For years, women have been inundated with messages that early detection of breast cancer saves lives. Yet, there's a substantial body of evidence that this is not the case.

The Other Side of the Mammogram Picture

Researchers have found that breast cancer rates increase significantly in countries after women begin undergoing regular mammograms. The World Health Organization tried to prove that the introduction of mammography in Europe was associated with a steep fall in mortality from breast cancer. What they found, however, is that the decline in mortality was the same in otherwise comparable countries that did not have routine screening. Researchers concluded the decline was due to treatment, not mammogram screening.

Screening detects indolent cancers, those that might never cause symptoms. In fact, 25 to 30 percent of all breast cancer diagnoses are what is known as "ductal carcinoma in situ" or DCIS, cancer confined to a single duct. DCIS was rare prior to widespread screening. According to H. Gilbert Welch, MD, author of Should I be Tested for Cancer?, most women with DCIS do not develop breast cancer and for those who do, the cancers develop slowly so watchful waiting might make sense. However, oncologists uniformly treat DCIS as invasive cancer.

With the rise in detection of early-stage cancers, we would expect the rate of advanced cases of cancers to decline. But, Welch says, this is not the case. Furthermore, screening tends to miss the most aggressive, deadliest cancers because they present clinically between routine screenings (for this reason physicians call them "interval cancers").

A review in the Journal of the American Medical Association (JAMA) concluded that, "after two decades of detecting and treating DCIS, there's no convincing evidence of substantial reduction in invasive breast cancer incidence."

The five-year survival rate, the most commonly used statistic in cancer reporting, also misrepresents the true picture of the benefits of mammograms. Because we are counting things that are not necessarily cancer, and because we're diagnosing cancer earlier, patients falsely appear to live longer. The number of deaths avoided also changes with age. The older we become, the more likely we are to develop cancer, so true survival rates must include age considerations.

Critics of current breast cancer screening recommendations believe physicians and health organizations give women information about mammograms that only stresses benefits and doesn't provide corresponding information about important risks and potential harms.

However, it is essential to talk with your doctor about your health needs and history before making decisions about how best to

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