THE WYSONG e-HEALTH LETTER 999
~Thoughts for Thinking People~

 

BREAST CANCER SCREENING

It is commonly assumed that breast cancer screening is beneficial and saves lives.  Both the medical profession and the government promote it.  But, as we so often discover, when the majority agree, it’s time to take a closer look.

First off, keep in mind that screening for a disease is not prevention. It is rescue medicine, medicine after the fact. It also assumes that detection by doctors means a cure by a doctor is at hand.

But there is no established breast cancer cure that medicine has to offer. Both prevention and cure lie in the life choices a person makes. And the best way to achieve health is to follow the Optimal Health Program.

The following is a review of the literature on breast cancer screening. First there are the articles that putatively demonstrate benefits. I follow with the articles that say the exact opposite.

Use this information to make informed decisions about screening and to provide to your physician if he/she insists on the unequivocal benefits.

Pro-screening
Berry, D.A., et al. Effect of Screening and Adjuvant Therapy on Mortality of Breast Cancer. The New England Journal Of Medicine, 353, (2005), 1784-1792.
http://content.nejm.org/cgi/content/abstract/353/17/1784

This study used an unorthodox method to arrive at conclusions. I have pulled out a few sentences to show the ambiguity and guesswork that saturates it. The results (even if they indicate benefits for the study group) cannot be accurately extrapolated to indicate benefits for the population.

* Because the increasing use of adjuvant therapies and screening occurred over nearly the same periods, distinguishing between the two effects is not easy.

*Although the conclusions of these models are qualitatively similar, their estimates vary. This variability is not surprising, given the diversity of the modeling approaches and assumptions.

*The extent to which these benefits translate to the population outside the controlled conditions of clinical trials is unknown.

Rebuttal:
Epstein, S., et al. Dangers and Unreliability of Mammography: Breast Examination Is a Safe, Effective, and Practical Alternative.  Int. J Health Services, 31, (2001), 605-615.

Summary:  Discusses flaws in mammography and its ineffectiveness; gives specific information about how different densities in breast tissue can render problems for many women; and all breast tissue (regardless of density) is sensitive to radiation.  This reference, then, specifically cites not only that mammography is ineffective but dangerous.

*Mammography has several negative features: inaccuracy, carcinogenic effect of radiation, over-diagnosis and over-treatment of ductal carcinoma-in-situ (DCIS), and high cost.

*Mammography results in missed tumors as well as a high number of false positives, "resulting in needless anxiety, more mammograms, and unnecessary biopsies.” The sensitivity of breast tissue to radiation has been known for decades.

*While many women are aware that false positive results can occur with mammography, few know that mammography can identify a type of cancer that usually does not progress. The authors say that this ‘over-diagnosis' often leads to over-treatment with surgery, radiation, and/or chemotherapy—and certainly skews mortality statistics since the claim can be made of improved cancer cure and decreased mortality when in fact there was no life-threatening disease in the first place.

*The American Cancer Society admitted in 1985, that "at least 90% of the women who develop breast carcinoma discover the tumors themselves.”

Pro-screening
National Cancer Institute, Breast Cancer Screening (PDQ®), PDQ Summary
http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessional

This reference gives a brief statement of benefit that “based on fair evidence, screening mammography … decreases breast cancer mortality.  The benefit is higher for older women, in part because their breast cancer risk is higher.”  Absolute benefit is approximately 1% overall but depends on inherent breast cancer risk, which rises with age.  Most of the content of this reference cites harms associated with screening based on solid evidence:

*Treatment of insignificant cancers (overdiagnosis, true positives) can result in breast deformity, lymphedema, thromboembolic events, new cancers, or chemotherapy-induced toxicities.

*Approximately 33% of breast cancers detected by screening mammograms represent overdiagnosis.

*Additional testing (false-positives) is estimated to occur in 50% of women screened annually for 10 years, 25% of whom will have biopsies.

*False sense of security, delay in cancer diagnosis (false-negatives).

*6% to 46% of women with invasive cancer will have negative mammograms, especially if young, with dense breasts, or with mucinous, lobular, or fast-growing cancers.

*Radiation-induced mutations can cause breast cancer, especially if exposed before age 30 years. Latency is more than 10 years, and the increased risk persists lifelong.

*Between 9.9 and 32 breast cancers per 10,000 women exposed to a cumulative dose of 1 Sv. Risk is higher for younger women.

Rebuttal:
Williams, R. Breast Cancer and Xenoestrogens. The Townsend Letter, 256 (2004), 45-47.
http://www.townsendletter.com/Nov2004/enviroissues1104.htm

This study specifies danger associated with mammography; also offers close analysis of the conclusions derived from earlier “pro-screening” studies.  Asks the question of how ethical it is to urge women of high risk to purposefully expose themselves to radiation of the breast, when radiation exposure is the only proven cause of breast cancer.

*Repeated mammograms might actually damage DNA in breast tissue, and increase a women's risk of developing breast cancer at a later time in her life.

