By Gary Schwitzer
A paper presented
at the 2011 American Society of Clinical Oncology (ASCO) breast cancer
symposium this month has drawn all kinds of news coverage — and much of
it is off the mark — in the eyes of one of the American Cancer
Society’s top docs.
The paper concluded:
"Results of this study validate the importance of annual
screening mammography in women older than 50 years, and women aged 40
to 49 years recently omitted from screening guidelines. There was an
increased prevalence of palpation (breast self exams) for the method of
detection in women less than 50 years of age. If screening mammography
is omitted in this group, cancers when detected may be of a more
advanced stage and result in more mastectomies. This study also supports
the use of palpation as a method of detection despite recent
recommendations against teaching self breast exams by the USPSTF (US
Preventive Services Task Force)."
WebMD’s lead sentence was:
"Once again, researchers are questioning the wisdom of
guidelines that do not recommend annual mammograms for women aged 40-49
who are at average risk of breast cancer."
HealthDay led with:
"Contrary to some other findings, new research indicates
that mammograms and breast self-exams are useful for the detection of
breast cancer, including cancers in younger women."
Not so fast.
Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, posted a very thoughtful analysis on his blog. Excerpt:
"You might imagine that-as an advocate of breast cancer
screening and the value of early detection – I would be dancing in the
streets as a result of this report.
Sadly, I am not.
In fact, if anything, I am concerned that the various representations
of this study that I have read missed a fundamental point: this study
reports information, but is not designed to answer the questions which
the headlines and the press release suggest as the appropriate
conclusions, namely that mammography and breast self-examination in
women between the ages of 40-49 saves lives.
…
Past research studies have not shown that a formal, monthly program of
breast self-examination saves lives, and this study wasn’t designed to
show that it does. Both the American Cancer Society and the USPSTF agree
on this point.
…
despite my bias in favor of screening — I don’t think it is wise to draw
sweeping generalizations for the public based on a limited set of
information that on close inspection does not support the conclusions
that some have suggested."
I can’t do justice to Dr. Lichtenfeld’s post without re-posting the
entire column. Instead, I encourage you to visit his blog and read it all there.