A recent study questions the value of mammograms for breast cancer screening, and concludes that a woman is more likely to be diagnosed with a small tumor that is not destined to grow than she is to have a true problem spotted early.

Joseph P. Russo, MD Section Chief of Women's Imaging at St. Luke's University Health Network,said, "in reading the controversial New England Journal of Medicine article on the effectiveness of mammography, it is vitally important that the public be aware of some of its incorrect baseline assumptions."The studyThe study aims to look at whether or not the screening's harms outweigh its benefits, as well as noting that screening is only worthwhile if it finds cancers that would kill, and if treating them early improves survival versus treating when or if they ever cause symptoms.Treatment has improved so much over the years that detecting cancer early has become less important.Mammograms do catch some deadly cancers and save lives. But they also find many early cancers that are not destined to grow or spread and become a health threat."I agree that the article's data that clearly shows that mammography screening catches more cancers early and reduces the number of women with cancers of advanced size," Russo said. "I do not agree with the authors' conclusion that improved radiation and chemotherapy is more key to breast cancer survival than mammography screening. Nor does the data support that mammography use leads to rampant overdiagnosis."He added that the paper's conclusions are debunked by a recent study in the British Medical Journal, which "confirmed that early detection of breast cancer via mammography is critical for improving breast cancer survival, regardless of therapy advances.""Numerous other studies show that even when women have access to the latest therapies, deaths from breast cancer decline at a much higher rate in women who get mammograms."MammogramsRusso said who is reading your mammogram is also of paramount importance."When nationwide reading statistics are applied to the evaluate the efficacy of mammography, I could see how the data may be confusing," he said. "However, if you applied the statistics of high-volume centers such as our St. Luke's Regional Breast Center, any statistician would see the undervalued benefit of mammography. The experienced mammographer is finding more cancers with less biopsies."Russo added, "Moreover, any article that only considers only 2-D mammography as the tool to screen women for breast cancer is quickly becoming a historical piece. There are multiple screening tools now available to improve our ability to detect cancer in women, specifically dense breast patients."For example, Russo said that 3-D mammography, automated breast ultrasound, MRI and others, are taking women's imaging to the next level in breast cancer survival."This is why it is critical that such one-dimensional articles do not discourage women from taking advantage of the lifesaving advances in breast cancer screening now available to them," he said.DetectionDr. Debra Schneider, Chief of Women's Imaging, Foundation Radiology Group, also weighed in on the results of the study, saying, "some of the counterarguments to the research article are very technical and based on statistics.""The authors argue that screening mammography detects more small cancers than large cancers, and that many of the small cancers may never progress to large cancers," Schneider said. "This is considered to be 'overdiagnosis,' because it results in treatment which may not be necessary."All cancers start out small; some grow slowly, but others grow aggressively," Schneider said. "We want to catch the very aggressive cancers when they are extremely small, because the aggressive ones can grow very quickly in one year."Unfortunately, we do not yet have a means of knowing, by palpation or imaging, which of these cancers will behave aggressively," she said. "Mammography remains the primary means of detecting these small cancers before they can be felt, and gives us the best chance of catching those that are aggressive when they are very small."Schneider said studies show that the outcomes for small cancers are better than those for large cancers in terms of mortality. Treatment of smaller cancers also results in better cosmetic results in many cases, with lumpectomy rather than mastectomy being more likely, she said.Reduced death riskStudies show that the risk of death from breast cancer has dropped about 37 percent since screening mammography became commonplace in the 1980s.Other studies have shown that the risk of dying from breast cancer is reduced almost in half for those who receive regular mammograms.The American College of Radiology and the Society of Breast Imaging recommend beginning annual screening mammography at the age of 40."Each year, I personally find several nonpalpable cancers in patients on their first screening mammogram at age 40," Schneider said. "These cancers found in young women are often of the more aggressive variety, and are exactly the ones we want to catch early."The Associated Press contributed to this story.