Risk of a Mammogram

While the controversy over mammograms continues to rage, I’m frequently asked my opinion on this topic.

I am sure that whatever my position is on this controversy, it can be refuted from the medical literature. There are literally thousands of medical articles defending or offending either side. This situation is similar to that of cholesterol drugs, steroids, chemotherapy, etc., which also have enormous support as well as opposition.

So what do I base my opinion on? I base it on the following irrefutable facts:
A. We know radiation produces cancer.
B. We know mammograms produce radiation.
C. We know the damage of radiation is cumulative—it adds up with each exposure.
D. We know the statistics show that screening mammograms do not reduce the risk of dying from breast cancer.

So what do I do when faced with the decision of ordering a mammogram on my patient, or sister, or daughter? I consider the individual case, and go from there.

First, is it a screening mammogram or a diagnostic one? I basically do not order screening mammograms; that is, a routine, yearly screening where there is no suspicion of disease. That’s particularly true of women under 50. I believe manual exams, ultrasounds and thermography are better choices.

Diagnostic mammograms, on the other hand, are useful when there is a suspicious lump, particularly on high risk women (family history of breast cancer, hormone treatment, etc.).

I believe that if an experienced physician feels a lump that has cancer-like characteristics, and orders a mammogram, you should have one done. In such a case, a mammogram is really one of the best tests, followed by a biopsy, if the mammogram is positive. If I feel a lump on the breast, and if it has suspicious characteristics, I will order a mammogram. Diagnosis, however, is only securely established by a biopsy. No imaging technique or physical exam can, with a high degree of accuracy, diagnose a lump under the intact skin.

Please peruse some of the latest literature below.

Dangers of Mammography

Mammography poses a wide range of risks of which women worldwide still remain uninformed. Read “Mammography’s Mixed Blessings” by Seaman and Epstein.

(Mercola.com) The Nordic Cochrane Center has put out a leaflet that every woman should read, explaining the potential benefits and potential harms of mammography. They point out that recent studies suggest mammography screening is not effective in reducing your risk of dying from breast cancer. And in fact, screening creates breast cancer patients out of healthy women who would never have developed symptoms. Treatment of these healthy women increases their risk of dying from heart disease and, yes, cancer itself.

For example, after systematically reviewing the randomized trials of mammography, the authors concluded that: If 2,000 women are screened regularly for 10 years, one will benefit from screening […]. Since these trials were undertaken, treatment of breast cancer has improved considerably. Women today also seek medical advice much earlier than previously, if they have noted anything unusual in their breasts… Because of these improvements, screening is less effective today and newer studies suggest that mammography screening is no longer effective in reducing the risk of dying from breast cancer.” … Since it is not possible to tell the difference between the dangerous and the harmless cell changes and cancers, all of them are treated. Therefore, screening results in treatment of many women for a cancer disease they do not have, and that they will not get. Based on the randomized trials, it appears that:

“If 2,000 women are screened regularly for 10 years, 10 healthy women will be turned into cancer patients and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and they will often receive radiotherapy, and sometimes chemotherapy. Treatment of these healthy women increases their risk of dying, e.g. from heart disease and cancer.”

Radiation Risks
Radiation from routine mammography poses significant cumulative risks of initiating and promoting breast cancer (1– 3). 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 (2). 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 (4); 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 (5); by some estimates, this accounts for up to 20 percent of all breast cancers annually in the United States (6).

Cancer Risks from Breast Compression
As early as 1928, physicians were warned to handle “cancerous breasts with care— for fear of accidentally disseminating cells” and spreading cancer (7). Nevertheless, mammography entails tight and often painful compression of the breast, particularly in premenopausal women. This may lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small, yet undetected breast cancers (8).

Delays in Diagnostic Mammography
As increasing numbers of premenopausal women are responding to the ACS’s aggressively promoted screening, imaging centers are becoming flooded and overwhelmed. Resultingly, patients referred for diagnostic mammography are now experiencing potentially dangerous delays, up to several months, before they can be examined (9).

