Breast cancer is in the news this week as Martina Navratilova reveals in a frank interview on Good Morning America that she was diagnosed with breast cancer in February this year. While her first reaction was to keep the news quiet she said she realised that by publicising her diagnosis she would help make more women aware that they need to go for regular mammograms. “The sooner you catch it, the better, so go for the bloody mammogram” she said in her typical upfront manner.
But when breast cancer is not in the news it is still stirring up controversy in medical circles. There is a debate over the problem of “over diagnosis” which leads to “over treatment”.
Mammogram Success Leads to Criticism
It seems ironic but the success of mammograms which has reduced death rates by approximately 35% in women aged 50 to 69 (the International Agency for Research on Cancer)is now attracting criticism because around one in four breast cancers diagnosed are not life threatening but once diagnosed often lead to treatment including surgery.
"A woman discovers she has breast cancer and frankly discusses her thoughts about treatment options."
This “over diagnosis” and subsequent “over treatment” may be causing many women to be unnecessarily "harmed" from psychological trauma and the physical side-effects of chemotherapy, radiotherapy, endocrine treatment and even mastectomy.
The practical problem is that doctors can't tell which abnormalities picked up during screening will turn out to be a problem and which won't. So to be safe and to avoid any claims of negligence, doctors tend to recommend that anything that looks pre-cancerous or cancerous, whether it will be life threatening or not in that woman’s life time, be cut out.
But its not a simple issue, Sally Crossing, founding member of the NSW Breast Cancer Action Groupsays she is worried that evidence on over-diagnosis will be used to restrict publicly-funded screening and undermine early detection of breast cancer.
Crossing, who is living with breast cancer, says most women would be happy to have something removed that might become cancer. And she thinks some public health researchers make over-diagnosis more of an issue than it is.
"We will be more worried and more harmed if we're not looked after," says Crossing who calls for more research that will help doctors distinguish between different types of cancers picked up in screening.
Cancer epidemiologist Professor David Roder, based at the Cancer Council South Australia in Adelaide, says he agrees: "We need to identify a group of tumours that we dare to leave and not treat," he says.
In the meantime, he agrees doctors may be increasingly likely to remove abnormal cells for fear of being sued.
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