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Chief Science and Medical Correspondent
NBC News
Women who have received a “false positive” on a mammogram may have new cause for worry, according to a study released Thursday.
A false positive occurs when a radiologist detects an abnormality in a mammogram – that is, there is some apparent growth that is checked out, usually with a needle biopsy -- but it is determined there is no cancer. The research from the University of Copenhagen found that women who have been given additional testing because of a false positive run a 67 percent greater risk of a breast cancer diagnosis in the future. Experts say the result from the records of 58,000 women in Denmark is not cause for alarm. But it is a warning for those who have gotten a false positive to be more vigilant.
False positives may just be an artifact that appears on the mammogram, but they also include abnormally growing cells classified as atypia, papilloma or lobular carcinoma in situ. These are not cancer and they don’t require treatment, but women with these growths “have a 25 to 33 percent lifetime chance of developing breast cancer versus 11 percent in the general population,”according to Dr. David Dershaw, head of breast imaging at Memorial Sloan Kettering Cancer Center in New York. So, any woman who has a false positive should consider a conversation with her doctor about whether she needs more frequent checkups or screening with higher resolution technology such as MRI.
There were further questions about mammograms in a large study released Monday, where researchers followed the records of almost 40,000 women in Norway. Because that country phased in regular mammography from 1996 to 2005, the researchers were able to look at the effects before and after regular screening. The study leaves no doubt that the screening is saving lives. But it found that between 15 and 25 percent of the women diagnosed with breast cancer would have lived to die of some other cause and thus did not need treatment.
Such “overdiagnosis,” as the study authors including some the Harvard School of Public Health characterize it, is inevitable with any cancer screening test. Some cancers can kill. Others never do. But as Dershaw puts it “until it is possible to differentiate which are bad and which are not, all need to be treated.”
The extent and potential harm of overdiagnosis make up almost all of the arguments about cancer screening tests. For some tests such as colonoscopies or pap tests the removal of abnormal growths that could become cancer subjects the patient to relatively little risk or discomfort. The PSA screening test for prostate leads so many men to harsh treatments they often do not need that many question its usefulness.
Most experts believe the overdiagnosis from mammography – especially for women 50 and older— is well worth it for the lives saved.
But one of the reasons why there is such continuing debate about the screening test is that it is far from ideal. Not only does it find cancers that will never be dangerous it can often miss ones that go on to be life threatening.
Many medical and activists groups have pushed hard to get more women screened with mammography. That is a noble goal. But it is a mistake to think that is the solution to the great public health threat of breast cancer
Some of the most hopeful breast cancer research is a search for a blood test or other reliable method of detecting breast cancer early, especially the life threatening forms. MRIs find more but also are so expensive and find so many false, that most doctors say they should be reserved for women at very high risk.
Neither study is an argument for women to avoid regular mammograms. Until scientists achieve the goal of finding a more reliable and cost effective test, it is the best breast cancer screening tool available.
Robert Bazell is NBC's chief science and medical correspondent. Follow him on Facebook and on Twitter @RobertBazellNBC
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The same thing is being seen with needle biopsies of the prostate. People who have had biopsies and come up "clean" have a hugely increased risk of having a prostate cancer diagnosis later. There are also well-founded suspicions that the actual needle biopsies may be causing the slow-growing type of prostate cancer to morph into the fast-growing type through a process called "needle trace tracking."
I just wish we could redirect efforts from detection and treatment, to prevention and cure...but in order for that to happen, we will have to remove the profit motive of endless research and half measures of treatment...The Medical "Community" needs to acknowledge that all (every single case) of every type of cancer is caused by viruses...Fight the cause not the disease
As with all science, separating the wheat from the chaff seems to be quite difficult. Our educational system bears a lot of the blame. A genius, almost by definition, won't do well because of the usual focus that genius entails. We are losing the best minds to a system that defines intelligence in a way that forces mediocrity. We spend billions on sports and other entertainment and pick our leaders for all the wrong reasons. Progress occurs in spite of our institutions, not because of them. There are of course stellar exceptions to this, with intelligence that is more socially acceptable. Too many of our teachers just have a job that was the best they could do. Money is not the only answer, more interest and a broader definition of what "smart" is, are a necessary part of improvement. With so many children in day care, the education process should take them younger and pick out the exceptional ones before they get disillusioned. We are failing ourselves by not placing an emphasis on bringing out talent that is not always easy to recognize.
