Renée Pellerin is a former CBC health journalist and the author of Conspiracy of Hope, The Truth About Breast Cancer Screening, published by Goose Lane Editions. Below is an except from her article in the Globe and Mail responding to the new guidelines published by the Canadian Task Force on Preventative Health Care for breast cancer screening.
“Every woman over 40 should be aware of new Canadian breast screening guidelines. Every family physician should be prepared to discuss those guidelines with their patients. Every provincial breast screening program should take a good, hard look at what it is telling women.
One of the main harms of screening is false positive results, which can lead to unnecessary further tests including biopsies and the anxiety resulting from being labelled as having cancer. The task force analysis is that false positive results occur in between 20 and 30 per cent of all women screened over seven years.
The other main harm is over-diagnosis, not to be confused with a false positive. It’s when a mammogram detects real cancer, but it’s one that does not grow, one that a woman will never feel, will never cause a problem. There is no way to know which screen-detected lesion will behave this way, thus it is always involves surgery and possible additional treatment.
A Canadian screening trial estimated that up to 50 per cent of screen-detected breast cancers in women under 50 were over diagnosed. The number of cases in older women were fewer, but still high. So while screening may discover early cancers that are more easily treated, it may also discover cancers that may be treated unnecessarily.
Yet, how many women and their doctors understand that the benefits of screening are limited, while the risk of over-diagnosis resulting in over treatment is significant?”
Here is the link to the full text from the Globe and Mail on December 11, 2018.
Here is the link to the book Conspiracy of Hope.
Dr Daniel Morgan, (an associate professor of epidemiology, public health and infectious diseases at the University of Maryland School of Medicine) has found in his research that many physicians misunderstand test results or think tests are more accurate than they are. Doctors especially fail to grasp how false positives work, which means they make crucial medical decisions — sometimes life-or-death calls — based on incorrect assumptions that patients have ailments that they probably don’t. “When we do this without understanding the science of risk and probability, we unacceptably increase the chances of making the wrong choice.”
In one study, gynecologists estimated that a woman whose mammogram was positive had a higher than 80 percent chance of having breast cancer; the reality is that her chance is less than 10 percent. Of course, women who have a positive mammogram often undergo other tests, such as an MRI and a biopsy, which can offer more precision about the presence of cancer. But researchers have found that even after the battery of exams, about 5 of every 1,000 women will have a false-positive result and will be told they have breast cancer when they do not.
The confusion has serious consequences. These women are likely to receive unnecessary treatment — generally some combination of surgery, radiation or chemotherapy, all of which have serious side effects and are stressful and expensive. Switzerland and France, grasping this problem, are halting and reconsidering their mammogram programs. In Switzerland, they’re not screening ahead of time, preferring to manage cases of breast cancer as they’re diagnosed. In France, doctors are letting women decide for themselves whether to have the tests.
Read the full article at the Washington Post.
Dr Kathy D. Miller of Indianan University explains in this video the difficulty in diagnosing inflammatory breast cancer.
Dr. Miller describes a common scenario among doctors diagnosing inflammatory breast cancer. Currently there is no clear answer, as the quote below describes a patients symptoms and the varying opinions of the team of doctors.
“The patient had been seen by a medical oncologist, a surgeon, and a radiation oncologist. We had a big discussion—really, an argument—over whether this woman had inflammatory breast cancer. Was the bogginess in her breast just localized swelling because of her extensive nodal disease? Was that sufficient to decide that this was inflammatory? Was the pinkness over enough of the breast or was it only over the area of the tumor, and [could that just have been] direct extension?”
Inflammatory disease is very much in the eyes of the beholder.
BreastDefense can take the guess work out for all invasive breast cancers. Dr. Miller explains that they are doing a study that will determine a definition and criteria for inflammatory breast cancer. BreastDefense goes far beyond “definition” to a test that will aim for 99% accuracy in diagnosing not only inflammatory breast cancer but all other invasive breast cancers.
