A Rational Approach To Breast Cancer Screening
by Martin J. Yaffe, PhD, C.M, Senior Scientist and Tory Family Chair in Cancer Research, Sunnybrook Research Institute, Professor, Depts. Medical Biophysics and Medical Imaging, University of Toronto, Director, Smarter Imaging Program, Ontario Institute for Cancer Research
Several times per year an article appears in the popular media, usually referring to a “new study” demonstrating that breast cancer screening is ineffective. And as has happened now, with the publication by Jorgensen et al. and the resulting media coverage, I am asked to comment on the “debate regarding the value of screening”. In fact, there really is no debate about the science, if one restricts oneself to studies that have been carefully conducted using appropriate methodology and analysis. The debate is really about values (those of women, health providers and government) in preventive medicine. Screening is expensive. Is the cost justified by the saving of lives and are the negative aspects of screening – abnormal recalls and negative biopsies – acceptable?
Overdiagnosis, Overdone: Unraveling Issues and Pitfalls
by Constantine Kaniklidis *, Research Director, No Surrender Breast Cancer Foundation (NSBCF) **
In a previous editorial on the mammography debate, I wrote: “that it is complex; that it is naïvely implausible to expect any decisive final resolution to the residual issues that will be convincing to the principle contending parties; and that behind it all, the devil is in the methodology”1. Almost two years later, the words stand true, but we have advanced significantly in illuminating the many dark cobwebbed corners of the debate. Center in that web is overdiagnosis (overdetection) with sister ills of false-positives and overtreatments, the harms that trouble – not illegitimately – so many critics of screening mammography, with heated disagreement about both the degree of overdiagnosis, and the validity of different estimation methodologies.
Mammography screening works
by Stephen W. Duffy, MSc, Wolfson Institute of Preventive Medicine, Queen Mary University of London
Since the 1960’s, hundreds of thousands of women have been enrolled in randomised controlled trials of breast cancer screening using mammography. It would be difficult to find a medical procedure which has undergone such extensive testing and scrutiny. The randomised trials show a significant reduction in breast cancer mortality, of the order of 20%, with invitation to screening. Since not all women invited to screening actually attend, it has been estimated that the effect of actually being screened is to reduce breast cancer mortality by 30-40%.
The so-called “debate” over breast cancer screening is not a true debate
by László Tabár, MD, FACR (Hon) and Peter B. Dean, MD.
Instead, it is an unequal confrontation between the scientists who have access to the individual patient-based data and also have the expertise needed to evaluate the data, and those who have strong prejudices against the early detection of breast cancer, but who must resort to “estimates”, “approximations” and “assumptions” to support their beliefs, having no access to individual patient data and lacking the expertise needed to interpret peer reviewed, published results.
by Khevin Barnes, Breast Cancer Survivor
I remember the very moment my primary care physician announced that he was scheduling me for a mammogram. It was May 3rd, 2014. I watched the expression on his face as he told me this, hoping to discover some faint smile to indicate that he was joking with me. I looked at him incredulously, not quite understanding the words he had just spoken. I waited for the punchline. There wasn’t any.
by Dr. Hayley Erdman B.Sc (Hons), ND
Finding credible information about how to incorporate complementary and alternative medicine (CAM) can be overwhelming for patients and caregivers, particularly after a cancer diagnosis. The perceived stakes are higher compared to the average healthcare consumer and the questions are many:
Will this supplement interfere with chemotherapy or radiation treatment?
Will this natural substance reduce or increase my chance of recurrence? Will it be beneficial or detrimental to my overall survival?
What does the research say about this CAM therapy and does it apply to me?
Do we know how this substance works in the body?
Helping individuals with a cancer history to navigate the complex and often conflicting opinions of CAM is vital. As a naturopathic doctor, my role is to educate patients regarding the benefits and risks of these therapies in the context of the best available evidence, allowing them to make more informed choices when combining natural supportive therapies and conventional medical treatment. Through this series of articles, I hope to provide a basic understanding of some of the most commonly suggested supplements used for cancer support, making the evidence more accessible and providing a starting point for those looking to start a conversation with their medical team about the addition of CAM therapies to their oncology care plan.