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Study: US Spends $4B a Year from False-Positive Mammograms and Breast Cancer Overdiagnosis

Story at-a-glance -

  • Every year in the US, $4 billion is spent on false-positive mammograms and breast cancer overdiagnosis
  • Rates of false-positive results are as high as 20-56 percent after 10 mammograms
  • Diagnosis and treatment of early stage cancer like ductal carcinoma in situ, or D.C.I.S., is controversial because it often causes no health problems

By Dr. Mercola

A mammogram, which is an x-ray of your breasts, is offered by conventional medicine as the best "prevention" strategy for breast cancer. The idea is that by detecting potential cancer early on, it is easier to treat and therefore should be less dangerous and, ultimately, less deadly.

Unfortunately, this theory is flawed for several reasons, including the fact that it does not account for the risks of the screening itself. Mammography is not an innocuous risk-free test.

As an x-ray, mammography exposes you to ionizing radiation that can cause cancer. Perhaps even worse, its rate of false positives is high, which means women are being subjected to additional invasive testing, psychological distress, and even treatment for "cancers" that pose no real health threat.

In November of 2009, the US Preventive Services Task Force, a federal advisory board, revised their cancer screening recommendations for these very reasons, saying annual mammograms weren't necessary for women under age 50 and that screenings were recommended only every two years after that.

The panel based the new guidelines on data indicating that mammography does more harm than good when used on younger women. Many cancer groups refused to adopt these guidelines, however, and still recommend women over the age of 40 to be screened annually.

This includes the American Cancer Society, the National Cancer Institute, and the American College of Radiology. But yet another study, this one conducted by a research fellow at Boston Children's Hospital along with a professor at Harvard Medical School, has again questioned mammography's merits…

Mammograms Result in $4 Billion a Year in Unnecessary Medical Costs in the US

Every year in the US, $4 billion is spent on false-positive mammograms and breast cancer overdiagnosis among women ages 40-59, according to new research published in Health Affairs.1 The researchers noted:

"The costs associated with false-positive mammograms and breast cancer overdiagnosis appear to be much higher than previously documented… the economic impact of false-positive mammography results and breast cancer overdiagnosis must be considered in the debate about the appropriate populations for screening."

The findings echo previous research that has found a strikingly high rate of false positives. In 2007, the Archives of Internal Medicine published a meta-analysis of 117 randomized, controlled mammogram trials. Among its findings: rates of false-positive results are as high as 20-56 percent after 10 mammograms.2

Similar results were found in a 2009 meta-analysis by the Cochrane Database Review, which found that breast cancer screening led to a 30 percent rate of overdiagnosis and overtreatment, which actually increased the absolute risk of developing cancer by 0.5 percent.

The review concluded that for every 2,000 women invited for screening throughout a 10-year period, the life of just ONE woman was prolonged, while 10 healthy women were treated unnecessarily.3

And in 2014, the Swiss Medical Board reported that for every breast-cancer death prevented in US women over a 10-year course of annual screening beginning at 50 years of age:4

  • 490 to 670 women are likely to have a false-positive mammogram with repeat examination
  • 70 to 100, an unnecessary biopsy
  • Three to 14, an over-diagnosed breast cancer that would never have become clinically apparent

False-Positive Mammograms Exact a Large Psychological and Potentially Physical Toll

When a woman is told she may have breast cancer, it causes considerable anxiety and psychological distress. Meanwhile, you will be subjected to more testing, such as biopsy or surgery, which carry their own set of risks, unnecessarily.

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.

Dr. Shahla Masood, the head of Pathology at the University of Florida College of Medicine in Jacksonville, told the New York Times:5

"There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin."

Some even hesitate to call D.C.I.S. "cancer" at all. Also known as stage zero cancer—or cancer you may die with but not from, D.C.I.S. is often essentially harmless... According to Dr. Christiane Northrup, a practicing physician and ob-gyn specialist:

"[Researcher Gilbert Welch] pointed to a study [from] way back, of women who died in car accidents in their 40s. They sectioned their breast tissues and found that 40 percent of them – this is normal healthy women dying in car accidents – had evidence of ductal carcinoma in situ that was never going to go anywhere. This is the big dilemma."

One of the Largest and Longest Mammogram Studies to Date: Mammograms Do Not Save Lives

Last year, one of the largest and longest studies of mammography to date, involving 90,000 women followed for 25 years, found that mammograms have absolutely NO impact on breast cancer mortality.6 As reported by the New York Times:7

"One of the largest and most meticulous studies of mammography ever done, involving 90,000 women and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age. It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: one in five cancers found with mammography and treated was not a threat to the woman's health and did not need treatment such as chemotherapy, surgery or radiation."

Research published in The Lancet Oncology in 2011 also demonstrated for the first time that women who received the most breast screenings had a higher cumulative incidence of invasive breast cancer over the following six years than the control group who received far less screenings.8

Susan G. Komen for the Cure Uses Misleading Statistics to Promote Mammography

A 2012 report in the British Medical Journal9 (BMJ) exposed how Susan G. Komen for the Cure is using misleading statistics to persuade women to undergo mammography. The authors wrote:

"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..."

