Why there may be fewer breast cancer ‘survivors’ in the future

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If women and their doctors ultimately follow the advice of the U.S. Preventive Services Task Force and delay their first mammogram until the age of 50, we will likely hear fewer stories of breast cancer “survivors.”

That’s not because there will be more women who don’t realize they have breast cancer until their tumors are too big to treat (though that is probably an inevitable consequence of pushing back the starting age by 10 years).

Rather, it’s because a good number of the women who are diagnosed with breast cancer in their 40s after getting a mammogram – and subsequently go on to “beat the disease” after grueling treatment – would have wound up cancer-free even without treatment. But if they had never known that the cancer was there in the first place, they wouldn’t describe themselves as cancer “survivors” when it was all over.

This prediction comes from Nancy Berlinger, a healthcare bioethicist at The Hastings Center, a bioethics research institute in Garrison, N.Y., who was quoted in Saturday’s story about the downside of widespread cancer screening.

If it comes to pass, it may be seen as evidence that the task force is off its rocker (to put it kindly) by the legions of breast cancer survivors and other vehement critics who assailed the new mammography guidelines when they were released last week. But that won’t necessarily be accurate, Berlinger said.

She points out that even women who are diagnosed with stage 0 ductal carcinoma in situ are treated as if they have breast cancer. Doctors know that some of these cases would never become life-threatening, but since they don’t know which patients fall into that category, all women are treated aggressively. Though that strategy has certainly saved lives, for some women it does more harm than good.

“None of the things we do in cancer treatment are without burden,” she said. “They’re very harsh things to do.”

There are other downsides too.

“Once you make somebody a cancer patient, you can’t un-make them,” Berlinger said. Even for survivors, “that’s a heavy burden in and of itself.”

-- Karen Kaplan