Blistering Attack on Susan G. Komen Foundation
Komen’s Cancer Awareness campaign claims that the key to surviving breast cancer is for women to get screened because “early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.”
But an article in the British Medical Journal concludes that mammography can reduce the chance that a woman in her 50s will die from breast cancer over the next 10 years from 0.53% to 0.46%, a difference of 0.07 percentage points.
“If there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down,” they write.
Wow. This is interesting.
People need to realize preventive medical services are not money saving. Neither are they necessarily “life-saving.” Rather they reduce the probability of death or reduce uncertainty. Some people have an aversion to risk that is greater than others. A service that might be of value to one woman may not be worth the money to another. By definition, the vast majority of people will be proven to be healthy. This suggests people are paying for peace of mind to a large degree.
Quality of life is likely not good for many of those that do survive.
Very interesting.
Maybe both of these statements are correct. If you are in the small percentage of mortalities that BMJ describes, you will be glad you had the test.
Sounds like the Komen Foundation is giving people false hope.
Well, the piece is behind a pay wall and the link’s write-up doesn’t give much in the way of details.
There were a number of large studies done before mammography improved that showed a moderate benefit from mammography and that tumors were caught at a much earlier stage thus, as the article says, increasing survival rates.
However, in 2009 the USPSTF still recommended mammography for women over 50 with a grade B recommendation. Hopefully the article behind the pay wall explains why the USPSTF is incorrect.
After all, every person in the US has a 1/10,000 chance of being struck by lightening in his lifetime. That’s a 0.01 percent chance (if I haven’t messed up the zeros), smaller than the survival benefit the authors say one has from a mammogram.
And yet people take precautions when big thunder storms move in. Maybe that’s a waste, too?
Susan G. Komen is, after all, a very successful advocacy for breast cancer detection, survival and awareness. Raising awareness and hyping the benefits of screenings furthers its mission. When you think about it, Komen has critics mostly because it is more successful at attracting attention to its mission than other disease advocacies. Just consider the controversy that erupted when the U.S. Preventive Disease Task Force suggested changing recommendations that women not begin mammograms until age 50 – rather than 40. The Task Force recommended mammograms at age 50 because the risk of breast cancer before age 50 was very small. From a marketing standpoint, pushing back the awareness and fear of breast cancer by a full decade (until age 50) would be a huge loss of awareness and urgency for a disease advocacy like Komen.
I was under the impression that hope, false or not, is an important thing. Awareness of the risk certainly is. Still, they netted over 163 million in 2011 and remain one of the most equitable non-profits around.
The papers cited by the USPDTF make it clear that screening under 50 raises expenditures and finds relatively few cancers. SO, if expenditures are of more concern than lives saved, then screening should start at 50.
If lives saved are the primary concern, however, the evidence cited suggested that screening from 40 on does save lives.
This is likely apples to oranges comparison. One source is regarding 5 year survival vs death rate in the other. If there is early detection and intervention then the five year survival may reflect this in a positive statistic, but the overall death rate per 100K may not be changed that greatly.
Example: If the natural history of a cancer from the first cell until death from the disease is say 13 years, then detection in year 6 might have a greater 5 year survival than detection at year 9 , but both have the same death rate.
There is the presumption/hope that early detection will result in better outcome, but an honest evaluation must compare the same statistics and then make judgement of value in terms of outcome including both the subjective life quality judgement and those that are in fact ” cured” . I am not defending this judgement being made by Obama’s so called death panel. Far from that. But detection and treatment have to be based on good information and that information will evolve.