Some women may tune out confusion over mammograms

Mixed messages blur value of screenings

It happened again this week: Headlines implied mammograms have been oversold to women. This time it was a study from Denmark that suggested one in three breast cancers found through the screening tests are “overdiagnosed” — meaning they never would have threatened a woman’s life but still led to treatments such as surgery, radiation and chemotherapy.

Most studies have found routine mammograms lower the overall risk of dying from breast cancer, but one published in 2014 did not. Mammograms are widely promoted, but the latest guidelines from major medical groups disagree on when and how often women should get them.

It sounds like a recipe for confusion and doubt.

Some doctors this week said they hear that confusion from women. Others said patients have started to tune out the noise.

“I think the controversy has been going on so long that women are getting kind of numb to it,” said Mary Daly, chair of clinical genetics at Fox Chase Cancer Center in Philadelphia.

Many women “are sick of the headlines” and are not making decisions around them, said Barbara Levy, vice president of health policy at the American Congress of Obstetricians and Gynecologists. Levy said “most women in this country continue to believe that more testing is better,” even when science says otherwise.

“Every headline does cause some questioning,” said Ruth Etzioni, a biostatistician at Fred Hutchinson Cancer Research Center in Seattle. Women defi- nitely “are still trying to figure it out,” and some are confused, she added. But Etzioni, who helped create mammogram screening guidelines for the American Cancer Society, said there’s nothing about the latest study that should add to any confusion.

Previous studies, she said, found overdiagnosis rates ranging from less than 5% to 50%. The real issue today, she said, is that doctors do not have all the tools they need to sort out which early tumors need treatment, especially in cases labeled ductal carcinoma in situ or DCIS. Research to see if some of these early or precancers can be safely monitored without immediate treatment is starting now.

Most women are not aware of the debate over DCIS and overtreatment and that should change, Etzioni says.

At least one survey found most women are aware that routine mammograms can raise false alarms that lead to biopsies and other follow-up tests. But that survey also found women did not consider that risk an important factor in making decisions about mammograms, said Therese Bevers, medical director of the Cancer Prevention Center at The University of Texas MD Anderson Cancer Center in Houston.

Most women who get a biopsy that turns out to be negative “are actually grateful the extra effort is being made,” she said.

“I think the controversy has been going on so long that women are getting kind of numb to it.” Mary Daly, Fox Chase Cancer Center