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cdr0000415525Եվրոպական Դաշինքի PERSONALISED բժշկության (EAPM) գործադիր տնօրեն Դենիս Հորգանը

An epidemic concerning the over-estimation of breast cancer risk has had the drastic effect that thousands of unnecessary mastectomies are taking place in Europe, the US and beyond.  Over-intensive screening is partly to blame for increased stress and worry among women of all ages (but especially the over-40s), leading them – and often their doctors -  to imagine, and often pointlessly act upon, worst-case scenarios. 

One recent article on the results of a US study, which suggested that aggressive surgical treatment of a possible precursor to breast cancer may be unnecessary, showed that many women had undergone a lumpectomy or mastectomy after being diagnosed with ductal carcinoma in situ (DCIS). DCIS involves abnormal cells in the milk ducts of a breast.

The study came to the conclusion that a lumpectomy or mastectomy is not the best option for most women who have what is known as ‘Stage 0 cancer’ because the treatment makes little difference to patients’ outcomes. Also, the chance of such patients dying from breast cancer is roughly the same as that of the general population.

The lead author of the study, Dr Steven Narod, was quoted as saying: “I think the best way to treat DCIS is to do nothing.” Another oncology study fits with previously produced evidence that a diagnosis of DCIS is not a death sentence. Yet women and doctors are still making decisions in the shadow of fear, which is to a degree understandable. But this fear appears to be causing a huge rise in the number of women deciding to have bilateral mastectomies. Surgical treatment for DCIS has not, as yet, been compared to what doctors call ‘watchful waiting’ in a rigorous clinical trial. There were so many women in the above study who opted for surgery that it is now impossible to compare its results to those women having had no surgery whatsoever.

Many health-care professionals see the solution as stepping up efforts to perform clinical trials on new screening tests while letting the world know that DCIS diagnosis represents more of a state of risk than it does the first stage of a deadly, destructive process. There are even calls to rename it. The Brussels-based European Alliance for Personalised Medicine (EAPM) is among other groups and cancer experts who believe that investment in better diagnostics, rather than performing those mastectomies and lumpectomies that have little or no benefit yet give considerable stress to patients and their families, is the way forward in many cases. There is also now a need for solid clinical trials of biomarkers in order to determine which treatments work for which women - the basic personalised medicine goal of giving the right treatment to the right patient at the right time. Importantly, it is now incumbent upon oncologists to explain to those women with DCIS that the majority of them have a very low chance of dying from breast cancer, and, crucially, that aggressive treatment does not improve the odds.

Doctors must be educated in these facts and empower the patient by explaining to them in an easy-to-understand, non-patronizing manner that allows the patient to become an equal partner in deciding her own treatment, taking into account lifestyle and other relevant factors. This gives her the choice of whether to opt for lumpectomy to remove the DCIS or even opt for simply leaving it untreated, depending on the individual properties of the lesion at that stage. Mammography has been with us for fifty years now but these screening tests are often over-used and lead to fear and the choosing of a treatment that is in many cases not necessary or, indeed, helpful. For example, many of these mammograms find lesions that will never spread, yet the patient comes away from reading test results in distress, uncertainty and - too often - panic. There is a large school of thought based on 2011 and 2013 reports that maintains that screening mammograms are virtually worthless and do not save lives. In fact those women who have had significantly less mortality over the past 20 are younger ones who have never had the tests.  Some experts have consistently argued that research evidence shows screening mammograms do more harm than good. For every woman whose life is saved, three or more woman are unnecessarily treated. This means their lives could be put at risk through radiation and toxic chemicals.

հայտարարություն

In 2012 it was announced that screening mammograms may save 1,300 lives a year in the UK but result in 4,000 women being misdiagnosed and even needlessly treated. Others say that lives saved are even less than the 1,300 figure, with some putting the figure – astonishingly – at zero. The Nordic Cochrane report of 2011 found that, if 2,000 women are regularly screened for 10 years, one woman will benefit and avoid dying from breast cancer while 200 will receive false positives. Meanwhile, ten will be unnecessarily treated with surgery, radio- and/or chemotherapy, with all the attendant risks.  Researchers at Southampton University attempted to assess the claim, with the results published in the British Medical Journal and their lead researcher concluding: “The default is to assume that screening must be good…but if a woman has an unnecessary mastectomy, or chemotherapy or radiation, that’s a tragedy. It’s difficult to balance the gain of one life against 200 false positives and ten unnecessary surgeries.” But it is still clear that better information and decision-making tools can help women, not least those with DCIS.

Above and beyond that, though, there is certainly a strong and compelling argument for investment and research into better tests that find diseases that actually need to be treated. What women absolutely do not need is the over-use of those tests that do not save lives and expose them to other potential dangers. There is a long way to go, but research and investment into better tests based on the tenets of personalised medicine offer much potential in this regard.

Կիսվեք այս հոդվածով.

EU Reporter-ը հրապարակում է հոդվածներ տարբեր արտաքին աղբյուրներից, որոնք արտահայտում են տեսակետների լայն շրջանակ: Այս հոդվածներում ընդունված դիրքորոշումները պարտադիր չէ, որ լինեն EU Reporter-ի դիրքորոշումները:
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