Breast Screening
The Breast Cancer Industry Is Deceiving Women
Are regular mammograms doing more harm than good? Let’s take a look at the science.
For the past two decades, controversy has swirled around the question of the benefits of mammography. Unfortunately, breast cancer is a huge and thriving industry, and its powerhouses have lined up squarely in support of mammography:
- Susan G. Komen for the Cure, which took in $342,373,526 in 2012 with major industry support and gave its CEO a 64% raise for a total pay package of $684,000, claims, “The Life-Saving Benefits of Mammography Are Clear!” (You may recall our 2011 article about Komen and their penchant for “pinkwashing.”)
- The American College of Radiology (ACR)—the organization that offers accreditation in breast MRI and mammography and rakes in tens of millions in fees from legally mandated mammography accreditations, says, “Mammography Saves Lives!”
- The American Cancer Society and the American Congress of Obstetricians and Gynecologists both recommend yearly mammograms, starting as young as age 40.
But what does the science say? This past February, a twenty-five-year-long Canadian trial found no difference in death rates from breast cancer among women who had regular mammograms and those who did not.
The American College of Radiology immediately trashed the study, calling it “incredibly flawed and misleading.” The ACR’s self-interested reaction dismayed many, particularly Dr. H. Gilbert Welch, a professor of medicine at the highly respected Dartmouth Institute for Health Policy and Clinical Practice. He published a scathing opinion piece via CNN blasting the ACR, and fuming that “it’s time to get the science back in screening mammography and to recognize that mammographers may not be the ideal source for balanced information.” Well said, Dr. Welch!
But mammograms aren’t merely useless—they could very well be harmful. First, they may increase your risk of cancer by subjecting you to unnecessary radiation and by abusing breast tissue. Second, they’re inaccurate to the point of being downright dangerous. According to the National Institutes of Health, 90% of abnormal mammograms are false positives; even a staunch proponent like Komen acknowledges that the likelihood of getting a false positive over the course of ten screenings is 50 to 60%. Additionally, mammography misses 17% of cancers—that means for every ten breast cancers, two are completely undiagnosed.
A false positive causes more than anxiety—it can cause pain, financial distress, and exposure to risky, unnecessary medical procedures. Women who receive an abnormal mammogram must go through additional mammographic screenings, ultrasounds, magnetic resonance imaging, and even painful tissue samplings via fine-needle aspiration, core biopsy, or excisional biopsy. If there is cancer, biopsy can spread it.
Perhaps the saddest mammogram side effect is over-diagnosis and over-treatment—the treatment of breast “cancers” that most likely would never have resulted in illness or death. Many breast cancers resolve themselves. And treatment itself can endanger your health. Chemo attacks your body and immune system. Radiation pointed at the breast can damage the heart, potentially leading to death years later from heart failure. By then, of course, nobody will associate the heart disease with the radiation that caused it.
So, why promote mammograms if they’re ineffective and expensive? Well, if every woman who is recommended to get a breast exam did so, it puts $8 billion dollars a year into the pockets of the radiology industry.
Conventional medicine is not a unified bloc on this issue. More and more physicians, and even organizations that are typically opposed to integrative medicine such as the United States Preventative Services Task Force are recommending less frequent mammograms.
But if not mammograms, then what? Some kind of screening is necessary. After all, breast cancer is on the rise—in 2012, 1.7 million women were newly diagnosed with breast cancer, up 20% from 2008. And one in eight American women (about 12%) will develop invasive breast cancer over the course of her lifetime. Although these figures are skewed by over-diagnosis, they still describe a very real threat.
Many integrative doctors recommend thermographic breast screening (thermography) as a safer, more effective alternative to mammograms. Thermography uses no uncomfortable mechanical pressure or ionizing radiation. Instead, it takes a picture of the heat produced by the body, which practitioners study for unusual changes or heat clusters. It can detect cancer up to ten years before a mammogram would, and can even detect cancer before tumors have formed.
The Mammogram Myth may be beginning to crumble, but don’t wait for the dust to settle—talk to your integrative physician about safer ways to prevent, detect, and treat breast cancer.
Source : Alliance for Natural Health USA
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Screening Decisions Must Balance Potential Benefits with Potential Patient Harms
Screening to detect medical conditions has become standard practice for many diseases, but insufficient attention has been paid to the potential for harm, according to research conducted at the University of North Carolina.
“I think guideline groups, just as they are systematic about thinking about benefits, need to be systematic about thinking about harms. We should not implement a screening program until we know enough to have a clear understanding of both benefits and harms,” said lead author Russell Harris, MD, MPH, Professor of Medicine in the UNC School of Medicine and Adjunct Professor of Epidemiology in the UNC Gillings Global School of Public Health, and member of the UNC Lineberger Comprehensive Cancer Center. Harris worked with a number of co-investigators at the UNC Research Center for Excellence in Clinical Preventive Services in the UNC Cecil G. Sheps Center for Health Services Research.
In an article published by the Journal of American Medical Association - Internal Medicine, Harris and co-authors outline a framework that physicians, patients, policy makers and researchers can use to think systematically about the harms of screening programs. This rationale – a “taxonomy of harms” – makes it easier for decision makers to fully consider all harms to balance against anticipated benefits. Harris said the framework for understanding harms provides physicians, patients, policy makers, and researchers with an approach for reviewing the potential downsides of any screening recommendation.
“Harms are any adverse effect that people feel because of screening. It is important to take the perspective of the patient, the one who experiences the harm. The whole idea of what we did was to develop a systematic way for people to look at a screening program and decide whether screening makes sense for them, without being blind-sided by harms that they didn’t know about and didn’t expect,” said Harris.
Harris’ team interviewed dozens of policy makers, physicians, researchers and patients to develop four major categories of harm that need to be considered in any screening recommendation:
• Physical harm – The potential for a screening procedure to cause physical injury to patient, such as when a colonoscopy perforates the intestine and requires hospitalization.
• Psychological harm – The immediate and long-term psychological strain caused by screening. For example, a patient whose screening test was positive but additional testing (“work-up”) was inconclusive, and the patient must then undergo further surveillance for some time without knowing whether she has a serious condition or not. This shows how screening can cause ongoing uncertainty and psychological strain.
• Financial strain – From the initial screening to follow-ups and monitoring, each medical intervention will increase the financial burden on patients, possibly interfering with their financial planning and security.
