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Better Health Update #46 - Monte Kline, Clinical Nutritionist

Mammograms

For many years mammograms have been recommended by conventional medicine for women in their forties and older as a breast cancer screening method. However, there is increasing question among authorities as to the wisdom of doing mammograms for forty-something women, and even for older women unless specific symptoms or history warrants.

As is the case with any challenge of conventional medical viewpoint, one seldom finds open-mindedness or a genuine seeking of the truth. Conventional medicine in America is a religion, if not the religion of the country, and therefore you're a dangerous "nut" if you don't dutifully fall in line to get your annual mammogram.

RISK vs. BENEFIT

In our whole discussion there's ultimately only one issue: Does the potential risk associated with having mammograms outweigh the potential benefit of early discovery of breast cancer? There is not a universal answer to this question. There are many opinions, not to mention individual situations and histories that may make your answer to that question different from the woman next to you. The goal of this article is simply to lay the questions before you so that you can better decide your correct course of action.

CONVENTIONAL RECOMMENDATIONS

In spite of a lot of challenging evidence, conventional medicine still recommends that women in their 40's get mammograms. This is the position of the American Cancer Society, the American College of Radiology, the American College of Obstetricians and Gynecologists, and the National Cancer Advisory Board.

However, a group of experts convened by the National Institutes of Health in 1997, reviewing the same studies as the other groups, concluded that mammograms should be optional until age 50. Likewise, the National Cancer Institute has reversed its long-standing recommendation that women under age 50 get mammograms, other than to evaluate suspicious lumps.

CHALLENGING EARLY MAMMOGRAMS

Dr. John Bailar, former editor of the Journal of the National Cancer Institute said in 1976:

There is a body of information that the benefits to women under the age of fifty may not be as great as was thought when the project was started.

A 1993 Swedish study from the famous Karolinska Institute suggested potential danger from exposing the female breast to ionizing radiation. They studied women who received massive radiation therapy for benign breast disease between the 1920's and 1950's. Critics will quickly note that these women received much more radiation than given by the modern mammogram, but nevertheless NCI's Dr. Charles Land noted that it is still wise to assume there is at least a small risk of women developing breast cancer as a result of mammography. Dr. Land believed that for women over 50 or those at high risk, benefits of mammography outweigh the risks - but not for women in their forties.

Dr. Suzanne W. Fletcherof of the American College of Physicians also reported in the Journal of the National Cancer Institute that for women age 40 to 49 there is no survival benefit to obtaining routine mammograms. Her panel's research did conclude, however, that for women age 50 to 69 mammograms did reduce the risk of dying of breast cancer. They found insufficient evidence to draw conclusions either way for women in their 70's.

MAMMOGRAM OBJECTIONS

Here are four objections to premenopausal women getting mammograms:

1. They don't work - A 1992 Canadian study found that routine mammograms on 25,000 women in their forties missed 40% of the breast cancer that developed. A similar Swedish study found 38% false negatives. Dense healthy breast tissue of younger women can resemble or camouflage tumors.

2. They don't improve chances of survival - The Canadian study just mentioned followed 25,000 women who had routine mammograms and 25,000 who did not. The results: Women in both groups developed and died of breast cancer at the same rates. Seven other studies have reported similar findings.

3. Mammograms may "find" non-existent tumors - A February 1996 study reported in the British Medical Journal found false positives on mammograms to be a significant problem. After a first mammogram 352 women were found positive. Further evaluation required 1112 doctor visits, 397 fine needle biopsies, 187 more mammograms, and 90 biopsies - all costing one-half million dollars, with women in their forties accounting for 41% of the costs. After six months, 64% were eventually found to NOT have cancer!

Just having a mammogram, not to mention having a abnormal mammogram can be very stressful. Besides mental scars, surgery leaves physical scars. All of this takes time and dollars, not to mention being embarrassing.

4. Mammograms may cause cancer - Modern mammography equipment confers much less radiation than machines originally used back in the 1970's. However, there is no minimum dose of radiation that has been proven safe with respect to breast cancer. Dr. John Gofman, past Associate Director of Livermore National Laboratory and co-discoverer of Uranium 233, states that, "Every dose, no matter low, confers some risk." Dr. Gofman estimates that for a 40 year old woman a typical mammograms results in a 1 in 2700 chance of developing breast cancer . . . but the risk is cumulative with each mammogram. So, after ten mammograms your chances are now 1 in 270.