*Mammograms for women between the ages of 40 and 49 with no symptoms may increase deaths from breast cancer within ten years after the first screening, as reported in the October 2003 Journal of the National Cancer Institute (JNCI).

*New findings indicate that mammogram screening for women over age 50 does not result in lower breast cancer deaths.

*Scientists have looked at all the published studies of screening mammography and found the studies which reported the highest benefit to women, were the most flawed in their methods, whereas studies like the large Canadian study that reported no benefits from mammography were the most reliable.

*A wiser approach would be to help these women, and all women, learn about environmental risk factors and provide them with information on ways to reduce or eliminate many unnecessary toxic exposures. Promoting alternative diagnostic tools to mammography would also be of great benefit.

Additional resources saying similar:
Gofman, J., MD, PhD, Preventing Breast Cancer: The Story of a Major, Proven, Preventable Cause of This Disease, CNR Bks., PO Box 421993, SF, CA 04142, 1996.

Wolfe, S., MD, "Breast Cancer: New Information About Screening Mammography and Genetics," Health Letter, Public Citizen Health Research Group, (www.citizen.org/hrg/), Wash., DC, Vol. 20, No. 1, Jan 2004.

Spanier, B., "Do Annual Mammograms Save Lives?" Capital Region Action Against Breast Cancer (www.craab.org 518–435–1055), Vol. 6, No. 3, Summer 2004.

Pro-screening
Screening for Breast Cancer. February 2002. U.S. Preventive Services Task Force.
http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm

This task force makes recommendations about breast cancer screening based on weak evidence (fair at best). 

*It is interesting that this study finds the evidence sufficient to recommend mammography, yet the benefits of clinical breast examination alone were considered indeterminable (“insufficient evidence”). 

*The task force concludes that the evidence is insufficient to recommend for or against routine CBE and to recommend for or against teaching or performing self-examination.

Rebuttal:
McKinlay, J. B., et al. The questionable contribution of medical measures to the decline of mortality in the United States in the twentieth century. Milbank Mem. Fund Q Health, 55 (1997), 405-428.

Summary: Analysis of United States data shows that introduction of specific medical measures and expansion of services account for only a miniscule fraction of the decline in mortality since 1900.

Faguet, G. The war on cancer: An anatomy of failure, a blueprint for the future.  New York: Sprinter Publishing, 2005.

Summary (book description from amazon.com): The author exposes the antiquated notions that have driven cancer drug development, documents the stagnation in treatment outcomes despite major advances in cancer genomics and growing NCI budgets, and identifies the multiple factors that sustain the status quo. He shows that, contrary to frequent announcements of breakthroughs, our current cancer control model cannot eradicate most cancers and explains the reasons why.       

(Wolfe and Boyd cite issues with radiation impacting breast tissue and other associated harms, all discuss actual effectiveness of screening in reducing mortality from breast cancer):

Wolfe JN. Risk for breast cancer development determined by mammographic parenchymal pattern. Cancer, 37 (1976), 2486-92.

Byrne C, Schairer C, Wolfe J, et al. Mammographic features and breast cancer risk: effects with time, age, and menopause status. J Natl Cancer Inst, 87 (2005), 1622-9.

Boyd NF, Dite GS, Stone J, et al. Heritability of mammographic density, a risk for breast cancer. The New England Journal of Medicine, 347 (2002), 886-94.

More Anti-screening Resources
A lot of excellent information available here: http://www.newstarget.com/010886.html

*Despite better technology and decreased doses of radiation, scientists still claim mammography is a substantial risk. Dr. John W. Gofman, an authority on the health effects of ionizing radiation, estimates that 75 percent of breast cancer could be prevented by avoiding or minimizing exposure to the ionizing radiation. This includes mammography, x-rays and other medical and dental sources.

*Since mammographic screening was introduced, the incidence of a form of breast cancer called ductal carcinoma in situ (DCIS) has increased by 328 percent. Two hundred percent of this increase is allegedly due to mammography. In addition to harmful radiation, mammography may also help spread existing cancer cells due to the considerable pressure placed on the woman's breast during the procedure. According to some health practitioners, this compression could cause existing cancer cells to metastasize from the breast tissue.

*In his book, "Preventing Breast Cancer," Dr. Gofman says that breast cancer is the leading cause of death among American women between the ages of forty-four and fifty-five. Because breast tissue is highly radiation-sensitive, mammograms can cause cancer. The danger can be heightened by a woman's genetic makeup, preexisting benign breast disease, artificial menopause, obesity, and hormonal imbalance.

*International studies have shown that routine premenopausal mammography is associated with increased breast cancer death rates at older ages. Factors involved include: the high sensitivity of the premenopausal breast to the cumulative carcinogenic effects of mammographic X-radiation; the still higher sensitivity to radiation of women who carry the A-T gene; and the danger that forceful and often painful compression of the breast during mammography may rupture small blood vessels and encourage distant spread of undetected cancers.