Trends in breast cancer treatment cause alarms, raise questions

Published: Wednesday, Nov. 28 2012 4:35 p.m. MST

West Jordan Mayor Melissa Johnson gets a mammogram from Melanie Lyon in West Jordan last year. Breast cancer specialists have raised concerns about recent trends.

Jeffrey D. Allred, Deseret News

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Overtreatment of breast cancer and minimal screenings are two recent trends raising concerns among breast cancer specialists and other physicians.

One trend centers around controversial guidelines issued by the U.S. Preventative Services Task Force in 2009, which details that women over 74 only need a screening every two years. Specialists say since these guidelines were enforced, there has been a decline in mammogram screenings for women over that age group.

"We'll never see 1,000 out of 1,000 women getting a screening mammogram, but you'd like to see that number closer to 1,000, and certainly higher than 322," said Dr. David C. Levin, professor and chairman emeritus of the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia, according to CBSNews.com.

Worried doctors, however, will have to wait to see if the drop in screenings makes any change in mortality statistics, since currently there's not enough data.

A recent study by the New England Journal of Medicine may also be a cause for the drop in women's screenings.

The study found one-third of breast cancer patients received treatment for a tumor that may not have been life threatening, according to Debra Sherman, a reporter for Reuters.

The American Cancer Society hasn't changed its guidelines to match the U.S. Preventative Services Task Force. The group says women over age 40 should receive annual screenings, according to Sherman.

"Our findings favor the American Cancer Society recommendations," Dr. Elizabeth Arleo of Weill Medical College of Cornell University told Sherman. Arleo studied the impact of the U.S. Preventative Services Task Force's new guidelines.

"In our book, it seems unacceptable to miss 19 percent of breast cancers, half of which were invasive," she said in the Reuters article.

One out of eight women in the United States will have invasive cancer in breast tissues during their lifetime, not just breast ducts, according to the American Cancer Society.

"We get questions all day long from patients and referring physicians on the appropriateness of screening mammography," Arleo told Michelle Castillo, reporter for the CBSNews article. "The inconsistent information is very confusing for everyone."

Misinformation from conflicting guidelines, or not being informed at all also appear to be growing trends.

Recent reports have shown that women who have breast cancer are opting to have a prophylactic mastectomy, while doctors like Dr. Jyoti Patel have said it is an "unnecessary surgery," according to an ABC News article.

This growing trend is another concern for breast cancer specialists because consumers drive it, Monica Morrow of Memorial Sloan-Kettering Cancer Center said in an NPR article.

Out of 564 of women who underwent mastectomies because of a primary tumor, 53 percent chose to have a double mastectomy, according to a study conducted by Dr. Sarah Hawley at the University of Michigan.

"When researchers surveyed women about their choice of therapy, not surprisingly they found the main factor was fear that cancer would 'spread' to the healthy breast — even though, surgeon Morrow says, 'it's a misunderstanding that cancer spreads from breast to breast," wrote Richard Knox, a journalist for NPR.

"In the absence of data to explain the increase, concern has arisen about the potential for overtreatment, particularly given the relative rarity — about 1 percent — of contralateral disease as a site of recurrence," wrote Charles Bankhed in the ABC News article.

Email: ehong@desnews.com Twitter: @erinhong

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