Here’s Why Small Tumors Aren’t Always Cause for Alarm

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In recent years, people have begun wondering why mammograms, ultrasounds, and other tools for cancer detection don’t save more lives than they do. Since mammograms have become more widely used and more tumors are being caught while they’re small, the death rates should be going down much more dramatically than they are. Now researchers are looking into it.

What they’ve learned is that women with small tumors—even if the tumors are malignant—aren’t generally “saved” by mammograms because they were highly unlikely to die in the first place. Many (perhaps up to 1/3 of people whose mammograms show an abnormality, according to this study) won’t even need treatment for their cancer in their lifetimes. Small tumors seen on mammograms are often small simply because they’re slow-growing and don’t pose much of a threat, not because they were caught early.

“We thought almost all breast cancers were alike,” says Donald Lannin, lead author of the study and a professor of surgery at the Yale School of Medicine. “You know, a breast cancer was breast cancer — it was bad.”

But now we’re finding that we were wrong. Many tiny tumors are simply not likely to cause any harm to the person over the course of the rest of their lives. While treatment is a good course of action for many women, there are others for whom it may be statistically unnecessary.

But most women still opt to have them treated out of fear that they could cause trouble down the road, and because doctors often have no way of knowing for sure whether a cancerous tumor will be the life-threatening kind or not. That means up to a third of women with abnormalities on their mammograms go through a lot of stress and expensive tests and treatments for no reason.

Don’t get us wrong—mammograms, ultrasounds, and other methods of breast cancer detection are fantastic diagnostic tools and have saved countless lives. But they’re also not infallible, and they can’t tell us everything about a patient’s tumor.

“There’s a tendency in the United States to think that screening is better than it actually is,” says Otis Brawley, chief medical officer at the American Cancer Society.

Some breast cancer organizations are using this research to change their screening recommendations. The American Cancer Society has recently decided to start suggesting mammograms at age 45 instead of 40.

Not all breast cancers are the same, so talk to your doctor about your risk factors and your specific tumor. Some cancers require immediate treatment. Others just need to be monitored to determine whether they pose a threat.

Researchers are currently searching for more accurate ways of discerning which tumors are likely to grow slowly and which are likely to grow quickly.

The debate over whether mammograms are more harmful or helpful will probably not end anytime soon, but future studies should make the decision whether or not to get a cancerous tumor treated or removed a much simpler process.

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Elizabeth Nelson is a wordsmith, an alumna of Aquinas College in Grand Rapids, a four-leaf-clover finder, and a grammar connoisseur. She has lived in west Michigan since age four but loves to travel to new (and old) places. In her free time, she. . . wait, what’s free time?