REFERENCES

  1. Gofman, J. W. Preventing Breast Cancer: The Story of a Major Proven Preventable Cause of this Disease. Committee for Nuclear Responsibility, San Francisco, 1995.
  2. Epstein, S. S., Steinman, D., and LeVert, S. The Breast Cancer Prevention Program, Ed. 2. Macmillan, New York, 1998.
  3. Bertell, R. Breast cancer and mammography. Mothering, Summer 1992, pp. 49– 52.
  4. National Academy of Sciences– National Research Council, Advisory Committee. Biological Effects of Ionizing Radiation (BEIR). Washington, D. C., 1972.
  5. Swift, M. Ionizing radiation, breast cancer, and ataxia-telangiectasia. J. Natl. Cancer Inst. 86( 21): 1571– 1572, 1994.
  6. Bridges, B. A., and Arlett, C. F. Risk of breast cancer in ataxia-telangiectasia. N. Engl. J. Med. 326( 20): 1357, 1992.
  7. Quigley, D. T. Some neglected points in the pathology of breast cancer, and treatment of breast cancer. Radiology, May 1928, pp. 338– 346.
  8. Watmough, D. J., and Quan, K. M. X-ray mammography and breast compression. Lancet 340: 122, 1992.
  9. Martinez, B. Mammography centers shut down as reimbursement feud rages on. Wall Street Journal, October 30, 2000, p. A-1.

Excerpted from “Dangers and Unreliability of Mammography: Breast Examination is a Safe, Effective and Practical Alternative”, in International Journal of Health Services, Volume 31, Number 3, Pages 605– 615, 2001 2001, Baywood Publishing Co., Inc.

According to updated guidelines set forth by the U.S. Preventive Services Task Force, women in their 40’s should not get routine mammograms for early detection of breast cancer.

The group’s previous recommendation was for routine screenings every year or two for women age 40 and older. They now recommend that before having a mammogram, women ages 40 to 49 should talk to their doctors about the risks and benefits of the test, and then decide if they want to be screened.

While roughly 15 percent of women in their 40’s detect breast cancer through mammography, many other women experience false positives, anxiety, and unnecessary biopsies as a result of the test, according to data.

The Obama administration distanced itself from the new standards, saying government insurance programs would continue to cover routine mammograms for women starting at age 40.

Dr. Mercola’s Comments:

A new recommendation from the U.S. Preventive Services Task Force is stirring up controversy in the conventional medical community, where the long-held advice was for women to get a mammogram every year or two after age 40.

Now the Task Force has revised their recommendation, saying that women in their 40s should not get routine mammograms.

The new advice is a small step in the right direction, but many are up in arms, fearing a decrease in mammograms will put women’s lives at risk from breast cancer, or that insurance companies will stop covering the procedure until a woman reaches age 50.

What is being completely overlooked by the majority of media outlets, however, is the reason WHY the Task Force decided to trim their mammogram recommendation. The prior advice was given in 2002, before a host of new research came out showing the problems of overdiagnosis, including false positives.

Back in 2001, around the time that U.S. health officials widened the use of mammograms to include women over 40 (previously it was only women over 50), a Danish study published in The Lancet revealed some startling data. The study concluded that previous research showing a benefit was flawed and that widespread mammogram screening is unjustified.

The fact that mammograms are still recommended at all speaks volumes about the state of modern medicine. Decades ago in 1974, the National Cancer Institute (NCI) was warned by professor Malcolm C. Pike at the University of Southern California School of Medicine that a number of specialists had concluded “giving a women under age 50 a mammogram on a routine basis is close to unethical.”

Why is Routine Mammography “Unethical”?
For starters mammograms expose your body to radiation that can be 1,000 times greater than that from a chest x-ray, which poses risks of cancer. Mammography also compresses your breasts tightly, and often painfully, which could lead to a lethal spread of cancerous cells, should they exist.

Dr. Samuel Epstein, one of the top cancer experts, stated: “The premenopausal breast is highly sensitive to radiation, each 1 rad exposure increasing breast cancer risk by about 1 percent, with a cumulative 10 percent increased risk for each breast over a decade’s screening.”

Dr. Epstein, M.D., professor emeritus of Environmental and Occupational Medicine at the University of Illinois School of Public Health and chairman of the Cancer Prevention Coalition, has been speaking out about the risks of mammography since at least 1992. As for how these misguided mammography guidelines came about, Epstein says: “They were conscious, chosen, politically expedient acts by a small group of people for the sake of their own power, prestige and financial gain, resulting in suffering and death for millions of women. They fit the classification of “crimes against humanity.”

Not surprisingly, as often happens when anyone dares speak out against those in power, both the American Cancer Society and NCI called Dr. Epstein’s findings “unethical and invalid.”

But this didn’t stop others from speaking out as well.

  • In July 1995, The Lancet again wrote about mammograms, saying “The benefit is marginal, the harm caused is substantial, and the costs incurred are enormous …”
  • Dr. Charles B. Simone, a former clinical associate in immunology and pharmacology at the National Cancer Institute, said, “Mammograms increase the risk for developing breast cancer and raise the risk of spreading or metastasizing an existing growth.”
  • “The high sensitivity of the breast, especially in young women, to radiation-induced cancer was known by 1970. Nevertheless, the establishment then screened some 300,000 women with x-ray dosages so high as to increase breast cancer risk by up to 20 percent in women aged 40 to 50 who were mammogramed annually,” wrote Dr. Epstein.

