Are Breast Cancer Survival Rate Claims Being Exaggerated?
Susan G. Komen for the Cure, the breast cancer charity that brought the world the pink ribbon, is exaggerating the benefits of mammography while minimizing its harms, according to a report in HealthDay News.
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The organization stated in a 2011 advertisement that the five-year survival rate for breast cancer when caught early is 98 percent, while it is only 23 percent if not caught early.
“The survival statistics they present are eye-catching and compelling. They imply that a woman would be crazy and irresponsible if they didn’t go for screening,” said Dr. Steve Woloshin, co-author of the article challenging the charity. “But the statistics are deceptive.”
What are the real survival rates…and the real dangers?
According to Woloshin’s commentary, a woman in her 50s who goes for regular mammograms for 10 years will actually only cut her chance of dying by a fraction of a percentage point – for every 10,000 women who are screened 7 deaths will be prevented.
Komen also minimizes the harms that can come from over-screening, according to the article.
For every woman whose life is saved by mammography, between two and 10 women are overdiagnosed, meaning they are told they have cancer when they do not and end up going through unnecessary treatment.
And up to half of women who are screened every year for a decade receive at least one false positive, meaning they have to undergo a biopsy and experience the fear of thinking they have breast cancer, if only temporarily.
When & how often should you get a mammogram?
The article comes at a time when there has been increasing furor over the value of breast cancer screening. The U.S. Preventive Services Task Force now recommends that women in their 40s do not get regular mammograms.
In contrast, the American Cancer Society recommends that all women aged 40 and over get annual mammograms.
In the end, women need to get reliable information from their physicians or other sources about the risks and benefits of mammography. One problem is that not all primary care physicians know the right numbers to convey to their patients, according to a recent survey.
How do doctors really feel about mammograms?
Overall, few doctors would argue that there isn’t some benefit to mammography.
Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City, supports the charity’s push for cancer screening.
“As physicians, we feel that breast cancer screening is extremely beneficial,” she said. “Screening does save lives, but it’s probably not as dramatic as it’s sometimes made out to be.”
Adds Woloshin, who is professor of medicine and community and family medicine at Dartmouth School of Medicine and The Dartmouth Institute for Health Policy and Clinical Practice: “There is some benefit but the magnitude is of a different order from what is implied by the ad. Women should make good decisions for themselves.”
What does the Komen Foundation have to say?
A representative of the Komen Foundation defended the organization’s position.
“Everyone agrees that mammography isn’t perfect, but it’s the best widely available detection tool that we have today,” said Chandini Portteus, Komen’s vice president of research, evaluation and scientific programs. “We’ve said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start, through biomarkers, for example,” she explained.
“Komen also is funding research to help accurately predict which tumors will spread and which won’t,” Portteus continued. “While we invest in getting those answers, we think it’s simply irresponsible to effectively discourage women from taking steps to know what’s going on with their health,” she noted.
“The numbers are not in question,” Portteus said. “Early detection allows for early treatment, which gives women the best chance of surviving breast cancer.”
How Breasts Change As You Age
Breast health is not, and never has been, a one-size-fits-all prescription. The general principles are the same whether you’re in your 40s, 50s, or 60s, but how you apply them changes with time. That’s because options in your 30s are different from those you confront in your 40s or 50s.
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Following is a decade-by-decade guide to your breast health.
Your Breasts in Your 30s
During this decade, hormones like estrogen help to keep breasts firm. Breasts contain no muscles. Rather, they consist of fibrous tissue, fatty tissue, plus dense glandular tissue that includes milk-producing glands called lobules and ducts to carry milk.
Fortunately, in the 30s, breast problems tend to be benign (noncancerous). Younger women commonly experience fibrocystic breast disease, a broad term that is characterized by breast pain, cysts, and noncancerous lumpiness. Fibroadenomas can also affect women in their 30s. These rubbery lumps made of fibrous and glandular tissue aren’t cancerous, but they can hurt. If they’re bothersome, they can be surgically removed.
During this decade, which has become more popular for childbearing, breastfeeding offers mothers some long-term protection against breast cancer. But some women worry that breastfeeding will cause breast sagging. Experts say that nursing doesn’t actually cause breast tissue to droop. Instead, breast swelling during lactation can stretch the skin over the breast.
Things that contribute to sagging include: larger pre-pregnancy bra cup size, greater number of pregnancies, cigarette smoking (which can weaken skin elasticity), and older age. As the years go by, breasts become less glandular and fattier, which makes them less firm.
You can’t do much to slow or prevent sagging. Because the breasts contain no muscles, you can’t really exercise your way to a perkier chest. However, some doctors advise women to wear sports bras during jogging to prevent bouncing that can stretch the ligaments. Breast cancer is uncommon; women aged 30-39 have a risk of only one in 229 of being diagnosed with breast cancer, according to the National Cancer Institute.
Unless there’s a strong family history of breast cancer, women in their 30s don’t need mammogram screening. In fact, younger women’s denser breast tissue makes it harder to detect breast cancers on mammograms.
However, regular manual breast exams by your doctor are crucial to check for lumps, skin dimpling, and other signs of breast cancer, according to experts.
Your Breasts in Your 40s
During the 40s, breast shape continues to change for most women. After menopause, the breast has less glandular tissue but more fat, leading to more sagging.
The Revlon/UCLA Breast Center reports that cysts are the most common type of breast lump seen in women during their 40s, although cysts can develop at other ages as well. These fluid-filled sacs aren’t cancerous, but they can be painful. Doctors can drain or surgically remove them.
Cellular changes like atypical ductal hyperplasia may also begin during this decade, Downey says. These abnormal cells in the milk ducts increase a woman’s chances of breast cancer.
The numbers show that breast cancer risk rises during this decade; a woman between the ages of 40 and 49 now has a one in 68 chance of being diagnosed. Therefore, mammogram screening enters the picture.
The medical community has debated the benefits of mammography for women in their 40s, in part because false positives can lead to unnecessary anxiety and procedures.
The National Cancer Institute recommends getting a first mammogram at age 40 and then one subsequently every one to two years afterward. However, women with a strong family history of breast or ovarian cancer should ask their doctors about starting mammogram screening before 40.
The National Cancer Institute also urges all women to report the following breast changes to their doctors:
- A lump in or near your breast or underarm
- Thick or firm tissue in or near your breast or underarm
- Nipple discharge or tenderness
- A nipple pulled back or inverted into the breast
- Itching or skin changes, such as redness, scales, dimples, or puckers
- A change in breast size or shape
But don’t worry about underwire bras, antiperspirants, or trauma to the breast increasing your risk, Steiner says. None of these has been proven to promote breast cancer.
Your Breasts in Your 50s
After menopause, the breasts not only become fattier but will shrink because women no longer need the milk-producing glands for breastfeeding.
While harmless lumps may come and go with the menstrual cycle in younger women, any new lump that appears after menopause requires a doctor’s prompt attention.
Most breast cancers occur in women over age 50, according to the National Cancer Institute. From ages 50 to 59, a woman’s chance of being diagnosed with breast cancer stands at 1 in 37.
In the 50s decade, experts advise women to get mammograms every year.
The good news? Doctors have an easier time detecting breast cancers in older women because breast density is less likely to obscure tumors. As the fat content increases, the sensitivity of the mammogram often increases.
It’s also smart to keep your weight under control. Research has shown that the chances of developing breast cancer after menopause are higher in overweight or obese women.