Mammogram may not be all that good

Almost any woman who had a cancerous tumour detected in her breast during a regular screening appointment would probably think the scan and subsequent surgery, radiotherapy or chemotherapy treatment saved her life. But that is not always true.

The fear is that over-diagnosis  may mean many women are undergoing unnecessary radical treatment, suffering the physical and psychological impact of a breast cancer diagnosis that would otherwise not have come up.

“What really bothers me...is the poor women who are the subjects of this debate, who must be utterly confused and not know what the hell is going on or what to do,” Michael Baum, the doctor who introduced Britain’s first breast screening programme said.

Row erupts

Low level argument over the merits of mammograms has bubbled for some years, but a political storm blew up in the United States last year when public health officials questioned whether screening for women in their 40s actually save lives and proposed upping the regular screening age to 50.

A team of Danish scientists published a study showing that breast cancer screening programmes of the type run by health services in Europe, the United States and other rich nations do nothing to reduce death rates from the disease.

A British team published a study showing a “substantial and significant reduction in breast cancer deaths” due to screening. The lead researchers on each paper, Stephen Duffy of Queen Mary, University of London, who led the British study, and Peter Gotzsche of the Nordic Cochrane Centre, who led the Danish team, said they suspected the other of having long-held biases on breast cancer screening that skewed their work.

At the heart of the matter is the issue of over-diagnosis. This is when a mammogram picks up something called ductal carcinoma in-situ (DCIS), which are cells that may progress into life-threatening cancer if left untreated.

The problem is, there is also the chance they would never progress or cause a problem, but instead leave the woman to live in blissful ignorance and die years later - but not of breast cancer.

Gotzsche’s evidence suggests that for every 2,000 women who are screened over 10 years, only one stands to have her life saved by the mammogram programme, whereas the risk of getting an unnecessary breast cancer diagnosis is 10 times that.   Duffy’s study, meanwhile, found that screening saves two women’s lives for every one who is given unnecessary treatment.

When the evidence changes

Yet other experts say the ongoing row exposes the failings of applying a “one size fits all” policy to a complex area of medicine, and the time has come for change.

Baum, an early pioneer of breast screening proposes: “What I’m advocating is that instead of one-size-fits-all we should think of it in the same way we think of other screening approaches -- we should identify the high risk groups first.”

Baum favours a “triage” system to divide women into high, middle and low-risk groups based on family history and lifestyle factors like alcohol consumption, weight, diet and exercise.  

He says high-risk women should be offered genetic testing to find out if they have a gene mutation while low-risk women should get advice on healthy eating, avoiding alcohol and minimising other risk factors.

Screening would then be reserved for those in the middle, where he thinks the benefit-risk balance makes most sense.

Multivitamin pills lead to breast cancer

London, pti: Women who regularly take multivitamin pills may face a higher risk of breast cancer, claims a new study .

According to researchers at Karolinska Institute in Stockholm, supplements may trigger tumour growth by increasing the density of breast tissue. However, they stressed the findings did not prove vitamin pills were to blame for an increase in cancer cases, as it is possible women may be compensating for an unhealthy lifestyle that puts them at increased risk.

Earlier studies have suggested that high doses of folic acid found in multivitamin pills may promote tumour growth. For the latest study, the researchers took account of whether the women smoked, did much exercise, or had a family history of the disease  but still they found a significant link with multivitamin use.

Kat Arney, Cancer Research UK’s science information manager, said: “Multivitamins may not actually be beneficial for your health. Most can get all the nutrients they need from a healthy balanced diet.”