GloucesterTimes.com, Gloucester, MA

January 15, 2013

'Overdiagnosis' on table for medical talk

By Joann Mackenzie
Staff Writer

---- — “There’s no such thing as breast cancer,” says Dr. Rich Sagall.

Sagall— physician, vice chairman of Gloucester’s Board of Health, and founding president of NeedyMeds, the innovative national RX savings program — will, he promises, clarify what he means by this when he diagnoses the ills of today’s diagnostic practices at tonight’s monthly gathering of the Cape Ann Skeptics — an organization he also helped found.

His talk, starting at 6:45 p.m. at Main Street’s La Trattoria restaurant, covers a spectrum from how cure rates can be manipulated, to how health care providers get credit for cures they shouldn’t.

Its title focus — “Are you really sick? Overdiagnosis, misdiagnosis, and the natural course of disease” — touches on topics that are giving rise to growing concern in medical science circles, with recent research debunking the value of everything from early screenings (including mammograms) to “medicalizing” social disabilities like shyness into conditions like “social anxiety disorder” requiring “treatment” and “medication.”

Sagall, who places a high value on having a good heathy skepticism about everything, has been keeping an increasingly skeptical eye on breast cancer. And he’s not alone. Google the words ‘“overdiagnosis breast cancer,” and you’ll find headlines in some of the most esteemed medical publications, including the New England Journal of Medicine, and BMJ (formerly the Boston Medical Journal).

Sagall feels the issues surrounding overdiagnosis have become important enough to warrant flagging the public’s attention any which way he can — even if it’s with risking readership wrath by declaring “there’s no such thing as breast cancer” in a cancer-conscious community like Cape Ann.

What Sagall means, he explains, is that “‘breast cancer’ is actually an umbrella term used to describe multiple cancerous conditions and stages of conditions that can occur in the breast. Along with multiple variants, there are multiple factors — the patient’s age, general health, family medical history, her own medical history, etc. all of which can contribute to very different implications for any given patient. Including the fact that, left untreated, an early stage tumor may never grow, an early stage condition may never progress, or actually regress.”

Among articles that back this up is one published Nov. 22 in the New England Journal of Medicine estimating that “from 1976 to 2008 in the incidence of early stage breast cancer ... breast cancer was overdiagnosed — (i.e.) tumors were detected on screenings that would never have led to clinical symptoms in 1.3 million women in the past thirty years.”

Yet women’s fear of breast cancer is so great that many increasingly resort to radical mastectomies as a means of dealing with even the slightest indication of pre-cancerous possibilities..

Although careful not to judge or comment on such preventive measures, Sagall — who never specialized in oncology— cites the wisdom of waiting and relying on what physicians call the ‘diagnostic creep.’ – Observing how the condition changes to confirm the diagnosis. “The diagnosis will increase its value as the condition clarifies itself, he says.

“I just strongly believe in science based medicine. In asking yourself: is there scientific evidence that supports the risk of any given treatment or procedure? Is the risk worth the benefit — especially an invasive procedure, with all its associated risks,” he says.

To a newly diagnosed “breast cancer” patient, risk of procedure vs. no procedure might seem like a no-brainer — until you consider statistics for, among other things, soaring rates of death due to post-surgical and hospital borne-infections.

There is, Sagall acknowledges, tremendous pressure on today’s doctors to ‘package’ their observations about a patient into neatly labeled diagnoses. It comes from many quarters, including patients themselves, who’ve been programmed by pharmaceutical advertising to ‘think diagnostically’ and ask doctors if this or that treatment or pill might be right for everything from ‘restless leg syndrome’ to ‘over-active bladder.’

Again, says Sagall, ask yourself: is the diagnosis based on sound scientific evidence? Is the risk worth the treatment? A single pill can kill, he warns, if you’re allergic to even one ingredient in it. And how can you tell if you’re allergic to it if you’ve never taken it before? --And how can you tell a “quirky kid” from a dangerous one, if both are labeled ‘autistic’ — a broad spectrum (and in Sagall’s opinion, suspiciously overdiagnosed) condition that’s been rocketed onto the national radar, as a result of the Newtown tragedy.

These are just some of the topics that will be tabled at tonight’s gathering of Cape Ann Skeptics. Anyone (including outraged readers) is welcome to join.

The event tonight is at La Trattoria, 64 Main St., with doors opening at 6:30 for food orders, mixing and mingling and the program set to start at 6:45.

Joann Mackenzie can be reached at 978-283-7000, x3457, or at jomackenzie@gloucestertimes.com.