Curing cancers that aren’t there?

June 3, 2008

MRI improving breast cancer detection. Outcomes unclear.

Adding MRI to mammography appears to improve breast cancer detection among women at high risk, according to a systematic review of studies published after 1994.

In advance of rigorous evidence for other indications (such as presurgical diagnosis), the use of MRI for breast cancer has doubled. Mastectomy rates have increased accordingly, reversing a decline.

This looks like the laudable result of early diagnosis. (Or are we seeing overtreatment of lesions that would never have progressed?)

Research/Reviews
What are the latest results comparing mastectomy to lumpectomy plus radiation?

Patient Education
Give your patients trustworthy reading material on the subject.

Related searches

Will Rogers phenomenon

MRI breast cancer overtreatment

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Breast cancer risk 2008: Obsessing

March 18, 2008

How many breast cancer patients (and MDs) ignore the greater risks?

The odds are about 50:50 that a breast cancer survivor over 60 will die as a result of something else – most likely heart disease or osteoporosis – according to a new report in the Journal of the National Cancer Institute. It calls for greater attention to these women’s other medical problems.

Another study in the same issue finds that women diagnosed with ductal carcinoma in situ (DCIS) radically overestimated their risk of progression to cancer or metastasis. They also showed “notable declines” in general health, vitality, and mental health during the 18 months after diagnosis.

A companion editorial to this study (look for the link at the bottom of the abstract) tentatively suggests a trial of “watchful waiting” for DCIS—rather than knee-jerk mastectomy. If it works for prostate cancer, then why not for this pre-malignant condition?

These articles aren’t full of advice about how to help patients who fret about their condition. But there are ideas elsewhere on SearchMedica.

Clinical Trials

Find the new trial mentioned in the DCIS editorial that is testing brief hormonal therapy before surgery. Researchers are looking for changes in tumor volume, with a goal of finding nonsurgical means to avert progression.

Patient Education

Find something worth sending home with a patient who will be thinking a long time about her diagnosis of early breast cancer.

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