How many lives do mammograms actually save?

A recent study has revisited this issue, and the answer seems to be ‘very few’. Women must be given accurate information outlining the risks and benefits of mammography so that they can make an informed decision about whether to be screened.

A study of 40,000 women in Norway aged 50-69, recently published in the New England Journal of Medicine, investigated the effects of screening mammography on breast cancer mortality. Some counties in Norway conduct mammography screenings, while others do not. Four groups of women were studied: a screening counties group and a nonscreening counties group followed from 1996 to 2005; and also ‘historical’ screening and nonscreening groups, who had been followed from 1986 to 1995. The goal of the study was to find out how much of the reduction in breast cancer mortality that has been observed over time was due specifically to mammography screening. The reduction in breast cancer mortality over time was 10% greater in the screening groups than the nonscreening groups. [1]

Mammogram. Flickr: NASA Goddard Photo and Video

What are the risks and benefits of screening mammography? The Nordic Cochrane Centre, an independent research group that conducts extensive and thorough reviews of the medical literature, assessed the potential benefits and harms of mammography in 2009. These were their conclusions: For every 2000 women that are screened regularly for ten years, one will have her life prolonged. However, 10 healthy women will be unnecessarily treated for breast cancer, either by having a lumpectomy, mastectomy, chemotherapy, or radiotherapy. Also, 200 healthy women will experience a false alarm, leading to substantial psychological and emotional strain. In their analysis, the Cochrane group stated that it is “not clear whether screening does more good than harm.”[2] In women under the age of 50, false positive results are very common. [3] In 2009, the U.S. Preventive Services Task Force began recommending against routine screening mammography in women between the ages of 40 and 49.[4]

Mammograms are not nearly as life-saving as we are led to believe. The main problem with mammograms is over-diagnosis. Eighty percent of biopsies initiated by a mammogram result are negative. Furthermore, many slow-growing, non-threatening tumors are being detected and treated; at the same time, the more dangerous and aggressive cancers may be missed because they can grow and become lethal in the time interval between screenings, and by then treatment will not work. [3, 5]

Whether or not to undergo mammography is a personal choice, but it is important to know the true risks and benefits of the screening in order to make a sound decision. Regardless of their decision on this matter, women should not rely solely on detection by mammography to protect them against breast cancer. The take home message is that mammograms can’t be counted on as the sole intervention to save women’s lives—they just don’t do enough. Taking steps to prevent breast cancer from developing in the first place – for example, exercising regularly, maintaining a slim, healthy weight, eating plenty of mushrooms, onions, and cruciferous vegetables, minimizing processed foods and animal products, maintaining adequate vitamin D levels, and limiting alcohol consumption – is a much more effective approach than detecting and treating breast cancer after it has begun to develop.

A pamphlet on the potential harms and benefits of mammography screening is available on the Cochrane group’s website.

Read more about diet and lifestyle methods for cancer prevention at DrFuhrman.com.

 

References:
1. Kalager, M., et al., Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med, 2010. 363(13): p. 1203-10.
2. Gotzsche, P.C. and M. Nielsen, Screening for breast cancer with mammography. Cochrane Database Syst Rev, 2009(4): p. CD001877.
3. Wright, C.J. and C.B. Mueller, Screening mammography and public health policy: the need for perspective. Lancet, 1995. 346(8966): p. 29-32.
4. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med, 2009. 151(10): p. 716-26, W-236.
5. Esserman, L., Y. Shieh, and I. Thompson, Rethinking Screening for Breast Cancer and Prostate Cancer. JAMA, 2009. 302(15): p. 1685-1692.

 

Research: Breast Cancer May Disappear Without Treatment

Editor’s Note: Dr. Fuhrman responds to a recent study in the Archives of Internal Medicine suggesting breast cancer screening, i.e. mammography, has lead to an over-diagnosis of cancer. The research, which took 4 years to get published, claims 22% of cancer cases do not need treatment and will resolve on their own.

It’s easy to understand why this study was so hard to get published and the stranglehold the drug companies and the medical profession has on the status quo in disease-care. It should not even be called health care!

It has been known for years that a large percentage of the so-called diagnoses of cancer are not really cancer. The movement of cells toward more and more abnormalities that eventually get diagnosed with cancer is not a black and white line that they cross. Some cells are clearly normal, other cells may be clearly cancerous, but many fall into a grey area, where the state of cancer (uncontrolled cell replication) is not 100 percent clear.

In this range, many of these so-called cancers are the most likely to reverse, or not really manifest cancerous properties after diagnoses. Additionally, these earlier and less definitive or early cancers are more likely to respond to nutritional interventions. In other words, the most likely scenario where a cancer disappears from nutritional interventions is in those cancers that are comprised of cells that are not as cancerous, if we could measure cancerous properties on a continuum.

Lastly, one of the reasons why mammograms have such a small, almost worthless impact on reducing deaths from breast cancer in so many medical studies is because, many of the so-called cancers that are then treated with chemotherapy or radiation are conditions that would never have progressed to a metastatic or life threatening condition, so the risks from the treatment were more significant than from the native disease.

This is especially concerning because belief in the success of chemotherapy for estrogen positive post-menopausal breast cancer is so ubiquitous, but the true benefits are miniscule. The point is that this is a confusing and complicated issue that we are only in the infancy of understanding and our present screening and treatment of most cancers is barbaric, ineffective and leaves much to be desired.

Superior nutrition and a healthful lifestyle is still the best way to win the war on cancer in the modern world, but these protective nutritional changes must taken throughout society, including children when the dividing cells are most susceptible to damage.

Via CBS News.