In a recent article in JAMA (Journal of the American Medical Association) dated July 29, 2013, the authors bring light to the issue of over-diagnosis and over-treatment of breast cancer.
The authors propose the definition of breast cancer should only apply to those breast cancers that have the ability to metastasize (spread beyond the breast to other parts of the body) and cause death to the patient. As such, the authors note that there are some pre-cancerous breast conditions and some breast cancers that will never metastasize and cause death, and therefore may not need treatment. Currently, however, almost all breast cancers are being treated as if they have the same potential to metastasize and cause death.
This “over-diagnosis” of breast cancer has been known for some time and is not a new issue. The “over-diagnosis” of breast cancer has likely been accentuated by the use of advanced screening technologies being used today such as digital mammography, high-resolution breast ultrasound, and breast MRI exams.
However, despite that there may be over-diagnosis and over-treatment of breast cancer, there currently exist no good guidelines or data to sort out which pre-cancerous conditions/breast cancers will go on to metastasize and potentially cause death to the patient and those which will not. Therefore, it remains most prudent to continue current treatment guidelines until clear, proven, and reproducible research suggests otherwise.
Dr. Thomas Bakondy, MD