CHARLESTON, W.Va. -- Are you a gambler?
You might have read a recent article in the Gazette on a study recently completed by the Cancer Research UK and the Department of Health (England) in which "overtreatment of breast cancer" is described. The study suggests that some breast cancers grow so slowly that a patient with that particular variety of the disease will die from anything else before the cancer endangers her life.
As is commonly the case with newspapers looking for news they consider worthy of publication, the printed narrative offers nothing to clarify how this information should be interpreted by you, the reader, who is left with the impression that breast cancer is, indeed, overtreated "15 to 20 percent of the time."
Now imagine for a second that you, a 52-year-old woman, has just been diagnosed with breast cancer and you read that article. How much attention will you give to it? Will the thought that perhaps you don't need treatment for your recently diagnosed cancer cross your mind?
I doubt it.
But it would be reasonable to learn what it is that the authors of the study are saying, because at least you will be able to ask your doctor the right questions. So you need to know that what the study reports is a statistical presumption, based on a defined period of follow up. So, what did the authors of the study actually do?
They looked at a group of women who had a mammogram and they did the same to a group who didn't have the test. They checked their progress for several years, and at the end they counted how many women died in each group. And then they reported that those who had a mammogram had "just a slightly lower number of deaths" compared with the group who didn't get a mammogram. Implied in the reported study is the idea that detecting breast cancer early does not make that much of a difference for certain types of breast cancer.
Now, for purposes of debate, let us say that you don't care to be among those who have a "slightly lower chance of dying." Let's say, instead, that you feel strongly about not having radiation, or chemotherapy, or an important surgical procedure, because you have been told that any or all of those methods will be the treatment that you will actually receive if you have been diagnosed with breast cancer. So you ask your doctor to determine if your cancer is the type that does not require treatment. His answer: we don't know how to determine such a thing.
Well, you say, can you refer me to somebody who does? His answer: I don't know of anybody who knows how to determine such a thing. You insist: What about the authors of the report? They don't know either.
CHARLESTON, W.Va. -- Are you a gambler?
You might have read a recent article in the Gazette on a study recently completed by the Cancer Research UK and the Department of Health (England) in which "overtreatment of breast cancer" is described. The study suggests that some breast cancers grow so slowly that a patient with that particular variety of the disease will die from anything else before the cancer endangers her life.
As is commonly the case with newspapers looking for news they consider worthy of publication, the printed narrative offers nothing to clarify how this information should be interpreted by you, the reader, who is left with the impression that breast cancer is, indeed, overtreated "15 to 20 percent of the time."
Now imagine for a second that you, a 52-year-old woman, has just been diagnosed with breast cancer and you read that article. How much attention will you give to it? Will the thought that perhaps you don't need treatment for your recently diagnosed cancer cross your mind?
I doubt it.
But it would be reasonable to learn what it is that the authors of the study are saying, because at least you will be able to ask your doctor the right questions. So you need to know that what the study reports is a statistical presumption, based on a defined period of follow up. So, what did the authors of the study actually do?
They looked at a group of women who had a mammogram and they did the same to a group who didn't have the test. They checked their progress for several years, and at the end they counted how many women died in each group. And then they reported that those who had a mammogram had "just a slightly lower number of deaths" compared with the group who didn't get a mammogram. Implied in the reported study is the idea that detecting breast cancer early does not make that much of a difference for certain types of breast cancer.
Now, for purposes of debate, let us say that you don't care to be among those who have a "slightly lower chance of dying." Let's say, instead, that you feel strongly about not having radiation, or chemotherapy, or an important surgical procedure, because you have been told that any or all of those methods will be the treatment that you will actually receive if you have been diagnosed with breast cancer. So you ask your doctor to determine if your cancer is the type that does not require treatment. His answer: we don't know how to determine such a thing.
Well, you say, can you refer me to somebody who does? His answer: I don't know of anybody who knows how to determine such a thing. You insist: What about the authors of the report? They don't know either.
There is no information yet to establish the biological behavior of breast cancer, although some day that might be possible. This means that there is not an answer to the question that you might have heard: How fast growing is this cancer? But even when research begins to put this puzzle together, this is a piece of information that will be difficult to prove, because breast cancer is not just one disease but many, with different behaviors and outcomes.
The controversy is particularly intense when we talk about certain types of breast cancer that are discovered at such an early stage that the cancer cells do not yet have a chance to spread. This situation, a good one, is encountered more and more often because of mammography. And that is just one reason why mammography continues to be a test with a proven record: It saves lives.
Even the authors of the study we are talking about confirm this fact, derived from their own statistics: Mammograms do save lives.
There is currently work in progress producing information derived from the genetic material of tumors that will eventually answer some of these questions, but not until then should you allow these newspaper articles to confuse the issues. And we have facts, good facts to prove that we are doing something correctly, because deaths from breast cancer have been declining steadily for three decades. And much of that decline is due to early detection, and mammograms are responsible for a good part of that improvement.
So the message is simple: There is no reason to change what is working well until something better comes along. You must continue to have an exam and a mammogram every year if you are 40 or older, and yes, I do think it's of great importance to discover cancer early.
I'm not a gambler. Are you?
Kusminsky is a doctor and has a master's in public health. He is a professor in the Department of Surgery at the WVU medical school's Charleston Division.
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