I have been putting off my yearly mammogram. I’ve had one almost every year since I turned 40, as dictated by someone somewhere as the thing I was supposed to do.
Recently, there has been some controversy as to whether the “need to start having mammograms” age was 40 or 50. Now, there is another controversy – that routine mammograms can cause breast cancers to be overly treated.
Overly treated? If you have breast cancer, can treatment really be overly? Maybe not, but maybe so says Dr. H. Gilbert Welch, who recently coauthored an analysis of mammograms published in The New England Journal of Medicine. He found that diagnoses of early-stage breast cancers had risen dramatically in the last three decades.
That sounds like good news, right? Maybe not.
Welch found that the incidence of late-stage cancers only declined a bit. He felt that mammograms aren’t catching more advanced breast cancers.
Welch and the other author of the analysis, Dr. Archie Bleyer, felt that many tumors found early on were being treated when it wasn’t necessary, resulting in “overdiagnosis.” The duo felt that as many as one million women were overdiagnosed and therefore receiving unnecessary treatment for breast cancer.
Welch points out that breast cancer has increased since the ‘80s, when the mammogram was introduced, but only in those over the age of 40. He questions why breast canceer hasn’t increased in those under the age of 40.
This has always been a controversial topic and this analysis has its opponents. Dr. Carol Lee, of Memorial Sloan-Ketting Cancer Center in NYC is on the communications committee of the American College of Radiology (ACR). The group released a statement which disagreed with the findings of the analysis, calling it “simply wrong.”
The ACR feels that there is a steady increase in invasive breast cancer and that’s why mammograms aren’t really lowering the occurrence of advanced breast cancers. Lee also thinks Welch is biased on the subject, pointing to his book “Overdiagnosed: Making People Sick in the Pursuit of Health” as proof.
Lee does admit, however, that the truth probably falls “somewhere in between” the two thoughts.