existence of disease once you already have it.)
- Does the relief of annually being pronounced ‘cancer-free’ outweigh the mental and emotional burden placed on those whose early detection label them a cancer patient? Both physical and emotional stress is placed on a cancer patient, in some cases, unnecessarily. This stress certainly affects quality of life, and in some opinions, can cause the spread of disease that is otherwise being contained by the body’s own defenses.
- And, finally, if early detection is ineffective in determining mortality, should the resources and attention be diverted from awareness to breast cancer research?
LEt me preface by saying that this is a difficult post for me to write – not only is breast cancer awareness a popular and compassionate advocacy platform, it is something meaningful to my family. Both of my grandmothers had it. My extended family is very involved in raising awareness. The wife of my childhood neighbor passed away this year from the disease. Presenting the dissenting side of “breast cancer screening” feels counter-intuitive to me. Since I don’t have the background or education to form an expert opinion, I am sharing what I can to give the chance for others to develop their own judgment and make informed choices with their doctors. This is certainly NOT medical advice, but rather a discussion on an important health topic that needs as much transparency and understanding as it can get. Heck, I don’t even have a good answer for Jen on whether she should get one in a couple of years.
So, what does all this mean? From the first point regarding pinkwashing, be prudent about contributing money to for-profit entities selling goods that donate “a part of the proceeds” to the breast cancer movement. Your money is likely better given to an organization dedicated to research of breast cancer, or at least supporting breast cancer patients (some national charities can be found and reviewed at charitynavigator.org).
If you look solely at the statistics, it also means that having mammograms does nothing to prevent you from dying of breast cancer. It might get it detected earlier. You might have more surgery. But you don't have a better shot of avoiding a potentially fatal cancer. These findings are at odds with public perception and most doctors’ advice. Be educated, on both sides of the fence. Statistics are another tool used to make informed decisions regarding your health, and they sometims suggest that conventional measures are not as effective as you previously thought.
Then again, if you believe the statistics, I'm supposed to be dead by next football season – yet here I am already planning my follow up blog post next October.
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