Mammograms Used Too Early and Too Often

On November 17, 2009, the U.S. Preventive Services Task Force panel of 14 doctors and scientists recommended that women in their 40s should stop getting routine annual mammograms; women over 50 should cut back to one mammogram every other year and women over age 74 don’t need them at all. Additionally, the panel recommended that doctors stop teaching women to do regular self-exams of their breasts because they do no good.

The panel’s review of the scientific research and clinical data led them to conclude that getting screened for breast cancer so early and so often leads to too many false alarms, unneeded biopsies and frequent anxiety, without substantially improving a woman’s odds of survival.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, a doctor at Arizona State University and the vice chair of the panel.

Shockingly, the assessment of cancer risk is not even evaluated in examining the risks vs benefits of mammograms in breast cancer screening.

Controversial Recommendations Quickly Renounced by Department of Health & Human Services

On November 18, 2009, the day after the recommendations were released, the White House Secretary of Health and Human Services, Kathleen Sebelius, announced that the report should be dismissed.

With the Obama administration fighting to push a sweeping overhaul of U.S. health insurance through Congress, Kathleen Sebelius was sent to quickly renounce the recommendations in order to distance the White House from any appearance of rationing of health care to women to reduce the cost of medicine.

New guidelines issued by the U.S. Preventive Services Task Force generally influence coverage of screening tests by Medicare and many insurance companies.

About 39 million women undergo mammograms each year in the United States, costing the health-care system more than $5 billion a year.

Who do you Believe?

Should you get a mammogram? The short answer is No! Absolutely Not! The study is right and doesn’t even go far enough. Mammograms emit ionizing Radiation that causes cellular damage associated with aging and DNA mutations that cause cancer.

The more mammograms you get the greater the risk. Women who start getting annual mammograms at age 40 have a 12-36% increased risk of developing breast cancer by the time they turn 50.

Several patient-advocacy groups, including the National Women’s Health Network and Breast Cancer Action group as well as many breast-cancer experts praised the bold recommendations, which were saying it represents a growing recognition that screening mammograms expose patients to a significant dose of cancer inducing radiation that may cause more harm than good.

A Woman Ages about 4 Years Every Time She Gets a Mammogram

Contrary to common assurances, the radiation exposure of Mammography is certainly not trivial. The routine practice of taking two films for each breast amounts to about 600 millirems focused directly on each breast and at least 1200 millirems total. That is equivalent to the amount of radiation a person gets every four years from environmental exposure.
Some women get even more due to radiology technician error, false positive mammograms, or x-ray guided imagery used to take a biopsy of a suptected lump. All of these require a woman to come back for more x-rays.
The bottom line is that there is no safe dose of x-rays and the DNA damaging effects are cumulative.

Women are Scared and Confused

“I have just gone through a long breast cancer scare the last couple of months, writes a woman who goes by “coffeelatte” on a popular woman’s health blog, “but I was extremely lucky in that the lumpectomy revealed my mass was not a cancer.”

“However, I was terrified for more than three months and I am wondering if the fear was worth it and also if the radiation from mammograms is safe or is it another source of problems?”

“I ask this because my suspicious mass was back against the breast wall so the radiologist had a very hard time finding the right area to target the wire for the excisional biopsy.  In all, it took her over one hour and I had 12 mammogram pictures before she found the right spot for the wire.”

“I am just so upset because I feel if I didn’t have the cancer this time, I sure will the next from all the radiation they are exposing me to.  Is this unrealistic of me?”

“I feel I try so hard to take care of myself but I end up with problems from the medical care part.  I also have a huge, sore incision and scar which is a constant reminder of this miserable ordeal.

“Do you ladies think it is best to continue with these mammograms?  I just am so confused.” (posted by “coffeelatte” July 2009)

How Many Women Get Annual Mammograms?

The Centers for Disease Control and Prevention says that about 29 percent of mammograms are done on women age 40 to 49, and around 13 percent are done on women over 75.

If these two recommendations are taken at face value the total number of mammographic procedures would be reduced from current 37.2 million to 15.6 million per year, a drop of 58 percent.

Dr. Petitti denied that the panel was influenced by the health-care reform debate or cost issues.

