More on the Dangers of Mammography

Recent confirmation by Danish researchers of longstanding evidence on the ineffectiveness of screening mammography has been greeted by extensive nationwide headlines. Entirely missing from this coverage, however, has been any reference to the well-documented dangers of mammography.

Screening mammography poses significant and cumulative risks of breast cancer for pre-menopausal women. The routine practice of taking four films of each breast annually results in approximately 1 rad (radiation absorbed dose) exposure, about 1,000 times greater than that from a chest x-ray.

The pre-menopausal 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. These risks are even greater for younger women subject to "baseline screening."

Radiation risks are some four-fold greater for the 1 to 2 percent of women who are silent carriers of the A-T (ataxia-telangiectasia) gene; by some estimates this accounts for up to 20 percent of all breast cancers diagnosed annually.

Since 1928, physicians have been warned to handle "cancerous breasts with care -- for fear of accidentally disseminating cells" and spreading the cancer. Nevertheless, mammography entails tight and often painful breast compression, particularly in pre-menopausal women, which could lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small undetected breast cancers.
Missed cancers are common in pre-menopausal women owing to their dense breasts, and also in postmenopausal women on oestrogen replacement therapy.

Mistakenly diagnosed cancers are common. For women with multiple risk factors including a strong family history and early menarche -- just those strongly urged to have annual mammograms -- the cumulative risks of false positives can reach as high as 100 percent over a decade's screening.

The widespread acceptance of screening has lead to over diagnosis of pre-invasive cancer (ductal carcinoma in situ), sometimes treated radically by mastectomy and radiation, and even chemotherapy.

As increasing numbers of pre-menopausal women are responding to aggressively promoted screening, imaging centres are becoming flooded. Resultingly, patients referred for diagnostic mammography are now experiencing potentially dangerous delays, up to several months, before they can be examined.

The dangers and unreliability of screening are compounded by its growing and inflationary costs. Screening all pre-menopausal women would cost $2.5 billion annually, about 14 percent of estimated Medicare spending on prescription drugs.

These costs would be increased some fourfold if the highly profitable industry, enthusiastically supported by radiologists, succeeds in replacing film machines, costing about $100,000 each, with the latest high-tech digital machines recently approved by the FDA, costing about $400,000 each, for which there is no evidence of improved effectiveness.

The ineffectiveness and dangers of mammography pose an agonizing dilemma for the millions of women anxious for reassurance of early detection of breast cancer. However, the dilemma is more apparent than real.

As proven by a September 2000 publication, based on a unique large-scale screening study by University of Toronto epidemiologists, monthly breast self-examination (BSE) following brief training, coupled with annual clinical breast examination (CBE) by a trained health care professional, is at least as effective as mammography in detecting early tumours, and also safe.

National networks of BSE and CBE clinics staffed by trained nurses should be established to replace screening mammography. Apart from their minimal costs, such clinics would empower women and free them from increasing dependence on industrialized medicine and its complicit medical institutions.
Samuel S. Epstein, M.D. Professor Emeritus Environmental and Occupational Medicine Chairman, Cancer Prevention Coalition University of Illinois at Chicago School of Public Health 312-996-2297 Web site: http://www.preventcancer.com

For further details and supporting documentation, see "Dangers and Unreliability of Mammography: Breast Examination is a Safe, Effective and Practical Alternative," by Samuel S. Epstein, Barbara Seaman and Rosalie Bertell, International Journal of Health Services, volume 31(3):605-615, 2001.

Expert Panel Cites Doubts on Mammogram's Worth

An independent panel of experts said January 24 that there was insufficient evidence to show that mammograms prevented breast cancer deaths. The group, which meets regularly to assess evidence on cancer and provide that information to doctors and to the public, said that while it was possible that mammograms were beneficial, it was also possible that they were not.

The group, called the P.D.Q. screening and prevention editorial board, agreed here today that seven large studies of mammography had serious flaws, weakening or casting doubt on the studies' validity.

The group, which writes information for the National Cancer Institute's online database, said that it would rewrite previous statements to reflect its new view. Previously, the group, which does not make specific recommendations for medical practices, had said that the evidence showed that mammograms prevented breast cancer deaths starting at age 40.

The decision by this group clouds a continuing debate over whether women should have regular mammograms. Since 1997, the National Cancer Institute has also recommended that women have regular mammograms, starting in their 40's.

For now, the cancer institute, whose new director, Dr. Andrew C. von Eschenbach, was sworn in on January 22, has not announced any plans to revisit the issue, raising the question of whether the Institute will end up with conflicting information on its Web site, with one statement saying that the screening is beneficial and another saying that those benefits have not been proved.

The institute's Web site, www.cancer.gov, says that women in their 40's and older should have the test and that it reduces the breast cancer death rate by as much as 30 percent.