• Missed opportunities – From the need to miss work to have the initial test to further time to have additional testing – the screening process requires multiple visits and testing. This all becomes a distraction, taking time and attention away from people trying to attend to healthy lifestyle and to taking part in the everyday activities of work and family life.
Because the research on screening has traditionally been focused only on its benefits, little evidence has been collected on the potential for harm. Harris said he hopes his work will spur the collection of such evidence, with an understanding that it must come from the patient perspective.
“Unfortunately, the data is not available in a systematic way. That would be wonderful if we had surveillance systems that we put in place 20 years ago to systematically look at benefits and harms,” said Harris. “Besides being helpful to decision makers today, we hope this taxonomy gives researchers a direction for future research.”
Source : Newswise
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Mammography: Are There Pros, or is It Just a Con?
By Johnnie Ham, MD, MBA
Many women are completely unaware that the science backing the use of mammograms is sketchy at best. As was revealed in a 2011 meta-analysis by the Cochrane Database of Systemic Reviews, mammography breast cancer screening led to 30 percent overdiagnosis and overtreatment, which equates to an absolute risk increase of 0.5 percent.
There's also the risk of getting a false negative, meaning that a life-threatening cancer is missed.
Unfortunately, even though some high-profile people agree that mammography has limitations as well as dangers, others prefer to ignore the science and continue to campaign for annual screenings without so much as a hint at the risks involved.
Now, they’ve unrolled “new and improved” 3D TOMOSYNTHESIS mammogram, which still requiring mechanical compression, and delivers 30 percent more radiation!
In order to make better informed decisions, I provide my patients with all of their screening options, their strengths and weaknesses, and I reinforce that they have a right to utilize those options. Some of the options may include; self and clinical breast exams, thermography, ultrasound and/or MRI. My role as a doctor is to diagnose and treat, but I am also an educator. I want my patients' focus to be on prevention to improve their health and well-being.
The Industry of Cancer Breast cancer has become big business, starting with the multi-billion dollar goliath, mammography. No other medical screening has been as aggressively promoted. My passion is providing integrative primary care as an MD for hundreds of patients. I also have over 23 combined years of military experience as an OB/GYN, trauma surgeon, experimental test pilot, and master army aviator.
My training prepared me to navigate through challenging, and sometimes life threatening situations. Unfortunately, most women do not have the training I received, yet they could certainly use some of it to help navigate through the fear based methods of the breast cancer industry.
The tide of thought on mammography’s benefits is rapidly changing as evidenced by recently published studies in the Archives of Internal Medicine,1 the Lancet Review,2 the British Medical Journal3 and the Nordic Cochrane Center;4 and the fact that the US Preventative Services Task Force5 and the Canadian Task Force on Preventative Health Care.6
Why are Nearly All Health Care Professionals Not Following Current Mammogram Recommendations? Nearly every woman age 40 and older continues to be told by their primary care physician, their gynecologist, the media, self-proclaimed advocacy groups, and even their medical insurance carrier, “get your annual mammogram!” despite the fact that nearly every recent authoritative study concludes that women should know all of the facts before agreeing to a mammogram screening. Yet nearly all health care professionals insist on mammograms. If a woman dare refuse, she may be chastised or worse, threatened. These efforts have gone beyond persuasion to guilt and even coercion, “I can’t be your doctor if you don’t get a mammogram.” Women need to stop this runaway train, not only for their sake, but for the sake of their daughters.
In November 2012, the New England Journal of Medicine published a study by Dr Archie Bleyer, MD from The Oregon Health Sciences Center, and his co-author, Dr H. Gilbert Welch, M.D., M.P.H., from Dartmouth, challenging the validity of mammogram screenings and concluded that mammograms have little to no influence in the reduction of the number of women who ultimately die of breast cancer.7
Thirty years of US government data studied found that as many as 1/3 of cancers detected by mammography may not have been life threatening, and that over 1 million women have been over-diagnosed; leading to unnecessary treatments involving disfiguring surgeries; radiation and chemotherapy. They also showed that mammogram screenings have increased from about 30 percent of women 40 and older in 1985, to about 70 percent of women screened, proving how effective we have been at convincing women they need to get a mammogram.
I have witnessed this strategy for decades and I have seen the profound psychological effect it has had on many of my patients. This paradigm has seriously misled women regarding the actual effectiveness, and the benefits vs. potential dangers of mammograms. They also have women confused about the erroneous belief that mammography is their only tool. Some women actually believe mammograms can prevent cancer, or do not realize they have the right to say, no!
Most women comply with the current “gold standard” in fear of the ravages of breast cancer, convinced their annual mammogram will save their life through early detection. It is nearly impossible for them to negate decades of slick marketing, annual reminders from radiology imaging centers and the exploitation of October’s Breast Cancer Awareness month blitz. All of these efforts beautifully packaged, tied up with a pretty pink ribbon.
I take my oath to do no harm very seriously. After many years of research, clinical practice; and due to my wife’s personal experience with mammography, I cannot in good conscience recommend mammograms. I inform my patients that mammograms are considered the current “gold standard”, but I also make certain they know the facts about the screening and that there are other screen tools available.
Facts and Persisting Concerns: Mammograms More women are refusing mammograms. This is reflected in the dramatic decline of 4.3 percent in 2010. Previously, mammography use had increased annually by 1 percent between 2005 and 2009. Mammograms:
- Are incorrect 80 percent of the time (providing a false negative or false positive)
- Require repeated ionized radiation that can cause cancer
- Use compression, which can damage breast tissue or potentially spread cancer
- Are not effective for up to 50 percent of women (women with dense breasts or implants)
- Can lead to over-diagnosis and over-treatment of non-invasive cancers
- Can lead to the disturbing practice of “preventative” double mastectomies
We cannot prove that screening mammography improves the ultimate survival rate. A quick look at the SEER data would suggest treatment has improved, by a decline in the death rate since 1998 of 1.9 percent.8 For every 1,000 women in this country, today 125 will ultimately be diagnosed with breast cancer. Of those 125, over 40 will be over-diagnosed, and receive treatment they never needed, and suffer the potential psychological consequences of a cancer diagnosis. That leaves about 80, of which 28 will die of breast cancer. The decline since 1998 in the death rate means that for our 28 women who would have otherwise died from breast cancer, 2 more out of 1000 women diagnosed with breast cancer survived due to over a decade of treatment advances.
