Monday, October 19, 2015

A long, hard look at mammograms

I just recently became aware of a 2014 report on a 25-year study involving almost 90,000 Canadian women to determine the benefits of mammograms. The researchers wanted to know if there was any advantage to finding breast cancers when they were too small to feel. The answer was no.

They also found that screening with mammograms can be harmful. One in five cancers found with mammography was not a threat to a woman’s health, yet the women received unnecessary chemotherapy, surgery, and/or radiation.

Approximately half the women were assigned to have regular breast exams by trained nurses, and half were given regular mammograms in addition to the breast exams.
At the end of the lengthy study, the number of women who died from breast cancer was 500 among those who had mammograms, and 505 among those who did not.

A quote from a NY Times article about the study:  “Many cancers, researchers now recognize, grow slowly, or not at all, and do not require treatment. Some cancers even shrink or disappear on their own. But once cancer is detected, it is impossible to know if it is dangerous, so doctors treat them all.”

This reminds me of something I once read about prostate cancer—that it’s unwise for men to be screened at too early an age because screening is likely to pick up cancers that will grow so slowly that they’ll never become a problem.

In Switzerland, the Swiss Medical Board has advised that no new mammography programs be started, and that those already existing  be limited in duration.  One member of the Board said mammograms were not reducing the death rate from the disease, and they led to false positives and needless biopsies.

Mammograms are big money-makers. In the U.S., about 37 million mammograms are performed annually at a cost of about $100 per mammogram. I guess it’s not surprising that although the results of the Canadian study came out last year, mammograms are still promoted in the U.S. as far as I can tell.

In discussing the potential harm done by mammograms, I have to mention radiation. My only known risk of breast cancer is from having my adenoids removed via radiation when I was 6 years old.  It has never made sense to me to expose myself to more of it, so I’ve had only two mammograms in my lifetime.

Another quote, this one from Dr. Russell P. Harris, a screen expert and professor of medicine at the University of North Carolina at Chapel Hill:  “The decision to have a mammogram should not be a slam dunk.”


crystal said...

Hi Susan. I've seen those article too. I wish I could convince my doctor that I don't need one but he's made me get one every year for the last few years. I've managed to talk him into one every other year from now on, I think. It seems to me that if you wanted to *give* someone breast cancer, a great way would be to irradiate their breasts every year :(

Susan said...

I don't understand how a doctor can "make" someone do something. It may be hard for you, as it is for many, to take a firm stand against something your doctor recommends, but remember the advice to "just say no"? Or smile and nod, and then go home and cancel the appointment. What's the worst that can happen? He'll drop you from his practice? Is that really so bad? Lots of doctors out there. More likely he'll shake his head and go "tsk, tsk" or the equivalent. On the other hand, he might forget the report from the radiologist never arrived.

Doctors pay a fortune for malpractice insurance, and covering their asses is given a high priority. He'll want it in your file that he strongly recommended the mammo.

Can you imagine how many doctors and nurses have tried to sign me up for a mammogram over the years? I wonder if they read the results of the Canadian study. I doubt it.

Kathleen said...

Thank you Susan. It is hard to think clearly about an issue like this, when the "mammograms save lives" voices are so loud in this country. This issue hasn't come up quite yet for me, but I feel like I have the kind of doctors who are going to hear me out.

crystal said...

Oh, he can make me do it because otherwise he won't sign off on my estrogen medication - sort of a swap in that if I want the one, I have to do the other. I think you're right that a lot of this is just, ahem, ass-covering.

Julia said...

I've just been watching a documentary about healing any kind of cancer with good nutrition and some other methods that doesn't hurts the body. They said that when doctors were taking their medical training, out of 4 years of training, the average doctor were only given 4 hours of nutrition instruction.

Chemo and radiation only harms the body and cancer comes back because it only kills the growths and not the rest of the cancer cells in the body. We must change the way we eat and stop eating processed foods and stop using chemicals. Eat live food like fruits and vegetable, grain, berries and nuts, olive oil, etc..

A healthy body doesn't grow cancer cells even though we all have cancer cells in our body. Cancer feeds on sugar. There is just too much information to write it here.

have a great day.

Susan said...

I agree 100%, Julia.

I recently posted this question on a popular message board: "Has your doctor ever asked what you eat?" Almost everyone responded "No."

Susan said...

Kathleen, I got a bulletin from the NY Times today saying the American Cancer Society has changed their recommendations and is now saying women should begin mammograms later and have them less often.

I can't imagine very many doctors will actually share the Canadian study with their patients and (gasp!) recommend that they forego a mammogram. Honestly, I can't blame them for the latter, given the malpractice situation in this country. But I do think they ought to read the study, think about it carefully, and discuss it with their patients. Oh, wait--that would take longer than five minutes.

Crystal, if the estrogen increases your risk of breast cancer, I can see why your doctor wants you to have those mammograms. I believe HRT will do that. If that's what you're taking, you might want to rethink it.

I had an argument with a female cardiologist years ago who wanted me to take HRT. I left her office and never went back. Some time later it came out that HRT increases one's risk of a heart attack. I wonder if she still pushes it on her patients.