As Medical Screening Increases For Breast Cancer, So Does Death
There is a secular trend between breast cancer mortality and screening programs specifically medial diagnostic techniques such as mammography. Breast cancer screening does not play a direct role in the reductions of deaths due to breast cancer in almost every region in the world. Part of the failure correlates to more than 70 percent of mammographically detected tumors being false positives leading to unnecessary and invasive biopsies and subsequent cancer treatment such as radiation which itself causes cancer.
The rate of advanced breast cancer for U.S. women 25 to 39 years old nearly doubled from 1976 to 2009, a difference too great to be a matter of chance.
In 1976, 1.53 out of every 100,000 American women 25 to 39 years old was diagnosed with advanced breast cancer, a study in the American Medical Association found. By 2009, the rate had almost doubled to 2.9 per 100,000 women in that age group -- a difference too large to be a chance result.
"Most studies have failed to show an absolute increase," said Dr. Benjamin Paz, a City of Hope Cancer Center surgeon who was not involved in the study. "Now, looking at a longer period of time, this study shows there's clearly been an increase. It's the first to do so."
The trend, which has yet to be explained, has raised real concerns about future efforts to treat the disease. Survival rates for young women with metastatic breast cancer are much lower than they are for older women.
Breast cancer screening with mammography protocols actually results in an increase in breast cancer mortality, according to long-term follow-ups in large-scale studies.
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.
At the same time, mammograms also have a high rate of missed tumors, or "false negatives." Dr. Samuel S. Epstein, in his book, The Politics Of Cancer, claims that in women ages 40 to 49, one in four instances of cancer is missed at each mammography. The National Cancer Institute (NCI) puts the false negative rate even higher at 40 percent among women ages 40-49. National Institutes of Health spokespeople also admit that mammograms miss 10 percent of malignant tumors in women over 50. Researchers have found that breast tissue is denser among younger women, making it difficult to detect tumors. For this reason, false negatives are twice as likely to occur in premenopausal mammograms.
Radiation exposure in known to cause genetic mutation in breast cells. It is also known to switch off the tumour suppressing gene. Now, new research from the Lawrence Berkeley National Laboratory in America (a US Government facility) has shown that radiation both changes the environment around breast cells, and increases the risks of mutation within them; a mutation that can be passed on in cell division.
The Myth of Early Diagnosis
It is also questionable whether screening mammograms can even provide genuine 'early diagnosis' as is frequently claimed. A new blood test being developed in America and Nottingham, England will pick up on proteins developed by the very earliest 'rogue' cells almost before a cancer has formed. In the press release the scientists claim that this is a good 4 years before a mammogram can show up a tumour. Apparently, a cancer makes about 40 divisions during its life, and mammograms cannot pick up a breast tumour until it is of a sufficient size, usually around 20 such divisions. So much for early diagnosis!
In Spring 2009, nine American scientists were so concerned by what they felt were distinctly dodgy practices at the Federal Drugs Agency, (FDA) they wrote to new President Obama, One of their main causes for concern was the FDA’s silence over the increasing knowledge of the risks associated with mammograms.
These concerns are part of a growing trend. Perhaps one of the most damning reports was a large scale study by Johns Hopkins published in 2008 in the prestigious Journal of the American Medical Association's Archives of Internal Medicine (Arch Intern Med. 2008;168[21:2302-2303). In the Background to the research it was pointed out that breast cancer diagnosis rates increased significantly in four Scandanavian counties after women there began receiving mammograms every two years.
Japan and Korea organized a breast cancer screening program in 2002 that combines mammography with clinical breast examination; so far, breast cancer mortality has only increased.
An increasing number of young women in the United States will present with metastatic breast cancer in an age group that already has the worst prognosis.
"There's no evidence that 29-year-olds should go out and get mammograms or anything like that," said Rebecca Johnson, director of the Adolescent and Young Adult Oncology program at Seattle Children's Hospital.
Philippe Autier, M.D., of the International Prevention Research Institute (iPRI) in France and colleagues, looked at data from the Swedish Board of Health and Welfare from 1960-2009 to analyze trends in breast cancer mortality in women aged age 40 and older by the county in which they lived. The researchers compared actual mortality trends with the theoretical outcomes using models in which screening would result in mortality reductions of 10%, 20%, and 30%.
The researchers expected that screening would be associated with a gradual reduction in mortality, especially because Swedish mammography trials and observational studies have suggested that mammography leads to a reduction in breast cancer mortality. In this study, however, they found that breast cancer mortality rates in Swedish women started to decrease in 1972, before the introduction of mammography, and have continued to decline at a rate similar to that in the prescreening period. "It seems paradoxical that the downward trends in breast cancer mortality in Sweden have evolved practically as if screening had never existed," they write. "Swedish breast cancer mortality statistics are consistent with studies that show limited or no impact of screening on mortality from breast cancer."
