In Mammogram Debate, Politics Trounces Science
August 15, 2012
By Dr. Mercola
The featured three-part article in Bloomberg News1, 2, 3 delves into the questionable practices supporting conventional breast cancer screening and takes a swipe at the politics connected with mammography, exposing much of what the mainstream media has avoided thus far. The articles are excerpts from Handel Reynolds' new book, The Big Squeeze: A Social and Political History of the Controversial Mammogram. Reynolds is a breast radiologist at Piedmont Hospital in Atlanta.
Citing the history behind who's been calling the shots through the years for this cancer screening test, Reynolds reveals how public pressure and key government health officials play a part in funding―or not funding―this test. One of the key issues is that mammography's failings have been studied for years in excruciating detail, and have shown that mammography has been oversold as an early detector of cancer.
"In a moment of unprecedented candor for an official of the normally message- disciplined American Cancer Society, Otis Brawley, its chief medical officer, made a startling admission... 'I'm admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated,'" Reynolds writes.
"Brawley was responding to an article that had just been published in the Journal of the American Medical Association, in which researchers argued that 20 years of widespread breast and prostate cancer screening had failed to deliver the promised health benefits... [S]creening had led to a huge increase in the incidence of early-stage disease, with only a very slight decrease in late-stage disease.
This is significant because the basic rationale for screening has always been that identifying and treating more early-stage cancers will lower the number of late-stage cancers. That this has not happened suggests that screening detects many nonaggressive cancers that would not have progressed if left undetected. The practical result of large-scale screening, in other words, was overdiagnosis and overtreatment."
Mammography May Actually RAISE Your Absolute Risk of Breast Cancer
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 Reviews4, mammography breast cancer screening led to 30 percent overdiagnosis and overtreatment, which equates to an absolute risk increase of 0.5 percent.
"[F]or every 2,000 women invited for screening throughout 10 years, one will have her life prolonged and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings. It is thus not clear whether screening does more good than harm." [Emphasis mine]
Another study, published in 2010, concluded that the reduction in mortality as a result of mammographic screening was so small as to be nonexistent—a mere 2.4 deaths per 100,000 person-years were spared as a result of the screening5.
False positives from mammograms—a diagnosis of cancer when in fact it is non-cancerous—are notorious in the industry, causing women needless anxiety, pain and, often, invasive and disfiguring surgical procedures. If a mammogram detects an abnormal spot in a woman's breast, the next step is typically a biopsy.
This involves taking a small amount of tissue from the breast, which is then looked at by a pathologist under a microscope to determine if cancer is present. The problem is that early stage cancer like ductal carcinoma in situ, or D.C.I.S., can be very hard to diagnose, and pathologists have a wide range of experience and expertise. There are no diagnostic standards for D.C.I.S., and there are no requirements that the pathologists doing the readings have specialized expertise.
Mammography Also Misses 20-40 Percent of Cancers
There's also the risk of getting a false negative, meaning that a life-threatening cancer is missed. It's important to realize that a negative mammogram does not equate to a clean bill of health. All a negative mammogram can tell you is that IF you have cancer, it hasn't grown large enough yet to be detected. According to the National Cancer Institute (NCI):
"Overall, screening mammograms miss up to 20 percent of breast cancers that are present at the time of screening."
This is particularly true for women with dense breast tissue. Forty-nine percent of women have high breast tissue density6, and mammography's sensitivity for dense breasts is as low as 27 percent7—meaning as many as 75 percent of dense-breasted women are at risk for a cancer being missed if they rely solely on mammography. Even with digital mammography, the sensitivity is still less than 60 percent.
New York and Virginia recently passed laws requiring women with dense breasts to be informed they may need to seek alternative screening methods.
Lunch Break with Melinda Beck: Mammograms miss 40% of breast cancers in women with dense breast tissue, and such women are four times more likely to develop breast cancer than others. A campaign dubbed "Are You Dense?" is now gaining momentum.
Beware: Popular Cancer Campaigns Fraught with False Claims
Unfortunately, even though high-profile people like Dr. Susan Love of the Susan Love Research Foundation agree that mammography has limitations as well as dangers, others like Kathleen Sebelius and the Susan G. Komen for the Cure prefer to ignore the science and continue to campaign for annual screenings without so much as a hint at the risks involved.
As stated in Bloomberg8:
"Advertisements often contain images of young women, thus heightening fears of breast cancer in this age group while masking the reality that the disease is much more common in older women. Promotions also tend to overemphasize the potential benefits of screening while remaining largely silent on its limitations. The statement 'Mammography can find breast cancer as small as the period at the end of this sentence' appeared on many promos in the 1980s and 1990s, leading many women to expect too much from the technology.
