Breast cancer deaths are on the decline, which is great news. But are mammograms to thank? Not according to a recent article in the British Medical Journal. They published a 2011 study which concluded that:
"[mammogram] screening did not play a direct part in the reductions in breast cancer mortality" (1).
And according to a 2001 Lancet study:
"[mammography] screening is unjustified because there is no reliable evidence that it reduces mortality" (2).
Doctors warned to "give women all the facts" about mammograms
Most doctors take a "hard-sell" approach towards mammograms. They use fear and propaganda to convince women to have the X-ray. That is unethical, warn Australian health experts. Women have the right to know the possible harms of mammograms, and to make an informed decision.
In a new article in Preventative Health, public health experts at the University of Sydney warn doctors that they have an "ethical obligation" to inform women about the possible harms of mammogram screening. Possible harms include radiation exposure and "unnecessary investigations and over-treatment". Current written materials about mammography "overestimate benefits and neglect harms", say the Australian researchers. (3)
The "significant harm" of false positives
- "People commonly regard screening as a safeguard for their health, even if an illness is rare. But additional testing may lead to unnecessary medical interventions that can result in harm, which means there is nothing "safe" about this strategy. And for the many overdiagnosed patients, treatment can only cause harm. An epidemic of diagnoses can be as dangerous to our health as disease is." - Dr Gigerenzer
Dr Gigerenzer is the author of "Knowing your Chances" an article about medical statistics published in Scientific American in April 2009. He says that statistics are used to create an "illusion of certainty" in medicine. In reality, most patients and doctors do not understand the true risks and benefits of testing and treatment methods. (4)
A large 2009 study (the Cochrane analysis) emphasises the significant harm done by false positives (5):
For every 2000 women undergoing 10 years of annual mammogram screening:
- 1 women will have her life prolonged
- 10 healthy women will undergo unnecessary treatment (including mastectomy, chemo and radiation)
- 200 healthy women will suffer significant psychological stress due to false positive results
The significant harm of radiation:
Mammograms are a source of radiation, and may ultimately increase your risk of breast and other cancers. Research from 2011 showed that radiation from screening mammography causes significant DNA damage, which is more pronounced in patients at risk for cancer (6)
Alternatives to mammograms
Breast exam. New research presented at the annual meeting of the American Society of Breast Surgeons says that breast self exam is "as accurate as mammography and magnetic resonance imaging (MRI) at detecting new breast cancers in high-risk women".
In 2000, a Canadian study found that adding mammograms to a skilled breast exam does NOT improve breast cancer survival rates over the exam alone. (7) Women should receive a physical exam from their doctor every year.
Ultrasound imaging is often used after a mammogram to clarify a diagnosis. Because it cannot view the entire breast, it has not been used routinely for screening. Ultrasound technology is steadily improving. Maybe ultrasound screening will one day be a reality.
Ductal lavage is a simple technique of collecting cells from the breast duct, kind of like a PAP smear for the breast. It is not yet available in Australia, but is under research. (8)
Computed tomography laser mammography (CTLM) is a breast imaging system that uses laser light and thermal heat (but no radiation) to produce a three-dimensional image. It is still under development.
Thermography uses a heat-sensing infrared camera to detect the surface heat over cancerous tissue. Thermography is available in Australia, but, at this point, the National Advisory Committee to the BreastScreen Australia Program does not recommend the use of it for the early detection.
Talk to your doctor.
Read Lara's Breast Cancer Prevention article.
Appointments at Sensible-Alternative
For a professional about breast cancer prevention, please call to make an appointment...
Locations in Crowsnest Pass, Canada and Sydney, Australia.
1) Dr Lara Grinevitch - Crowsnest Pass, Canada
Lara sees patients on Mondays.
Phone Crowsnest Clinic: 1 403 563 3334. (Clinic phone is attended Tuesday-Friday)
Text message or leave a voicemail on Lara's cell: 1 587 880 4436
2) Biljana Koga or Deborah Gibson - Sydney, Australia
Two Sydney locations: Chatswood - Cronulla
Sydney phone number: 02 8011 1994
To email our Sydney head office: click here.
References:
(1) Autier P et al. Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. BMJ. 2011 Jul 28;343:d4411. doi: 10.1136/bmj.d4411.
(2) Gotzshe PC and O Olsen, 2001. Cochrane review on screening for breast cancer with mammography. Lancet. 358:1340-1342
(3) Hersch, J et al. How do we achieve informed choice for women considering breast screening? Preventive Medicine 2011. 53(3): 144-146
(4) Gigerenzer, G et al. Knowing your chances. Scientific Amer Mind April/May 2009: 44-51.
(5) Gotzsche PC et al. Screening for breast cancer with mammography. 2009. Cochrane Database Sys Rev (4): CD001877.
(7) Mandelson MT, et al. 2000. Breast density as a predictor of mammographic detection: comparison of interval-and screen detected cancers. J Natl Cancer Inst. 92: 1081-1087
(8) Dooley WC et al. 2001. Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst. 93(21): 1624 - 1632
