A new report in the New England Journal of Medicine raises questions about the benefits of mammography. The authors looked at cases of early-stage and late-stage breast cancer among women 40 years of age or older for more than three decades, from 1976 through 2008. They argue that while screening mammography has doubled the number of women in the U.S. who have been diagnosed with early-stage cancer, it has had little impact on the number of late-stage cancer cases. The number of late-stage breast cancers, which are most likely to be life-threatening, have dropped only slightly.
What does this mean? The authors believe that screening mammography has resulted in breast cancer being overdiagnosed. Although the breast cancer death rate in the U.S. continues to fall, the authors believe believe this is largely the result of better treatment, not screening. For women who are 40 or older, they assert, screening should be a choice. While they don’t dismiss the possibility that screening may help some women, they believe it leads many more to be unnecessarily treated and are advocating for a new approach to protect women from overdiagnosis. The article will undoubtedly add to the already lively debate about screening guidelines.