Mammograms Often Give False Positives
Aside from the radiation risks, mammograms carry a first-time false positive rate of up to 6 percent. False positives can lead to expensive repeat screenings and can sometimes result in unnecessary invasive procedures including biopsies and surgeries.

Just thinking you may have breast cancer, when you really do not, focuses your mind on fear and disease, and is actually enough to trigger an illness in your body. So a false positive on a mammogram, or an unnecessary biopsy, can really be damaging. Not to mention that women have unnecessarily undergone mastectomies, radiation and chemotherapy after receiving false positives on a mammogram.

What about Breast Self-Exams?
The revised U.S. Preventive Services Task Force recommendations also discourage doctors from teaching breast self-examination (BSE). BSEs have long been recommended as a simple way for women to keep track of anything unusual in their breasts. However, studies have found that such exams do not reduce breast cancer death rates, and actually increase the rate of unnecessary biopsies. So the problem with breast self-exams is that it typically forces women into a conventional, and potentially dangerous, diagnostic model, as if you do find something unusual, you will typically be brought in for a mammogram.

A Safer Breast Screening Option
Most physicians continue to recommend mammograms for fear of being sued by a woman who develops breast cancer after he did not advise her to get one. However, research demonstrates that adding an annual mammogram to a careful physical examination of the breasts does not improve breast cancer survival rates over getting the examination alone.

I encourage you to think for yourself and consider safer, more effective alternatives to mammograms.

The option for breast screening that I most highly recommend is called thermographic breast screening. Thermographic screening is brilliantly simple. It measures the radiation of infrared heat from your body and translates this information into anatomical images. Your normal blood circulation is under the control of your autonomic nervous system, which governs your body functions.

Thermography uses no mechanical pressure or ionizing radiation and is pain free! More men’s lives could also be spared from the disease as mammography is not frequently used on men, which leads to most men with breast cancer being diagnosed at a very late stage.

Mammography cannot detect a tumor until after it has been growing for years and reaches a certain size, but thermography is able to detect the possibility of breast cancer much earlier, because it can image the early stages of angiogenesis (the formation of a direct supply of blood to cancer cells, which is a necessary step before they can grow into tumors of size).

Top Breast Cancer Prevention Tips

Women have a one in eight chance of developing breast cancer during their lifetime. In fact, breast cancer is the most common cancer among women — except for skin cancers — and the second leading cause of cancer death in women, exceeded only by lung cancer.

The American Cancer Society estimates that over 192,000 new cases of the disease will be diagnosed in women in 2009, and over 40,000 will die from it.

While screening tools can help you to detect breast cancer, they obviously do nothing to help prevent the disease, and this latter strategy is the best one for avoiding cancer.

Researchers estimate that about 40 percent of U.S. breast cancer cases, or about 70,000 cases every year, could be prevented by making lifestyle changes.

A healthy diet, physical exercise, optimized vitamin D levels and an effective way to manage your emotional health are the cornerstones of just about any cancer prevention program.

It’s also important to make sure you’re getting sufficient amounts of animal-based omega-3 fats such as krill oil. Two studies from 2002 offer explanations for how omega-3 fats can protect against breast cancer. BRCA1 (breast cancer gene 1) and BRCA2 (breast cancer gene 2) are two tumor suppressor genes that, when functioning normally, help repair DNA damage (a process that also prevents tumor development).

Earlier research had discovered that women who carry mutated versions of these two genes are at higher risk of developing both breast and ovarian cancer than women who do not have these genetic mutations. Currently, women with BRCA1 mutations account for about 5 percent of all breast cancer cases. Omega-3 and omega-6 fats have been found to influence these two genes.

Omega-3 fats tend to reduce cancer cell growth while highly processed and toxic omega-6 fats have been found to cause cancer growth.

Three additional steps that can lower your breast cancer risk as well include:

  • Not drinking alcohol, or limiting your drinks to one a day for women
  • Breastfeeding exclusively for up to six months
  • Watching out for excessive iron levels. This is actually very common once women stop menstruating. The extra iron actually works as a powerful oxidant, increasing free radicals and raising your risk of cancer.

All you need to do is measure your ferritin level and if it is above 80, donate blood, which will reduce the amount of iron that you have and thereby lower your cancer risk.

Dr. Mercola’s Comments:

Your doctor isn’t telling you about this painless and non-invasive breast cancer screening test that’s been shown to prevent cancer, not just find it. Instead, your doctor probably advises you to undergo mammograms, despite their known health hazards..

 

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