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A sobering report about breast cancer

“By any standard,” the National Breast Cancer Coalition report bluntly states, “we have not made adequate progress.”

Despite years of campaigns to raise awareness, ever expanding screening programs, increased fundraising efforts and more research, there has been little impact on the important outcomes in breast cancer.
REUTERS/Jean-Paul Pelissier

The National Breast Cancer Coalition released its annual breast-cancer progress report on Monday. It’s a very sobering document.

It’s also an honest document. The 62-page report doesn’t hide the truth about breast-cancer survival behind misleading statistics. Nor does it oversell the benefits of mammogram screening.

“By any standard,” the report bluntly states, “we have not made adequate progress. Despite years of campaigns to raise awareness, ever expanding screening programs, increased fundraising efforts and more research, there has been little impact on the important outcomes in breast cancer. Breast cancer incidence and mortality have not changed significantly.”

Unacceptable losses

As the report points out, an estimated 290,000 women and 2,190 men will be diagnosed in the United States with breast cancer in 2012. And an estimated 39,510 women and 410 men will die of the disease — about one every 14 minutes.

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“US breast cancer mortality has been declining but only slightly,” the report says. “In 1991, in the United States, 119 women died of breast cancer every day. This year, that number is estimated to be 108. If we continue making progress at the current rate, it could take a few centuries to end breast cancer. These are not merely statistics, they represent millions of lives. These losses are unacceptable.”

The public has many “myths and misunderstandings” about breast cancer, the report adds. But “in order to make real progress toward saving lives and ending breast cancer, we need to better understand its reality at all levels. The reality is troubling.”

Here, from the report, are a few of those troubling realities:

Regarding early detection:

A great deal of attention and resources have focused on the area of early detection. A mantra that has been drummed into our consciousness over the past forty years is that early detection saves lives. The reality is otherwise. About 70% of women in this country over age 40 have had a mammogram in the last two years. Unfortunately, randomized controlled trials for mammography have shown, at best, a marginal benefit. Breast self-exam (BSE) has also been a key women’s health mantra. But research has demonstrated that routine BSE does not lead to a decrease in mortality from breast cancer nor does it find breast cancer at an earlier stage.

Yet many resources are devoted to giving the message of early detection and promoting breast self-exam and mammography screening for younger and younger populations. Attempts to apply evidence to the message of early detection are often met with anger and derision, as evidenced by the response to the revised screening guidelines issued by the United States Preventive Services Task Force in 2009. These are matters of science.

Regarding survival statistics:

While we want to believe we have made significant progress in saving lives, that is not the case. The incidence of women diagnosed with advanced breast cancer has not changed. Rates of diagnosis of truly lethal disease have remained stable since 1975. …

Survival statistics do not reflect the real experience of people with breast cancer. The [National Cancer Institute] reports that five-year breast cancer survival is 98% for localized disease. Survival rates are skewed by screening: the more you screen, the more you find and thus more women will be alive at five years. But they were not going to die of breast cancer in that time frame even if they had not been screened. And these numbers do not take recurrence into account. While many mistakenly point to five-year survival statistics as proof of progress, an estimated 20% to 30% of women diagnosed with invasive breast cancer will have a recurrence of their disease and may go on to die of the disease, yet they are included as survivors in the five-year survival statistics.

Regarding breast cancer treatment:

The cost of treating breast cancer continues to rise without accompanying significant decreases in breast cancer mortality. The national cost of cancer care in 2010 was estimated to be $124.6 billion, with female breast cancer care leading all cancer sites at an estimated $16.5 billion. Despite that investment, a person with a new diagnosis of cancer has approximately a one in five chance of failing to receive elements of cancer care that are evidence-based and consistent with practice standards. And millions of Americans have no insurance, which not surprisingly has an impact on the quality of their health care.

Regarding the media and the realities of the disease:

[A]n analysis of breast cancer coverage during 2011 National Breast Cancer Awareness Month [found that] more than half of the articles included one or more personal stories. Among 24 personal stories that shared the age of diagnosis, merely three of the women were over 60 years of age at diagnosis. This does not reflect reality: 50% of breast cancer occurs in women aged 62 and older. It comes as no surprise that young women who read these ‘news’ reports throughout the month believe they have a much higher risk of the disease than they actually do. Furthermore, the majority of personal accounts were primary, early stage, breast cancer diagnoses. Often times, a picture was painted of survivors who are disease-free and overcame the disease. Only about 1 in 9 articles portrayed women battling metastatic disease.

“Breast cancer continues to take a toll in the US and globally despite significant attention and resources directed at the disease,” the report concludes. “Billions of dollars have been invested in breast cancer research, and many organizations and public health officials continue to focus attention on early detection and awareness campaigns as the primary approach to addressing breast cancer. Given the attention and resources directed to breast cancer, the public understandably believes that we have made significant progress, [but] that is not the case.”

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We need to do better. And we need more honest assessments like this one.