I am curious How many women die from breast cancer in third world countries?
Does anyone know?
My guess would be very few because I believe cancer is caused from all the food preserves, coloring, additives,
also the vaccine + growth hormone feed to our livestock. People in the third world would not have the availability to these sorts of things probably.
I am not sure. I just thinking out loud. What do you think?
Very good question. I tend to think not only are environmental factors a big problem, but I truly believe more people die of chemotherapy and cancer treatments. The idea of poisoning the body and hoping the cancer dies before the patient does, IMO, defies the Hippocratic Oath.
Yes everybody I ever knew who got chemo and cancer treatments is now dead from cancer in other parts of the body than where originally treated.
Cancer can also be linked to the amounts of exposure people are getting from these tests, there is significant radiation from x-rays, CAT scans, etc. The pressure from mammographies is also now considered possibly dangerous as they may spread or aggravate non-serious tumors into something worse.
While chemotherapy and radiation are certainly not the most enjoyable therapies, the improvement in survival rates as treatments have evolved supports their use. As a testicular cancer survivor I am very thankful for the BEP chemo regimen used in treatment. Prior to the introduction of BEP the mortality rate for testicular cancer was close to 95%; however, today, thanks to the BEP regimen the SURVIVAL rate for testicular cancer is 95%. Chemo is worse than most people can imagine, but we are often left with few other viable treatment options.
@JCA, your belief regarding the cause of death for cancer patients is both right and wrong. Most late-stage cancer patients who choose salvage therapies will often die of a combination of the cancer and treatment side effects, however, more than half of the cancer patients diagnosed each year survive. Since more are surviving than dying, the numbers say the treatments are, in fact, working.
My grandparents grew their own food, drank water straight from their own well, my grandmother never had a mammogram, yet she died of breast cancer. That does not mean we should not look for environmental causes like food preservatives, just realize there are multiple causes which probably includes genetics. As to third world countries, many women in third world countries die of many other diseases before they would ever get breast cancer, since most breast cancers appear in the 50s or 60s.
Modern methods of early detection, chemo and radiation treatments, plus improved surgery techniques have greatly increased the survival rates for breast cancer. Can they be improved? Of course! Mammograms have false positives and also totally miss certain types of breast cancers. Surgery can still be pretty disfiguring in all but the earliest breast cancers. And chemo and radiation have horrible side effects. But compared to the 1960s, when my grandmother died of breast cancer, the progress is amazing!
Also radiation causes cancer, and women are subjected to 4 doses at least once a year.
With the GOP pushing to end Planned Parenthood and all women's mental needs this wont be a topic of discussion. Good news is men can still got full health care coverage and even Viagra in the health care plan. As even female Republican Law Makers agree that women aren't interested in health care. Good news our elected Law Makers and their families have full health care coverage paid in full by the taxpayers. Even Dick Cheney moved to the head of the list for a heart transplant while others were pushed down. At lease Iran gets to small with such a bad country they have free health care. Canada might catch on to Americans like Sarah Palin and her family using Canada's free health care. But Gov. Haley spoke the views of all American women as she said women aren't interested in health care.
I'm a cancer survivor - I had a very aggressive form of Lymphoma. It was caught early (Stage 1) and I went through chemo and radiation. I am in my 7th year of recovery and am very grateful for that but I don't know if, given the choice again with a more advanced stage of cancer, I would go through the treatment again. Awful stuff!
I'm a cancer survivor - a very aggressive form of Lymphoma. It was caught very early (Stage 1) and I am in my 7th year of survival. I had chemo and radiation. If I was diagnosed again, depending on the Stage and the prognosis, I am not sure if I would go through it again. Pretty awful stuff!
The whole "catching it early" thing is fraught with credibility problems. There is much evidence that the "spots" and small lumps they find will often simply go away by themselves. Many people have gone through unnecessary chemo and radiation. Many women have had mastectomies when they didn't really have cancer. I will wait until the tumor is large enough to cause me pain before accepting a cancer diagnosis. I want to see for myself that the tumor continues to grow for awhile before undergoing any kind of drastic treatment.