40% of Women Over 40 Have Dense Breasts.
Why does this matter?
the denser the breast the higher the risk of getting breast cancer.
having dense breasts is a greater risk factor than having a family history of breast cancer.
mammograms miss about 50% of breast cancer in the densest breasts.
The above Facts come from the website dense breasts canada Watch their video- it is very powerful.
EARLY DETECTION MATTERS
Dense breasts are normal and common. 40% of women over the age 40 have dense breasts.
Dense breasts make it harder for radiologists viewing your mammogram to spot cancer because dense breast tissue shows up as white and so does a cancerous tumour.
Ask your doctor if you have dense breasts.
Are young women a forgotten generation when it comes to breast cancer? Thousands of young women are diagnosed every year. They often face the most aggressive cancers.
One young Canadian women, profiled in Rachel Ray Everyday shared her story. Judit Saunders was 26 years old and working as a registered nurse at a major children’s hospital in Calgary when she discovered a lump. She was diagnosed with hormonally driven HER2 positive breast cancer. She went through all the standard care treatments. Two and a half years later , it came back as stage four breast cancer. Now, she is in treatment for life, but she hasn’t let the disease stop her from living.
BreastDefense could make the ongoing monitoring of cancer easier.
When cancer is diagnosed in a young person it is a very different experience than when diagnosed mid to late life. “In the young adult years, you’re really laying the foundation for the rest of your life. Finishing school, starting careers, starting a family” says Geoff Eaton, Young Adult Cancer Canada (YACC) executive director and two time cancer survivor.
Young Adult Cancer Canada has teamed up with Memorial University to conduct a study that hopes to shed more light on the challenges of young adults with cancer. “we’re spending more money on people who are kind of past the majority of their life and ignoring the people who have most of their life still to live” says MUN’s Dr. Shelia Garland. The Prime Study – named since it is examining people who are diagnosed with cancer in the prime of their lives – has seen 500 young adult cancer survivors weigh in with their own experiences.. The aim is to explore the physical, social and emotional challenges facing young adults with cancer.
The majority of breast cancers – 51% , are women between the ages of 50 and 69. But there are still many many women under the age of 40 – (over a 1000 new cases a year in Canada), that get the news from their doctor that they have breast cancer.
BreastDefense is a simple test that could benefit breast cancer survivors in monitoring remission.
The largest precision medicine study ever done was presented at a plenary session at the annual meeting of the American Society of Clinical Oncology in Chicago. Researchers looked at more than 10,000 women aged 18-75.
Researchers were looking at whether the standard of care of chemotherapy and endocrine therapy benefit all women with the HER-2 breast cancer.
The test assigned women to a score of 0-100 based on the likelihood that cancer would return within 10 years. The study’s aim was to assess the majority of women in the middle range of 11-25 to see if there was a benefit from chemotherapy.
The results concluded that, depending on a patients age, women who received only endocrine therapy did not fare worse than those who were also treated with chemotherapy.
“practically speaking, this means that thousands of women will be able to avoid chemotherapy with all its side effects, while still achieving excellent long term outcomes” said Dr. Harold Burstein, an associate professor at Harvard Medical School.
The abstract from the New England Journal of Medicine can be found here.
The wide net of cancer detection is picking up the Sharks – the aggressive tumors – and the Minnows- the non-aggressive tumors.
“We are not seeing enough of the really lethal cancers, and we’re finding too many of the slow moving ones that probably don’t need to be found” says Laura Esserman, a breast cancer surgeon at the University of California, San Francisco.
Early detection has long been seen as a powerful weapon in the battle against breast cancer. Some experts now see it as a double edged sword.
BreastDefense will be able to solve this problem. BreastDefense will be able to distinguish the Sharks from the Minnows.
The entire article can be found here.
This article was written in 2014. There is still no test to tell the difference between invasive and benign breast cancer. However in the past couple of years big data and biology have intersected to create novel methods of research. The technology is advancing rapidly.