Wednesday, April 11, 2007

Finding More Breast Cancer Isn't the Answer

Last week I talked about the recent literature re. the new recommendations by the American Cancer Society on breast MRI's for cancer screening. I touched on both the financial considerations as well as the potential for increased screening to cause more problems then it solved.

There's an excellent overview of this in the Washington Post which crystallizes many of these concepts more eloquently then I. Click here to read.

From the article:
...if you really want to find as much cancer as possible, we would suggest whole-body CT, MRI and PET scans every month. But that would be absurd. Why? Because the goal is not to find more cancer. The goal is to save lives. The two goals are not the same...Over-diagnosis is the reason that the number of people with cancer diagnoses is increasing much more quickly than the numbers dying from those cancers.

For breast cancer, MRI may (or may not) be the best test. We just don't know. The only way to know is to do a true experiment -- a randomized trial -- in which half the participants have MRI while half have mammograms, and determine how many die from breast cancer in each group. These experiments are a lot of work and they take a lot of time. But they are the only way out of what is beginning to appear to be a vicious cycle: more and more testing finding more and more cancer, with the assumption of benefit...Early detection is a strategy that turns many more people into patients. Its effect on how many people die is relatively small, at best. People will die from cancer, whether or not they are tested.

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