I agree with JCA - I often believe not only are environmental factors a major problem, but I too believe more people die of chemotherapy and cancer treatments. I actually came across a review site which talks about the herbal extract, graviola. Apparently graviola extract has been proven to combat cancer cells. Pretty awesome review.
I come from a long line of people afflicted with fibroid cysts....My great grandmother and grandmother, who lived to great age had these things from young womanhood, but they were monitored and nothing more was done-and no, they didn't develop breast cancer, uterine cancer, or ovarian cancer despite the fact that fibroids were all found in these places during their lives. My mother was probably among the first generation to have regular cancer screenings, and they found the same sorts of fibroids in both my mother and her sister....but the doctors elected to merely monitor it, and strangely enough, the fibroids began to shrink after menopause (and no, neither my mother or my aunt ever died of a cancer)....I dutifully went for a baseline mammogram and cancer screening, and wasn't even home from the testing center before they were burning down the phone lines that I had to come back in for more tests, and then I was referred to a surgeon who had to biopsy the cyst, and put some sort of marker in its place for future cancer screenings etc......They made my life living hell for several weeks, and then didn't even have the decency to actually call me regarding the results of the biopsy (I had to track them down to get an answer) It was a fibroid cyst......and I have never gone back for another mammogram since.....Nobody in the process even cared about the medical history of the family, and that there was no documented cancers in the family.....just off to the races because the mammogram showed a spot.
"The study leaves no doubt that the screening is saving lives. But it found that between 15 and 25 percent of the women diagnosed with breast cancer would have lived to die of some other cause and thus did not need treatment."
Wow, what a weird statement. Could it just not have been more easily stated that between 15 and 25 percent of women diagnosed with breast cancer would not have died from the cancer?
I disagree with Dr. Bozell as far as "Lobular carcinoma in situ" NOT being cancer. The word "carcinoma" MEANS cancer. Lobular carcinoma of the breast DOES NOT ALWAYS SHOW UP ON MAMMOGRAMS, and thus presents as a very "sneaky" cancer. I know - I was misdiagnosed as having "atypical hyperplasia" when I actually had invasive lobular carcinoma. Although it is often said that "in situ" cancers of the breasts are not cancer, most often this diagnosis turns into a breast cancer diagnosis later on. Always follow your instincts, and, if you don't believe the diagnosis you are given, GET SECOND OPINIONS - ALWAYS !!!
Yes, they are probably getting cancer b/c after a false-positive they end up squeezing and irradiating their poor breasts over and over again... I blame the medical professionals - and I use that term loosely. I read somewhere recently that sonogram radiation does more damage to a fetus than the mother drinking moderate amounts of wine during pregnancy. And yet we tell women not to have a sip of wine but to go have sonograms done regularly... and now they have 3D, no less. It's all messed up.
Find a spot on a mamogram, have more tests - the medical "professionals" love it - $$$ in their pockets. Don't kid yoursef - they don't actually care about the person, they care about their insurance. Whats the first thing they ask when you walk in the door, even in the ER? Not about your health, it is about your ability to PAY. They love to get you on a regiment of pills, pills, pills because you have to keep coming back to them to get them refilled. Cha ching. Greed is the name of the health care game.
@ Sue: I too, had a spot detected on my mammogram and have fibroids and history in my family, with my mother having it too. I guess it depends on the radiation department's actional procedures when something like this is detected. I too, was somewhat alarmed for several weeks, but they were steady rather than panic-causing in my case. I scheduled a sonogram next, at their suggestion for a closer look (and, its important to distinguish the hype from the facts on these comment boards..please note @Jules78, sonograms use radio soundwaves. Sonogram comes from sonic which means auditory. There is NO Radiation involved whatsoever, Ionized or otherwise.) Anyway, the spot was at the very far left almost underneath the armpit, and after the docotr axamined that 3d I was relieved to hear it was a cyst, that over time would dissolve eventually, on its own.
I would MUCH RATHER have the extra tests, then not...the co-pay and lab bills I received afterward were happily paid. Thank you Sanford Health!