Mamograms

I am deeply concerned about the recommendation sent out for women to get "free mammograms" and encourage other women to do so over the internet. There are very serious shortcomings associated with mammograms, many of which are unknown to the average woman and given little if any attention my the medical industry. It is a woman's choice whether or not to have a mammogram, and she can only make a wise choice if she is well informed about the potential risks and shortcomings of this diagnostic tool. Below I have included a direct extraction from my book The Truth About Breast Cancer. This chapter is devoted to mammography and the facts that every woman needs to consider in deciding whether to have one or not. If you do not have the time or interest to read the following chapter, at least know the following:

Mammograms DO NOT prevent cancer

Mammograms have a failure rate as high as 40 percent (this means they fail to reveal an existing cancer)--most frequently this is in younger women (under 40) due to greater tissue density when mammograms do detect cancer, more often than not, it is not an early dectection, as the publicity leads women to believe. In fact most cancers detected via mammography are at least a decade old. At this age, the cancer may well have metasticised (spread elsewhere in the body)

Mammograms expose women to ionizing radiation---an indisputable human carcinogen. This fact is documented in basic biology text books!

In the Lancet (8 /355; 9198--pp129-34---this year) Danish researchers concluded "there is no reliable evidence that [mammographic] screening decreases breast cancer mortality." . It involved half a million women in the US and abroad. In two of the best controlled trials (out of six) it was clearly shown there was no survival benefit. This study comes on the heals of the 1999 Swedish study which basically came to the same conclusion.

PLEASE READ ON:

Sincerely, Dr. Joseph Keon Author, The Truth About Breast Cancer www.preventingbreastcancer.com

(the numbers appearing at the end of text refers to documentation (citations) from the original publication--there are over 300 citations in the second edition that was released this week).

The Uncertainties of Mammography

As the previously mentioned survey indicated, the role of mammography is largely misunderstood. The effectiveness and risks associated with mammography are also largely a mystery to women. Mammography is the primary and often only thing women think of when considering their risk of breast cancer. I feel it is essential that this tool and its shortcomings be defined before you read about any of the other risk factors in this book.

A quotation from The Lancet states: "The benefit [of mammography] is margina l, the harm caused is substantial, and the costs incurred are enormous." After completing this chapter, perhaps you will concur. This chapter should make it abundantly clear that prevention, and not the hope of "early detection," is our best strategy in contending with breast cancer. The National Cancer Institute (NCI) estimates that $2 billion is spent annually for breast cancer screening in the U.S. General Electric sells over $100 million a year in mammography machines.28 The National Cancer Institute estimates that there are 14,000 mammography machines installed in the U.S., two to three times more than is required for current mammographic needs. Each year some 24 million mammograms are performed. There is no question that the use of mammography in the U.S. is big business. There is a question, however, about the quality and safety of the service that is provided for this staggering sum of money.

The year 1997 was a volatile year for mammography. In a period of just three months, an expert panel assembled by the National Institutes of Health (NIH) stated that it felt there was no reason to recommend mammography screening to women in their forties. Its advice was that women in this age group should "decide for themselves." At the same time, the American Cancer Society (ACS) was recommending that women in their forties have a mammogram every year. This recommendation was an increase from its previous recommendation of "every one to two years." At the same time, the National Cancer Institute (NCI) was recommending that if a woman is at "average risk" of developing breast cancer, she should have mammograms every one to two years. Very quickly, the NIHâ*s recommendation that women in their forties avoid mammography drew sharp criticism from the medical community, and subsequently the NIH reversed its recommendation.

This galvanized the already contentious debate over the effectiveness and safety of mammography screening. Why is there such controversy over this diagnostic tool? Here are a few concerns that every woman needs to be aware of before making a decision about whether to have regular mammograms, and if so, how often and at what age.

The Myth of Mammography in Breast Cancer Prevention

Do you remember the non sequitur "Early detection is your best prevention"? This popular slogan appeared in ads on the radio, on television, and in print to promote reliance upon mammography. In fact, public health organizations and magazine articles assured women that mammography was their best chance at preventing breast cancer.29 Although the slogan is seldom heard anymore, the flawed logic persists in the minds of millions of women. As the previously mentioned survey by the Physicians Committee for Responsible Medicine indicated, 37 percent of women surveyed believe that mammograms are a preventive tool.

