BALANCING BENEFITS AND COSTS OF MAMMOGRAMS.

BALANCING BENEFITS AND COSTS OF MAMMOGRAMS. My brother Elmer and I were independently struck by this article—and struck by the same sentence in the article. The point of the article is that “the American Cancer Society is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.” The sentence refers to a new study just published this week. Here is the troubling sentence: “In [the new study], researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body.” It is the “just a 10 percent decline” phrase that disturbed my brother and me. If a breast cancer has spread to the lymph nodes or beyond, survival rates are dramatically affected. Patients who are diagnosed after the cancer has spread beyond the breast will be subject to the terrors of heightened danger, even if they survive. In other words, the ten per cent decline is a large benefit, which must be balanced against the costs of the overdiagnosis which is included in the 40 % increase in total diagnoses. The facts in the article indicate that the decision by a person to have a cancer test will require balancing several probabilities and evaluating the consequences of various outcomes. Hopefully, the new guidelines which the American Cancer Society seems to be working on will lay out those considerations in detail.