Members of the P.D.Q. board said they knew that it was not going to be easy for women and doctors to decide what to do. At the meeting, the members wrestled with the question of how much benefit, if any, mammograms confer. Some, like the board chairman, Donald A. Berry, chairman of the department of biostatistics at M. D. Anderson Cancer Centre in Houston, said they thought it was unlikely that there were benefits that could make the test worthwhile.

But others said that they were uncertain and that they were having a hard time coming to terms with the profound flaws they now saw in studies they had thought put mammograms on solid ground. "What this new material has contributed is a softening, at least in my mind, of what I thought was true," said Dr. Isra Levy of the Canadian Medical Association. "I still think that for women aged 50 to 69 there might be something there. But we've had our confidence shaken."

In the end, the group decided not to deal with age, saying doubts persisted for women of all ages.

The group focused on flaws in the studies that were recently uncovered by two scientists in Denmark. The report, published in October by Dr. Peter C. Gotzsche and Ole Olsen of the Nordic Cochrane Centre in Copenhagen, concluded that the case for the screening was unproven.

The studies were so poorly designed and carried out that they might have found benefits when there were none or exaggerated what benefits there were, the researchers said. None of the studies found that mammography prolonged life, and even when the studies were analysed as a group, women who had the test lived no longer, dying of diseases other than breast cancer.

Some experts have taken issue with Dr. Gotzsche and Mr. Olsen's analysis. But today, the P.D.Q. Board said it believed that the scientists had found serious problems. The board's assessment of mammography is expected to be posted on the cancer institute's Web site in April.

The P.D.Q. Board said it would like to see others take on a detailed and independent analysis of the mammography studies and that some of the data that might settle questions about the quality of the studies could be obtained with difficulty.

The issue of whether women should have mammograms has been controversial for some time. In January 1997, when an independent panel convened by the National Institutes of Health took on the question of mammograms for women in their 40's, Congress got involved.

That panel said then that there was no evidence that the test prevented breast cancer deaths in women under 50 and suggested that those women discuss mammograms with their doctors before deciding to have one.

Before the week was over, the panel's chairman, Dr. Leon Gordis of the Johns Hopkins University, had been summoned by Senator Arlen Specter to testify before Congress. Later, going against the conclusions of the panel convened at its behest, the cancer institute said women in their 40's should have mammograms.

The P.D.Q. Board, which issues its statements independently, has also said over the last several years that mammograms prevent breast cancer deaths for women in their 40's. Today, the P.D.Q. Board emphasized that mammograms have drawbacks, leading at times to excessive treatments for tumours that would not have threatened a woman's life.

The group agreed that doctors should respect a woman's decision, adding that it was rational to decide to have mammograms and that it was rational to decide not to. Whatever they decided, Dr. Berry said in a telephone interview on Tuesday that he was acutely aware of the difficulty in questioning an enormous mammography business.

"Screening programs bring in patients," Dr. Berry said. "It isn't just the mammography, but it's the biopsies, the surgeries and the like. We know that screening is exquisitely fine at finding cancers. Therefore it brings in patients and they demand treatment."

The problem, he said, is if the women who have mammograms fare no better, or do even worse because of excessive treatment, than women who are not screened.
New York Times January 24, 2002

DR. MERCOLA'S COMMENT:
The New York Times is one of the best newspapers in the US. This is their second recent article on this topic. Now, it appears that even the National Cancer Institute is willing to say that mammograms don't work. It seems that the writing is on the wall. Save yourself the expense and danger and replace your mammograms with regular self breast exams.

You really don't have to be a nuclear physicist and physician to understand that mammograms (x-rays) cause cancers, but it helps. Dr. Gofman is a nuclear physicist and a medical doctor and that is his conclusion.

Mammography is a perfect example of modern medicine "putting the cart before the horse." Although there is no evidence that it saves lives, that is exactly what everyone is led to believe.

CTM Comment:

In addition to Dr Mercola's comments, the quoted Dr John Gofman has this to say about mammograms:

"Breast cancer is a largely PREVENTABLE disease, and we reach that good news because of our finding that a large share of recent and current breast cancer in the United States is CERTAINLY due to past medical irradiation of the breasts with x-rays - at all ages, including infancy and childhood. Much of today's radiation dosage is preventable, without any interference with necessary diagnostic radiology, and hence many future breast cancers need not occur."

Professor Samuel Epstein concurs with the risks mammograms and x-rays in general pose for the unknowing patient:

"X-rays are carcinogenic. The more X-rays you submit to and the greater the dose, the greater is your risk of cancer… Whatever you may be told, refuse routine mammograms to detect early breast cancer, especially if you are pre-menopausal. The X-rays may actually increase your chances of getting cancer…. Very few circumstances, if any, should persuade you to have X-rays taken if you are pregnant. The future risks of leukaemia to your unborn child, not to mention birth defects, are just not worth it."
(excerpted from Health Wars by Phillip Day - www.credence.org)