It’s a tough call, deciding which topics gets readers most incensed.
Evolution always makes a strong run for the title, but I have to go with
something else: readers get really, really upset when you tell them
that early cancer detection is unlikely to save their life. So apologies that I have to say it again. But the latest review of
studies evaluating the value of monthly breast self-exams—a staple of
college health centers, OB-GYN visits and women’s mags—comes to a dismal
conclusion: there is no evidence that they actually reduce
breast-cancer deaths, and instead may do more harm than good. Before you roll your eyes and say, oh, just one little study, what
does it know?, let me say this: there are actually a lot of studies
casting doubt on what breast self-exams can do for you. In 2002, for
instance, scientists at the Fred Hutchinson Cancer Research Center in Seattle concluded in the Journal of the National Cancer Institute
that teaching women breast self-examination does not decrease the
number of deaths in the group from breast cancer. And just as the study
released this evening finds, teaching BSE increases the rate of benign
breast biopsies, which are no fun. A JNCI editorial concluded that
rather than spending time teaching breast self-exam, physicians should
educate women about cancer symptoms and take more time performing the
clinical breast exam. “Routinely teaching BSE may be dead,” they wrote,
“but giving women information . . . should live on.” Alas, six years later, BSE is not at all dead, and the myth of the
value of self-exam persists. Lest you think this is all a vast
conspiracy on the part of unfeeling male scientists to make more of us
die from breast cancer, check out the Website of the National Breast Cancer Coalition, a women's research and advocacy group that has often taken unpopular positions. For years it has been telling women that “there is currently no scientific evidence from randomized trials that breast self-exam (BSE) saves lives
or enables women to detect breast cancer at earlier stages. In
addition, there are some data that show that BSE greatly increases the
number of benign lumps detected, resulting in increased anxiety,
physician visits, and unnecessary biopsies. Therefore, NBCC does not
support efforts to promote and teach BSE on a population-wide level in
any age group of women.” And the American Cancer Society stopped
recommending monthly self-exams five years ago; there’s just no evidence
it saves lives. How can it be that self-exam doesn’t make you less likely to die of breast cancer, as the latest paper, from the Cochrane Library,
concludes? (And that the PSA test for prostate cancer, mammograms, and
X-ray screening for lung cancer also have little to no value in keeping
you alive?) For one thing, many tumors grow so slowly that they can be in you for
years with no ill effects. So whether you find the tumor today or on
July 15, 2014, makes no difference. For another, just because someone
who found a tumor herself lives for 17 years, while someone whose tumor
was found on a mammogram lived only 6, doesn’t mean the earlier
detection improved survival: the ultimately fatal outcome might have
been inevitable, and the only thing early detection bought was more
years of living with cancer, not more years of life. |