TUESDAY, Sept. 13 (HealthDay News) -- One of the goals of
mammograms is detecting breast cancer early enough to avoid needing
a mastectomy. But a new Norwegian study suggests that mastectomy
rates climb higher as more women undergo the screening test.
Using national cancer data for more than 35,000 women aged 40 to
79 who were diagnosed with early or invasive breast cancers, Oslo
researchers found a 31 percent increased risk of mastectomy in
women invited to screening compared with a non-invited younger age
group. The Norwegian breast cancer screening program began in 1996
in four counties, encompassing the country's remaining 15 counties
While scientists did not investigate why mastectomy rates
climbed in screened groups, study author Pal Suhrke said the main
reason is likely "cancer overdiagnosis," or the detection and
subsequent treatment of tumors that might grow very slowly and not
pose much of a risk.
"Since the introduction of screening is associated with a more than 50 percent increase in breast cancer rates, some of these women are treated by mastectomy," said Suhrke, a doctoral candidate in the pathology department at Oslo University Hospital. "For many, these results are surprising and disappointing because one might suspect that due to earlier detection of tumors, the number of women needing mastectomies would decrease."
The study is published in the Sept. 13 online edition of
Suhrke and his colleagues found that the country's annual
mastectomy rate rose by 9 percent in women aged 50 to 69 -- the
group invited to screening -- between the pre-screening period from
1993 to 1995 and the introduction of biennial screening from 1996
In contrast, mastectomy rates fell by 17 percent in non-invited
women aged 40 to 49 and 13 percent in non-invited women aged 70 to
Dr. Stephanie Bernik, chief of surgical oncology at Lenox Hill
Hospital in New York City, said the study raises some valid points,
but "they haven't addressed all the issues," such as the idea that
some breast cancer patients opt for more radical surgery because
they don't want to worry about the potential for recurrence of even
The researchers also noted that some Norwegian women in the
study didn't live near a radiation center, Bernik said, making
mastectomy a safer option because follow-up radiation treatments
were not otherwise accessible. Breast reconstruction techniques
have also improved greatly in the past decade, she added.
"I think it's true, if you screen more you're going to find more cancers. That ultimately should lead to better survival for these patients," she said. "Mastectomy is not as dreadful a choice as it used to be."
Indeed, a recent study by the Mayo Clinic indicated that few
breast cancer survivors who opt for a double mastectomy as a
precautionary measure regretted their decision decades later.
Twenty years after surgery, 92 percent said they would make the
same decision, according to preliminary findings presented at the
American Society of Breast Surgeons' annual meeting in April.
Bernik cautioned that the take-home message of the Norwegian
study isn't that women shouldn't get screened. While mammograms do
find some early-stage cancers that may never progress, and those
women go on to be treated anyway -- "you can't pick and choose
which ones are going to be a problem or not . . . and so there is
going to be an element of overtreatment," she said.
"I think we should continue screening and work toward ways of potentially trying to figure out who needs more extensive surgery," Bernik added.
Learn more about breast reconstruction surgery after mastectomy
American Cancer Society.
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