–Samantha Armytage’s advice on mammograms was misguided

February 25, 2018

The on-air screenings on Sunrise may have riveted viewers concerned for the host’s future as she experienced a false alarm. But there’s an important issue that was overlooked: while some women will benefit from being screened for breast cancer, others will be harmed. Covering the risks of screening as well as the benefits could have helped their viewers make informed decisions about whether to be screened.

It may surprise most people to learn that screening tests can lead to “overdiagnosis”: the detection of cancers that are so slow growing, they will never cause symptoms or death and are better left alone. Further, screening healthy women in their 40s is more likely to harm than save lives.

Mammograms every two years are recommended for women aged 50 and over.

Mammograms every two years are recommended for women aged 50 and over.

As a doctor and epidemiologist who has studied screening for more than 20 years, I am very familiar with the research assessing the value of breast screening for women in different age groups. Screening women in their 40s may reduce the risk of dying from breast cancer by a small amount, but the number of deaths avoided, if any, is much less than among older women. Most of the benefit of screening occurs in women aged 50-74.

The chance of having a false alarm – as experienced by Armytage – and unnecessary biopsies, however, is higher for women in their 40s. Research shows the anxiety and emotional effects of health scares can be distressing and long lived. Armytage herself spoke about her experience of a false alarm on-air and said: “Immediately I thought the worst… It was a very scary day.”

Screening can turn healthy women of all ages into cancer patients who have surgery and drug and radiation treatments for a harmless cancer. One of the difficulties we have in talking about overdiagnosis of breast cancer is that doctors don’t have reliable tests to tell us which cancers will cause harm and which ones won’t.

But we do know that if you get “overdiagnosed” with breast cancer, you can be seriously harmed by the treatment. For example, research shows radiotherapy will increase your risk of heart disease if the breast cancer is on your left side, the same side as the heart.

In addition, you would very likely experience common side effects of hormone therapy like tamoxifen, including menopausal symptoms: hot flushes, mood swings, low libido and vaginal dryness — as well as an increased risk of blood clots and stroke.

The impact won’t stop there. If you have sisters or daughters, they will probably feel anxious about their “family history of breast cancer”. For me, the psychological impact and physical risks of being treated for an overdiagnosed cancer would start immediately. And I wouldn’t know if I was going through all that for a cancer that might have the potential to kill me, or for one that would have stayed dormant for the rest of my life. This is why having a cancer test when I don’t have any breast symptoms (such as a lump) isn’t a no brainer for me.

It’s the poor balance of benefit to harm for women in their 40s that’s led to recommendations to start regular screening from 50 years, when the trade-off between risks and benefit becomes more favourable. With all this in mind, I urge women in their 40s to take a hard look at the latest research before following a celebrity’s well-meaning but uninformed advice.

To be clear, if you decide not to have a mammogram, that does not mean pretending breast cancer cannot happen to you. If you notice a change in your breasts such as a lump, or bleeding from your nipple, you should see a doctor to get it checked.

You can also take evidence-based steps to reduce your risk of getting breast cancer in the first place by watching your weight, exercising regularly and moderating your alcohol intake.

Alexandra Barratt is an epidemiologist and professor of public health at Sydney University.

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