Does breast cancer screening really save lives and is it still effective?
This was the headline that became the topic of conversation for many causing the likes of researchers, clinicians and cancer survivors alike to be at loggerheads over the matter.
The articles that have been published, in my opinion ,confuse the matter further by not completely spelling out what the actual problem is - whether it's the actual screening process, the literature on screening, the fact we have better treatments, or a combination of all the above.
I haven't experienced a mammogram myself, though I have heard that they are not the most comfortable of experiences and at times painful. With this in mind, I have still always thought of the mammogram as a "life saver", so to hear of its effectiveness being questioned came as somewhat of a surprise.
For those unaware, a mammogram is the process by which the breast is compressed between two plates so to even out the tissue to take a clear picture by x-ray. Its purpose is to identify growths at its earliest stage, those that are undetectable through self-checking which could lead to breast cancer.
For this reason you would expect that screening is surely a good thing? With breast cancer being the most common cancer in the UK and the most common diagnosed cancer in females worldwide it would be seen as a win, win situation.
However, because it detects lesions at such an early stage, it is possible that the lesion spotted could be cancer, the key word being "could"; but it is also possible for it to be non cancerous.
It is for this reason that the effectiveness of screening is being subjected to questioning. The fact that screening can lead to the detection of false positives which then starts the rigmarole of unnecessary stress, treatment and possible surgery leaves it looking slightly inefficient. I totally sympathise with this argument, because let's face it, no one wants to think they have cancer; yet on the other hand, is a false positive a small price to pay to be safer rather than sorry?
And anyway, nothing has a 100% success rate, even with the use of condoms there is still a chance of pregnancy occurring, but we are not told to stop using them?
Which leads me to my second point and an argument put forth by many; are patients ill-informed? It is speculated that the literature on breast cancer screening does not explicitly enlist the pros and cons of screening sufficiently to allow the public to decide for or against the act of screening.
I am all for literature that clearly puts forward these arguments to allow an individual to make an informed choice of their own. We live in a world, where freedom of information allows us to make these choices and not to be coerced down a route where the benefits are exaggerated. It is the individuals right to know of the risks of false positive readings which can arise from screening. Though I doubt it is difficult to rectify the literature available, it appears it is a necessary step to improve it to a standard that gives a truer account. I am however, reluctant to see what a major difference this would make to the effectiveness of screening asides from the individual being better educated.
Since screening was introduced in 1988 for women over 50, it is right to say it has "saved lives". With a shift in time, as with all things, in this day and age, is screening still an effective measure? I think the ultimate argument behind this is the fact we are now in a position where more women than ever are surviving a diagnosis of breast cancer. But is this still due to mammogram screening? It is unclear and very difficult to answer this. One thing I do know is that the medical profession is now much better equipped at treating the early detection of breast cancer effectively through much better drugs and treatment. This means a possible lesion can be left undetected until it can be felt by an individual and be treated to an extent where it is no longer life threatening. Inevitably the treatment, not the screening, becomes the "life saver".
It would seriously be misguiding of me to suggest that there is no longer a place for breast screening in today's society. Many screening trials have been attempted before with many being inconclusive and few suggesting that screening does "save lives", albeit a much lower percentage than originally thought. Are we reaching a point where we are now much better at treating breast cancer that screening is becoming less important? This may be the case, though there is still a benefit to more mature women and those who have a family history it seems.
Whichever side you reside on, I for one relish in the announcement of an independent review into the matter; I sure believe that if anything, only good can come of it. It can only lead to a better understanding and treatment of a cancer which is becoming ever more incidental in the developing world.
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