But, we really don’t know what actually saved those 2 women, of the 125 diagnosed with breast cancer for every 1,000 women in our group. If we attribute anything to lifestyle changes we have emphasized recently (which has been shown repeatedly to work), then either we wipe out any improved survival rate from decades of treatment advances, or worse, we cause death to some of those 40 women who were over-diagnosed!
If You Have Dense Breasts it is Even Worse Breast density laws have now been passed in California,9 Connecticut, New York, Virginia and Texas making it mandatory for radiologists to inform their patients, who have dense breast tissue (40 to 50 percent of women) that mammograms are basically useless for them. Dense breast tissue and cancer both appear white on an X-ray, making it nearly impossible for a radiologist to detect cancer in these women. It’s like trying to find a snowflake in a blizzard. A law is now being considered at a Federal level as well.
Some radiologists already provide density information to their patients, and encourage them to utilize other options like thermography, ultrasound and/or MRI. I believe it reasonable for a woman to trust that her radiologist is not withholding vital density information. Unfortunately, many have kept this potentially lifesaving data from women for decades, and our government agencies have failed to protect them from this unethical practice.
I know it is extremely difficult to navigate through all of the contradicting information and study findings. It would better serve women if efforts, money and resources were utilized on educating women on cancer prevention, being that 95 percent of disease is lifestyle related. Yet 40,000 women continue to die of breast cancer each year. The only way to reduce this number is through utilizing preventative therapies.
Basic Cancer Prevention Strategies As mentioned above, many women are completely unaware that the science backing the use of mammograms is sorely lacking, and that more women are being harmed by regular mammograms than are saved by them. Many also do not realize that the “new and improved” 3D tomosynthesis mammogram actually delivers even MORE ionizing radiation than the older version. This is not a step forward...
Please understand that there are other screening options, each with their own strengths and weaknesses, and you have a right to utilize those options. Also remember that in order to truly avoid breast cancer, you need to focus your attention on prevention.
A few simple, yet great options to assist in your efforts to avoid breast cancer are: making sure you are getting enough vitamin D, K2 and iodine; that you utilize lymphatic massage; use stress management techniques, exercise often, and balance your hormones naturally. It is also wise to eat a Mediterranean diet consisting of organic foods. Avoid processed and GMO foods; and toxic environments.
In my practice, I recommend breast thermography, even for young women to get a baseline, but also combine the imaging not only with a review of the findings, but more importantly, as a venue to educate women on breast health. It is far more effective to prevent breast cancer, than it is to wait until it is there and then treat it. We are all different so make sure you consult with your doctor and do your own research before utilizing any of these suggestions.
The advice I give all of my patients is to be your own health advocate, do your own research and always ask questions before agreeing to any therapy or treatment, screening and/or procedure.
About the Author: Dr. Johnnie Ham, MD, former Lieutenant Colonel of the US Army Medical Corps, is the Medical Director of Coastal Prestige Medical Services, Pismo Beach, CA. Coastal Prestige Physicians offer top-notch comprehensive healthcare, with an emphasis on evidence-based primary care and preventive health for all ages.
Source : Dr. Mercola (April 2013)
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Study Suggests Breast Cancer Overdiagnosed
As a result of mammographic screening programs, as many 1.3 million women over age 40 were overdiagnosed with breast cancer over three decades, researchers reported.
In a study that seems certain to generate controversy -- as is apparent in MedPage Today's discussant video -- the researchers concluded that overdiagnosis is involved in up to a third of all newly discovered tumors and that screening plays only a small role in reducing breast cancer mortality.
Over the past 30 years, mammogram programs have increased the detection of early-stage breast cancer, according to Archie Bleyer, MD, of Oregon Health and Science University in Portland and H. Gilbert Welch, MD, of Dartmouth University in Hanover, N.H.
But screening had little effect on the detection of late-stage disease, they reported in the Nov. 22 issue of the New England Journal of Medicine, implying that many women underwent treatment for early forms of cancer that would never have caused serious disease.
Bleyer said the finding – while suggesting that screening is largely ineffective – is actually good news, because it implies that therapy is actually more effective than had been thought.
Breast cancer mortality has been falling in the U.S., a decline usually attributed to a combination of increased screening and better treatment, Bleyer told MedPage Today. The study implies, he said, that "treatment ... is the main, if not the only, reason for the improvement" in survival.
The findings come from a retrospective analysis of annual breast cancer data from the Surveillance, Epidemiology, and End Results database, coupled with assumptions about how the incidence of the disease changed over time.
The researchers used a 3-year period near the beginning of the database – 1976 though 1978 – to develop baseline incidence estimates for breast cancer among women 40 and over.
They estimated current incidence using the 3 years from 2006 through 2008. For calculations that covered all 3 decades, they adjusted the observed incidence from 1990 through 2005 to account for increases attributed to the use of hormone replacement therapy over that period.
Finally, their main assumption about the change in background incidence over time among women over 40 was that it would parallel what was seen among younger women – an increase of 0.25% a year.
In 2006-2008, they found, the incidence of early-stage cancer was markedly higher than before screening in 1976-1978, while the incidence of late-stage disease changed minimally.
They found that, annually, there were:
- 7 cases per 100,000 women of ductal carcinoma in situ in the early period, compared with 56 per 100,000 more recently
- For localized disease, 105 per 100,000 women in 1976-1978 and 178 per 100,000 in 2006-2008
- For regional disease, 85 per 100,000 women in the earlier period and 78 per 100,000 in the later period
- 17 cases of distant disease per 100,000 women in both periods
"With the assumption of a constant underlying disease burden, only 8 of the 122 additional early-stage cancers diagnosed were expected to progress to advanced disease," they argued.
In 2008, that would have amounted to overdiagnosis in 70,000 women, or about 31% of all diagnosed breast cancers, they reported.
After adjusting for the hormone-replacement era – and assuming that incidence trends in older women mirrored those in their younger counterparts -- that adds up to overdiagnosis in 1.3 million U.S. women in the past 30 years, they concluded.
The study has already generated some heated responses. Aside from the comments made by Appleton and Bevers in the accompanying video, a statement from the American College of Radiology and the Society of Breast Imaging said bluntly: "The thesis by Bleyer and Welch is simply wrong."
