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Health Column: Komen fibbin’ with their ribbons?

Phil Mohler, M.D.
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist

What are they?

They adorn the jerseys of NFL players, KFC buckets of chicken, a Smith and Wesson handgun, and front row seats at WWE wrestling arenas. They are, of course, pink ribbons!

Susan G. Komen is the most widely known, largest and best-funded breast cancer organization in the United States. They have spent more than $1.5 billion for breast cancer education, research, and health services since their beginnings in 1982.

Solid group? Maybe? Maybe not.

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Komen pulled the political plug on their support of Planned Parenthood mammograms, pays its CEO $700,000 a year, and has formed alliances with questionable enterprises like handgun manufacturers, a fast-fat food company (Buckets for the Cure) and Jingle Jugs, a novelty product that depicts female breasts that move in rhythm to a popular song.

More damning is Komen’s consistent overstatement of the benefits of mammograms and their failure to tell women about the risks. Komen’s ads in 2012 emphasized that the five-year survival for breast cancer was 98 percent when discovered early with mammogram screening, but only 23 percent when it was not. Dr. Lisa Schwartz, writing in the British Medical Journal, comments that Komen should be given an Oscar for misleading statistics.

She explains: “Suppose three women are diagnosed with breast cancer at age 67 when a doctor finds a small lump. They die of the disease three years later, when they are 70. The five-year survival rate is zero percent, as no one lived five years past their diagnosis date. Now, suppose the same women were diagnosed when they were 64, because the cancer showed up on a mammogram, but they still die of breast cancer at age 70. The five year survival rate is a 100 percent, even though the women actually survived cancer the same length of time.”

A fairer way to express the benefits of screening mammograms (based on many clinical trials) is that 1,400 women need to be screened with a mammogram for 10 years to prevent one breast cancer death compared to women not screened with a mammogram. So less than 0.1 percent of women screened with mammograms are actually “saved” by the procedure.

Komen’s blind insistence on mammography for all increases the chance of over-diagnosis, when mammograms detect cancers that will never grow, cause symptoms or ever show themselves. Finally, as with any screening test, there is the false positive problem. A “spot” on the mammogram leads to a second test or even a biopsy when there is no malignancy present at all.

Komen’s Take: “….mammography is not perfect, but it’s the best detection tool we have.”

My Take: The decision to do any screening is a complex one with benefits and liabilities. Talk to your doctor about what’s best for you.

GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 38 years. He has a particular interest in pharmaceutical education. Phil works part-time for both Primary Care Partners and Rocky Mountain Health Plans. Email him at pjmohler@bresnan.net.


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