Breast cancer is a touchy subject and the statistics on it are sobering. Here in the United States, it results in the highest mortality rates of any cancers in women between the ages of 20 and 59. According to the Breast Cancer Fund’s latest report State of the Evidence: 2010, today a woman’s lifetime risk of breast cancer is 1 in 8 and, as of 2006 more than 2.5 million U.S. women were living following a diagnosis of breast cancer.
While breast cancer rates are higher in industrialized countries, it affects more women worldwide than any other type of cancer, and is still the leading cause of cancer-related deaths among women.
Fortunately, it’s not all bad news. After a very long period in which the incidence of breast cancer steadily grew (between 1973 and 1998), rates have actually started to decline. Ask breast cancer researchers, radiologists, and primary care physicians, and most of them will likely attribute the decline to aggressive screening through mammography and early detection. This has been the mantra and gold standard for the medical community for more than a decade. But the reality isn’t that simple.
Do Mammograms Really Work?
The most widely discussed explanation for the recent decrease in breast cancer rates, is the sharp decline in use of post-menopausal hormone replacement therapy (HRT), especially following the announcement in 2002 of the association of HRT use with increased risk for breast cancer.
Add to that the results of numerous studies evaluating the ability of screening mammograms to decrease the mortality (death rate) from breast cancer, and a different story starts to emerge. While the breast-cancer-awareness propaganda machine continues to promote regular mammograms as the best form of early detection, some of mammography’s major downsides: false positive tests that send millions of women to unnecessary needle biopsies, and increased risk of harm from radiation exposure, and the length of time the disease has to proliferate before it can be detected on a mammogram, have been conveniently swept under the rug.
That is, until November 2009, when the United States Preventive Service Task Force –a non-partisan panel of medical experts appointed by the Department of Health and Human Services– blew the lid off with its announcement regarding the effectiveness or need for mammograms prior to age 50.
Their findings, which are supported by many studies, were that mammograms are neither necessary nor helpful in reducing breast cancer mortality among women aged 40-49. In addition, they recommended that women 50 and older have a screening mammogram every two years instead of every year.
Needless to say, this caused an uproar that was followed by a lot of confusion that, in the absence of any clear directives, still lingers. The confusion is due in part to the complexity of the disease and the many nuances associated with it. Many women in their 40s swear that having a mammogram saved their life, but studies indicate that the reduction in mortality rates from this method of detection are nominal at best, calling into question whether regular mammograms actually do more harm than good.
On the surface, the heart of the controversy appears to be centered around how often and at what age women should start getting mammograms. But the real controversy revolves around two key concerns:
The limitations of mammography in distinguishing between cancerous cells that are life-threatening and those that will cause no harm and can be left alone.
Whether the so-called “early detection” through regular mammograms is early enough to prevent the disease.
The American Cancer Society still urges women in their 40s to get regular mammograms every year –despite their own admission that for every 1,000 women in their 40s screened for 10 years, 600 will be called back for a repeat mammogram for something suspicious, 350 will get biopsies and after all is said and done, only 5 will end up with a diagnosis of breast cancer. They even concede that some women might get treated for a cancer that would never have caused a problem.
Even the National Cancer Institute states in one of its fact sheets, “Screening mammograms miss up to 20 percent of breast cancers that are present at the time of screening.”
Let’s forget for a moment that mammography is a form of radiation that in and of itself may pose a risk of harm. There’s still the question of whether detecting breast cancer through mammography can really lower mortality rates from the disease or save women from the agony of having their breasts surgically removed.
According to Dr. Susan Love, a breast cancer expert and author, by the time you can feel a cancer or see it on a mammogram, it’s already been there for 8 to 10 years. That’s because in order for it to be detected by physical examination or on a mammogram, the tumor or cancerous growth has to have grown to a significant size. This simple truth flies in the face of the conventional wisdom that “early” detection through regular screening is the best way to treat and cure the disease.
Alternatives for Early Detection
In order for early detection to really work it has to be early enough in the process to prevent the disease from proliferating. In a recent Huffington Post article on the subject, Dr. Christiane Northrup questions why doctors continue to rely on mammograms when there are better technologies available for early detection.
In her opinion, the best test for early detection of breast cancer is something called a Thermogram — a form of thermal (infrared) imaging that can identify precancerous or cancerous cells very early, and produces unambiguous results, minimizing the need for additional testing. Thermal imaging is a non-invasive technology that allows doctors to detect changes at the cellular level before the actual formation of a tumor –and it doesn’t hurt the body the way radiation can. This can allow you to make preventive changes to your diet and lifestyle for example, or reduce your exposure to potentially harmful substances and monitor the impact of those changes on your cells.
In addition to thermography, several other promising detection technologies have been approved by the FDA, including ultrasound, magnetic resonance imaging (MRI), and computer-aided detection and diagnosis. While none of these tools in and of themselves are “ideal,” their wide adoption can greatly increase the odds of preventing breast cancer while minimizing the risks of over-treating and needless cutting. This requires weening ourselves from the spoon-fed idea that mammograms are the best tool for the job.
The controversy over mammograms has caused a lot of anguish and confusion but this may be the necessary step to shift the focus towards meaningful early detection and ultimately, prevention. In the end, the old proverb “An ounce of prevention is worth a pound of cure” holds true, because only finding and eradicating the causes of any disease can really prevent it.
Sources:
State of the Evidence 2010. A report of the Breast Cancer Fund
Not Just a Pretty Face: The Ugly Side of the Beauty Industry. Stacey Malkan, New Society Publishers, 2007
Behind the Mammogram Controversy, Ruth Conniff, The Progressive, November 18, 2009
Some Experts Say Mammogram Controversy Overdue, Cynthia L. Cooper, WEnews, February 3, 2002
The Best Breast Test: The Promise of Thermography, Christiane Northrup, MD, Huffington Post, October 12, 2010
