Tuesday, October 5, 2010

A different perspective on screening for breast cancer

A nurse practitioner and writer living in Washington, DC, Veneta Masson contributed a guest post to Common Sense Family Doctor earlier this year. This month, she published a thought-provoking piece in the journal Health Affairs, titled "Why I Don't Get Mammograms." Explaining her decision to stop receiving yearly mammograms after age 56, she eloquently articulates her perspective as a patient informed by clinical experience and syntheses of scientific evidence regarding the benefits and harms of screening for breast cancer. In doing so, she challenges the public and medical consensus that routine mammography is an unqualified societal good. Ms. Masson concludes:

I accept that sooner or later, I’ll die of something. It could be breast cancer. It’s also possible that I’ll die with cancerous changes in my breast (or some other location) that never progressed enough to cause harm. ... It’s been ten years since my last mammogram. I don’t have to wonder whether this will be the year for a false alarm, false reassurance, or discovery of a cancer that might or might not require treatment. I accept the fact that life is uncertain.

I’m grateful for the gift of good health, recognizing that that’s what it is: a gift. I will always mourn my sister’s untimely death, which took place three years after her [breast cancer] diagnosis despite state-of-the-art treatment. If it were in my power, I’d honor her by redirecting the $5 billion this country spends each year on screening mammography to other purposes. I’d direct those sums instead to the study of how breast cancer starts, and what we can do to treat it more effectively.

This piece is especially timely in light of a recent study in the New England Journal of Medicine that suggested that nearly two-thirds of the reduction in breast cancer mortality observed after the implementation of routine screening mammography in Norway was actually the result of advances in treatment, rather than earlier detection. Both articles are must-reads for clinicians and patients who want to better understand the limitations and tradeoffs associated with breast cancer screening and screening for cancer in general.