The Chant of "Regular Mammograms"

If you ask the average woman what she should do to prevent breast cancer, often her reply will be that she should get regular mammograms and perform self-exams. Women have been hearing for years that mammograms and self-exams are important in preventing breast cancer. For the most part, this is the only message women have heard. Unfortunately, it is dead wrong. When I give a presentation about breast cancer, the very first thing I say is that mammograms do not prevent breast cancer. They never have, and they never will.

Many women have acquired a false sense of confidence from the chronic chant of "regular mammograms and self-exams." Responsible healthcare practitioners donâ*t ever directly promise that mammograms prevent breast cancer. However, simply by the fact that the campaign is so strong in the absence of any other strategy, diagnostics have been misconstrued as preventive. The tremendous emphasis placed on mammography without offering any useful prevention information has diverted womenâ*s attention from the truly preventive strategies they could be practicing. As one woman said to me, "Whatâ*s there to do? You get your mammogram and just hope youâ*re not the next one."

A good deal of the ongoing debate about recommending regular mammography screening pertains to its ability to provide advanced notice of an existing cancer. The logic is that if one detects the cancer early enough, eradication will be more likely."Women have been led to believe that there is this tool out there thatâ*s going to save our lives. But itâ*s just not true," says Fran Visco of the National Breast Cancer Coalition. Studies of mammography suggest women should heed Ms. Viscoâ*s words.

Defining "Early Detection"

For a cancer in the breast to be detected by our current mammography equipment, about 30 cell divisions must have taken place.30 These divisions occur at a rate of between 25 and 200 days, with the average taking about 110 days. At the rate of 110 days, the tumor might be detected in nine years (110 days x 30 divisions). That means the cancer has been growing in the body for nearly a decade â*" sufficient time for an additional problem to arise. This problem is called metastasis. In metastasis, cancerous cells may break away from the original tumor, and use the blood vessels or the lymphatic system to travel to and infiltrate other organs of the body. As the cancer colonizes other organs, successful eradication becomes very unlikely. In fact, metastatic cancer is what kills. Obviously, even if earlier detection increases survival rates, it is clearly preferable to prevent breast cancer in the first place.

Another drawback to mammography as a diagnostic tool is that, as the National Cancer Institute confirms, the technology fails to detect tumors in as many as 25 percent of cases for women in their forties. The error rate is even higher in premenopausal women due to greater tissue density. In 70 to 80 percent of positive readings, a follow-up biopsy shows the patient to be cancer-free.31 According to a Lancet study, the rate of false positives may be as high as 93 percent.32 In other words, there are many false positives. With those false positives comes an untold degree of undue fear and anxietyâ*"even after it has been determined cancer is not present. In one study, 26 percent of women continued to experience anxiety a full three months after it had been determined they were cancer-free.*

Some research has indicated that mammography can actually increase the risk of metastases, through the compulsory compression of the breast during screening. If cancer cells are present during this compulsory compression, the cells can be pushed in a way that they may spread out to other parts of the body.33

The Danger of Medical Radiation

Mammograms pose another problem: They emit ionizing radiation, a risk factor for cancer itself. This fact receives curiously little attention. Because of the focused way in which the radiation is delivered during a mammogram, mammography poses a particular risk for breast cancer.34 If you have ever asked a radiologist administering an X-ray about the safety of the procedure, you likely heard the all-too-common retort, "Itâ*s only a very small dose."
Others are fond of saying, "Youâ*ll receive more radiation on a flight to Paris than from this X-ray." Both of these responses need to be addressed. While a single film today may expose a woman to only a fraction of the radiation used in the past, we simply cannot ignore the fact that ionizing radiation is a human carcinogen at any dose. This means that a cellular mutation could occur with a single exposure or after 20 or more exposures.

We simply cannot know. Because of the latent period of carcinogenesis, a cancer that has been initiated by medical radiation may not manifest for anywhere from 5 to 50 years. Furthermore, each dose of radiation we receive is cumulative â*" more time in between exposures does not lessen the risk.

