Dangers and Unreliability of Mammography
By Ben Wasserman
Oct 9, 2005 - 11:59:00 PM
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Mammogram screenings can find more traces of breast cancer. That is what the mainstream news media and the medical industry keep saying. But they never say the fact that these results may come with a high price. This is because the results of mammography tests are not accurate, while x-ray radiation and the procedure per se impose a real risk on the patients.
X-ray radiation is a human carcinogen officially recognized in 2005 by the Department of Health and Human Services. The carcinogenesis of x-ray radiation has been well studied throughout the years. Authorities say there is no zero risk. Additionally, any dose of x-ray poses a risk. The risk is always downplayed by the medical professionals while the benefits of mammogram screening for the detection of breast cancer are overstated.
Samuel S. Epstein M.D., Professor Emeritus Environmental Medicine, University of Illinois at Chicago School of Public Health and his colleagues wrote an excellent review on mammogram screening based on 47 scientific articles. Their article is titled "Dangers and Unreliability of Mammography: Breast Examination is a Safe, Effective, and Practical Alternative."
Dr. Epsteinís article, published in 2001in the International Journal of Health Services, concludes that mammogram screening is dangerous and unreliable when it comes to the detection of breast cancer.
According to Dr. Epstein's article, the dangers with mammography testing include induction and promotion of breast cancer, falsely positive and negative diagnosis of breast cancer, and over-diagnosis. These negatives come largely from x-ray radiation, breast compression and unreliable results. This does not count for $2.5 to $10 billion a year of medical expenditure.
The article says the dose of x-ray used in the mammography is not as small as that used in a chest x-ray, or that received from nature by an individual who stays in Denver for a one-week period. Actually, one mammogram screening may deliver a 1,000-fold higher dose of x-ray than one single chest x-ray does.
With this dose of x-ray, the risk of developing breast cancer is one percent. If mammogram screenings are performed once a year, the accumulative risk for a 10-year period goes as high as 10 percent. Women aged 40 to 50 years old are particularly sensitive to x-rays. One to two percent of women are silent carriers of the A-T (ataxia-telangiectasia) gene and they are particularly sensitive to x-ray radiation. Some estimates indicate that up to 20 percent of all breast cancers in the U.S. may be affected by mammogram screening.
The effect of x-rays on breast cancer is substantial. According to Dr. John Gofman, a noted medical physicist, 75 percent of breast cancer patients are exposed to medical x-rays, although the x-ray is not the sole cause of breast cancer. Dr. Gofman is Professor Emeritus of Molecular and Cell Biology in the University of California at Berkeley. His book titled Preventing Breast Cancer: The Story of a Major, Proven, Preventable Cause of this Disease is exclusively and extensively focused on the effect of x-rays on breast cancer.
Cancer risk of mammogram screening comes also from breast compression. "Mammography entails tight and often painful compression of the breast, particularly in premenopausal women. This may lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small, as yet undetected breast cancers," according to Dr. Epstein's article.
The results of mammogram screenings seem limited and unreliable. First, patients need to take mammogram screenings every year. Mammogram screenings at age 45 does not foretell whether or not you get breast cancer at any age after 45.
Mammogram screening is unable to detect all the real breast cancers. About one third or more of pre-menopausal cancers are not found at the screening. In a couple of months, aggressive breast cancer, in many cases, can double its size and can pose a serious danger. In this case, mammogram screening gives patients a false assurance that they are free of breast cancer while the breast cancer is actually in the works.
Falsely negative mammograms are common, particularly in pre-menopausal women, due to the dense and highly glandular structure of their breasts and their increased proliferation late in their menstrual period. Mammograms may also miss breast cancer in those post-menopausal women on estrogen replacement therapy.
Likewise, false positive mammograms are also common for the same reasons iterated above, particularly in pre-menopausal women and post-menopausal women who are on estrogen replacement therapy. Falsely positive mammograms can lead to needless anxiety, more mammograms, and unnecessary biopsies which are also harmful in many cases. This can be a problem particularly for those who are at high risk, such as those with family history, prolonged use of contraceptive pills, early menarche, and nulliparity.
One striking feature of mammogram screening is over-diagnosis. Many suspected cases of breast cancer do not need any treatment. Mammograms tend to over-diagnose breast cancer. For instance, patients with ductal carcinoma-in-situ (DCIS), a pre-invasive cancer with an incidence of 40,000 annually, once diagnosed, often receive treatments such as lumpectomy plus radiation or even mastectomy and chemotherapy. However, 80 percent of all DCIS never become invasive even if left untreated. Mortality of DCIS is about one percent; early detection does not improve the mortality, according to Dr. Epstein's article.
Dr. Epstein and his colleagues deputed the major claim by the mainstream media and the medical industry that "early detection by mammogram screening can save life." The article says this claim is at best questionable. The fact is, the majority of breast cancers are unaffected by early detection with mammography, either because they are aggressive or slowly growing. The prognosis of a case depends on not only early detection, but largely on the nature of the breast cancer and the host's immune response.
According to Dr. Epstein's article, "the January 1997 National Institutes of Health Consensus Conference recommended against pre-menopausal screening (24), a decision that the NCI, but not the ACS, accepted (4). However, under pressure from Congress and the ACS, the NCI reversed its decision some three months later in favor of pre-menopausal screening."
The U.S is the only nation that recommends mammogram screening for pre-menopausal women. Two or more mammograms per breast annually in post-menopausal women are common in the U.S. In contrast, European countries are more cautious and they recommend a single mammogram every two or three years.
Dr. Epsten and colleagues summarize that, "mammography screening is a profit-driven technology posing risks compounded by unreliability. In striking contrast, annual clinical breast examination (CBE) by a trained health professional, together with monthly breast self-examination (BSE), is safe, at least as effective, and low in cost. International programs for training nurses how to perform CBE and teach BSE are critical and overdue."
"Contrary to popular belief and assurances by the U. S. media and the cancer establishment- the National Cancer Institute (NCI) and American Cancer Society (ACS)- mammography is not a technique for early diagnosis. In fact, a breast cancer has usually been present for about eight years before it can finally be detected. Furthermore, screening should be recognized as damage control, rather than misleadingly as "secondary prevention."," wrote Dr. Epstein and colleagues.
For more information, visit preventcancer.com and rational.org