The new guidelines were based on a comprehensive analysis of the medical literature that included an update of a Swedish study involving about 70,000 women, new results from a British trial involving more than 160,000 women and data from more than 600,000 women from the U.S. Breast Cancer Surveillance Consortium.

In addition, the task force commissioned a study funded by the National Cancer Institute that was done by six independent teams of researchers conducting separate mathematical models of the risks and benefits of 20 screening strategies.

For every 10,000 women screened by mammograms beginning at age 40, the statistical analysis indicates that 7 lives might be saved but the screening would cause 4800 false-positives and lead to 330 unnecessary biopsies.

Twenty Plus Years of Medical Practice

In my 23 years of medical practice, I have watched the recommendations change several times. Two decades ago mammograms were recommended only for women after age 50 and then only every 3 years. However, in the mind of the conventional medical establishment, mammography is now considered “preventive care.”

Most doctors believe the hypothesis that early detection of small breast lumps allows them to intervene earlier with surgery, chemotherapy and more radiation to saves lives.

Since the recommendation that women start getting mammograms beginning in their 40s, the American Cancer Society has reported that 18% of all new breast cancer cases in the U.S. occur among women in their 40s. In 1999, the American Medical Association (AMA) cited these figures to justify its reason for recommending that all 40-year-old women begin getting mammograms every year rather than every other year.

Mammograms Causing Cancer?

Could it be that more 40 year olds are getting breast cancer because more of them are getting mammograms more often? Is it possible that the American College of Radiologists is finding more breast tumors in younger women because they are causing them with the radiation from annual mammograms?

The world’s largest study of routine mammograms including 50,430 women aged 40-49, conducted at 15 hospitals across Canada from 1980-1990, found that women who got annual mammograms and physical exams (MP group), had 22% more breast cancer than the women who did self breast exams rather than get annual mammograms (Usual Care-UC group). The Mammogram group had twice as many cases of cancer metastasis to 4 or more lymph nodes, than the UC group and 36% more breast cancer deaths. (Canadian Med Assoc Journal 1992 Nov 15;147(10):1459-76)

This study should have ended the debate, however, old practices die hard. The controversy is a simple one. Mammography is a $5 billion dollar industry. It has to be justified to be continued.

With best intentions doctors have assumed for decades that X-Rays, being able to detect small tumors in breasts before they could be found by physical exam, would save lives by early diagnosis, which would lead to early intervention.

Several studies in women over age 50 have shown that mammography screening vs getting no annual physical breast exam, reduces the risk of dying from breast cancer by 5-33% depending on the age a woman begins getting mammograms.

In a long-term Swedish study, the reduction was 5% in women aged 50-54 years and a 33% reduction in women aged 60-69 years at entry. (Lancet 2002 Mar 16;359(9310):909-19)

Poorly Designed Studies Produced Misleading Results

The problem with these studies is that they have compared mammograms vs doing nothing, rather than comparing mammograms to physical breast exams with a trained physician.

However, the Canadian National Breast Screening Study:2 (NBSS-2 Study) did it right for the first time. It compared the efficacy of annual mammography plus physical examination of the breasts to physical examination of the breasts without mammogram in reducing the rate of death from breast cancer among 39,405 women aged 50 to 59.

By the end of the NBSS-2 Study, 693 cases of breast cancers were found in the mammography plus physical examination group, compared to 626 cases in the physical examination-only group.

At a 13-year follow-up, a similar number of deaths from breast cancer had occurred (107 and 105) in the respective groups. The authors concluded, “In women aged 50-59 years, the addition of annual mammography screening to physical examination has no impact on breast cancer mortality.

In reality the group that got mammograms had 10% more breast cancers and 2% more cancer deaths. (J Natl Cancer Inst 2000 Sep 20;92(18):1490-9)

No Reliable evidence that Regular Mammograms Reduce Risk

The truth is there is no reliable evidence that having regular mammograms reduces the risk of dying of breast cancer in women of any age. In fact, there is strong evidence to the contrary.

According to the Nordic Cochrane Center, in Copenhagen, a respected international body that assesses medical evidence, an analysis that examined seven completed and eligible trials involving half a million women found that “The currently available reliable evidence does not show a survival benefit of mass screening for breast cancer.”(Lancet 2001 Oct 20;358(9290):1340-2).