The groups argued that the assumptions in the study were wrong and that – far from there being no evidence of a screening benefit – mammograms have reduced the incidence of invasive disease.
In particular, they argued, the assumption that the change in incidence is just 0.25% a year – or even 0.5% a year, in what Bleyer and Welch called an "extreme" scenario – is not backed up by the facts.
"The incidence of invasive breast cancer has actually increased by 1% per year for decades," the groups said in the statement. "If such misinformation is used to determine screening guidelines and recommendations, the cost may be lost lives," the statement concluded.
There is likely some overdiagnosis of breast cancer, argued Therese Bevers, MD, of M.D. Anderson Cancer Center in Houston, but nowhere near the 31% suggested by the authors.
Instead, she told MedPage Today, it is "much smaller, probably on the order of about 10%."
"It is my feeling, based on data from randomized trials and not retrospective data such as these, that the benefits (of screening) outweigh the harms," Bevers said.
Even if there's a risk of overtreatment, she said, "we really don't understand which cancers we really don't need to be treating" and both patients and their doctors feel more comfortable with therapy rather than watchful waiting.
Catherine M. Appleton, MD, of Washington University St. Louis Medical Center, joined Bevers in expressing concerns about the study, as seen in the discussant video accompanying this article.
For his part, Bleyer said he's convinced that the assumptions in the study are conservative and that doctors and patients need to be aware of the harm associated with overdiagnosis as well as any potential benefit from early diagnosis.
The remedy, Bleyer told MedPage Today, would be to reduce the scope of mammographic screening in line with the 2009 recommendations of the U.S. Preventive Services Task Force.
The panel recommended against routine screening mammography for women younger than 50 and said the recommended screening interval for women 50 and older should be every 2 years instead of annually.
"There's no question about continuing mammography," Bleyer said, but widespread adoption of those recommendations would go far to reducing overdiagnosis and overtreatment of early-stage breast cancer.
Source - MedPage Today via New England Journal of Medicine
Bleyer A, Welch HG "Effect of three decades of screening mammography on breast-cancer incidence" N Engl J Med 2012; 367: 1998-2005.
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Mammograms Linked To An Epidemic of Misdiagnosed Cancers
For most of the twentieth century, mastectomy was the first line treatment for Ductal Carcinoma In Situ (DCIS), and younger patients were more likely to undergo the procedure. Even after lumpectomy and radiotherapy were shown to be at least as effective for invasive cancer as mastectomy, still in 2002, 26% of DCIS patients were still receiving mastectomy.1
The most common scenario today following diagnosis of DCIS is for the oncologist to recommend lumpectomy, followed by radiation and hormone suppressive therapies such as Arimidex and Tamoxifen. The problem here is that women are not being educated about the nature of DCIS or the concept of "non-progressive" breast cancers. There is still the black and white perception out there that you either have cancer, or do not have cancer.
In a poll on DCIS awareness published in 2000, 94% of women studied doubted even the possibility of non-progressive breast cancers.2 In other words, these women had no understanding of the nature of DCIS. And why would they? Major authorities frame DCIS as "pre-cancerous," implying its inevitable transformation into cancer. When the standard of care for DCIS is to suggest the same types of treatment used to treat invasive cancer, very few women are provided with the information needed to make an informed decision.
Early detection through x-ray mammography has been the clarion call of Breast Cancer Awareness campaigns for a quarter of a century now. However, very little progress has been made in making the public aware about the crucial differences between non-malignant lesions/tumors and invasive or non-invasive cancers detected through this technology. When all forms of breast pathology are looked at in the aggregate, irrespective of their relative risk for harm, disease of the breast takes on the appearance of a monolithic entity that you either have, or don't have; they call it breast cancer.
The concept of a breast cancer that has no symptoms, which can not be diagnosed through manual palpation of the breast and does not become invasive in the vast majority of cases, might sound unbelievable to most women. However, there does exist a rather mysterious clinical anomaly known as Ductal Carcinoma In Situ (DCIS), which is, in fact, one of the most commonly diagnosed and unnecessarily treated forms of "breast cancer" today.
What women fail to understand—because their physicians do not know better or have not taken care to explain to them—is that they have a choice when diagnosed with DCIS. Rather than succumb to aggressive treatment with surgery, radiation and chemo-drugs, women can choose watchful waiting. Better yet, a radical lifestyle change can be focused on eliminating exposure to chemicals and radiation, as well as improved exercise and nutrition. This choice is not being made in most cases because the medical community is not informing their patients that there is such.
Ductal Carcinoma In Situ (DCIS): Cancer or Benign Lesion? Between 30-50% of new breast cancer diagnoses obtained through x-ray mammography screenings are classified as Ductal Carcinoma In Situ (DCIS).3 DCIS refers to the abnormal growth of cells within the milk ducts of the breast forming a calcified lesion commonly between 1-1.5 cm in diameter, and is considered non-invasive or "stage zero breast cancer," with some experts arguing for its complete re-classification as a non-cancerous condition.
Because DCIS is almost invariably asymptomatic and has no palpable lesions, it would not be known as a clinically relevant entity were it not for the use of x-ray diagnostic technology. Indeed, it was not until the development and widespread application of mammography in the early 1980s as the central push behind National Breast Cancer Awareness campaigns that rates of DCIS diagnosis began to expand to their present day epidemic proportions.4,5 It is no wonder, therefore, that the United States, which has one of the highest x-ray mammography rates, also has the highest level of DCIS in the world. As of January 2005, an estimated one-half million U.S. women were living with a diagnosis of DCIS.6
Proponents of breast screenings claim they are saving lives through the early detection and treatment of DCIS, regarding it as a potentially life-threatening condition, indistinct from invasive cancers. They view DCIS a priori as "pre-cancerous" and argue that, because it could cause harm if left untreated it should be treated in the same aggressive manner as invasive cancer. The problem with this approach is that while the rate at which DCIS progresses to invasive cancer is still largely unknown, the weight of evidence indicates that it is significantly less than 50%—perhaps as low as 2-4%.