A flight from the U.S. to Paris, France, might expose a passenger to 5 millirads of cosmic radiation; however, this smaller dose is dispersed to the entire body. A mammogram focuses radiation on one area of the body. An average mammogram will result in an exposure of about 300 millirads (a millirad is one-thousandth of a rad) of radiation for each image taken. However, if there is a suspicious area in the first films, she may be exposed to 10 or more follow-up x-rays, with a total dose of radiation of 3,000 millirads or more. Because of this very real risk, it seems humane and ethical that patients be exposed to medical radiation only when absolutely necessary, and then only after being informed of the associated risk. In 1963, John William Gofman, M.D., professor emeritus of molecular and cell biology at the University of California at Berkeley established the Biomedical Research Division for the Livermore National Laboratory, where he actively researched the relationship between chromosomal abnormalities and cancer. Having received the Right Livelihood Award in 1992 for his work to expose the health effects of low-level radiation, today, through his work with the Committee for Nuclear Responsibility (CNR), Dr. Gofman is one of the most outspoken advocates of the responsible use of radiation.

In his book Preventing Breast Cancer, 35 Gofman states his belief that, in conjunction with other factors, 75 percent of all breast cancer today is the consequence of previous radiation exposure, derived primarily from medical sources, such as X-rays, from infancy through adulthood. Dr. Gofman recognizes as valid the numerous other risk factors associated with breast cancer, but believes that in the absence of prior radiation exposure, such factors may not play as large a role. Considering the degree to which diagnostic and therapeutic radiation has been used, the likelihood of its role in todayâ*s cancers becomes quite clear.

The Proliferation of Medical Radiation

Consider that it was once a practice to perform pelvimetry (pelvic X-rays) and placentography (X-rays of the placenta) to ascertain whether a woman was going to be able to give birth vaginally. Radiation therapy was used to treat post-partum mastitis, a condition in which the breasts become infected. Fluoroscopy (use of an X-ray device) was commonly employed to evaluate tuberculosis. Radiation therapy was used to treat bronchial asthma, and in the treatment of pneumonia and hyperthyroidism. Monitoring the progress of scoliosis (curvature of the spine) required ongoing X-ray exams. For a period of time, fluoroscopy in shoe stores was common to ascertain proper shoe size. This procedure not only exposed the customer, but also, because of radiation scatter, nearby children, their parents, the shoe fitter, and other bystanders in the store who were within a 25-foot radius of the fluoroscopy machine. There was a time when beauty shop personnel administered radiation to treat hypertrichosis (unwanted body hair on the face, breasts, and other areas), and dermatologists found the technology effective in treating skin disorders such as eczema (in some cases of the breast), dermatitis, and psoriasis. Many women, therefore, have already been exposed repeatedly to radiation, a major risk factor for breast cancer.

Haphazard Administration

As can be seen, historically we have relied upon X-ray technology to a greater degree than could be considered safe. In conjunction with this, numerous surveys over the years have shown an alarming incidence of faulty X-ray machines, untrained operators, and patient overdosing. An FDA study showed that, depending on where the X-ray was administered, the dose of radiation from a chest X-ray could vary one hundred-fold. Surveys of mammography facilities are equally discouraging. One found that of 319 facilities nationwide, only 71 percent regularly monitored the dose of radiation emitted. In another survey of 96 mammography units in the state of Michigan, 8 exceeded the "acceptable" dose of radiation, and 36 had other problems.36 In a survey that was printed in the Wall Street Journal, state officials estimated that 15 to 50 percent of machines inspected did not meet patient safety requirements, and that as many as 20 percent of administrators did not have formal training in radiology.

In the same article, Dr. Robert Quillin, director of the Ohio Radiological Health Program, was questioned about a device called a collimator. The collimator is used to direct the beam of an X-ray. The wider a collimator is set, the more broadly the beam is broadcast, and the greater the degree of superfluous exposure, or what technicians call "scatter." When a collimator is set properly, the beam is directed to the most specific area being filmed, limiting unnecessary exposure. Dr. Quillin indicated that it would not be unusual to find collimators wide open in random inspections of machines. The result, he says, is X-ray exposure "from your knees to the top of your head."37 These drawbacks apply to mammography as well as to other forms of X-ray technology.

Diagnostic Alternatives

You now may be asking, "Okay, so what am I supposed to do now?" With the well-established shortcomings and risk associated with mammography, there is a growing interest in alternative imaging technologies. One promising technique is digital mammography. While it still uses X-rays, with the assistance of advanced digital enhancement, the images are sharply improved, and can be enhanced on a screen utilizing special software.

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