Breast Cancer Is Being Overdiagnosed and Overtreated – Why?

Cancer Immunity Illustration

According to the researchers, the positive impact of screening is gradually falling as cancer treatment improves.

A recent study raises the issue of whether the advantages of breast cancer screenings have steadily diminished to the point where they are no longer outweighed by the costs associated with overdiagnosis and overtreatment.

Breast cancer screening is costly. This is shown by a Danish/Norwegian study that examined 10,580 breast cancer fatalities among Norwegian women between the ages of 50 and 75.

“The beneficial effect of screening is currently declining because the treatment of cancer is improving. Over the last 25 years, the mortality rate for breast cancer has been virtually halved,” says Henrik Støvring, who is behind the study.

The issue, according to the researchers, is that screenings result in both overdiagnosis and overtreatment, which has a cost on both a human and economic level.

Overdiagnosis and overtreatment

When screening was first implemented, it was estimated that around 20% of breast cancer-related deaths among those screened may be avoided. This equated to around 220 deaths a year in Denmark 25 years ago, but the figure has now been cut in half.

Henrik Stovring

Breast cancer screening leads to overdiagnosis and overtreatment, says associate professor Henrik Støvring. Credit: AU Health

According to the study, whereas it took 731 women to prevent one breast cancer death in Norway in 1996, it would take at least 1364 and likely closer to 3500 women to accomplish the same result in 2016.

The negative consequences of screening, however, remain the same.

“One in five women aged 50-70, who is told they have breast cancer, has received a ‘superfluous’ diagnosis because of screening – without screening, they would never have noticed or felt that they had breast cancer during their lifetime,” says the researcher.

One in five corresponds to 900 women annually in Denmark. In addition, every year more than 5000 women are told that the screening has given rise to suspicion of breast cancer – a suspicion that later turns out to be incorrect.

Peaceful, small nodes – but in who?

Henrik Støvring notes that the result is not beneficial for the screening programs. According to him, the Norwegian results can also be transferred to Denmark. Here, women between 50 and 69 are offered a mammogram screening every second year. This is an X-ray examination of the breast, which can show whether the woman has cellular changes that could be breast cancer.

The Danish screening program became a national program offered to all women in the age group in 2007 – three years after the Norwegians. Approx. 300,000 Danish women are invited to screening for breast cancer every year.

According to the researcher, the challenge is that we are not currently able to tell the difference between the small cancer tumors that will kill you and those that will not. Some of these small nodes are so peaceful or slow-growing that the woman would die a natural death with undetected breast cancer if she had not been screened. But once a cancer node has been discovered, it must of course be treated, even though this was not necessary for some of the women – we just do not know who.

“The women who are invited to screening live longer because all breast cancer patients live longer, and because we have got better drugs, more effective chemotherapy, and because we now have cancer care pathways, which mean the healthcare system reacts faster than it did a decade ago,” says Henrik Støvring.

Reference: “Change in effectiveness of mammography screening with decreasing breast cancer mortality: a population-based study” by Søren R Christiansen, Philippe Autier and Henrik Støvring, 23 June 2022, The European Journal of Public Health.
DOI: 10.1093/eurpub/ckac047

6 Comments on "Breast Cancer Is Being Overdiagnosed and Overtreated – Why?"

  1. Being a cancer patient and having had it spread to lymph nodes because of lack of screening at young ages this is so hard to read. The cost of having ultrasounds of the breast is much lower than having to go through multiple surgeries, chemo, radiation, etc. We need more early diagnosis so that we can avoid the more invasive treatments. It’s good to have better chemo drugs, but it would be better not to get them at all.

  2. As a stage 4 breast cancer patient I am finding that more and more younger women are getting cancer and stage 4 cancer so I m not sure how this study is actually relevant. I know tests cost money but not all drugs are available in all countries and a lot are very expensive as most people don’t have insurance to pay for them . Not everyone with breast cancer is living longer . I find this study to be a slap in cancer patients faces

  3. If the prevalence of breast cancer was equal for men and women, this ridiculous reduction in screenings would not be considered.

  4. Virginia Lambert | August 7, 2022 at 5:24 pm | Reply

    As a human being this article offends me. It would seem the number crunchers and penny counters of this study have not been impacted by breast cancer, or the loss of loved ones because of it. It seems too many breast cancer victims are living, shame on us. Is he saying the cost benefit analysis doesn’t justify the lives being save? As a breast cancer survivor this article horrifies me. My mother died from a very late diagnosis of breast cancer. A sister and cousin, receiving annual mammograms, were diagnosed with mid-stage breast cancer. With his plan all three of us would be dead. Another cousin is in experimental treatment, I pray she is as lucky as we were. I cannot believe this man advocates checking every two years. Of course the insurance companies would have saved a fortune not having to pay for our treatment and the treatment of others. I would like to see a similar study on prostate cancer and how checking/testing for it doesn’t benefit men because too many of them are being treated and dare to live. I am thrilled diagnoses of cancers have increased and I am thrilled more cancers are being treated and cured. This study belongs in the garbage.

  5. I have torn rotator cuff from. Mamogram that will have me in pain for life. My complaint was meet with assurance to repeat. I will suicide before I return.

  6. As a recent diagnosis of breast cancer I have had two separate opinions the lastest is two tumors one in my nipple and one in my lymph node .Plan is and radiation chemo

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