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 explained, 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 stated.

Mammograms May Also Offer a False Sense of Security

Aside from false positives, 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 cannot be equated with a clean bill of health. All a negative mammogram can tell you is that IF you do have cancer, it hasn't grown large enough yet to be detected. This is particularly true for women with dense breast tissue. 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.

Forty-nine percent of women have high breast tissue density,10 and mammography's sensitivity for dense breasts is as low as 27 percent11—meaning about 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.

Breast density laws have been passed in California, Connecticut, New York, Virginia, and Texas, making it mandatory for radiologists to inform their patients who have dense breast tissue that mammograms are basically useless for them. 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. I believe it reasonable for a woman to trust that her radiologist is not withholding vital breast-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, albeit profitable practice.

Women with BRCA ½ Mutations Are Especially at Risk from Mammogram

Another at-risk group are women with BRCA 1/2 mutation, which is associated with an increased risk of breast cancer. But results published in BMJ in 2012 showed that women carrying this mutation are particularly vulnerable to radiation-induced cancer.12

Women carrying this mutation who were exposed to diagnostic radiation before the age of 30 were twice as likely to develop breast cancer compared to those who did not have the mutated gene. They also found that the radiation-induced cancer was dose-responsive, meaning the greater the dose, the higher the risk of cancer developing. The authors concluded that:

"The results of this study support the use of non-ionizing radiation imaging techniques (such as magnetic resonance imaging) as the main tool for surveillance in young women with BRCA1/2 mutations."

Despite these findings, the National Cancer Institute reports that some expert groups recommend women with BRCA 1/2 mutation have a mammogram every year starting as young as age 2513 – the exact scenario that the BMJ study found may double their breast cancer risk!

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 actual prevention and not just early detection.

How to Lower Your Risk of Breast Cancer Naturally

Cancer screening that does more harm than good can hardly qualify as your "best bet" against becoming a cancer statistic. I believe the vast majority of all cancers could be prevented by strictly applying basic, commonsense healthy lifestyle strategies, such as the ones below.

  • Avoid sugar, especially fructose, and processed foods. All forms of sugar are detrimental to health in general and promote cancer. Refined fructose, however, is clearly one of the most harmful and should be avoided as much as possible. This means avoiding processed foods, as most are loaded with fructose.
  • Optimize your vitamin D levels. 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 probably be between 70 and 100 ng/ml. Vitamin D works synergistically with every cancer treatment I'm aware of, with no adverse effects. Ideally, your levels should reach this point by exposure to the sun or a safe tanning bed, with oral vitamin D used as a last resort.

  • Optimize your gut health. Gut microbiota is known to affect inflammation and metabolism, both of which are hallmarks of cancer. Microbes can affect cancer susceptibility by modulating your immune system and inflammation. They can also influence gene expression, and appear to have the ability to alter the stability of your genes.
  • Gut microorganisms even appear to impact the efficacy of various cancer treatments. In addition to avoiding sugar, you can optimize your gut health by eating fermented vegetables and/or taking a high-quality probiotic supplement.

  • Limit your protein. Newer research has emphasized the importance of the mTOR pathways. When these are active, cancer growth is accelerated. One way to quiet this pathway is by limiting your protein to one gram of protein per kilogram of lean body mass, or roughly a bit less than half a gram of protein per every pound of lean body weight.
  • For most people, this ranges between 40 and 70 grams of protein a day, which is typically about 2/3 to half of what they are currently eating.

  • 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 and leptin receptor sensitivity. The best way to do this is by avoiding sugar and grains and restricting carbs to mostly fiber vegetables. Also make sure you are exercising, especially with Peak Fitness.
  • Exercise regularly. One of the primary reasons exercise works to lower your cancer risk is because it drives your insulin levels down, and controlling your insulin levels is one of the most powerful ways to reduce your cancer risks. It's also been suggested that apoptosis (programmed cell death) is triggered by exercise, causing cancer cells to die.
  • Studies have also found that the number of tumors decrease along with body fat, which may be an additional factor. This is because exercise helps lower your estrogen levels, which explains why exercise appears to be particularly potent against breast cancer.

  • Maintain a healthy body weight. This will come naturally when you begin eating right and exercising. It's important to lose excess body fat because fat produces estrogen.
  • Drink a pint to 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 cancer. It actually has the most evidence-based literature supporting its use against cancer of any nutrient, including vitamin D.14 For example, it has demonstrated major therapeutic potential in preventing breast cancer metastasis.15It's important to know that curcumin is generally not absorbed that well, so I've provided several absorption tips here. Newer preparations have also started to emerge, offering better absorption. For best results, you'll want to use a sustained release preparation.
  • Avoid drinking alcohol, or at least limit your alcoholic drinks to one per day.
  • Avoid electromagnetic fields as much as possible. Even electric blankets may increase your cancer risk.
  • Avoid synthetic hormone replacement therapy, especially if you have risk factors for breast cancer. 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 certain forms of cancer. Dr. David Brownstein, 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.16
  • 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 far too high.

  • 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 cancer risk as well.