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Celebrities Should Inform Women about Risks as Well as Benefits of Mammograms

The views expressed are those of the author and are not necessarily those of Scientific American.

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Last week, a friend who knows my views on excessive medical tests and treatments sent me a link to a People magazine cover story about Amy Robach, the correspondent for ABC’s Good Morning America. After receiving an on-air mammogram in October, Robach was diagnosed with breast cancer and underwent a double mastectomy. The cover of People quotes Robach saying, in big yellow letters, “I’m lucky to be alive.”

I wrote about Robach’s case last month. I’m returning to it now because I fear that Robach, whose courage and candor I admire, is misinforming women about mammograms. For example, she tells People that she regrets not receiving a mammogram earlier. “A year could have made a big difference,” she says.

Robach is 40. The National Cancer Institute, a federal research agency, states that “studies to date have not shown a benefit from regular screening mammography in women under age 40.” Indeed, for women of any age, the benefits of mammograms are questionable and the risks considerable.

Gemma Jacklyn and Alexandra Barratt, public health experts at the University of Sydney, note that Robach and other celebrities publicizing their mammograms “have a simple message that’s easy to embrace–mammography screening saves lives. Sadly, it’s not that simple.”

A positive test for breast cancer, Jacklyn and Barratt assert, is more likely to represent a case of “overdiagnosis” than to be “life-saving.” Overdiagnosis” involves detecting “small cancers that, if left alone, would not cause any symptoms or death,” they explain.

A 2012 report in Lancet by the Independent U.K. Panel on Breast Cancer Screening concluded that women who undergo screening every two years for 20 years are three times more likely to be over diagnosed than have their life saved. “We’re used to thinking of breast cancer as uniformly lethal if left untreated,” Jacklyn and Barratt say. “But studies increasingly show that finding tiny cancers doesn’t necessarily translate into saving lives.”

Some studies of mammograms show even higher rates of overdiagnosis. A 2006 report in the British Journal of Medicine estimates that screening 2,000 women for 10 years will prevent one woman from dying of breast cancer. Meanwhile, “10 healthy women, who would not have been diagnosed without screening, will have breast cancer diagnosed and be treated unnecessarily; 4 of these will have a breast removed, 6 will receive breast conserving surgery, and most will receive radiotherapy.”

In a 2011 study in Archives of Internal Medicine, H. Gilbert Welch, a physician at Dartmouth and authority on medical testing, and a co-author concur that a majority of 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.”

Writing about Amy Robach for CNN, Welch notes that “powerful survivor stories that appear regularly in the media” are too often interpreted “as evidence of the benefit of mammograms. Unfortunately, the more likely interpretation is that they represent evidence of harm: unnecessary surgery, chemotherapy and/or radiation.”

When I have discussed these data with female friends, many say that they will continue to receive mammograms; they are willing to endure what may be unnecessary, unpleasant tests and treatments for even a slight reduction of their chances of dying of cancer.

But of course, surgery, chemotherapy and radiation can also adversely affect health. I thus emailed the following question to Welch: “Has anyone estimated how many women die prematurely because of receiving unnecessary treatment for cancer?”

The short answer is no,” Welch replied, “or at least not to my knowledge. The near-term death risks from these treatments are not zero, but they are low. My take on the trade-off is less about death vs. death, more the very small chance of avoidance of cancer death (unknown effect on all-cause mortality) vs. a larger chance of unnecessary diagnosis and treatment and a much larger chance of false alarm with increased sense of vulnerability (not cancer, but not normal). No right answer, but clearly a choice–not a public health imperative.”

In his CNN column on Robach, Welch notes that “no one wants to dispute the interpretation of a well-meaning cancer patient who is trying to help people… But news stories about health–particularly on television–are too driven by powerful personal anecdotes. The public deserves more nuance.”

John Horgan About the Author: Every week, hockey-playing science writer John Horgan takes a puckish, provocative look at breaking science. A teacher at Stevens Institute of Technology, Horgan is the author of four books, including The End of Science (Addison Wesley, 1996) and The End of War (McSweeney's, 2012). Follow on Twitter @Horganism.

The views expressed are those of the author and are not necessarily those of Scientific American.

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  1. 1. tuned 7:12 pm 12/12/2013

    If Angelina Jolie didn’t inform you then you are uninformable.

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  2. 2. ccabek 10:44 pm 12/12/2013

    I wonder if Mr. Horgan is married, and if so would he be willing to risk his wife’s life? Many of people who can survive with non-treatment of breast cancer are elderly, and with possibly 10 more years to live. (The same problem with prostate cancer.)
    I discovered a lump in summer of 2012, and of the many lumps I have found, figured it was just another cyst. Come to find out, if I had not checked this one out, I would probably be dead in less than another 10 yrs. It was breast cancer. Doctors today have ways to find the type of cancer, what treatments will be best. How bad the tumor is and what to do about it.
    Until there is a cure for cancer or all types, no woman will take this chance. Is Mr. Horgan nuts? Or perhaps we should just not treat cancer since there could be side effects?
    We are very lucky to have such diagnostic tools now. His argument just won’t hold water with women, and I would assume most husbands who might be going through this with their significant other. Dead? Alive? Treatment? No Treatment? Is there really a question?

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  3. 3. Blurgle 6:06 am 12/14/2013

    Ah, yes: if women get the test they’re alarmist, fear-driven crazy irrational nutcases. If they were just more like logical, superior men and (sigh) just understood the risks…

    But if they don’t take care of their health, they’re negligent airheads who are at fault got not taking better care of themselves. If they were just more like logical, superior men and (sigh) just understood the risks…

    Belittled if you do, belittled if you don’t.

    On rereading this, too, it seems clear that the writer has not considered that early detection may extend life even when it doesn’t allow for a cure.

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  4. 4. lmowle 10:04 am 12/15/2013

    Your site is not showing the whole story just a part of it. If you watch this YouTube video you will see the whole thing:
    you will see that the Dr that ends up sitting next to Amy stated that women who get news that they have cancer should get a second opinion or a third.
    I have three people that I know that are currently going through treatment for breast cancer (and a number of survivors that have already gone through the process) and all of them were told to get a second opinion. Two of these women were diagnosed stage IV because it had spread. I would not have them in my life if they had not gotten the mammogram. So your opinion is don’t have one? Really? Now I would have to say YOUR story is irresponsible. To say I question your logic is one thing…but I also question your ethics in writing this and putting it out in public.

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  5. 5. spunky1 8:47 pm 12/16/2013

    What exactly are the risks of early detection? It certainly was not explained in the article. And I agree with the other poster regarding if it was his wife or daughter would he recommend skipping mammograms? Or prostate screening, does he skip his?
    I think I would rather risk over treatment than death. But hey, that’s me.

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