Indeed, the 10-year survival rates of patients with DCIS (96%-98%) post-treatment speaks volumes to the relatively benign nature of the condition.7,8 Another study found that at the 40-year follow-up period 40% of DCIS lesions still had no signs of invasiveness.9 Adding even more uncertainty, another study showed that coexisting DCIS independently predicts lower tumor aggressiveness in node-positive luminal breast cancer, indicating its possibly protective role. 10
Watchful Waiting (Around Doing Nothing of Use) A solid argument can be made that watchful waiting is the most appropriate response to the diagnosis of DCIS, and that in many cases DCIS would be better left over-diagnosed and under-treated. As one paper discusses:
"The central harm of screening is over-diagnosis—the detection of abnormalities that meet the pathologic definition of cancer but will never progress to cause symptoms." 11
A solid body of evidence has emerged suggesting that when DCIS is left undiagnosed and untreated rarely will it become malignant. DCIS was in fact poorly named from the outset, as it is does not behave like most carcinomas (cancers). Cancer, like the constellation named after it, derives from the Greek word for Crab, indicating the manner in which is expands outward in uncontrolled growth. In situ means exactly the opposite, "in place." An unmoving cancer is therefore a contradiction in terms. These problems with classification have not gone unnoticed in the medical journals:
"Despite the presence of the word carcinoma, ductal carcinoma in situ (DCIS) is the poster child for this problem (a senior pathologist involved in developing classification systems confided to one of us that he regretted the use of the term carcinoma in DCIS). No one believes that DCIS always progresses to invasive cancer, and no one believes it never does. Although no one is sure what the probability of progression is, studies of DCIS that were missed at biopsy (1,2) and the autopsy reservoir (3) suggest that the lifetime risk of progression must be considerably less than 50%." 12
The true irony here is that while participation in x-ray mammography is considered by the public a form of breast cancer prevention and "watchful waiting," it has become—whether by design or accident—a very effective way of manufacturing breast cancer diagnoses and justifying unnecessary treatment. This is not unlike what has been seen with prostate cancer screenings that track Prostate Specific Antigen (PSA); the aggressive treatment of lesions/tumors identified through PSA markers may actually increase patient mortality relative to doing nothing at all.
Women diagnosed with DCIS are simply not given the option to decline treatment. The problem is illustrated below:
"Because the 'best guess' is that most DCIS won't progress to invasive cancer, the risk of over-diagnosis would be expected to be greater than 50%. The problem with over-diagnosis is that it leads to overtreatment. Because it is impossible to determine which individuals are over-diagnosed, almost everyone gets treated as if they had invasive cancer." 13
Over-diagnosis is a huge problem, discussed in greater depth here:
"Over-diagnosis plays havoc with our understanding of cancer statistics. Because over-diagnosis effectively changes a healthy person into a diseased one, it causes overestimations of the sensitivity, specificity, and positive predictive value of screening tests and the incidence of disease (13). As the MLP and a recent analysis of Surveillance, Epidemiology, and End Results (SEER)1 data illustrate (14), over-diagnosis also markedly increases the length of survival, regardless of whether screening or associated treatments are actually effective. However, over-diagnosis does not reduce disease-specific mortality because treating subjects with pseudo-disease does not help those who have real disease. Consequently, disease-specific mortality is the most valid end point for the evaluation of screening effectiveness." 14
Ultimately DCIS over-diagnoses contribute to the appearance that conventional breast cancer screenings and treatments are more successful and less harmful than they actually are, while at the same time making the industry far more profitable than otherwise would be the case. ∆
Sayer Ji is the founder of GreenMedInfo.com, the world's largest, open source and evidence-based natural medicine and toxicology database, with close to 20,000 indexed across 2500 Diseases and 1500 Substances. He can be reached at [email protected] References 1, 10 Overdiagnosis and overtreatment of breast cancer: Rates of ductal carcinoma in situ: a US perspective. Breast Cancer Res. 2005 Nov. 11. PMID: 1657703
2 US women's attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey. BMJ 320 : 1635 doi: 10.1136/bmj.320.7250.1635 (Published 17 June 2000)
3. The management of ductal carcinoma in situ of the breast. Endocrine-Related Cancer. 2011 8 33-45.
4,6 NIH State-of-the-Science Conference. Diagnosis and Management of Ductal Carcinoma in Situ (DCIS), Sept. 2009 Source: http://consensus.nih.gov/2009/dcisstatement.htm
5 The Dark Side of Breast Cancer Awareness Month GreenMedInfo.com. 2011 Oct 1.
7 Ductal carcinoma in situ (DCIS): are we overdetecting it? http://breast-cancer-research.com/content/6/S1/P23
8 Mortality among women with ductal carcinoma in situ of the breast in the population-based surveillance, epidemiology and end results program. Arch Intern Med. 2000 Apr 10;160(7):953-8. PMID: 1761960
9 Coexisting ductal carcinoma in situ independently predicts lower tumor aggressiveness in node-positive luminal breast cancer. Med Oncol. 2011 Oct 8. Epub 2011 Oct 8. PMID: 21983862
11, 12, 13 The Sea of Uncertainty Surrounding Ductal Carcinoma In Situ – The Price of Screening Mammmography. Journal of The National Cancer Institute 2008 Feb. 12. PMID: 18270336
14 Overdiagnosis: An Underrecognized Cause of Confusion and Harm in Cancer Screening. Journal of The National Cancer Institute 2000 PMID: 10944539
Source : Green Med Info
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BMJ OpEd Says Komen Ads False
The world's largest breast cancer charity used misleading statistics and deceptive statements about mammography to promote breast cancer awareness and screening, authors of an opinion piece asserted.
In promotional material for the 2011 Breast Cancer Awareness Month, Susan G. Komen for the Cure suggested large differences in breast cancer survival among women who undergo screening mammography and those who do not. Specifically, the advertisement stated a 5-year survival of 98% when breast cancer is caught early and 23% when it is not.
In doing so, the organization ignored "a growing and increasingly accepted body of evidence [showing] that although screening may reduce a woman's chance of dying from breast cancer by a small amount, it also causes major harms."
"This benefit of mammography looks so big that it is hard to imagine why any one would forgo screening. She'd have to be crazy," Steven Woloshin, MD, and Lisa M. Schwartz, MD, of the Department of Veterans Affairs Medical Center in White River Junction, Vt. and the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H., wrote in an article published online in BMJ.
"But it's the advertisement that is crazy," they added.
