Breast Cancer Screening with Mammography

Five years after being treated for breast cancer, "Good Morning America" co-host Robin Roberts has a new health fight on her hands.

Roberts said Monday she is beginning chemotherapy treatment for myelodysplastic syndrome, or MDS, a blood and bone marrow disease once known as preleukemia. She is expected to get a bone marrow transplant sometime this fall.

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She developed MDS as a result of her breast cancer treatment - a manner of transmission so unusual it affects only a few hundred people per year, said Dr. Richard Besser, ABC's medical correspondent.

-from the Miami Herald's Monday digital-edition

When we [at the Nordic Cochrane Centre] first published this leaflet in 2008, the Summary was:

It may be reasonable to attend for breast cancer screening with mammography, but it may also be reasonable not to attend, as screening has both benefits and harms.

If 2000 women are screened regularly for 10 years, one will benefit from the screening, as she will avoid dying from breast cancer.

At the same time, 10 healthy women will, as a consequence, become cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy, and sometimes chemotherapy.

Furthermore, about 200 healthy women will experience a false alarm. The psychological strain until one knows whether or not it was cancer, and even afterwards, can be severe.

These numbers were derived from the randomised trials of mammography screening. However, since the trials were performed, treatment of breast cancer has improved considerably. More recent studies suggest that mammography screening may no longer be effective in reducing the risk of dying from breast cancer.

Screening produces patients with breast cancer from among healthy women who would never have developed symptoms of breast cancer. Treatment of these healthy women increases their risk of dying, e.g. from heart disease and cancer.

It therefore no longer seems reasonable to attend for breast cancer screening. In fact, by avoiding going to screening, a woman will lower her risk of getting a breast cancer diagnosis. However, despite this, some women might still wish to go to screening.
 
h/t Dr. McDougall.