Breast cancer patients frequently undergo dangerous screening tests like mammograms, however imaging has increased in dramatic and significant ways, say researchers from Fox Chase Cancer Center. More patients have repeat visits for imaging than they did 20 years ago, and single imaging appointments increasingly include multiple types of imaging.
In a Swedish study of 60,000 women, 70 percent of the mammographically detected tumors weren't tumors at all. These "false positives" aren't just financial and emotional strains, they may also lead to many unnecessary and invasive biopsies. In fact, 70 to 80 percent of all positive mammograms do not, upon biopsy, show any presence of cancer.
Researchers, led by Richard Bleicher, M.D., surgical oncologist at Fox Chase, found that between 1992 and 2005, the percentage of patients who had multiple (2+) imaging visits nearly quadrupled. Bleicher says additional visits present a burden to patients, many of whom are elderly.
“The burden to the patient is increasing substantially,” Bleicher says. “The number of days patients are having mammograms, MRIs, and ultrasounds is going up steadily year by year. They’re having imaging done more frequently on separate dates during the preoperative interval than ever before. It’s surprising.”
Paul Yaswen, a cell biologist and breast cancer research specialist with Berkeley Lab's Life Sciences Division says "our work shows that radiation can change the microenvironment of breast cells, and this in turn can allow the growth of abnormal cells with a long-lived phenotype that have a much greater potential to be cancerous." Yawsen stated that radiation specialists have been slow in understanding these concepts. "Many in the cancer research community, especially radiobiologists, have been slow to acknowledge and incorporate in their work the idea that cells in human tissues are not independent entities, but are highly communicative with each other and with their microenvironment."
Earlier recommendations from the Society of Breast Imaging (SBI) and the American College of Radiology (ACR) on breast cancer screening suggested that breast cancer screening should begin at age 40 and earlier in high-risk patients. Published in the January issue of the Journal of the American College of Radiology (JACR), the recommendations released by the SBI and ACR state that the average patient should begin annual breast cancer screening at age 40. They also target women in their 30s if they are considered "high risk" as they stated.
No evidence has ever supported any recommendations made for regular periodic screening and mammography at any age. Exposure to mammograms today can lead to cancer much later in life. As ABC News reported, Dr. Len Lichtenfeld, the deputy chief medical officer of the American Cancer Society, says, "Radiation exposure from these scans is not inconsequential and can lead to later cancers."
The occurrence of breast cancer has dramatically increased in the past 50 years and for more than 30 years mammograms have been the unquestioned, standard screening device used by the medical community.
Susun S. Weed, author of Breast Cancer? Breast Health! The Wise Woman Way said "Screening mammograms are unsafe other ways, too: they expose sensitive breast tissues to radiation, and they increase your chances of having a biopsy and being overtreated for carcinoma in situ. Scientists agree that there is no safe dose of radiation. Cellular DNA in the breast is more easily damaged by very small doses of radiation than thyroid tissue or bone marrow; in fact, breast cells are second only to fetal tissues in sensitivity to radiation. And the younger the breast cells, the more easily their DNA is damaged by radiation."
The more radiation a woman receives in her lifetime, whether it is during a dental exam, at an airport, or during her yearly mammogram, the more likely it is that she will develop breast cancer. In fact, the spiraling rates of breast cancer seen in the last 25 years may be directly tied to the increased use of mammography.
The preoperative interval begins when a patient first reports to a doctor with a breast complaint and ends when the patient undergoes therapeutic surgery to resect a tumor. Fox Chase researchers found that for the more than 65,000 patients involved in their study, the preoperative interval lasted 37 days on average. In 1992, roughly one in 20 cancer patients (4.9 percent) diagnosed with invasive, non-metastatic cancer underwent imaging twice or more during the preoperative interval. By 2005, that portion had climbed to about one in 5 (19.4 percent). In the extreme case, a small subset of 20 patients underwent mammograms on five or more visits during the preoperative interval.
The researchers also found that a single imaging visit increasingly includes multiple imaging types. In 1992, 4.3 percent of patients underwent multiple types of imaging; in 2005, that rate rose to 27.1 percent.
With the increased use of imaging, Bleicher says that for physicians, “the question becomes, ‘How are we affecting patients overall with what we’re ordering nowadays?’”
The researchers discovered the climbing trend after studying data on Medicare patients from the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program. Their results came from the records of 67,751 women who were treated for invasive, non-metastatic breast cancer with surgery and lymph node staging. The researchers omitted patients diagnosed with either metastatic disease or DCIS because those types of breast cancer require different approaches to imaging and treatment.
Routine mammograms are far less effective at preventing breast cancer deaths and far more expected to cause unnecessary procedures, over-treatment and ultimately accelerate death.
A routine mammogram screening typically involves four x-rays, two per breast. This amounts to more than 150 times the amount of radiation that is used for a single chest x-ray. Bottom line: screening mammograms send a strong dose of ionizing radiation through your tissues. Any dose of ionzing radiation is capable of contributing to cancer and heart disease.
Screening mammograms increase the risk of developing cancer in premenopausal women.
Screening mammograms require breast tissue to be squeezed firmly between two plates. This compressive force can damage small blood vessels which can result in existing cancerous cells spreading to other areas of the body.
Cancers that exist in pre-menopausal women with dense breast tissue and in postmenopausal women on estrogen replacement therapy are commonly undetected by screening mammograms.
For women who have a family history of breast cancer and early onset of menstruation, the risk of being diagnosed with breast cancer with screening mammograms when no cancer actually exists can be as high as 100 percent.
In 1974, while mammography was in its infancy, the National Cancer Institute was warned by Professor Malcolm C. Pike at the University of Southern California School of Medicine that a number of specialists had concluded that "giving a women under age 50 a mammogram on a routine basis was close to unethical". This warning was ignored.
Also in the 1970's, the Director of Biostatistics at Rosewell Park Memorial Institute for Cancer Research, Dr. Irwin Bross, headed a study involving data from 16 million people. This ground breaking study found that the main cause of the rising rates of leukemia was medical radiation in the form of diagnostic medical X-rays. Applying his findings to the breast cancer screening program, Dr. Bross later elaborated that "women should have been given the information about the hazards of radiation at the same time they were given the sales talk for mammography."
One of the largest mammogram studies ever initiated had to be cancelled because the mammogram group of women developed more cancer than the non-mammogram control group. This study is dismissed now because it was done in the early 70's and radiology has greatly progressed since then [they say].
In the early 1980's as the mammogram began to be rolled out to women across the country in the face of this research, the NCI and ACS jointly urged annual breast X-rays for women under age 50. Doctors assumed there was good evidence supporting the recommendations and became enthusiastically ordered mammograms for all their female patients, even though they should have know better.
In 1985, the Lancet, one of the five leading medical journals in the world, published an article condemning the mammography recommendations under which "Over 280,000 women were recruited without being told that no benefit of mammography had been shown in a controlled trial for women below 50, and without being warned about the potential risk of induction of breast cancer by the test which was supposed to detect it.
The U.S. Preventive Services Task Force's panel last fall recommended against routine screening for women in their 40s. Thousands of scientists and medical professionals are unconvinced from conclusions of the new study and maintain that extreme caution is necessary before recommending a mammogram at any age.