In response to the BMJ article, Susan G. Komen for the Cure issued a statement from Chandini Portteus, vice president of research, evaluation, and scientific programs.
"Everyone agrees that mammography isn't perfect, but it's the best widely available detection tool that we have today," said Portteus. "We've said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start, through biomarkers, for example."
But Woloshin and Schwartz argued that the timing of breast cancer diagnosis has minimal impact on long-term survival, citing evidence that mammography reduces a 50-year-old woman's 10-year risk of dying of breast cancer from 0.53% to 0.46%.
"Five-year survival is all about what happens from the time of diagnosis," Woloshin and Schwartz wrote. "It is the proportion of women who are alive 5 years after diagnosis. Because screening finds cancers earlier, comparing survival between screened and unscreened women is hopelessly biased."
The authors also faulted Komen's deception for emphasizing the benefits of mammography but making no mention of the possible risks. Woloshin and Schwartz cited evidence indicating that 20% to 50% of women screened annually for a decade will have at least one "false alarm" that leads to a biopsy.
For every life saved by mammography, the imaging leads to overdiagnosis of two to 10 women, many of whom receive unnecessary interventions and treatment, they added.
With regard to the need for balanced information about mammography, Komen's Portteus said, "We have long advocated for women to be informed about the benefits and risks of early detection and treatment. We encourage women to work with their healthcare providers to find out what's right for them.
"At the same time, Komen is funding millions of dollars in community health programs that educate, screen, and provide financial and social support for low-income and uninsured women through treatment," she added.
"Women need much more than marketing slogans about screening," Woloshin and Schwartz concluded. "They need -- and deserve -- the facts. The Komen advertisement campaign failed to provide the facts.
"Worse, it undermined decision making by misusing statistics to generate false hope about the benefit of mammography screening. That kind of behavior is not very charitable."
Source : Medical News Today via BMJ - Woloshin S, Schwartz LM "How a charity oversells mammography" BMJ 2012; 345: e5132.
Link to Source
Cancer Screening
Dr. Mercola has a lot of information about Breast Cancer Screening, below is taken direct from his website:
Your Greatest Weapon Against Breast Cancer (Not Mammograms)
According to the National Breast Cancer Foundation, 200,000 new cases of breast cancer will be diagnosed each year in the US, making it three times more common than other gynecological cancers.
Breast cancer will claim the lives of 40,000 people this year.
In fact, the only type of cancer that claims the lives of more women is lung cancer.
Even more disturbing is the speed at which breast cancer rates have risen over the past 5 decades.
In 1960, one in 20 women was diagnosed—but today, it is one in seven.
The following are some important facts about this type of cancer:1
- Breast cancer is the leading cause of death for women age 40 to 55.
- 15 percent of all breast cancers occur in women under age 45; in this age group, breast cancers are more aggressive and have lower recovery rates.
- 80 percent of breast lumps are NON-cancerous.
- 70 percent of breast cancers are found through breast self-exams.
- About 80 percent of women diagnosed with breast cancer have no family history of breast cancer.
Several recent studies have clearly shown that breast cancer screenings may be causing women more harm than good.
A new study published in the British Medical Journal (December 2011) confirmed that breast cancer screening may cause women harm, especially during the early years after they start screening.2 This harm is largely due to surgeries, such as lumpectomies and mastectomies, and other (often unnecessary) interventions. The study highlights losses in quality of life from false positive results and unnecessary treatment.
Fortunately, we're beginning to see the initial stirrings of change, as this latest report from the Institute of Medicine (IOM) shows, which calls into question the role environmental exposure may be playing in the development of breast cancer.3 The IOM committee is absolutely correct in calling for more research into the risks of various environmental exposures over the course of a woman's lifetime.
Isn't it ironic that the mammogram—the principle diagnostic test given to women to help detect and prevent breast cancer—is responsible for increasing women's risk for developing it?
Mammogram Radiation is Much More Damaging than a Chest X-Ray Mammograms use ionizing radiation at a relatively high dose, which can contribute to the mutations that can lead to breast cancer. You can get as much radiation from one mammogram as you would from 1,000 chest X-rays. Mammography also compresses your breasts tightly, which can lead to a dangerous spread of cancerous cells, should they exist. Dr. Samuel Epstein, one of the world's top cancer experts, has stated:
"The premenopausal breast is highly sensitive to radiation, each 1 rad exposure increasing breast cancer risk by about 1 percent, with a cumulative 10 percent increased risk for each breast over a decade's screening."
Breast Cancer Screening May Lead to Unnecessary Treatments and Surgeries that Can Actually SHORTEN Your Lifespan Another concern is that mammograms carry an unacceptably high rate of false positives—up to six percent. False positives can lead to expensive repeat screenings, exposing you to even more radiation, and can sometimes result in unnecessary invasive procedures such as biopsies, surgery, radiation, and chemotherapy. In fact, if you undergo breast screenings, you have a 35 percent increased risk of having surgery.4 If a mammogram detects an abnormal spot in your breast, the next step is typically a biopsy.
This involves taking a small amount of tissue from your breast, which is then looked at by a pathologist under a microscope to determine if cancer is present. These biopsies are notoriously inaccurate, often leading to misdiagnosis and unnecessary treatments, not to mention undue emotional stress.
Just thinking you may have breast cancer, when you really do not, focuses your mind on fear and disease, and the stress is actually enough to trigger an illness. It is well established that stress has damaging effects on your health. So, a false positive diagnosis can be damaging to your health from multiple angles. In a 2009 Cochrane Database Systematic Review of breast cancer screening and mammography, the authors wrote:5
"Screening led to 30 percent overdiagnosis and overtreatment, or an absolute risk increase of 0.5 percent. This means that for every 2000 women screened for 10 years, one will have her life prolonged, and 10 healthy women who would not have been diagnosed if they had not been screened, will be treated unnecessarily."
Unfortunately, the disturbing scientific findings do not end there. This means that by having these breast cancer screenings, you may be shortening your life, rather than extending it. In reference to the 2011 BMJ findings about the damage being done by breast cancer screening, SayerJi of Green Med Info wrote:6
"What is perhaps most disturbing about these findings is that, while they clearly call into question the safety and effectiveness of breast screenings, the studies upon which they are based use an outdated radiation risk model, which minimizes by a factor of 4 to 5 the carcinogenicity ... What this indicates, therefore, is that breast screenings are not just 'causing more harm than good,' but are planting seeds of radiation-induced cancer within the breasts of millions of women."
