Screening Our Way to a Cure?

Long before I became a reasonably healthy person, I told a friend that when I reached 40 years of age, I had no intention of undergoing mammogram screenings.

She looked at me like I had lost my mind.

“That’s so irresponsible.  If you don’t get them, you’re just asking for cancer!”

I countered that, well, I didn’t know all the details of the procedure exactly, never having gotten one.  But there was something that felt counter-intuitive about using a machine that emits radiation – a well-known cause of cancer – to possibly detect it.

She told me I was being ridiculous.

But the very same year I turned 40 – and turned healthy – the US Preventive Services Task Force actually reversed course on its mammogram recommendations.  Suddenly, the professionals were telling me to wait ten years for that first screening, and even to do it less often than previously recommended when the time came.  Till that point, my criticism of mammograms struck many as almost sacrilegious… or at least as off the charts as my criticism of standardized testing in public schools.  But the new recommendations from a bona fide panel of experts were sweet vindication indeed!

Of course now, I’m not so sure even those recommendations are the right ones.  In fact, my new declaration is that I never plan to undergo a mammogram.  There is too little evidence that the procedure does any good at all, too much evidence that it causes harm, and boatloads of proof that corporate interests are put well ahead of women’s health and well-being when it comes to promoting this particular screening.

Mammograms Are Not Effective

For years we’ve been told that mammograms are the best way to detect cancer early so we can take advantage of lifesaving treatments.  And yet between 1970 (about when mammograms were first used) and 1990, breast cancer diagnoses rose 24%.  Why?  Not because more women were developing breast cancer, but because mammograms were detecting more cancer.  On the surface, this seems like a good thing.  But it’s a deceptive statistic.

In 2009, Dr. Laura Esserman published an article in the Journal of the American Medical Association in which she and her team of researchers noted that diagnoses of cancer actually increased, and never decreased again, after mammography screening was introduced.  At first glance, one might reasonably assume that this means the cancers that would have been discovered later were just found earlier, thus giving women a better chance at life-saving treatment.  But in fact, what it means is that the screening found “cancers” that would not have been found otherwise – cancers that are neither aggressive nor invasive, and could quite safely remain undetected because they would never metastasize.  Deaths resulting from breast cancer did not drop on account of mammography screening, according to Esserman’s research.

Last October, perhaps the most damning indictment from medical researchers appeared in the Archives of Internal Medicine.  Researchers Dr. H. Gilbert Welch and Brittney A. Frankel from Dartmouth University published a study that they summed up by bluntly stating, “’Most women with screen-detected breast cancer have not had their life saved by screening. They are instead either diagnosed early (with no effect on their mortality) or overdiagnosed.”

What do they mean by the term “overdiagnosed?”  Basically, it refers to women who are treated as if they have an aggressive but treatable malignancy, but who in fact have a cancer that will not grow or spread, and is best left alone.  Dr. Welch states:

“Between 20% and 50% of women screened annually for a decade experience at least one false alarm requiring a biopsy. Most importantly, screening results in overdiagnosis. For every life saved by mammography, between two to ten women are overdiagnosed. Women who are overdiagnosed cannot benefit from unnecessary chemotherapy, radiation, or surgery. All they do experience is harm…. The presumption often is that anyone who has had cancer detected has survived because of the test, but that’s not true.  In fact, and I hate to have to say this, in screen-detected breast cancer, survivors are more likely to have been overdiagnosed than actually helped by the test.”

In other words, mammograms often find cancers that never needed to be found. One minute you’re a healthy person, the next minute, you’re a cancer “survivor.”  But if you never knew about the cancer, you never would have stopped identifying as a “healthy person.”  Danish researchers put it another way in an online report last November when they stated, “Avoiding getting screening mammograms reduces the risk of becoming a breast cancer patient by one-third.”   By one-third!  Of course, a mammogram may uncover a truly aggressive and invasive cancer, but odds are very good that form of cancer can’t be treated no matter how early you find it, and you will die from it regardless.  And you will die from it no later than you would have had you found the cancer later, you just will have known you have cancer for longer.

All these millions of mammograms have led to, indeed, a much greater awareness of breast cancer.  There are many more women aware of the fact that they have cancer because of mammograms, even cancers that are not invasive or aggressive – in other words, cancers they could live with.  Five and ten year survival rates for the more aggressive cancers may look like they have improved, but of course, if the cancer is detected earlier, it just looks like women are living longer with the disease.  A simple analogy would be the difference between being pushed off a 30 story building and being thrown from an airplane flying at 50,000 feet without a parachute.  For sure, you know you’re going to die once you hit the ground either way.  But the mammogram is a bit like being tossed from the airplane: you just have more time to live with knowing what’s coming.

Mammograms Cause Harm

Mammograms come with risks, and generally speaking, these are either not publicized, or downplayed as insignificant.  Again, the evidence says otherwise.  The radiation risks aren’t just clear.  They’re common sense.

According to the Cancer Prevention Coalition, “Radiation from routine mammography poses significant cumulative risks of initiating and promoting breast cancer. Contrary to conventional assurances that radiation exposure from mammography is trivial— and similar to that from a chest X-ray or spending one week in Denver, about 1/ 1,000 of a rad (radiation-absorbed dose)— the routine practice of taking four films for each breast results in some 1,000-fold greater exposure, 1 rad, focused on each breast rather than the entire chest. Thus, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads for each breast. As emphasized some three decades ago, the premenopausal breast is highly sensitive to radiation, each rad of exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of premenopausal screening, usually from ages 40 to 50; risks are even greater for ‘baseline’ screening at younger ages, for which there is no evidence of any future relevance. Furthermore, breast cancer risks from mammography are up to fourfold higher for the 1 to 2 percent of women who are silent carriers of the A-T (ataxia-telangiectasia) gene and thus highly sensitive to the carcinogenic effects of radiation; by some estimates this accounts for up to 20 percent of all breast cancers annually in the United States.”

