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| Sun sets over silver path, leaving Gibraltor (photo credit to Jan) |
Last week's perusal of the health headlines led to a very thought-provoking discovery. I see today that this story has been picked up by all the major newspapers across Canada and the US. This major US study, funded by cooperative universities (Dartmouth, St. Charles Health System, and Oregon University) and performed over a thirty-year period, was published in the well-regarded New England Journal of Medicine on November 8. It has revealed that mammograms have done surprisingly little to catch deadly breast cancers before they spread. No screening medical test is perfect, and mammograms are no exception. They have, however, doubled the number of early stage cancers detected. And I am here as living proof of the value of a diagnostic test that didn't let me down, by catching a tumor so small it was not detected by any other means. I am one of the 60% of mammogram-diagnosed cases.
Does this make me feel better? Not really. The study also suggests that up to one-third of all breast cancers, 50,000 to 70,000 per year, are being treated for cancers "that never would have threatened their lives." Some abnormalities called "cancer" are not a health threat. I am assuming these are cancers of an indolent nature - early stage, or of a cell type that mysteriously stays quiescent. Unless I misinterpreting the facts, the crux of the matter is not so much about the inadequacies of mammograms; it's about being unable to differentiate which cancers require aggressive treatment, and which do not.
"The study is important because what it really highlights is that the biology of the cancer is what we need to understand" - in order to know which ones to treat and how. All breast cancers are subject to treatment once diagnosed, and we are all lumped (bad pun) into a diagnostic category and subject to surgery, chemotherapy, radiation and hormone therapy, all of which contain their own risks. The costs are staggering - to the health care system, to the victims, to their families. It is sobering to even consider the possibility that "more than a million women have been treated for growths that never would have threatened their lives."
I do not cast doubt, nor do I affirm, the conclusions of the study. The fact is, statistics are malleable and a study based on statistics doesn’t always yield a single answer. Mark Twain said "Facts are stubborn, but statistics are more pliable." Armed with this knowledge, I would have made exactly the same choices that I did. But it's a beacon that shines a light on where research really needs to focus - in the pathology lab, where the little monsters are stained and named and appointed chief conductors in our live's direction. Because until the biochemistry and nature of breast cancer is fully understood, we will never really know if we made the right choices. I have embraced the most optimistic slant on this. If this study is true and I'm one of the 30% that didn't really need treatment, then bully for me, because I now have double indemnity. If not, those bases are covered too. It's the best that anyone can do, until more research is done. Thoughts, anyone?