Mammograms are NOT Really Saving Lives, Research Says In September 2010, the New England Journal of Medicine, one of the most prestigious medical journals, published the first study in years7 to examine the effectiveness of mammograms. Their findings are a far cry from what most public health officials would have you believe.The bottom line is that mammograms seem to have reduced cancer death rates by only 0.4 deaths per 1,000 women—an amount so small it might as well be zero. Put another way, 2,500 women would have to be screened over 10 years for a single breast cancer death to be avoided.
So, not only are mammograms unsafe, but they are NOT saving women's lives, as was commonly thought. Past research has also shown that adding an annual mammogram to a careful physical examination of the breasts does not improve breast cancer survival rates over physical examination alone. If mammograms won't save you, then what will?
Cancer's Greatest Enemy: Your Immune System Recent discoveries suggest that your immune system is designed to eliminate cancer. However, when you implement caustic medical interventions (such as radiation and chemotherapy) that damage your immune system so that it cannot respond appropriately, you are destroying your body's best chances for healing. Unfortunately, mammograms tend to increase the likelihood that women will undertake medical procedures that interfere with this natural healing ability. There is now a great deal of scientific evidence supporting the theory that your own immune system is your best cancer weapon:
- Individuals with liver or ovarian cancer survive longer if their killer T cells have invaded their tumors.
- A 2005 study showed that colon cancers that most strongly attract T cells are the least likely to recur after treatment.8
- Another study found that 60 percent of precancerous cervical cells (found on PAP tests) revert to normal within a year,and 90 percent revert within three years.9
- Some kidney cancers are known to regress, even when highly advanced.
Thirty Percent of Breast Tumors Go Away on their Own According to breast surgeon Susan Love of UCLA, at least 30 percent of tumors found on mammograms would go away if you did absolutely nothing.11 These tumors appear to be destined to stop growing on their own, shrink, and even go away completely. This begs the question—how many cancer cures that are attributed to modern interventions like chemotherapy and radiation, are actually just a function of the individual's immune system ridding itself of the tumor on its own? How many people get over cancer in spite of the treatments that wreak havoc on the body, rather than because of them? It is impossible to definitively answer this question.
But it is safe to say that the strength of your immune system is a major factor in determining whether or not you will beat cancer, once you have it.Nearly everyone has cancerous and pre-cancerous cells in their body by middle age, but not everyone develops cancer. The difference lies in the robustness of each person's immune system.
Dr. Barnett Kramer of NIH12 says it's becoming increasingly clear that cancers require more than just mutations to progress. They need the cooperation of surrounding cells, certain immune responses, and hormones to fuel them. Kramer describes cancer as a dynamic process, whereas it used to be regarded as "an arrow that moved in one direction" (e.g., from bad to worse). What does this mean for you?
The better you take care of your immune system, the better it will take care of you.
One way to strengthen your immune system is to minimize your exposure to mammograms and other sources of ionizing radiation. But you can also build up your immune system DAILY by making good diet and lifestyle choices. One of the best ways to do this is by optimizing your vitamin D level.
Vitamin D: Cancer Fighter Extraordinaire Vitamin D, a steroid hormone that influences virtually every cell in your body, is one of nature's most potent cancer fighters. Receptors that respond to vitamin D have been found in almost every type of human cell, from your bones to your brain. Your liver, kidney and other tissues can convert the vitamin D in your bloodstream into calcitriol, which is the hormonal or activated version of vitamin D. Your organs then use it to repair damage and eradicate cancer cells.
Vitamin D is actually able to enter cancer cells and trigger apoptosis, or cancer cell death.
When JoEllen Welsh, a researcher with the State University of New York at Albany, injected a potent form of vitamin D into human breast cancer cells, half of them shriveled up and died within days.The vitamin D worked as well at killing cancer cells as the toxic breast cancer drug Tamoxifen, without any of the detrimental side effects and at a tiny fraction of the cost.
I strongly recommend making sure your vitamin D level is 70 to 100ng/ml if you've received a breast cancer diagnosis. You can achieve this through direct, safe exposure to ultraviolet light, or if this is not possible, by taking an oral vitamin D3 supplement. Vitamin D works synergistically with every cancer treatment I am aware of, without adverse effects. Please watch my free one-hour lecture on vitamin D for more information. For a comprehensive guide to breast cancer prevention and treatment, refer to this previous article. Some of the other research-based breast cancer fighters include the following:
- Eating plenty of fresh, whole, organic vegetables, especially fermented vegetables
- Avoiding all processed foods, and minimizing sugar, grains and starchy foods
- Vitamin A plays a role in preventing breast cancer; your best sources are organic egg yolks, raw milk and butter, and beef and chicken liver (from organically raised, grass pastured animals)
- Curcumin (the active agent in turmeric) is one of the most potent tumor-inhibiting foods; black cohosh, artemisinin, green tea, kelp, cruciferous vegetables and evening primrose oil also show promise in helping to prevent breast cancer
- Getting plenty of exercise daily
The majority of breast cancer is preventable. But if you are hit with that diagnosis, don't lose hope! There is a great deal you can do to harness your body's own powerful healing abilities.
References:
- 1 1 About Breast Cancer, The Breast Cancer Site.
- 2 Possible Net Harms of Breast Cancer Screening: Updated Modelling of Forrest Report, British Medical Journal, December 8, 2011: 343; d7627, James Raftery and Maria Chorozoglou.
- 3 Breast Cancer and the Environment: A Life Course Approach, Institute of Medicine of the National Academies, December 7, 2011.
- 4 Confirmed: Breast Screenings Cause More Harm Than Good, GreenMedInfo.com, January 5, 2012: Sayer Ji.
- 5 X-ray Mammography: For Every Woman Whose Life is Prolonged 10 Women's Lives will be Shortened, i.e. "Treated Unnecessarily", Cochrane Database of Systematic Reviews, October 7, 2009: 2009(4); CD001877, Peter C. Gotzsche and Margrethe Nielsen.
- 6 Confirmed: Breast Screenings Cause More Harm Than Good, GreenMedInfo.com, January 5, 2012: Sayer Ji.
