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Study Questions Mammograms 'Overdiagnosis'


A new study out this week provides further evidence that routine mammograms may lead to unnecessary treatment. Writing in the New England Journal of Medicine, cancer researchers say one-third of all breast cancers detected by mammograms don't need to be treated. They found that over the past 30 years - a time when women over 40 were advised to get a yearly mammogram - the mammograms have had only a small impact on the death rate for breast cancer.

To talk about the implications for screening recommendations that this study has, we turned to Dr. Len Lichtenfeld of the American Cancer Society.

Good morning.

DR. LEN LICHTENFELD: Good morning.

MONTAGNE: Now, there has actually been a rather controversial change recently, as a federal task force came out saying women under the age of 50 don't generally need a yearly mammogram. Could you give us a very brief summary of the current recommendations?

LICHTENFELD: Well, the current recommendations from the American Cancer Society remain that a woman at average risk of breast cancer should have an annual mammogram beginning at age 40. What I think is important, given all of the discussion and the task force recommendations, is that we also believe it's very important that women have a clear understanding of the benefits, risks and harms of mammography, and if they have any questions, should discuss them with a health care professional.

MONTAGNE: Well, just briefly break it down. Just if cancer is detected at a very early stage, that's the idea of a mammogram: catch it early, treat it, and one should have a better outcome. Why would one-third of all breast cancers caught by a mammogram really not need to be treated?

LICHTENFELD: Well, Renee, what you just said was true back in the 1970s. And I have to say I was there when mammography started to get traction. And we did believe and we wanted to believe that every mammogram catching every breast cancer at a very small size, before we could feel it, was going to lead to cure and effective treatment.

What we have learned over time are two things. Number one, mammography is only a part of the process in improving the outlook for women with breast cancer. Let's remember, we have had a significant reduction in deaths from breast cancer in this country as a result of several factors.

We always knew back in the 1960s, before mammography, that there were breast cancers that would be found at autopsy that never caused a woman a problem. We're now finding those cancers more routinely. But even though experts may disagree on the level of breast cancers that are quote, unquote, "overdiagnosed," the reality is the majority of women - most experts would agree - do benefit from treatment for their breast cancer.

We really need better signs to help us pinpoint which women have a more aggressive breast cancer and require aggressive therapy, as opposed to which women where the breast cancer may not be a source of difficulty for them as their lives progress.

MONTAGNE: So the American Cancer Society is sticking with its more traditional recommendation?

LICHTENFELD: We are sticking with that recommendation, as of this date. We recognize that others do not agree with that. They have come to different conclusions. We do believe mammograms save lives. We may not agree on when they should start or how often they should be given, but we at the American Cancer Society do stand by the recommendation that they should start age 40 every year. And we will, as we always do, we'll always carefully look at the science and change that recommendation if we feel that the science merits it.

MONTAGNE: Dr. Len Lichtenfeld is deputy medical director of the American Cancer Society. Thanks for joining us.

LICHTENFELD: And thank you. Transcript provided by NPR, Copyright NPR.