"This study shows that the more we look, the more you find," says Joann Elmore, a professor of medicine at the University of Washington who wrote a commentary
accompanying the study. "The more you screen, the more likely you are
to detect early precancerous abnormalities like ductal carcinoma in situ
and early-stage cancer."
It's not clear how many women are
overdiagnosed; Elmore says 10 to 20 percent may be a good estimate. But
with the current tests, there's no way for a woman to know if she's in
that 10 to 20 percent or if she really does have a dangerous cancer.
Thus most women who get a diagnosis of DCIS or early-stage invasive
cancer opt for treatment, which can mean surgery, radiation or
chemotherapy.
"That is so hard," Elmore says. "I really feel
for those women. I need help both figuring out how to explain this to
women, and I need better research helping me look at the tissue and
figure out whether these women are overdiagnosed or not."
"As is the case with screening in general, the balance of benefits
and harms is likely to be most favorable when screening is directed to
those at high risk, provided neither too frequently nor too rarely, and
sometimes followed by watchful waiting instead of immediate active
treatment," they wrote.
Current guidelines from the U.S. Preventive Services Task Force recommend
screening every two years for women ages 50 to 74 and that those who
are younger should also consider screening depending on individual risk
factors, such as family history of the disease.
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