November 13, 2013 | 5
On October 1, ABC reporter Amy Robach received a mammogram on “Good Morning America” to raise awareness of breast cancer, The 40-year-old reporter revealed this week that she has been diagnosed with breast cancer and has elected to undergo a double mastectomy.
Robach wrote on an ABC website that “while everyone who gets cancer is clearly unlucky, I got lucky by catching it early… The doctors told me bluntly: ‘That mammogram just saved your life.’… I can only hope my story will inspire every woman who hears it to get a mammogram, to take a self-exam. No excuses. It is the difference between life and death.”
Robach’s statement echoes the pro-mammogram message of various high-profile groups, notably the Susan G. Komen foundation, a fund-raising juggernaut credited with creating the “pink ribbon” campaign to raise awareness of breast cancer, and the American Cancer Society. The latter has joined forces with the National Football League to create a program, “A Crucial Catch,” that touts “the importance of annual screenings [for breast cancer], especially for women who are 40 and older. Throughout October, NFL games will feature players, coaches and referees wearing pink game apparel, on-field pink ribbon stencils, special game balls and pink coins–all to help raise awareness for this important campaign.”
There is a dissonance between these mass media messages and the emerging scientific consensus, which I have discussed previously, that Americans are being overtested and overtreated for cancer. A leader in exposing the limited benefits of cancer tests in general and mammograms in particular is H. Gilbert Welch, a physician at the Dartmouth Institute for Health Policy and Clinical Practice.
In 2011 Welch and a Dartmouth colleague presented an analysis in Archives of Internal Medicine of the risks and benefits of mammograms and concluded: “Most women with screen-detected breast cancer have not had their life saved by screening. They are instead either diagnosed early (with no effect on their mortality) or overdiagnosed.” The authors estimated that fewer than 25 percent of women—and possibly as few as three percent—diagnosed with cancer because of a mammogram have their lives extended; others will undergo surgery, chemotherapy and radiation for a “disease” that would not have harmed them.
Last year Welch and another physician presented an analysis of almost 30 years of data on breast cancer in The New England Journal of Medicine. They concluded that “breast cancer was overdiagnosed (i.e., tumors were detected on screening that would never have led to clinical symptoms) in 1.3 million U.S. women in the past 30 years. We estimated that in 2008, breast cancer was overdiagnosed in more than 70,000 women.”
In a followup editorial in The New York Times, Welch wrote that screening proponents have “encouraged the public to believe two things that are patently untrue. First, that every woman who has a cancer diagnosed by mammography has had her life saved (consider those ‘Mammograms save lives. I’m the proof’ T-shirts for breast cancer survivors). The truth is, those survivors are much more likely to have been victims of overdiagnosis. Second, that a woman who died from breast cancer ‘could have been saved’ had her cancer been detected early. The truth is, a few breast cancers are destined to kill no matter what we do.”
Journalist Peggy Orenstein, a breast cancer survivor, wrote a tough, courageous critique of the mammogram-promotion industry for The New York Times Magazine last spring. Her article ended: “It has been four decades since the former first lady Betty Ford went public with her breast-cancer diagnosis, shattering the stigma of the disease. It has been three decades since the founding of Komen. Two decades since the introduction of the pink ribbon. Yet all that well-meaning awareness has ultimately made women less conscious of the facts: obscuring the limits of screening, conflating risk with disease, compromising our decisions about health care, celebrating ‘cancer survivors’ who may have never required treating. And ultimately, it has come at the expense of those whose lives are most at risk.”
I have not seen data on how many women have their lives cut short by receiving unnecessary treatment for cancer. But the data of Welch and others suggest that groups like the Komen foundation and the National Football League, however well-meaning, may be harming more women than they help by aggressively promoting mammography. My heart goes out to Amy Robach and her family. But I wish she would use her fame to educate women about the risks as well as benefits of mammograms.
Photo: Ida Mae Astute/ABC.