It's Time to End Mammograms, Some Experts Say

It's Time to End Mammograms, Some Experts Say
From TIME - December 6, 2017

Prevention is the best medicine, doctors say, and nowhere is that truer than in cancer. Picking up early signs of disease is the best way to prevent cancer from taking root, so doctors have urged people get screened for all types of cancer on a regular basis. The assumption is that screening will save them from developing advanced cancer, which is less treatable and deadlier.

That was the reason behind a worldwide push to have every woman get regular mammogram screenings. The idea was to lower the rates of advanced cancers and ultimately deaths from the disease. But in a new study published in BMJ, researchers show that mammography did little to reduce either deaths or advanced breast cancer over a period of 23 years in the Netherlands. Instead, they found that the X-ray based test designed to pick up tumors led to overdiagnoses 60% of the time.

MORE: The Case for Annual Mammograms Is More Complicated Than Ever

The study involved all Dutch women who were screened with mammograms every other year between 1989 and 2012about 8 million women in all. The researchers, led by Dr. Philippe Autier from the University of Strathclyde Institute of Global Public Health, wanted to see if the screening affected the number of advanced breast cancers recorded over that time, as well as deaths from the disease. A previous study using some of the same data had found decreases in the incidence of some advanced breast cancers from 1989 to 1997, hinting that widespread mammography was effective.

However, over the longer time period, the scientists failed to find the same reduction. In fact, from 1989-2012, there was no significant decrease in the incidence of stage 2 to stage 4 breast cancers. On the other hand, incidence of early stage in situ cancers, in which the tumor hasnt spread to surrounding tissues, increased by 4% each year. And Autier calculated that 59% of lesions detected by mammograms were overdiagnosed, meaning they didnt necessarily need treatment.

Mammography doesnt actually pick up tumors but rather the changed breast tissue surrounding tumors; its possible that many advanced cancers are growing without significantly changing breast tissue, and therefore not getting picked up by mammograms in time.

The findings support a growing number of other population-based studies from the U.S., Australia, and Norway that have also shown that since mammograms were recommended in the 1970s, rates of advanced breast cancer have not dropped dramatically. While deaths from breast cancer have been declining in the U.S., experts say that better treatments, rather than a reduction in advanced cases picked up by mammograms, may be responsible.

Based on such accumulating data, in 2009, the U.S. Preventive Services Task Force recommended that most women begin regular screening at age 50 instead of age 40, and receive the test once every two years instead of every year.

MORE: New Clarity on Who Needs Mammograms, When


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