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Breast Cancer Activists Fault Mammography Study

Say report finding 44% reduction in death is misleading

THURSDAY, Aug. 8, 2002 (HealthDayNews) -- A group of breast cancer activists is criticizing a new study finding that routine mammography reduces breast cancer deaths by as much as 44 percent.

"A woman needs to understand that if she becomes a member of the dreaded sisterhood of breast cancer, her likelihood of surviving or not probably has far more to do with the biology of her particular disease and the treatments available," cautions Barbara Brenner, executive director of Breast Cancer Action, a grass-roots education and advocacy organization based in San Francisco.

Brenner said in an earlier statement that breast cancer caught early is not necessarily treatable.

The study in question, which appeared in the Aug. 1 issue of Cancer, showed a 44 percent reduction in mortality for women in seven counties in Sweden during the period after mammography became available, compared to an earlier period when the technology was not available.

The paper is considered by many physicians to be a landmark study and one that reinforces the value of mammograms.

"This is the report that confirms the benefits of screening mammography," says Dr. Carina Biggs, chief of breast surgery at Maimonides Medical Center in New York City.

"To suggest that mammographic screening has no value doesn't make a whole lot of sense to me," she adds.

A mammogram, which is basically an X-ray of the breast, can detect suspicious masses when they are still quite small and earlier than if they were to be detected by a hand exam.

"There's no screening tool that will detect every cancer, but the best that we have at this time is mammography, and mammography is quite good," Biggs says. "We have several studies that have taught us that it detects 90 percent of breast cancers."

The activists, however, say that ordinary people reading these statistics will misunderstand them.

"When people see a study that says a 44 percent reduction in mortality, that does not mean that [for] an individual who has a mammogram and breast cancer is found . . . just having a mammogram reduced her risk of dying by 44 percent," says Brenner, who was first diagnosed with breast cancer in 1993.

It's true that a mammography itself does not influence a person's survival rate once the cancer is detected.

It's also true that breast cancers differ biologically from one patient to another, with some cancers being particularly aggressive and others being less vigorous, but it's not clear how this is related to screening and detection.

Finding a cancer early does improve a patient's prognosis, doctors say.

It also impacts what kind of treatment course to follow, points out Dr. Paul Tartter, associate professor of surgery at Columbia University College of Physicians and Surgeons in New York City.

If the tumor is big, many women will have to undergo a mastectomy followed by a complicated regimen of chemotherapy. A smaller tumor may require a lumpectomy -- a less radical operation than a mastectomy -- and less chemo.

For the activists, however, all this attention on mammography only obscures the "real" issues.

"We are seeking more effective and less toxic treatments for everyone, with a particular focus on more effective treatments for women who are not helped by what is currently available," Brenner says. "Mammography is so far from perfect. We can't use it to ignore what's going on in [the] body."

What To Do

Learn more about what Breast Cancer Action does. Click here to view the National Cancer Institute statement on mammography.

SOURCES: Paul Tartter, M.D., associate professor of surgery, Columbia University College of Physicians and Surgeons, New York City; Carina Biggs, M.D., chief, breast cancer surgery, Maimonides Medical Center, New York City; Barbara Brenner, executive director, Breast Cancer Action, San Francisco; Aug. 1, 2002, Cancer
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