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Integrative View of Routine Mammogram Screening

October 17rd, 2016

A while back the Swiss raised a lot of eyebrows by declaring—with good evidence published in the New England J. of Medicine—that mammograms are not what they are cracked up to be. They don’t recommend them anymore.

Abolishing Mammography Screening Programs? A View from the Swiss Medical Board     N Engl J Med 2014; 370:1965

Now we hear the same thing from another set of investigators. Take the time to study this issue on your own. Don’t take my word for it. But, I still feel that a THERMOGRAM is the best way to screen women in addition to decreasing exposure and increasing detoxification of XENOESTROGENS in the environment.

Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness     N Engl J Med 2016; 375:1438.

After the advent of screening mammography, the proportion of detected breast tumors that were small (invasive tumors measuring <2 cm or in situ carcinomas) increased from 36% to 68%; the proportion of detected tumors that were large (invasive tumors measuring ≥2 cm) decreased from 64% to 32%. However, this trend was less the result of a substantial decrease in the incidence of large tumors (with 30 fewer cases of cancer observed per 100,000 women in the period after the advent of screening than in the period before screening) and more the result of a substantial increase in the detection of small tumors (with 162 more cases of cancer observed per 100,000 women). Assuming that the underlying disease burden was stable, only 30 of the 162 additional small tumors per 100,000 women that were diagnosed were expected to progress to become large, which implied that the remaining 132 cases of cancer per 100,000 women were overdiagnosed (i.e., cases of cancer were detected on screening that never would have led to clinical symptoms). The potential of screening to lower breast cancer mortality is reflected in the declining incidence of larger tumors. However, with respect to only these large tumors, the decline in the size-specific case fatality rate suggests that improved treatment was responsible for at least two thirds of the reduction in breast cancer mortality.

Conclusions

Although the rate of detection of large tumors fell after the introduction of screening mammography, the more favorable size distribution was primarily the result of the additional detection of small tumors. Women were more likely to have breast cancer that was overdiagnosed than to have earlier detection of a tumor that was destined to become large. The reduction in breast cancer mortality after the implementation of screening mammography was predominantly the result of improved systemic therapy.

MEDSCAPE Commentary:

The AP (10/12, Marchione) reports that research published in the New England Journal of Medicine “questions the value of mammograms for breast cancer screening.”

Reuters (10/12, Emery) reports that investigators “found that mammography resulted in the discovery of 162 more cases of breast cancer for every 100,000 women, but only 30 of those small tumors were expected to grow and become a danger,” which “suggests more than four times as many cases – 132 in all – were what is known as overdiagnosed.”

MedPage Today (10/12, Walker) reports that the study “also found that while the breast cancer mortality rate improved during the study period, screening did not appear to be the predominant reason.”

NBC News (10/12, Douglas, Dunn, Fox) reports on its website, however, that some “experts…called the report deeply flawed and urged women to get mammograms as recommended.”

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