Breast cancer screening is a hot topic that hits a nerve with my readers. But that doesn’t mean we should shy away from talking about the scientific truth and the shortcomings of mammography.
The way I see it, debate is a good thing in medicine. Especially when it comes to cancer screenings and treatments. It means people are talking about, aware, and participating in their health decisions. And we can only hope it will lead to more discovery and bring some much-needed science to the debate.
That being said, I have studied the challenges of screening for breast cancer since I was a senior investigator at the National Cancer Institute 30 years ago. At that time, I was tasked with developing a follow-up to the largest, most expensive breast cancer screening study that had ever been done to that date–the Breast Cancer Detection Demonstration Project.
Ultimately, what is known today as the Women’s Health Initiative (WHI) came out of some of my original plans for a follow-up study to that Demonstration Project. And over the past three decades, the WHI has yielded important information about the real risk factors for breast cancer.
As a reminder, these real risk factors for breast cancer are:
- Early age at menarche (early puberty)
- Late age at menopause
- Having few (or no) pregnancies
- Late age at first pregnancy (over 30 years old)
- Lack of breastfeeding
- Lack of being breastfed (as an infant)
- Taking certain birth control and hormone drugs
- Having one or more first degree relatives
- Genetic risk according to the “BRAC” gene test
Of course, the government has spent billions of research dollars trying to prove that adult diet, dietary fat, excess calories, or being overweight cause breast cancer. But none of that panned out. (Of course, we do now know that new prescription drugs increase the risk of breast cancer. I’ll tell you more in an upcoming Daily Dispatch.)
If you have several of the REAL risk factors for breast cancer, mammography screening after 40 may make sense for you as an individual. You should always consult with a trusted, qualified physician to help you make that decision.
But, unfortunately, the use of routine, one-size-fits-all, annual mammograms for the population as a whole has still not proven itself.
As you’ll recall, in February a major, 25-year long Canadian clinical trial found no difference in death rates from breast cancer among younger woman who had regular mammograms and those who did not. According to the study’s authors, “Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.” In other words, annual mammograms for women ages 40-59 do not reduce death rates any better than do physical exams.
Now, you can argue about a lot of different kinds of measurements. But there is nothing clearer–and more final–than death rates.
Nonetheless, the American College of Radiologists immediately attempted to discredit the study. Of course, in their argument, they presented much more “expert medical opinion” than scientific data.
A real medical expert, Dr. Gilbert Welch, Professor of Medicine at Dartmouth Institute for Health Policy and Clinical Practice, noted the unscientific PR campaign mounted by this supposed professional organization.
I was fortunate to catch Dr. Welch live on CNN one evening this past winter. He presented a scathing report on mammograms. And he said it’s time to get back to the science. He also suggested perhaps those who make a fortune off mammograms–the radiologists–aren’t the best sources for objective evaluation.
Here’s another problem with mammograms…
Aside from not preventing deaths any better than physical exams, they’re also harmful. They may actually increase your risk of breast cancer by subjecting you to radiation–and by physically abusing breast tissue.
Over the past 25 years or so, the frequency of breast cancer has dramatically increased–from about 1 in 11 to now about 1 in 9 women. This past quarter-century is exactly the same time period of time that “everyone” has been getting mammograms.
So maybe we are “detecting” more small cancers, and maybe even causing some, with annual mammograms. But remember, we’re not lowering the death rates of the population.
Plus, mammograms are highly inaccurate. In fact, according to the National Institutes of Health, 90 percent of “abnormal” findings turn out to be false positives for breast cancer.
Even the pink-ribboned Komen Foundation admits when women get all the mammograms they recommend, 50 to 60 percent of them will end up with a false positive. So the majority of women get at least one traumatic “cancer scare” during their lifetime. (Ironically, mammograms miss 17 percent of breast cancers that are really present.)
Why all the false positives?
Well, today, mammograms are more sensitive than ever. They detect very small lesions of cells that look suspicious. So the woman (and her family) has to go through the pain and stress of a biopsy. But once you put the cells under a microscope, we discover they aren’t cancerous at all.
Even when we do classify these small lesions as “cancer,” sometimes they don’t really behave like cancer in the body. They will never cause illness or death. This is often true of ductal carcinomas of the breast. But they still get treated as real cancer. And we subject the women to the tortures and dangers of real cancer treatment.
In a recent interview with Medscape, my friend and colleague Dr. George Lundberg explained why it’s important to assess each individual cancer carefully. He’s the former editor-in-chief of the Journal of the American Medical Association. He said:
For a long time, it made sense to try to eradicate all cancers, as early and as completely as possible. Mass efforts were launched to find cancers wherever they were and destroy them. Since the earliest cancers seemed to evolve from some identifiable premalignant conditions, wouldn’t it make sense to also nip those in the bud? Sounds logical.
But, as with many exuberant efforts, this one got out of control. Many lesions that were called “cancer” really were not cancers at all in behavior, and this fact began to be recognized in large numbers of patients. These unfortunate victims have experienced massive psychological and physical harm and costs without any clear benefits achieved by finding and treating their “non-cancers.”
And here’s the real kicker…
In the cases where a woman has a real, aggressive cancer, and the mammogram finds it, she still needs a biopsy. And that biopsy can end up spreading the cancer.
Overall, mammograms are ineffective for the population as a whole. And sometimes dangerous. They also contribute to the epidemic of over-diagnosis and over-treatment of cancers. This has helped feed the growing beast of today’s cancer industry.
As I pointed out earlier, when doctors diagnose and treat “false cancers,” it creates fake statistics that can show steady cancer death rates even in the false face of “rising” rates of cancer incidence. This illusion allows statisticians to claim a false victory in the war on cancer. But, as in the case of mammograms, nothing is changing the actual death rates.
Having said that, there are individual examples of women who discover they have breast cancer through their annual mammogram. Presumably, they would not have found it otherwise. Ultimately, the early detection made a real difference in their treatment and survival. (But, of course, we will never know what would have happened in any individual case if she had not gotten that mammogram. That’s why we do research to learn more about the real benefits of early cancer detection.)
I have also heard from fortunate women who are personally convinced they survived breast cancer because they got a mammogram. It is always great to hear of these success stories. However, these individual anecdotes do not equate to scientific evidence that routine mammograms offer superior results for screening among all women in the population. Especially when weighed against all the dangers.
We still need more options. And tomorrow I’ll tell you about a good alternative to mammography. I’ll also tell you some shocking financial facts about the breast cancer industry. Stay tuned.
Sources:
1. “Annual screening does not cut breast cancer deaths, suggests Canadian study,” British Medical Journal, published on-Line, 2/11/2014
2. “Annual Screening Does Not Reduce Death from Breast Cancer,” Medical News Today (www.medicalnewstoday.com) 2/12/2014
3. “Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement,” JAMA 2013;310(8):797-798
4. “Rethinking Screening for Breast Cancer and Prostate Cancer,” JAMA 2009;302(15):1685-1692
5. “Cancer? Not!” Medscape (www.medscape.com); Aug 29, 2013