Dartmouth student’s mammography research reveals surprising results

by Madison Pauly

29 Oct 2011

 

Ear­lier this week, Brit­tney Frankel ’12 got a sur­pris­ing call from her pro­fes­sor and re­search men­tor, Dr. H. Gilbert Welch: His study about the ef­fi­cacy of mam­mog­ra­phy screen­ings, which Frankel co-au­thored, was about to be fea­tured in The New York Times.

“It was re­ally weird and un­ex­pected but also re­ally ex­cit­ing,” Frankel said. “It’s re­ally nice to get recog­ni­tion for some­thing I worked re­ally hard on and think is im­por­tant.”

The title of the re­search? “Like­li­hood That a Woman With Screen-De­tected Breast Can­cer Has Had Her ‘Life Saved’ by That Screen­ing” Pretty self-ex­plana­tory.

Pub­lished on Oct. 24, the study was im­me­di­ately picked up by the Times, the Daily Beast, and News­wise, among oth­ers.

Using na­tional data on women with breast can­cer, Welch and Frankel set out to in­ves­ti­gate the truth be­hind sur­vivor tes­ti­mo­ni­als that tout the idea that early screen­ing saves lives.

“We found that the largest pos­si­ble chance that a woman’s life has been saved is 25 per­cent, which I think is re­ally sur­pris­ing and counter-in­tu­itive to what med­ical cul­ture sug­gests,” Frankel said.

Other prob­a­bil­ity es­ti­mates from the study in­di­cate that mam­mog­ra­phy may only save lives in less than 10 per­cent of the cases de­tected.

Ac­cord­ing to Frankel, that num­ber is small be­cause there are three pos­si­ble sce­nar­ios for each case of breast can­cer: First, that early di­ag­no­sis and treat­ment ac­tu­ally did save the woman’s life. Sec­ond, that catch­ing the can­cer ear­lier or later would have had no ef­fect on treat­ment. And third, that the dis­ease would have gone into re­mis­sion any­way, mean­ing that the woman was over di­ag­nosed and sub­ject to po­ten­tially harm­ful treat­ment.

“I think mam­mog­ra­phy is every woman’s in­di­vid­ual choice,” Frankel said. “This study is by no means say­ing you shouldn’t get a mam­mo­gram, but that there are pros and cons to doing so and that you should know both … This is just sug­gest­ing that early di­ag­no­sis is good in some cases but not all and there are al­ter­na­tive sce­nar­ios.”

A gov­ern­ment major who is in­ter­ested in pub­lic health, Frankel said she first learned about pub­lic health and ev­i­dence-based care when she read Welch’s book “Should I Be Tested for Can­cer?” in her writ­ing 5 class fresh­man year. She got in­volved in his re­search in her ju­nior spring after tak­ing his pub­lic pol­icy course the pre­vi­ous year.

“This pro­ject helped me re­al­ize that I loved gov­ern­ment but I also wanted to study med­i­cine,” Frankel said. “I re­al­ized that this was where my in­ter­ests lay — in the im­por­tance of com­mu­ni­cat­ing med­ical in­for­ma­tion clearly within the med­ical com­mu­nity and also in order to have reg­u­lar peo­ple un­der­stand it.”




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