Nereo Segnan, M.D., MSc Epi, CPO Piemonte, of the Unit of Cancer Epidemiology at ASO S Giovanni Battista University Hospital in Italy and colleagues write that, in the assessment the efficacy of the introduction of screening, the paradox is that descriptive analyses of time trends of breast cancer mortality rates are used to confute the results of incidence based mortality studies, employing individual data and conceived for overcoming some of their limitations, or of randomized trials.
The conclusion by Autier et al that the 37% decline in breast cancer mortality in Sweden was not associated with breast cancer screening seems therefore difficult to justify and partially unsupported by data (two groups of Swedish Counties do show a mortality decrease that, according to the stated criteria, could be linked to screening).
They also feel that "it is time to move beyond an apparently never-ending debate on at what extent screening for breast cancer in itself conducted in the seventies through the nineties of the last century has reduced mortality for breast cancer, as if it was isolated from the rest of health care."
Michael W. Vannier, M.D. of the Department of Radiology at the University of Chicago Medical Center, feels that it's hard to see mortality reduction as a screening benefit because outliers such as the natural history of the disease, along with the frequency of screening as well as the duration of follow up may misrepresent the time patterns in the mortality reductions. "We know that isolating screening as an evaluable entity using death records fails to reveal major benefits," he writes, adding that even if screening were 100% effective, the number of deaths may remain unchanged. Still he feels that without a better alternative, mammography screening will continue to be used.
The Dangers of Routine Mammography
The recent Komen controversy has the media buzzing about a reversal of policy over its decision to cut funding to PP and mammogram screening procedures. The real issue for women's health is not about funding but about the deadly effects from radiation spewing from mammogram screening devices.
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 more than any other screening method on women.
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 ionizing 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].
The U.S. Preventive Services Task Force's panel in late 2010 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.
If mammograms result in unnecessary procedures and over-treatment of what are actually harmless cancers that would go away by themselves, what is not being clearly stated is how many women die from or are seriously harmed by complications from biopsies and chemotherapy. Every surgical procedure carries risk, and women are being regularly subjected to those risks unnecessarily because of faulty (yet very profitable) tests. Cancer treatment is of course known to carry very real risk, including a non-significant risk of death from the treatment, yet women are being unnecessarily subjected to that too (also very profitable).
If mammograms are both useless and dangerous, why then does the medical community continue to use it and other "heroic" cancer practices? The answer as to why they behave so caustically toward patients has been given many times in the history of medicine with the only difference now being that they have legally suppressed a citizen's right to choice in health care.
A Better Solution: Thermography
Thermography (also called thermology) is a little-known technique for breast cancer detection that’s been available since the 1960s. It’s non-invasive and non-toxic, using an infrared camera to measure thermal emissions from the entire chest and auxiliary regions. Cancerous tissue develops a blood supply to feed a growing tumor, and the abnormal blood vessel formations generate significantly more heat than the surrounding healthy tissue. The infrared camera detects the differences in heat emitted from abnormal tissue (including malignancies, benign tumors and fibrocystic disease), as compared to normal tissue. There is no physical contact with the patient, who stands several feet away from the camera while a technician takes a series of images.
A second set of images is taken following a “cold challenge”. The patient places her hands in ice cold water for one minute causing healthy tissue to constrict while the abnormal tumor tissue remains hot. The infrared scanner easily distinguishes the difference, and these images are compared with the first set for confirmation.
Thermography can detect abnormalities before the onset of a malignancy, and as early as ten years before being recognized by other procedures such as manual breast exam, mammography, ultrasound or MRI. This makes it potentially life-saving for women who are unknowingly developing abnormalities, as it can take several years for a cancerous tumor to develop and be detected by mammogram. Its accuracy is also impressive, with false negative and false positive rates at 9% for each. Thermography is also an effective way to establish a baseline for comparison with future scans; therefore, women should begin screening by the age of 25.
Although widely embraced by alternative health care practitioners, thermography’s obscurity in the mainstream means that too many women rely on mammograms as their only option. There are several reasons for thermography’s lack of support by the conventional medical community. Early thermal scanners were not very sensitive, nor were they well-tested before being used in clinical practice. This resulted in many misdiagnosed cases and its utter dismissal by the medical community. Since then the technology has advanced dramatically and thermography now uses highly sensitive state-of-the-art infrared cameras and sophisticated computers. A wealth of clinical research attests to its high degree of sensitivity and accuracy. In 1982, the FDA approved thermography for breast cancer screening, yet most of the medical establishment is either unaware of it or still associates it with its early false start. Since most women are also uninformed of the technology there is no pressure on the medical community to support it.
Modern-day breast thermography boasts vastly improved technology and more extensive scientific clinical research.
In fact, the article references data from major peer review journals and research on more than 300,000 women who have been tested using the technology. Combined with the successes in detecting breast cancer with greater accuracy than other methods, the technology is slowly gaining ground among more progressive practitioners.