A 2003 survey found that many American women harbor the misconception that mammography can actually prevent breast cancer from occurring. 'Screening' is not synonymous with 'prevention'; mammography reduces the risk of death only by finding breast cancer early. "
A recent article in the British Medical Journal9 (BMJ) exposes how Susan G. Komen for the Cure is using misleading statistics to persuade women to undergo mammography. The authors write:
"Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen's advocacy for it. A growing and increasingly accepted body of evidence shows that although screening may reduce a woman's chance of dying from breast cancer by a small amount, it also causes major harms. In fact, the benefits and harms are so evenly balanced that the National Breast Cancer Coalition, a major US network of patient and professional organizations, "believes there is insufficient evidence to recommend for or against universal mammography in any age group of women."
... In contrast, Komen's public advertising campaign gives women no sense that screening is a close call... The advertisement states that the key to surviving breast cancer is for women to get screened because 'early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it's not? 23%.'
This benefit of mammography looks so big that it is hard to imagine why any woman would forgo screening. She'd have to be crazy. But it's the advertisement that is crazy..."
Komen's Behavior "Not Very Charitable"
The data Komen uses—the five-year survival data—presents a dramatically distorted picture. (Furthermore, the advertisement makes no mention of any of the harms clearly associated with the screening at all.) The authors go on to explain why survival data cannot be used to make a case for or against mammography:
"To see how much lead time can distort five year survival data, imagine a group of 100 women who received diagnoses of breast cancer because they felt a breast lump at age 67, all of whom die at age 70. Five year survival for this group is 0%. Now imagine the women were screened, given their diagnosis three years earlier, at age 64, but still die at age 70. Five year survival is now 100%, even though no one lived a second longer."
Overdiagnosis also distorts survival statistics because women who receive false positives are counted as having survived the cancer! As mentioned earlier, for every woman saved, 10 women are misdiagnosed and treated unnecessarily, so the distortion due to overdiagnosis is massive. And, as the authors explain, the more women are overdiagnosed, the more the survival statistics are skewed.
"If there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down. There is no way to disentangle lead time and overdiagnosis biases from screening survival data," the authors state.
The only statistic that matters is how many deaths are prevented. And the only way to determine whether a screening test works in that regard or not is to evaluate how many cancer deaths are eliminated in a randomized trial. Shockingly, according to a recent survey10, most primary care physicians in the US mistakenly interpret survival data as evidence that mammography saves lives, so if you have been similarly duped, you're in good company...
In terms of actual benefit, the authors point out, mammography can reduce a woman in her 50's chances of dying from breast cancer sometime over the next decade by 0.07 percent. Again, the reduction in actual risk is so negligible as to be nonexistent... and that, of course, does not make for compelling advertising. In fact, it undermines the entire cancer industry, which is built around expensive cancer screening tests and drug treatments. In conclusion, the authors state:
"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."
FDA Whistleblower Accused of Blocking New Mammography Devices
In related news, Dr. Robert Smith, one of the whistleblowers who became a victim of the FDA's spy program as a result of expressing concern that faulty approval procedures allowed dangerous cancer detection devices to be approved, now stand accused of keeping such devices off the market. That's right. In this upside-down world, his actions are reportedly being scrutinized to see whether or not he might have prevented market-entry of valuable new technology in the fight against cancer.
From my perspective, based on the testimony from other FDA whistleblowers, people across the US probably owe him a debt of gratitude for standing up to immense pressure to approve unsafe devices—not reproach! According to MassDevices.com11:
"Dr. Robert Smith spent nearly 4 years at the FDA's radiological devices arm, during which time none of the 6 digital mammography systems up for approval passed muster with the federal watchdog agency. A total of 5 such devices were approved prior to Smith's appointment and 13 have been approved since, according to the Wall Street Journal... '[Smith] was just upholding the law, being an honest and rigorous regulator,' Smith's attorney, Stephen Kohn, told the Journal. "Industry has a cozy relationship with many at the FDA, but they did not have a cozy relationship with Dr. Smith."
Mother Jones12 recently published an engaging article that summarizes the unfolding drama. So far, the evidence points to the FDA opting to put conscientious safety reviewers on the chopping block rather than displease their clients, the drug companies,—i.e. the very companies they're supposed to regulate:
"It looks like the FDA knowingly chose to expose untold thousands of people to unnecessary cancer risk to apparently to appease General Electric and other medical-device makers. And here's the kicker: The scientists were apparently right. The Times reported last week that the US Office of Special Counsel, an independent federal investigative agency, has 'found a 'significant likelihood' that the devices posed 'a substantial and specific danger to public safety' as the scientists had warned.'"
Articles such as the one by MassDevices.com start to look even more like an attempt at a smear campaign when you consider that most of the devices Dr. Smith and others had objections to were approved against their advice anyway. Three of those devices were feared ineffective, as they risked missing signs of cancer. There were also serious concerns about a computer-aided imaging device designed to help identify cancer. Despite being rejected by the safety reviewers three times, this device was ultimately approved anyway by a senior manager.
