Increased awareness, improved treatments not mammograms responsible for drop in breast cancer deaths, Study finds

The New York Times: "A new study suggests that increased awareness and improved treatments rather than mammograms are the main force in reducing the breast cancer death rate. ... The study, medical experts say, is the first to assess the benefit of mammography in the context of the modern era of breast cancer treatment. While it is unlikely to settle the debate over mammograms — and experts continue to disagree about the value of the test — it indicates that improved treatments with hormonal therapy and other targeted drugs may have, in a way, washed out most of mammography's benefits by making it less important to find cancers when they are too small to feel. Previous studies of mammograms, done decades ago, found they reduced the breast cancer death rate by 15 to 25 percent, a meaningful amount. But that was when treatment was much less effective. In the new study, mammograms, combined with modern treatment, reduced the death rate by 10 percent, but the study data indicated that the effect of mammograms alone could be as low as 2 percent or even zero" (Kolata, 9/22).

The Philadelphia Inquirer: The study and editorial in Thursday's New England Journal of Medicine by researchers from Norway and Harvard University "expands the never-ending debate over the value of mammograms. Previously, the debate centered on women in their 40s, when breast cancer is relatively rare but often aggressive." The new research "concludes that screening doesn't save many lives, even among women aged 50 to 69, who are at higher risk of the malignancy. Screening this postmenopausal age group for a decade reduced breast cancer deaths by a 'modest' 10 percent" the equivalent of "one life saved per 2,500 women who got the breast X-rays, according to the analysis of Norway's cancer registry. Previous studies have estimated this 'mortality benefit' to be about 25 percent" (McCullough, 9/23).

Healthday/Bloomberg Businessweek: The study "raises new questions about the benefits versus risks of screening mammography and is already reigniting tensions over its frequency of use in the United States. … Last November, the U.S. Preventive Services Task Force spurred dissension among breast cancer experts with controversial new guidelines for breast cancer screening. The task force recommended that women begin having screening mammograms at age 50 -- not 40 -- and that those exams occur every other year, instead of annually. But some cancer organizations reject the panel's advice. The American Cancer Society still recommends annual mammograms starting at age 40, as long as a woman is still in good health" (Pallarito, 9/23).

The Associated Press: Researchers were able "to separate the effects of mammography from other factors that may have an impact on survival such as improved treatment and increased awareness. … More than 1 million women worldwide are diagnosed with breast cancer each year and more than 500,000 die from it. In the United States last year, there were an estimated 194,280 new cases and 40,610 deaths from the disease" (Chang, 9/22).

USA Today: H. Gilbert Welch of Dartmouth Medical School, wrote the accompanying editorial, and "notes that most people are unaware of the risk of mammograms: They sometimes detect slow-growing tumors that don't pose a threat. Because doctors can't reliably tell which are life-threatening, however, they tend to treat all of them. Studies suggest that for every life saved by mammograms, five to 15 women may go through unnecessary treatment, he says. Other experts note that the study may underestimate mammogram's benefits" (Szabo, 9/22).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.