Mammogram Rates May Fall When Women Learn of 'Overdiagnosis' Risk

Study found patients were more reluctant to undergo the screen if told it often caught less harmful disease

By Robert Preidt

Thursday, February 19, 2015

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THURSDAY, Feb. 19, 2015 (HealthDay News) -- Educating women about the possibility of "overdiagnosis" from mammography screening may make some of them less likely to get the test, a new study says.

One expert said the findings are important.

"The take-home message needs to be that women should be informed, not only of the benefits of mammography, but also of the shortcomings of the test," said Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill Hospital in New York City.

"In this way, they can make informed decisions about their health care," said Bernik, who was not involved in the study.

The risks and benefits of routine mammography continue to be debated. While some studies suggest that regular screening does save lives, other experts are concerned about the problem of overdiagnosis.

Over-detection and overdiagnosis means that women are diagnosed and treated for breast cancer that may not have posed a risk to them during their lifetime. This overtreatment can cause women unnecessary physical and emotional harm, the Australian research team explained.

The study included nearly 900 women, ages 48-50, who had not had mammography screening in the past two years and did not have a personal or strong family history of breast cancer.

Some of the women were assigned to a "decision support group," where they learned about the risks of over-detection and overdiagnosis associated with mammography screening.

Compared to women who didn't receive the information, those in the decision support group had less favorable opinions about the screening and were much less likely to undergo it.

"Mammography screening can reduce breast cancer deaths, but most women are unaware that inconsequential disease can also be detected by screening, leading to overdiagnosis and overtreatment," study lead author Kirsten McCaffery, of the University of Sydney in Australia, said in a university news release.

The study "underlines the ethical imperative for women to have clear decision support materials so that they can make more informed decisions about whether they want to have a breast screening mammogram," she added.

Dr. Alison Estabrook is chief of breast surgery at the Comprehensive Breast Center at Mount Sinai Roosevelt Hospital in New York City. She agreed that -- as happens with all cancer screening tools -- mammograms can lead to overdiagnosis.

She said the study brings up a number of important questions: "Can we find a group of women that does not need to be screened every year? Can we educate surgeons and other breast oncologists not to overtreat early cancers?"

But Bernik also believes that the Australian study had some flaws.

She noted that the women in the study hadn't gotten a mammogram for at least two years. "Women who chose not to get mammograms may feel more strongly about their decisions than women who go every year," Bernik noted.

"They may also be more eager to give their opinions than women who are committed to following a yearly routine," she added. "The study also excluded women who are at high risk, a group of women that are usually highly informed about whether or not they feel mammograms are beneficial."

The study was published Feb. 17 in The Lancet.

SOURCES: Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; Alison Estabrook, M.D., chief, breast surgery, Comprehensive Breast Center, Mount Sinai Roosevelt Hospital, New York City; University of Sydney, news release, Feb. 17, 2015

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