Several things are missing such as non-cancer deaths after 10 years, that chemotherapy for breast cancer doesn’t save lives.  In clinical trials of terminal patients it extends life an average of 2 months.  For a discussion of the failure of 90% of chemotherapies read on “Hope’s Hypothesis” section 23.  Second the blocking of estrogen commonly done shorten lives at least 4 years.  That is why pharma is against HRT.  For a discussion of HRT and its benefits.   The correlation in the study at bottom and breast cancer is because of indulent benign tumors be labeled as adrenocarcinoma, which explains why early detect is a sham, and why so too is chemotherapy.  If the chemotherapy worked then there would be a major reduction in deaths through early detection.  However since chemotherapy doesn’t alter the progression of breast cancer it doesn’t reduce mortality.   This is another product of pharma’s KOL promoting sales, in this case through implying that the new guidelines supporting mammograms is justified. 

http://www.aei.org/publication/mammograms-are-a-mixed-bag/    Health Care, Health Economics

1.       Joel M. Zinberg, American Enterprise Institute (Conservative think tank based in Washington).  Dick Cheney was its Vice President in 2005, and more than 20 staff members served in the Bush administration. 

July 23, 2015 | US News and World Report

Mammograms are a mixed bag

Too much money is wasted on unnecessary breast cancer screenings.

It is always better to find cancer early by screening, right? Well actually, it depends. For some cancers (e.g. colon cancer) the evidence is clear: screening saves lives. For other cancers like breast cancer, the answer is a contentious, mixed bag

This is not a purely academic question – U.S. mammogram screening for breast cancer costs $8 billion per year. A new study in JAMA Internal Medicine suggests this is not money well spent. Current screening programs recommending annual mammograms starting at age 40 may harm some of the women they are meant to help and waste billions of dollars.

If screening is effective, it should pick up cancers early to reduce the number of cancers diagnosed at an advanced stage (i.e., those most likely to kill) and decrease breast cancer mortality. The study compared different rates of screening, breast cancer incidence and breast cancer mortality in 16 million women 40 years old and older, residing in 547 U.S. counties. The women were screened for breast cancer in 2000 and followed for 10 years.

The study found a positive correlation between the extent of screening and breast cancer incidence, i.e., more screening finds more cancers. But there was no correlation between the extent of screening and 10-year breast cancer mortality. The increased numbers of cancers discovered by screening were largely small cancers (less than 2 centimeters) and early stage cancers. There was neither a reduction in the numbers of larger cancers, nor in the incidence of more dangerous cancers whether locally advanced or that had already spread through distant metastases.

These new findings mirror a 2012 New England Journal of Medicine review of 30 years of mammography screening that showed a 109 percent increase in the incidence of small, early-stage breast cancer but only an 8 percent decrease in the incidence of advanced cancers with virtually no reduction in the most advanced, metastatic cases.

Why hasn’t screening delivered? A big part of the problem is overdiagnosis: finding early forms of cancer such as non-invasive disease or very early invasive disease that would have never become clinically apparent or affected the woman’s life expectancy. An estimated 19-31 percent of mammographically detected cancers are over-diagnosed. Once uncovered, these cancers are treated with surgery (with young women increasingly selecting unilateral or even bilateral mastectomies rather than lumpectomies), radiation (which can affect the heart and lungs), and toxic chemotherapy – all of which is unnecessary. The women are left psychologically traumatized by the inaccurate diagnosis of a life threatening disease.

Overdiagnosis is not the only problem with screening. 20 percent of patients screened with mammography are told something is wrong when in fact nothing is wrong. These “false positives” lead to additional testing, unneeded biopsies and anxiety until the diagnostic uncertainty is resolved. A study in the health policy journal Health Affairs finds that overdiagnosis and false positives in women 40-59 years old costs $4 billion per year – i.e., half of the annual expenditure on mammography screening. There is also a 20 percent rate of mammograms missing cancers that are actually there. These “false negatives” give women a false sense of reassurance and may lead them, and sometimes their physicians, to ignore signs and symptoms of disease like a breast mass.

None of the above is meant to suggest that screening should never be done, only that it should be directed at the people most likely to benefit. The ability of mammography to uncover dangerous breast cancers rises as women age because the incidence of breast cancer rises and the breasts become less dense, making mammograms easier to interpret. The number of screening harms declines as women age for the same reasons.

The U.S. Preventive Services Task Force recently released updated recommendations for breast cancer screening and found that for women under age 50 who have an average risk of cancer, the harms outweigh the benefits of screening. It recommends that women between the ages of 50-74 should be screened only every other year, and suggests that women below 50 consult with their physicians to discuss if their history and individual risk factors warrant screening before age 50. The American College of Physicians High Value Care Task Force recently made identical recommendations. These recommendations mirror guidelines used around the world. The U.S. has been unique in initiating annual screening at age 40 and continuing indefinitely (50 percent of women over 80 are screened despite the Preventive Services Task Force’s recommendation to stop at 74). Other countries start at 50 and then test every two to three years up to 70-74 years old.

Raising the starting age and decreasing the frequency of screening programs has been loudly criticized by a variety of patient and cancer advocacy groups. Politicians have also chimed in. Rep. Debbie Wasserman Schultz, D-Fla., who was diagnosed with breast cancer at age 41, warned in the Washington Post that, “deferring them [mammograms] until after age 50 is dangerous” and will result in “needless deaths.” But her criticism fails to take into account the documented limitations and pitfalls of mammography. Ironically, Wasserman Schultz discovered the lump in her breast herself, two months after a negative screening. Thankfully, she was aware of the signs of breast cancer and was not falsely reassured by the false negative mammogram..

Screening early and often, no matter how well intentioned, is costly and counterproductive. Finding every last cancer, no matter how small or innocuous, does not save lives and subjects many women to unnecessary treatment. If we are serious about evidence-based medicine and greater value in healthcare, mammogram screening should be limited to those populations most likely to benefit. The money saved would be better spent on breast cancer research and treatment and on providing women with the information they need to make informed decisions about cancer screening.