American Cancer Society Plans To Shift Message About Benefits Of Screening For Breast, Other Cancers

The American Cancer Society is working to modify its message about screenings for breast and prostate cancers to say that the benefits of early detection might have been overstated, the New York Times reports. According to the Times, the new message will caution that screenings can lead to overtreatment of small cancers while overlooking potentially deadly cancers.

The cancer society's decision to reconsider its message about the risks and benefits of screening was in part spurred by an analysis published Wednesday in the Journal of the American Medical Association . Authors Laura Esserman of the University of California-San Francisco's Carol Frank Buck Breast Cancer Center and Ian Thompson of the Department of Urology at the University of Texas Health Science Center reported that a 40% increase in breast cancer diagnoses and a nearly 100% increase in early-stage cancers have coincided with just a 10% decline in cancers that have spread to the lymph nodes or to other parts of the body. According to the analysis, screenings are contributing to huge increases in breast and prostate cancer diagnoses because they are finding innocuous tumors that have no risk of spreading and do not necessarily require treatment. The key is to distinguish between those tumors that are innocuous and those that need aggressive treatment. The analysis noted that if screenings were really as beneficial as they are promised to be, the significant increase in detection of early cancers would correspond to a massive decline in late-stage cancers -- which has been the case for colon and cervical cancer screenings but not for breast or prostate cancers.

ACS chief medical officer Otis Brawley said, "The issue here is, as we look at cancer medicine over the last 35 or 40 years, we have always worked to treat cancer or to find cancer early," but "we never sat back and actually thought, 'Are we treating the cancers that need to be treated?'" Barnett Kramer, associate director for disease prevention at NIH, said that the notion that some cancers are not dangerous and could go away on their own is "so counterintuitive that it raises debate every time it comes up and every time it has been observed." According to Kramer, "Overdiagnosis is pure, unadulterated harm."

However, the researchers don't believe that screening should go away - but that people should better understand the risks and benefits. ACS plans to revamp its screening message on its Web site next year. Currently, the site states that a mammogram is "one of the best things a woman can do to protect her health." Brawley said, "We don't want people to panic." However, he added, "I'm admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated" (Kolata, New York Times, 10/21).


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