RADIATION-CAUSED BREAST CANCER

Dr. Gofman, as author of four scholarly books on radiation health effects, in 1994 stated:

It is astonishing that past medical exposure to ionizing radiation is barely ever mentioned as a prime explanation for the current high rate of breast cancer. . . Why is this undisputed fact almost never mentioned in public? Why doesn't the medical community come clean about its past role in the current incidence of breast cancer? There is no logical escape from the conclusion that past medical irradiation of the breast explains a large share of today's breast-cancer incidence.

MAMMOGRAMS FOR AGE 50+

Most of the authorities that now maintain women in their 40's should not necessarily get mammograms feel that women in the 50's still should. Not everyone agrees, though. A Canadian study that found mammograms inappropriate for under age 50 women has also found no reduction in deaths in the 50-55 age group either. The fact of the matter is there is no study showing that mammography reduces breast cancer deaths over that of breast self-examination or physician examination.

According to Dr. John McDougall, developer of the McDougall Diet, the potential benefits of mammograms for women over age 50 is minimal, while the risks are significant. No benefits have been found for mammography of women over age 69.

MAMMOGRAMS AND MARKETING

Please excuse my cynicism, but ultimately mammograms are a marketing tool for conventional cancer therapy. I'm not saying this is necessarily intentional, nor that it's always a bad idea to have a mammogram, nor that mammograms don't in some instances save lives. I am saying that the end result of mass screening of the female population with mammograms is "selling" the "products" of surgery, radiation and chemotherapy.

Mammograms detect possible masses that a physical or self-exam would often not detect. Those possible masses may be cancer, or they may be one of those false positives discussed earlier. Particularly if it were a benign occurrence, it might have gone away on its own - breast cysts often do.

But the mammogram has dramatized and perhaps inflated the problem to the status of requiring a heroic conventional medicine solution - beginning with surgery, and possibly involving radiation or chemotherapy. Dr. McDoughall comments that it's not so much the radiation of under age 50 women that causes a greater incidence of breast cancer, but rather that having mammograms makes it more likely that you will be treated for breast cancer. And the treatment modalities - surgery, radiation, and chemotherapy - in and of themselves kill.

BREAST CANCER PREVENTION

It's always amazed me that cancer screening tests like mammography seem to start with the assumption that "cancer just happens," and that there's nothing you can do about it - other than try to detect it as soon as possible and then use ridiculous symptom-treating methods to try to cure it.

There's a lot I don't understand about cancer, but one thing I'm sure of is that it doesn't just happen! High animal protein and fats, particularly meats with hormonal residues, should be avoided. For the same reason that Japanese women have little PMS or menopausal problems, we can expect less breast cancer.

Lack of proper exercise appears to have a role in breast cancer, just as in most health problems. And what about stress? That appears to be the usual triggering factor with virtually all types of cancer.

I've even run across some reported evidence linking wearing bras to breast cancer incidence . . . and it does make some sense. Bras, particularly the increasingly tighter ones that compress the breasts more, are a fairly recent phenomenon. I would maintain that ongoing compression of the breasts can't be good, anymore than wearing too tight a shoes. I'm not advocating that women go back to the bra-less hippie 60's, but I think some consideration should be given to less constricting undergarments.

MAMMOGRAMS - YES OR NO?

As I shared at the beginning, I don't believe there's an absolute answer to that question - rather it's something each woman must decide having looked at the available facts. As a general principle for premenopausal women, though, the evidence would seem to be moving away from regular mammograms, unless you have a special reason - suspicious lumps, family history, etc.

For over age 50 women, the choice isn't as clear from the point of current scientific evidence. Again, I think you have to ask if there's a real reason to have a mammogram, rather than just doing this as an annual screening method.

I'm obviously not a woman and thus will never have to make this decision. However, I am a cancer survivor and a cancer radiation treatment survivor. Most of the health problems I've had since having cancer have been the result of radiation "therapy." Thus I am very leery of radiation exposure. I get X-rays rarely - only when I absolutely have to have them. The thought of routine radiation exposure through mammograms, on top of all the other radiation exposure sources we have, is a little scary to me.

Weigh the potential risks versus the potential benefits and make your decision. But also practice even more important preventive measures to insure the best cancer prevention.

DISCLAIMER: The information contained in this publication is for educational purposes only. It is not intended to diagnose illness nor prescribe treatment. Rather, this material is designed to be used in cooperation with your nutritionally-oriented health professional to deal with your personal health problems. Should you use this information on your own, you are prescribing for yourself, which is your constitutional right, but neither the author nor publisher assume responsibility.