A review article published in this week’s Journal of the American Medical Association (JAMA) suggests that the benefits of screening using mammography are often overestimated, while harms are underestimated. It calls for more guidance for patients and their doctors on how best to individualize breast cancer screening. The review was done by researchers at Harvard Medical School’s Department of Health Care Policy and Brigham and Women’s Hospital, who say they hope their review will help physicians understand the complex data and encourage the development and use of tools for customizing the information shared with their patients.
We asked Chief Cancer Control Officer Richard C. Wender, M.D. for a comment.
“Screening mammography along with improved treatments and increased awareness has played a key role in a 34 percent drop in breast cancer mortality in the past two decades. And while regular mammography beginning at 40 years is an integral part of avoiding premature death from breast cancer, it is true that a lot of women need to be screened to benefit a relatively small number of women, particularly for women in their 40’s. It is important that women are aware of the kind of information in this article, such as how many breast cancer deaths are averted at different ages, and the risks of false positives and more follow up tests, to help women make personalized screening decisions.
“As the authors themselves report, research is still needed to get a better understanding of what these numbers are for individual women, so we can more accurately portray each woman’s risk. The authors also note that research is needed to explore the long-term effects of decision aids for screening decisions, especially since women with more information may actually be less likely to engage in screening.
“Better information to guide individual screening decisions is helpful, but what another important part of this is improving the quality of breast cancer screening for women of all ages. Better tests would offer an important opportunity to improve the number needed to screen reflected in this report. New tests and strategies are needed, and some are being tested now.
“We are entering an era of personalized medicine, based not just on someone’s DNA, but also based on a man or woman’s personal values. Women who value the opportunity to prevent a premature cancer death are willing to accept a high rate of abnormal mammograms, recalls, and biopsies to avoid a breast cancer death. Some women may place greater value on avoiding recalls, biopsies, and treatment of conditions like DCIS that do not always progress to cancer. These women may opt to delay starting mammography or even to not be screened at all. Learning to discuss risk and personal values poses a new challenge and will require new tools.”