To mammogram, or not to mammogram

I’m not surprised there’s so much confusion about the new mammogram recommendations from the U.S. Preventive  Services Task Force.  The findings are counter-intuitive.  And the message is coming from data people, who can’t communicate it in a way that makes sense.

What’s more: There are a lot of people with a vested interest in the current mammogram regime.  I don’t mean to impugn their motives.  They have the best of intentions.  But, if your medical career, or your clinic, is built on the premise that all testing is good and early diagnosis is the Holy Grail, then it’s hard to be objective.  And, if you are affiliated with a non-profit advocacy group, trying to raise awareness and money to battle breast cancer, then it’s going to be hard to swallow the idea that not everyone needs to be tested.

A young woman lines up for her mammogram (at Baylor Medical Center)

This is intuitive:  Cancer starts small, and if you test for it, you might find it before it spreads and becomes lethal. If everyone gets tested, we’ll catch most cancers before they can kill.  Period.

This is not intuitive:  If we test people, and get a lot of false-positives, that causes anxiety and unnecessary biopsies.  So, it’s better to do less testing and risk a few deaths.

I’m not a specialist, and I won’t make any claims to know what all women should do.  But, the panel making the new recommendation deserves to be respected.  And their conclusion is not unprecedented.  Other researchers have been arguing for years that we do too much breast and prostate cancer screening.  European countries with the most advanced health systems do not recommend annual mammograms under the age of 50.

And as I talk to middle-aged women, I hear a lot of stories of false positives, or hard-to-read mammograms, and unhappiness with what feels like a treadmill of testing and worry. (Not to mention the mammogram procedure itself ….)

Back in the 1990’s, as CT scanning machines became more common (and less expensive),  “full body scans” became the rage.  Remember the ads?  They promised to find the diseases lurking in your body that hadn’t yet shown up in symptoms.  The medical profession roundly condemned these scans.  Why?  Because they lead to a lot of false positives, further useless testing, and possibly procedures that are unnecessary.  In the end, for most people, they do more harm then good.

If the government or medical profession is recommending that everyone should get a certain test or vaccine, then they need good evidence that the benefit outweighs the risks.

One fact we don’t like to think about:  We are all carrying around parasites and growths and abnormalities all the time.  Most of these are kept in check by natural systems.  If we tried to intervene on all of them, we’d create chaos in our bodies.

I imagine as this story evolves, we’ll see two sets of recommendations emerge–one for women with a family history of cancer (or other higher-risk status), and one for everyone else.

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About Admin

I was the Science & Health Reporter for 12 years, and the Environment Reporter for 5 years, at NPR member station KPLU, in Seattle, WA (now re-born as knkx). Today, I've left journalism but keep this blog as a place for writing about some of the topics that I tracked over the years.

3 thoughts on “To mammogram, or not to mammogram

  1. Pingback: Mammograms: To screen or not to screen? « A Healthy Future

  2. Pingback: Mammograms: To screen or not to screen? « The Future of Health

  3. Suzanne Fletcher, a professor of ptevenrive medicine at Harvard Medical School. She added that cancer screening programs are built on the assumption that “finding it earlier is finding it better. . . . This study questions that assumption.” In fact, truly early detection would be better, but by the time a tumor has grown to a sufficient size to be detectable by either a mammogram or a physical examination, it has been growing for several years, and achieved more than 25 doublings of the malignant cell colony. As Alternative Medicine has maintained for years, mammograms do far more harm than good. Their ionizing radiation mutates cells, and the mechanical pressure can spread cells that are already malignant (as can biopsies). In 1995 the British medical journal The Lancet reported that, since mammographic screening was introduced in 1983, the incidence of ductal carcinoma in situ (DCIS), which represents 12% of all breast cancer cases, has increased by 328%, and 200% of this increase is due to the use of mammography. This increase is for all women: Since the inception of widespread mammographic screening, the increase for women under the age of 40 has gone up over 3000%. Mammogram interpretation is often wrong. In 1996, the journal Archives of Internal Medicine published results of a test of 108 radiologists throughout the United States. The test used a set of 79 mammograms where the diagnosis had been verified by subsequent biopsies, surgeries or other follow-up. The radiologists missed cancer in 21% of the films, thought 10% of the women with no breast disease had cancer and thought 42% of benign lesions were cancerous. Further, mammograms are not diagnostic and too frequently lead to unnecessary breast biopsies, which are an expensive, invasive surgical procedure that causes extreme anxiety, some pain and often physical harm to many women who do not have cancer. According to the 1998 edition of the Merck Manual, for every case of breast cancer diagnosed each year, from 5 to 10 women will needlessly undergo a painful breast biopsy. Statistically, this means that any woman who has annual mammograms for 10 years has at least a 50% chance of having at least one biopsy — even if she never develops breast cancer. Why, then, does mainstream medicine keep recommending mammograms? Do the math: a $100 mammogram for all 62 million U.S. women over 40, and a $1,000+ biopsy for 1-to 2-million women, is an $8 billion per year industry. There is a superior alternative: advanced thermography, which does not use mechanical pressure or ionizing radiation, and which can detect signs of breast cancer years earlier than either mammography or a physical exam. Mammography cannot detect a tumor until after it has been growing for years and reaches a certain size. Thermography is able to detect the possibility of breast cancer much earlier, because it can image the early stages of angiogenesis. Angiogenesis is the formation of a direct supply of blood to cancer cells, which is a necessary step before they can grow into tumors of size. Thermographic breast screening is brilliantly simple. Thermography measures the radiation of infrared heat from our body and translates this information into anatomical images. Our normal blood circulation is under the control of our autonomic nervous system, which governs our body functions without our conscious will. To screen for breast cancer, a thermographer blows cool air over a woman s breasts. In response, our autonomic nervous system reduces the amount of blood going to the breast, as a temperature-regulating measure. However, the pool of blood and primitive blood vessels that cancer cells create is not under autonomic control and is unaffected by the cool air. It will therefore stand out clearly on the thermographic image as a “hot spot.”

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