Why has this issue become so clouded and controversial? Why have these studies been ignored and criticized? Could it be that the conventional medical establishment has a too much vested interest in mammography, or too great a legal liability at stake to admit the obvious: Annual mammography, which admittedly causes significant side-effects, including cancer inducing radiation, and false-positives that lead to untold physical, emotional and financial stress, is no more effective than a good old-fashioned physical exam of the breasts.

Doctors Beat mammograms at Detecting Breast Lumps

Dr. Gavin T. Royle and colleagues from the Southampton Breast Unit studied diagnostic data for 350 women with suspected breast cancer. Presenting their findings to the 7th Nottingham International Breast Cancer Conference, Royle’s group said that mammography was up to one-third less likely to detect lumps than were physicians. However, mammography was much more effective in determining whether lumps were benign or malignant. (Eur J Cancer 2001 Sep;37 Suppl 5:1-48)

General practitioners (GPs) successfully identified lumps in 78% of cases, while breast surgeons were found to be slightly better with an 82% success rate. Mammography only proved sensitive in 63% of patients. “Both GP and breast surgeon clinical examination were more sensitive than mammography in determining if a lump was present,” Royle told conference participants. The study also found that ultrasound, which emits no radiation, was the best noninvasive way of determining whether lumps were benign or malignant.

Breast Cancer Radiation Risks

“A woman can’t help noticing when the X-ray technician dashes for shelter behind a leaden window, before flicking on the X-Ray machine, that there must be significant risk of radiation from the test,” says Susan Brenner, director of the Breast Cancer Action group. It seems ironic to her that the technology the government regards as a lifesaving device uses ionizing radiation, which in high enough doses, is a well-established cause of breast cancer.

In most of the cancer literature, radiation is conveyed as an almost negligible concern. The National Cancer Institute guidelines state, “A final potential concern about mammography is radiation-induced breast cancer, but there are few data to directly assess this risk.”

“Now that the benefits of mammography have begun to be cast in greater doubt,” says Cindy Pearson of the National Women’s Health Network, in Washington, D.C., “those risks may also need to be better defined. Is there a level below which it is reasonably safe? They’ve never answered this question,” she says.

That’s because scientists have never been able to show what an absolutely safe dose is, says Barry Kramer, senior medical scientist in the cancer prevention division at the National Cancer Institute. “There is no doubt that X-rays cause cancer; it all boils down to your dose.”

According to Dr. John Gofman, Professor Emeritus of Molecular and Cell Biology at the University of California in Berkeley, here’s what we can know about x-rays:

  • For decades, the scientific community has known that x-rays cause a variety of mutations.
  • X-rays are known to cause instability in our genetic material, which is usually the central characteristic of most aggressive cancers.
  • There is no risk-free dose of x-rays. Even the weakest doses of x-rays can cause cellular damage that cannot be repaired.
  • There is strong epidemiological evidence to support the contention that x-rays can contribute to the development of every type of human cancer.
  • There is strong evidence to support the contention that x-rays are a significant cause of ischemic heart disease.

Mammography Radiation Risks Notoriously Underestimated

Dr. Samuel Epstein, a professor of environmental medicine at the University of Illinois at Chicago School of Public Health, argues that the radiation risks of mammography are notoriously underestimated.

Mary Helen Barcellos-Hoff, a radiation biologist at Lawrence Berkeley Laboratories in San Francisco, the average American gets about 360 millirems (a unit for measuring absorbed doses of radiation) of radiation annually, from natural background radiation coming from rocks, radon and cosmic rays, as well as man-made sources.”

To help protect women, the Food and Drug Administration limits the amount of radiation that X-rays can deliver to women’s breasts to 300 millirems per film per view, says Kramer. Even with that restriction, Epstein says, women receive too much radiation. Radiologists routinely take two films per breast.

Reporting in the International Journal of Health Services, Epstein and coauthors Rosalie Bertell and Barbara Seaman argue that the premenopausal breast is particularly sensitive to radiation. They estimate that every 1000 millirems of radiation exposure increases the risk of breast cancer by 1 percent. The typical mammogram consists of two X-Rays of each breast for a total of 1200 millirems of radiation and many women get much higher doses do to technician error that require extra retakes.

