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Overdosing on diagnosis

By Helen Lobato - posted Monday, 7 December 2009


I once watched a surgeon slice off a woman’s breast, and coldly drop it into a dish, where it slid and slithered before arriving for its final mutilation, confirming its carcinogenicity.

Contemporary women live with the fear of finding breast lumps detected either by manual palpation or mammography. From a very early age, my sisters and I had became overly concerned that our mother would develop the disease; her own mother’s untimely death at the age of 47 being due to breast cancer. Our formative years were accompanied by an ever present unease that the cancer was inevitable in mum or in one of us; the familial angst further heightened by the growing numbers of health campaigners preaching eternal vigilance over our troublesome breasts.

The degree to which we should be concerned about becoming a victim to breast cancer, needs to be discussed in light of the findings of a recent New South Wales-based study, that looked into the introduction of routine breast screening for older women. The study found that around one quarter of Australian women now undergoing breast cancer treatment are doing so because of tumours that are slowly growing and could have been safely ignored. This is because women are being screened with overly sensitive equipment, capable of detecting very small and non progressive tumours.

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The author of the study, Dr Stephen Morrell, told The Age, on November 13, that before screening for breast cancer was introduced, the cancer incidence among Australian women aged 50 to 69 years was about 150 cases per 100,000 in the population. With the advent of screening, the incidence has jumped to almost 300 cancer diagnoses per 100,000 women.

That of all breast cancers now diagnosed in New South Wales, 23 to 29 per cent were "over-diagnosed" and could be ignored is shocking news. To understand how we have arrived at this point a brief look at the history of breast cancer needs to be undertaken.

One of the earliest mentions of the disease was found in an Egyptian papyrus written between 3000-1500BC with the early treatment for removal of tumours performed with an instrument known as “the fire drill”. The surgical treatment of breast cancer with radical mastectomy began in the 19th century, removing the affected breast, the underlying chest wall muscle, and the nearby lymph nodes, and continued to be the mainstay of breast cancer treatment until the 1960s.

Breast cancer became a political issue in the 1970s, with women embracing breast-conserving surgery rather than the mutilating radical mastectomies of the past. Around this time breast cancer awareness took on a level of heightened urgency across the world, encouraged by the stories of celebrities who became victims then survivors of the disease. The emphasis was on early detection being the best prevention which could to be achieved through breast self examination or increasingly by way of mammography.

In 1990 funding for the National Program for the early detection of breast cancer was announced providing free screening mammograms at two-yearly intervals for Australian women aged 50-69. The cancer council of Victoria define a mammogram as an X-ray of the breast using low doses of radiation. However Dr Samuel Epstein, author of Danger and Unreliability of Mammography, says that the radiation a woman receives from mammography puts her at risk of initiating and promoting breast cancer. He explains that while we have been assured that radiation exposure from mammography is low and similar to that received from a chest X-ray, the standard routine of taking four films for each breast results is some 1,000-fold greater exposure.

Opinions vary as to the benefits of mammography with Dr Stephen Morrell, author of the NSW study regarding mammography saying there is “a net benefit”, in that mortality has declined. Professor Ian Olver, the chief executive of The Cancer Council of Australia agrees that mammography has resulted in a decline in mortality amounting to 35 per cent.

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However, in 2001, researchers from the Nordic Cochrane Center in Sweden found that screening was likely to reduce the relative mortality risk of breast cancer by 15 per cent, not the 30 per cent that most groups quote. Their conclusion: “For every 2,000 women [age 50-69] invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.”

Professor Alex Barrett, co-author of the NSW study, which found that as many as a third of women diagnosed with breast cancer may not need treatment, has said that the results show that over-diagnosis of cancer happens, and is an important downside of cancer screening.

For decades now, women have been encouraged to front up and have regular x-rays of their breasts. The incidences of over-diagnoses are tragic, and have resulted in unnecessary mutilating surgery and toxic drug treatments. Surely a better way is to prevent this cancer by giving due attention to our diets and lifestyles; simple measures such as getting enough vitamin D, avoiding transfats, eating organic as much as possible, and omitting the regular mammograms.

The incidence of breast cancer increased by 18 per cent from 1995 to 2005, and it is estimated that one in 11 women will be diagnosed with breast cancer before the age of 75. I wonder just how many of these incidences of breast cancer could have been left undiagnosed and untreated. My sisters and I have avoided becoming statistics in the current breast cancer epidemic, and hope to remain untouched. We will not have our breasts squashed between two plates of steel and irradiated. We will take our chances.

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About the Author

Helen Lobato is an independent health researcher and radio broadcaster with community radio 3cr and at present is a co-producer of Food fight, a weekly program around food security issues. Helen has a background in critical care nursing.

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