Posted on: Tuesday, September 10th 2024 at 3:00 am
The latest news coverage on breast cancer screening overlooks critical issues, conflating cancer risk with mortality and failing to address the harms of overdiagnosis and overtreatment.
Quick Summary:
- CNN's article fails to distinguish between cancer risk and cancer mortality, an essential nuance in understanding breast cancer.
- It ignores the significant harms of overdiagnosis and overtreatment, especially for DCIS (ductal carcinoma in situ).
- The FDA's new rule does little to alleviate concerns about mammography's limitations, while ignoring safer alternatives like thermography.
- Dense breast tissue may not be as clinically significant as portrayed, particularly in regard to mortality.
CNN's Flawed Reporting: Risk vs. Mortality
CNN's article titled, *Women Will Soon Be Notified About Their Breast Density After a Mammogram*, by Jacqueline Howard, highlights the U.S. Food and Drug Administration's (FDA) new regulation mandating breast density notifications in mammogram result letters.1 While it presents breast density as a crucial risk factor for breast cancer, CNN fails to distinguish between risk of developing breast cancer and mortality after diagnosis, leaving readers with an incomplete understanding.
It is important to note that while dense breasts are associated with a higher risk of developing breast cancer, studies do not show a direct correlation between dense breasts and higher mortality once diagnosed.2 After adjusting for factors such as stage at diagnosis and the type of treatment received, breast density alone is not a reliable predictor of breast cancer death.3 For example, research from Pettersson et al. found no significant difference in survival rates between women with dense breasts and those with non-dense breasts after diagnosis, suggesting that the emphasis on breast density as a high-risk factor may be misplaced.4
In light of this evidence, CNN's omission of these crucial findings perpetuates unnecessary fear and fuels misconceptions, contributing to a broader misunderstanding about the role of breast density in breast cancer outcomes.
The Harms of Overdiagnosis: DCIS and Beyond
One of the most alarming issues with mammography screening--something CNN fails to address--is overdiagnosis, particularly with ductal carcinoma in situ (DCIS). DCIS is a non-invasive form of breast cancer that, in many cases, may not progress to a life-threatening condition.5
Overdiagnosis refers to the detection of cancers that would not have caused harm during a person's lifetime. The consequence of overdiagnosis is overtreatment: patients undergo unnecessary surgeries, chemotherapy, radiation, or mastectomies for conditions that would not have progressed.6 In fact, research suggests that up to 80% of DCIS cases detected via mammograms may be overdiagnosed.7
Studies like those conducted by Welch et al. highlight that the harms of overdiagnosis include significant emotional distress and physical consequences from needless treatments.8 Despite this, CNN's article makes no mention of the pitfalls of overdiagnosis and overtreatment--issues that directly impact the quality of life for thousands of women each year.
Furthermore, X-ray-based mammograms, by their nature, expose women to small but cumulative doses of radiation, which paradoxically increases their long-term risk of developing cancer.9 In their coverage, CNN does not acknowledge this danger, nor the fact that increased screening often leads to a cycle of further imaging, biopsies, and unnecessary medical interventions.
Breast Density and Its Limited Role in Mortality
In addition to the risk of overdiagnosis, the focus on breast density in the FDA's new rule and CNN's coverage misrepresents the actual role breast density plays in breast cancer outcomes. Recent studies have challenged the narrative that breast density is a key determinant in breast cancer mortality. A study by Engmann et al. concluded that although breast density increases the risk of developing breast cancer, it does not correlate with a higher likelihood of death from the disease once it has been diagnosed.10 This raises the question: Why is breast density being portrayed as an urgent factor for all women, when its relevance to outcomes like mortality is not well-supported?
The problem lies in conflating detection difficulty with clinical outcome. Yes, denser breast tissue can make it harder to detect tumors on a mammogram, but detection difficulties do not inherently translate into worse prognoses or higher mortality rates.11 In fact, once diagnosed, women with dense breasts do not face a higher risk of dying from breast cancer than women with less dense tissue, as found in studies by Pettersson et al. and others.12
Unfortunately, CNN's failure to mention these studies perpetuates a cycle of fear-based screening rather than evidence-based discussion, leading many women to believe that dense breast tissue will inevitably result in worse outcomes.