Therefore, women who start getting annual mammograms at age 40 would have at least a 12% increased risk of developing breast cancer due to the screening procedure by the time they turn 50. That does not sound like preventive care to me.

In Dr. Epstein’s opinion, the bottom line is this: “In healthy women, the risks of undergoing routine mammograms to screen for breast cancer outweigh the benefits.”

David Brenner, professor of radiation oncology and public health at Columbia University, says that younger women have more cells that are actively dividing, making them even more vulnerable to radiation’s effects than women over the age of 50. Additionally, Mammograms are less reliable in younger women because of their denser breast tissue.

Mammogram Radiation Kills Thousands of Women Annually

The National Cancer Institute estimates that annual mammography of 100,000 women for 10 consecutive years beginning at age 40 would result in up to eight radiation-induced breast cancer deaths. But Brenner’s studies, subjecting rodent cells to mammogram-level radiation, show that this estimate may be off by a factor of two.

While the risk of getting cancer from a mammogram is extremely low for the individual woman, Brenner says, it becomes a complicated public health question. He points out that currently some 30 million to 40 million women each year get mammograms. According to his calculations, given these theoretical models, mammography is likely responsible for 4,800 to 6,400 radiation induced cancers every year.

The fear of cancer and the prominent proponents of mammography are perhaps themselves the instigators of an epidemic of breast cancer induced by the so-called “preventive measure” itself. According to a Center for Disease Control report, “the percentage of women aged 40 and over who reported having a mammogram increased from 64% in 1989 to 85% in 1997.”
 
Officially the American Medical Association and the American Cancer Society both recommend that all women 40 and over get an annual mammogram, the National Cancer Institute, the Health and Human Services Department and the U.S. Preventive Task Force recommend that all women age 40 to 49 get mammograms every one or two years and women over age 50 get them annually.

Preventive Recommendations by The Arizona Institute of Natural Medicine

Dr. Clark Hansen, Medical Director of The Arizona Institute of Natural Medicine, recommends that a woman get only one mammogram at age 50 as a baseline for comparative purposes. That way if a physical exam finds a suspicious growth it can be compared to the baseline view.

The truth is an annual physical breast exam has been shown to be more effective in finding breast lumps than mammography. Dr Hansen simply says, “Stay behind the leaden glass window anytime an X-Ray machine goes off. The radiation could kill you.”

Instead of an annual mammogram get an annual breast exam from your family doctor. For real prevention, Dr. Hansen recommends the following Rx:

  1. Don’t get routine mammograms; Get a breast exam from the same physician every year
  2. Don’t take synthetic estrogens, including Birth Control Drugs and hormone replacement therapy (HRT)
  3. Avoid saturated fats, especially estrogen fed beef and dairy
  4. Eat plenty of broccoli which is a known anti-carcinogen which sweeps the harmful estrogens (estrone and estradiol) out of the body
  5. Eat soy regularly because it contains a plant estrogen that is identical to Estriol, the body’s cancer preventing estrogen
  6. Get plenty of sleep inducing melatonin because of its potent anti-cancer activity
  7. Eat lots of anti-cancer, flavonoid containing foods like purple grapes (and their seeds), blueberries, plums, cherries, and cranberries, and Green Tea
  8. Take a High Potency Multi-Vitamin with Folic acid antioxidants (Vit A, Beta-Carotene, C, & E)
  9. Take GSE Ultra Grape Seed Extract or Flavinox by Vital Formulations for the preventive polyphenols
  10. Take Cimicifuga (Black cohosh), or natural bio-identical Estriol and Progesterone to balance and regulate female hormones.

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Dr Hansen, Hansen Clinic of Natural Medicine

About the Author

Dr. Clark H. Hansen is a licensed Naturopathic Medical Doctor (N.M.D.) who has been in private practice in Scottsdale, Arizona, since 1986. He is the President and Medical Director of the Hansen Clinic of Natural Medicine, Aesthetics and Mesotherapy. Dr. Hansen is one of the most well respected Naturopathic Physicians in the country and a Diplomat of the World Society of Anti-Aging Medicine.

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