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With Breast Cancer, the Best Treatment May Be No Treatment
Author: Megan Molteni
Date: 2017
From: Gale Opposing Viewpoints Online Collection
Publisher: Gale, part of Cengage Group
Document Type: Viewpoint essay
Length: 1,125 words
Content Level: (Level 4)
Lexile Measure: 1230L
Full Text:
Article Commentary
“An incorrect diagnosis wastes time and money on treatments that may not help, and causes unnecessary anxiety.”
Megan Molteni is a freelance science writer and editorial research fellow at Wired magazine. In the following viewpoint, Molteni
argues that many breast cancer diagnoses overestimate the threat, leading health-care providers and patients to pursue
unnecessary treatment. She acknowledges that mammographies can help to identify breast cancers early. However, she also notes
that advances in other detection methods allow physicians to make a more confident determination about whether or not different
types and stages of cancer will require treatment. She acknowledges that the increased precision of mammograms as well as earlier
detections of cancer through genetic testing may have contributed to many patients unnecessarily undergoing expensive treatments
that cause undue pain and anxiety. She encourages health-care providers and patients to adopt a more practical approach to
treatment.
As you read, consider the following questions:
1. What impact has mammography had on breast cancer survival rates since the 1960s?
2. According to the author, under what circumstances is genetic testing the most useful method of detecting breast cancer?
3. Based on the studies cited by Molteni, do you agree that it is better not to pursue aggressive treatments for small, earlystage cancers? Explain your answer.
Mammography, the boob-smooshing imaging technique used to detect breast cancer, has an overdiagnosis problem. Doctors have
long known that some portion of the tumors revealed by the scans might never become life-threatening—but they haven’t been able
to discern harmless growths from those that grow and spread. Finally, though, researchers have learned which cancers account for
the majority of problematic diagnoses—and their work suggests mammograms are better at catching innocuous tumors than deadly
ones.
In a paper (http://www.nejm.org/doi/full/10.1056/NEJMsr1613680) published Wednesday in The New England Journal of Medicine,
Yale University scientists analyzed invasive tumor data from hundreds of thousands of breast cancer patients nationwide. The
researchers divided the tumors according biological features—how closely they resembled normal breast cells and whether they had
certain hormone receptors. Turns out those features could predict whether a small tumor would grow into a big one. Most don’t. And
those that do become problematic grow so quickly that mammograms rarely identified them before patients could feel a lump.
“For 100 years we thought that small cancers had a better prognosis because we caught them earlier,” says surgeon and study coauthor Donald Lannin. “But it turns out small cancers have better outcomes because they’re fundamentally different in their
composition.”
That raises some big questions about the value of early detection and diagnosis. Researchers have spent the past few years calling
for a crackdown on breast cancer overdiagnosis. An incorrect diagnosis wastes time and money on treatments that may not help, and
causes unnecessary anxiety. At the same time, though, a growing number of health care companies are urging women to seek even
earlier preventive care in the form of genetic testing. Those tests provide anything but simple answers—and they too can send
frightened patients chasing treatments they may not need, or may not benefit from.
Genetic tests really sell the promise of precision medicine—that more information leads to better healthcare options. But when it
comes to breast cancer, those promises are hard to deliver on. The biggest impact lies with treatment, even if that might mean no
treatment at all.
Detection Roulette
In the early 1960s, one of every three women diagnosed with breast cancer died within five years. Over the next few decades, as
mammograms emerged as the primary method for detecting early cancerous lesions, those odds improved significantly. The idea that
better screening tools led to better outcomes stemmed from a simple, universally accepted truth: Small tumors carry a better
prognosis than large ones. The earlier you find the tumor, the smaller it is, and the better chance your chance of survival.
And so science set about making mammography technology ever more sensitive. Over the last 30 years, radiologists have learned to
detect cancers as small as 1 millimeter. But doctors didn’t see a commensurate drop in the number of large cancers, or in mortality
rates. In the past decade and a half, as genetic tests for some of the genes associated with a high risk of breast cancer (BRCA1/2,
TP53, E-Cadherin, and others) became widely available, mortality rates have improved by just 1 percent.
Yet the number of women in the US receiving double mastectomies tripled in the same timeframe. And according to a study
published April in the Journal of Clinical Oncology, many of those women didn’t need that procedure. A Stanford University survey of
more than 2,000 women who had mastectomies found that half of them didn’t carry the genetic mutations known to increase the risk
of additional cancers. Instead, the women had what are known as variants of uncertain significance, ones that often turn out to be
harmless.
Granted, genetic testing absolutely helps women with high-risk backgrounds—if their mothers and aunts and grandmothers all had
the disease. Such information can help them make informed decisions about a course of treatment. But in the absence of a strong
family history, the value of preventive genetic testing is significantly degraded.
Until recently, the prevailing theory among cancer researchers was that most breast cancers have a lead time of three to four years,
give or take. (Lead time being the time between when a mammogram can discern a tumor, and when that tumor becomes
problematic.) But Lannin’s study showed that most aggressive cancers progress to life-threatening within just a year or two. On the
other hand, a large proportion of small cancers grow so slowly that they have a lead time of as long as 20 years. Since breast cancer
is most frequently diagnosed among women aged 55 to 64, that means that some patients may never actually get cancer. These
women could avoid the expense and side effects of chemotherapy, hormone therapies, and mastectomies, all of which remain blunt
instruments of disease control.
This is where precision medicine is only beginning to make its mark: not in diagnosis, but in treatment. In recent years, doctors have
increasingly turned to genetic tests to analyze tumors—to see if the cells might respond to hormone therapy. If not, doctors can
recommend other treatments, like chemo. It’s just a start, but other assays are in development. And combining these kinds of tests
with physical features of the tumor cells can give doctors a much better idea about whether a cancer will become deadly. If it is,
patients still need better, more targeted treatments than doctors have now. But for cancers that remain small, doctors and patients
may have to get comfortable with the idea of redefining cancer as something you can live with. Because sometimes, the most
personalized medicine may be no medicine at all.
Full Text: COPYRIGHT 2022 Gale, a Cengage Company
Source Citation (MLA 9th Edition)
Molteni, Megan. “With Breast Cancer, the Best Treatment May Be No Treatment.” Gale Opposing Viewpoints Online Collection,
Gale, 2022. Gale In Context: Opposing Viewpoints,
link.gale.com/apps/doc/OFSPOF422304900/OVIC?u=lom_davenportc&sid=bookmark-OVIC&xid=e880172a. Accessed 27 Nov.
2022. Originally published as “With Breast Cancer, the Best Treatment May Be No Treatment,” Wired, 8 June 2017.
Gale Document Number: GALE|OFSPOF422304900