If you have watched the news in the past couple of months, you would of heard about a certain concern regarding screening for breast cancer. BBC news reported the story on their website under the headline ‘Breast cancer screens leads to ‘unnecessary treatment”. This story in particular was published in April this year but it seems the practice has been under scrutiny for a while now with links to studies from 3 years ago to be found below the article.

The Science

Breast screening is achieved through the use of a technique called “mammography”. Low energy – i.e. low doses of radiation – x-rays are administered to each breast and the results are then scrutinized by radiologist professionals. Sometimes other forms of screening can be used such as magnetic resonance imaging (MRI) or ultrasound, both of which are usually used in order to investigate the presence of an anomaly in the breast tissue.

The mammogram has been used for almost a century now, becoming more refined since it’s first application to examine mastectomy tissue. Over time radiation doses have been lowered at the same time as producing clearer images. There are some disadvantages to the practice such as false positives (an image indicating a tumour when in fact there isn’t) and false negatives (the tumour has been overlooked through poor quality of x-ray) hence the emergence of other forms of scanning such as MRI scans. Below is an example of an x-ray that has produced a false negative on the left but through another technique called “molecular breast imaging” (MBI), a potential tumour has been picked up.

The Controversy

This particular article reports that 1 in 4 breast cancers that have been detected by screening would never have become lethal or at least caused any problems to the individual. The treatment administered to these individuals is therefore deemed unnecessary. It should be noted that this initial statistic of up to 1 in 4 people was found in a study involving almost 40,000 women in Norway. The findings from that study were reinforced by a further study involving 600,000 women where it was reported that “screening led to 30% over-diagnosis and over-treatment”. The authors’ conclusion, quite rightly, brings to light the distress that is then caused to the individual for the few months following a positive diagnosis, whether eventually going through treatment or not (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001877.pub4/pdf ).

In contrast to these findings, more recent studies have reflected an opposing opinion. For example, in an article again written by the BBC, it has been found that breast cancer screening can save the life of two women for every one that is misdiagnosed. This report even suggested that for every 1,000 women screened, between 7 and 9 women were saved with 4 women being over-diagnosed. Initially when reading this report, it is very easy to come to the conclusion that breast cancer screens save many more lives than it may unnecessarily damage through incorrect diagnosis. This is where the controversy lies. Should the treatment continue to be used if there is someone going through a completely unnecessary emotional and physical battle against a disease they do not have, or indeed do not need, to fight?

Should this really be a concern?

With results such as these, it is very tempting to have an opinion of pros outweighing the cons, however there does need to be some consideration as to the concerns over breast screening. I strongly believe that treatment for cancer is as much a psychological battle as it is a physical one. Unfortunately it is a side to cancer that can sometimes be overlooked by many as the physical changes to an individual can often distract others from the psychological battle they are facing at the same time. Support groups such as Macmillan or the Willow foundation are deliberately designed as to provide the support for cancer patients throughout their struggle, from the very first positive scan or blood result. Exposing an individual to such an emotional journey through a false positive result is something that no one wants, no professional wants to submit a patient to the ordeal and no patient wants to experience it.

In this sense, the scrutiny breast screening has endured over the past decade or so is completely justified and, in my opinion, is a healthy thing to do. Science should be examined and probed for any disadvantages it can cause, no matter if it is 1 in 10 affected or 1 in 100 for this is the only way the technique can be perfected and developed to reduce the risk as much as possible. The only concern I have over the ordeal is the fact that a major news corporation such as the BBC gives a wholly negative impression. Probably what media outlets are most guilty of is producing drama from the slightest hint of failure. Scrutinising our scientific methods is something the scientific community is doing constantly. Trials upon trials of new medicine are created in order to identify what needs to be improved upon, ultimately producing a better final product.

It should also be noted that most medicines come with a risk factor. It is impossible for scientists to label a medicine or technique as being 100% efficient in the sense of not producing side effects, whether physical or emotional. Breast screening therefore will always have an error margin. In supporting evidence, 4 out of 1000 will be over-diagnosed. Granted the medicine they will be exposed to can be damaging; chemotherapy and radiotherapy can produce secondary cancers and physical surgery will, in the majority of cases, produce a permanent scar. But 4 out of 1000 pails in significance when considering the numbers of people that are diagnosed correctly and therefore treated quickly and in the least aggressive manner. Surely there have been more diagnoses made over the years that have alleviated a patient from early death?

Perhaps then it should be a question of believing in new screening techniques. Rather than causing mass panic and putting the public off of breast screening – which cancer authorities have unfortunately had to try and prevent – the disadvantages and advantages of new techniques should be clearly explained and put forward in order to enable the public to make their own mind up. In this situation, the matter of whether to be safe than sorry would become clear. If it were me, I would much rather be safe.

Below is a link to the article posted by BBC news called ‘Breast cancer screening under review’. It contains a useful video outlining the situation.

References:

The BBC News article called ‘Breast Cancer Screening Under Review’: http://www.bbc.co.uk/news/health-15444879

The BBC News article called ‘Breast Cancer Screening Does More Harm Than Good’: http://www.bbc.co.uk/news/health-19571173

Article called ‘Screening for Breast Cancer with Mammography’: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001877.pub4/pdf

Image courtesy of:

http://blog.cleveland.com/health/2008/09/09072008_breastcancer.jpg

 

Advertisements