The FDA's New Rule: Is It Really a Step Forward?
The FDA's new rule requiring mammogram facilities to notify patients about breast density has been touted as a step forward for women's health.13 However, this rule may exacerbate the issue of overdiagnosis and overtreatment, while providing little actionable information. The notification simply informs women that dense breast tissue makes cancer harder to detect and may increase their risk of developing cancer, but it does not offer any concrete guidance for next steps.
Moreover, the rule emphasizes mammography as the go-to screening tool for women with dense breasts, without addressing the risks associated with the technology itself.14 Despite studies indicating that mammography can cause more harm than good, the FDA and mainstream media, like CNN, continue to present it as the gold standard in breast cancer detection.
The Overlooked Alternative: Thermography
One of the most glaring omissions in CNN's article, as well as the FDA's new rule, is any mention of thermography as a safer, non-invasive alternative to mammography. Thermography uses infrared imaging to detect heat and blood flow in breast tissue, and it does so without exposing women to radiation.15
Thermography has proven especially beneficial for women with dense breast tissue because it doesn't rely on structural imaging, which can be obscured by dense tissue, but rather detects physiological changes, such as increased blood flow, which can be early indicators of tumor growth.¹⁶ Despite these benefits, thermography has not been widely adopted, partly due to entrenched interests in promoting radiological methods of screening, even though mammography carries its own set of risks.
Considering that thermography provides a safer, non-radiative alternative, it's disappointing that neither the FDA nor CNN is bringing it into the conversation. Women deserve to be informed about all their options, not just the ones that fit within a certain medical framework.
Conclusion: A Call for Evidence-Based Reporting
CNN's coverage of the new breast density notification rule glosses over key issues that should be central to the discussion of breast cancer screening. The conflation of cancer risk with mortality, the lack of acknowledgment of the harms of overdiagnosis and overtreatment, and the failure to mention safer alternatives like thermography all point to a need for more nuanced, evidence-based reporting.
The focus on breast density, while important, must be balanced with the understanding that breast density does not necessarily translate to worse outcomes. Women need to be empowered with comprehensive, truthful information that helps them make informed decisions about their health--information that goes beyond fear and addresses the complex realities of breast cancer screening.
Learn more about breast cancer on the Greenmedinfo.com database.
References
1. Jacqueline Howard, "Women Will Soon Be Notified About Their Breast Density After a Mammogram," *CNN*, September 9, 2024.
2. Engmann, N. J., et al. "Population-attributable risk proportion of clinical risk factors for breast cancer." *JAMA Oncology*, 5(9), 1290-1298.
3. Pettersson, A., et al. "Mammographic density phenotypes and risk of breast cancer: A meta-analysis." *Journal of the National Cancer Institute*, 106(5), 2014.
4. Pettersson, A., et al., 2014.
5. GreenMedInfo, "Disease: Breast Cancer - Ductal Carcinoma in Situ (DCIS)," accessed September 9, 2024.
6. Welch, H. Gilbert, *Overdiagnosed: Making People Sick in the Pursuit of Health* (Boston: Beacon Press, 2011), 30.
7. GreenMedInfo, "The Anti-Therapeutic Action of X-Ray Mammography in Breast Cancer Screening," accessed September 9, 2024.
8. Welch, H. Gilbert, *Overdiagnosed*, 34.
9. GreenMedInfo, "The Anti-Therapeutic Action of X-Ray Mammography in Breast Cancer Screening."
10. Engmann, N. J., et al., 2019.
11. GreenMedInfo, "The Anti-Therapeutic Action of X-Ray Mammography in Breast Cancer Screening."
12. Pettersson, A., et al., 2014.
13. U.S. Food and Drug Administration, "Important Information: Final Rule to Amend the Mammography Quality Standards Act (MQSA)," accessed September 10, 2024.
14. U.S. Food and Drug Administration, "Federal Breast Density Requirements," accessed September 10, 2024.
15. GreenMedInfo, "Thermography: A Radiation-Free Alternative for Breast Cancer Detection," accessed September 9, 2024.
16. "Thermography," *Breast Cancer Choices*, accessed September 9, 2024, https://breastcancerchoices.
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