These are disturbing figures.  In fact, many researchers have concluded that many more women, especially pre-menopausal women, are harmed by exposure to the radiation than are ever helped by finding a tumor in time to prescribe effective treatment through this procedure.

Interestingly, breast compression itself can be a dangerous practice.  Again the Cancer Prevention Coalition notes that as early as 1928, physicians knew to handle “cancerous breasts with care— for fear of accidentally disseminating cells” and spreading cancer.   And yet, as anyone who has undergone a mammogram can attest, the breast is handled in a way that can be described as anything but “with care.”  The forceful, even painful compression can lead to the spread of malignant cells by rupturing blood vessels surrounding small tumors.

This is bad enough.  But then we also have the issues of false positives and false negatives to deal with.  How many women have had to undergo repeated screenings because the doctor sees something suspicious and wants to confirm what it is (probably to avoid a lawsuit)?  The anxiety, the stress, and the repeated doses of radiation all conspire to negatively impact a woman’s health, as do the unnecessary drugs and even radical treatments like chemotherapy, radiation, and mastectomies that follow when a cancerous but non-lethal tumor is found.

On the other hand, because there is entirely too much faith placed in the almighty mammogram, when results come back normal, a woman might relax and feel confident she’s out of the woods.  Problem is, in women 40 to 49 years of age, mammography misses 30 percent of malignancies.  That’s a terrible statistic.  It’s a machine that far more often than not finds all the wrong tumors and fails to find the ones that matter.  And even when it finds the ones that do matter, it still finds them too late.

If You Don’t Get a Mammogram and Die, It’s Your Fault

If the Komen Foundation were truly honest about what it does, its slogan wouldn’t be “Race for the Cure.”  It would be “Race to Get Screened,” because that’s primarily where its focus lies.

Beware when any group claims to educate you, but is in fact spreading propaganda in order to line its own pockets.  As I mentioned in last week’s piece, Susan G. Komen for the Cure receives substantial funding and has stock options in companies, such as General Electric and Dupont, that are in the business of manufacturing mammogram equipment and supplies.   Two months ago, the organization came under fire from two medical researchers, again from Dartmouth University, for overstating the benefits of mammograms and failing to tell women about the risks.

They overstated them in a print ad that might easily be mistaken for a public service announcement, seemingly educating women in a helpful, unbiased way.

“What’s key to surviving breast cancer? YOU. Get screened now,” the ad says.

And so, if you die from breast cancer, whose fault is it?

Yours.

Drs. Lisa Schwartz and Steve Woloshin very convincingly called out the deception in a recent article in the British Medical Journal.   They argued that Komen was irresponsible in its assertion that mammograms are the primary, if not only, way women can save themselves from breast cancer, and that their ads are misleading because they fail to acknowledge the risks.

“The breast cancer advocacy group Susan G. Komen for the Cure ignores these risks and uses misleading data in mammogram campaigns,” the authors say.

The misleading data in question?  This outrageous claim:

“Early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.”

Of course, it’s nowhere near that simple, and all the evidence I’ve pointed to earlier in this piece demonstrates what a ridiculous statement this is.  But the ad is taken apart in the British Medical Journal as follows.

Says Komen:  “What’s the key to surviving breast cancer?  You!”

Not so, say the researchers!  “Screening mammography does not guarantee that a woman will ‘survive’ breast cancer.  The best evidence indicates that it decreases the chance that a 50 year old woman will die from breast cancer in the next 10 years roughly from 0.53% to 0.46%… a difference of 0.07 percentage points.   Because breast cancer treatments are much more effective now than when trials of screening were done, some experts question whether screening mammography has any benefit.”

Says Komen:  “Early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.”

Not so, say the researchers!  “The five year survival rate for early and late stage cancers tells you nothing about the benefit of screening.  Because of biases caused by lead time (the time from diagnosis by screening to when a tumour can be felt) and overdiagnosis, five year survival can improve regardless of whether cancer mortality is increased, decreased, or unchanged by screening.”

There Is Real Hope

“You can’t expect from mammography what it cannot do,” says Dr. Laura Esserman, director of the breast care center at the University of California, San Francisco and author of the first study cited above. “Screening is not prevention. We’re not going to screen our way to a cure.”

That’s for sure.  So if mammograms are marginally worthwhile for a very small percentage of women at best, and harmful to many more of us at worst, what are our options?

The fact is, there are plenty of powerful ways to really make a difference when it comes to prevention and treatment of breast cancer.  None of them involve expensive physician visits, exposure to radiation, or painful breast compressions.

But the “cure” may be closer than you think.

Check back next week for the final piece in my series.

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3 thoughts on “Screening Our Way to a Cure?

  1. I agree with you Sue- but there are other ways…check out thermograms.. thermograms are non-invasive and if there are any potential issues, a thermogram will identify this a lot earlier than any mamogram. Furthermore, they are not just for breasts but can more clearly identify any potential issues throughout the body.
    The only issue is that they are not generally covered by insurance- of course not!!!! but they are not cost prohibitive either.
    Thank you

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