- 7 Effect of Screening Mammography on Breast-Cancer Mortality in Norway, New England Journal of Medicine, September 23, 2010: 363(13); 1203-10, Mette Kalager, MD, et al.
- 8 Effect of Screening Mammography on Breast-Cancer Mortality in Norway, New England Journal of Medicine, September 23, 2010: 363(13); 1203-10, Mette Kalager, MD, et al.
- 9 Regression of Low-grade Squamous Intra-epithelial Lesions in Young Women, The Lancet, November 6, 2004: 364(9446); 1678-1683, Anna-Barbara Moscicki, M.D., et al.
- 10 Cancers Can Vanish Without Treatment, but How?, The New York Times, October 26, 2009: Gina Kolata.
- 11 Could This Be The End of Cancer?, Newsweek, December 12, 2011: Sharon Begley.
- 12 Cancers Can Vanish Without Treatment, but How?, The New York Times, October 27, 2009: Gina Kolata.
Link to Source
More information on Breast Cancer Screening, this time reported on MedPage (December 9th 2011)
New Study Adds to Negative Votes on Mammography
After 10 years of mammograms, a woman may get more harm than good from the screening, researchers from the U.K. found.
When false positive diagnoses and unnecessary surgeries were taken into account, the quality-adjusted life years (QALYs) gained were significantly reduced, James Raftery, PhD, of the University of Southampton, and colleagues reported online in BMJ.
"Inclusion of the harms from false-positive results and unnecessary surgery reduced the benefits of screening by about half, with negative net QALYs in the early years after the introduction of screening," they wrote.
In 1986, the Forrest report led to breast screening in the U.K., suggesting it would reduce the death rate from breast cancer by almost a third, and with few harms and at low cost.
After 10 years of mammograms, a woman may get more harm than good from the screening, researchers from the U.K. found.
When false positive diagnoses and unnecessary surgeries were taken into account, the quality-adjusted life years (QALYs) gained were significantly reduced, James Raftery, PhD, of the University of Southampton, and colleagues reported online in BMJ.
"Inclusion of the harms from false-positive results and unnecessary surgery reduced the benefits of screening by about half, with negative net QALYs in the early years after the introduction of screening," they wrote.
In 1986, the Forrest report led to breast screening in the U.K., suggesting it would reduce the death rate from breast cancer by almost a third, and with few harms and at low cost.
Since then, a number of harms associated with screening have been acknowledged, particularly false positives and overdiagnosis of cancers that would never have caused symptoms. Also, a recent Cochrane review noted that mortality reductions may be smaller than initially expected, the researchers said.
So to assess the potential benefits of screening in terms of QALYs when those harms were included, Rafferty and colleagues looked at data from eight trials involving 100,000 women from the U.K., ages 50 and up, who had breast screening.
They found that taking the effects of those harms into account reduced the estimate of net cumulative QALYs gained after 20 years by more than half, from 3,301 to 1,536.
And when they changed the reduction in mortality from that suggested by the Forrest study to that suggested by the recent Cochrane review, the net QALYs at year 20 fell to 834, they reported.
That also generated negative QALYs for the first seven years of screening, and only 70 QALYs after 10 years, they reported.
Indeed, in sensitivity analyses, the results persisted, especially up to 10 years, suggesting that screening may have caused net harm, they reported.
"Our study supports the suggestion ... that mammographic breast cancer screening could be causing more harm than good after 10 years," they wrote. After that, net QALYs accumulate, but are much lower than would be expected, they added.
Means of reducing the harms from screening might include less frequent screens, particularly for younger women, the researchers said.
The study was limited because it relies on older clinical trial data regarding mortality and surgery and because the researchers didn't include information on recurrence and or re-operations.
Raftery and colleagues wrote that more research is needed on the extent of unnecessary treatment and its impact on quality of life. Further study should also focus on identifying patients who stand to benefit most from surgery, they added.
"From a public perspective, the meaning and implications of overdiagnosis and overtreatment need to be much better explained and communicated to any woman considering screening," they concluded.
Source : MedPage
Link to Source
Below is a study abstract from The Journal of National Cancer Institute published online 21 November 2011.
The author Stefanex explained in the commentary in December in the JNCI that "at least 1,900 women in their 40s would need to undergo mammography to avoid one death over 11 years. During that follow-up time, there would be 2,000 false-positive tests, "along with the resulting unnecessary biopsies, overdiagnosis, and overtreatment,"
Mammograms for 50-70 year old women - 838 women have to screened for a 6 year period to prevent one death from breast cancer. Five in 1,000 women over the the age of 50 years are expected to get breast cancing in a 10 year period. Annual screening in the 10 years would prevent only of the five expected deaths. Stefanex argued that almost 1,000 women "screened for ten years will have gained nothing, and may have been subject to as many as 50% false-positive tests, unnecessary biopsies, overdiagnosis, and overtreatment for breast cancer,"
Uninformed Compliance or Informed Choice? A Needed Shift in Our Approach to Cancer Screening
Michael Edward Stefanek
Abstract
It has been more than 30 years since the first consensus development meeting was held to deal with guidelines of mammography screening. Although the National Cancer Institute has wisely focused on the science of screening and of screening benefits vs harm, many professional organizations, advocacy groups, and the media have maintained a focus on establishing who should be screened and promoting recommendations for which age groups should be screened. Guidelines have been developed not only for mammography but also for screening at virtually all major cancer sites, especially for prostate cancer, and most recently, with the preliminary results of the National Lung Screening Trial, for lung cancer. It seems clear that we have done an inadequate job of educating screening candidates about the harms and benefits of cancer screening, including the extent to which screening can reduce cancer mortality. We must also question whether our practice of summoning women to have mammograms, while providing men informed choice for prostate cancer screening, is consistent with a scientific analysis of the relative harms and benefits. We have spent a staggering amount of time and energy over the past several decades developing, discussing, and debating guidelines. Professional and advocacy groups have spent much time aggressively advocating the adoption of guidelines supported by their respective groups. It seems that it would be much more productive to devote such energy to educating screening candidates about the harms and benefits of screening and to engaging in shared decision making.
Source : Journal Of The National Cancer Institute
Link to Abstract as above
See Also "Natural history of breast cancers detected in the Swedish mammography screening programme: a cohort study"