How to Help Prevent Breast Cancer
As mentioned earlier, cancer screening is NOT to be misconstrued as a form of cancer prevention. Preventing breast cancer is far more important and powerful than simply trying to detect it after it has already formed, which is why I want to share my top tips on how to help prevent this disease in the first place.
In the largest review of research into lifestyle and breast cancer, the American Institute of Cancer Research estimated that about 40 percent of U.S. breast cancer cases could be prevented if people made wiser lifestyle choices13,14. I believe these estimates are far too low, and it is more likely that 75 percent to 90 percent of breast cancers could be avoided by strictly applying the recommendations below.
- Avoid sugar, especially fructose. All forms of sugar are detrimental to health in general and promote cancer. Fructose, however, is clearly one of the most harmful and should be avoided as much as possible.
- Optimize your vitamin D. Vitamin D influences virtually every cell in your body and is one of nature's most potent cancer fighters. Vitamin D is actually able to enter cancer cells and trigger apoptosis (cell death). If you have cancer, your vitamin D level should be between 70 and 100 ng/ml. Vitamin D works synergistically with every cancer treatment I'm aware of, with no adverse effects. I suggest you try watching my one-hour free lecture on vitamin D to learn more.
- Get plenty of natural vitamin A. There is evidence that vitamin A also plays a role in helping prevent breast cancer15. It's best to obtain it from vitamin A-rich foods, rather than a supplement. Your best sources are organic egg yolks16, raw butter, raw whole milk, and beef or chicken liver.
However, beware of supplementing as there's some evidence that vitamin A can negate the benefits of vitamin D. Since appropriate vitamin D levels are crucial for your health in general, not to mention cancer prevention, this means that it's essential to have the proper ratio of vitamin D to vitamin A in your body. Ideally, you'll want to provide all the vitamin A and vitamin D substrate your body needs in such a way that your body can regulate both systems naturally. This is best done by eating colorful vegetables (for vitamin A) and by exposing your skin to safe amounts sunshine every day (for vitamin D).
- Avoid charring your meats. Charcoal or flame broiled meat is linked with increased breast cancer risk. Acrylamide—a carcinogen created when starchy foods are baked, roasted or fried—has been found to increase breast cancer risk as well.
- Avoid unfermented soy products. Unfermented soy is high in plant estrogens, or phytoestrogens, also known as isoflavones. In some studies, soy appears to work in concert with human estrogen to increase breast cell proliferation, which increases the chances for mutations and cancerous cells.
- Improve your insulin receptor sensitivity. The best way to do this is by avoiding sugar and grains and making sure you are exercising, especially with Peak Fitness.
- Maintain a healthy body weight. This will come naturally when you begin eating right for your nutritional type and exercising. It's important to lose excess body fat because fat produces estrogen.
- Drink a quart of organic green vegetable juice daily. Please review my juicing instructions for more detailed information.
- Get plenty of high quality animal-based omega-3 fats, such as krill oil. Omega-3 deficiency is a common underlying factor for cancer.
- Curcumin. This is the active ingredient in turmeric and in high concentrations can be very useful adjunct in the treatment of breast cancer. It shows immense therapeutic potential in preventing breast cancer metastasis17. It's important to know that curcumin is generally not absorbed that well, so I've provided several absorption tips here.
- Avoid drinking alcohol, or at least limit your alcoholic drinks to one per day.
- Breastfeed exclusively for up to six months. Research shows breastfeeding can reduce your breast cancer risk.
- Avoid wearing underwire bras. There is a good deal of data that metal underwire bras can heighten your breast cancer risk.
- Avoid electromagnetic fields as much as possible. Even electric blankets can increase your cancer risk.
- Avoid synthetic hormone replacement therapy. Breast cancer is an estrogen-related cancer, and according to a study published in the Journal of the National Cancer Institute, breast cancer rates for women dropped in tandem with decreased use of hormone replacement therapy. (There are similar risks for younger women who use oral contraceptives. Birth control pills, which are also comprised of synthetic hormones, have been linked to cervical and breast cancers.)
If you are experiencing excessive menopausal symptoms, you may want to consider bioidentical hormone replacement therapy instead, which uses hormones that are molecularly identical to the ones your body produces and do not wreak havoc on your system. This is a much safer alternative.
- Avoid BPA, phthalates and other xenoestrogens. These are estrogen-like compounds that have been linked to increased breast cancer risk
- Make sure you're not iodine deficient, as there's compelling evidence linking iodine deficiency with breast cancer. Dr. David Brownstein18, author of the book Iodine: Why You Need it, Why You Can't Live Without it, is a proponent of iodine for breast cancer. It actually has potent anticancer properties and has been shown to cause cell death in breast and thyroid cancer cells.
For more information, I recommend reading Dr. Brownstein's book. I have been researching iodine for some time ever since I interviewed Dr. Brownstein as I do believe that the bulk of what he states is spot on. However, I am not at all convinced that his dosage recommendations are correct. I believe they are too high.