Firestorm erupts over new mammography recommendations

by Mary Budinger — 

New guidelines released mid-November by the Preventive Services Task Force call for fewer mammography screenings. Most women should now forgo routine mammograms if they are in their 40s. Starting at age 50, the new guidelines call for 10 mammograms in a lifetime, one every two years.

The task force said that the modest benefit of mammograms must be weighed against the harms — false positives, overtreatment and radiation exposure. “I can’t tell you how many friends I have who’ve gone through severe worries from false scares,” said Maren Waxenberg, a Manhattan mother. “At least three of them have had biopsies. And it turned out to be nothing.”

The task force determined that starting screening at age 40 would prevent one additional death but also lead to 470 false alarms for every 1,000 women screened. The panel found insufficient evidence for the benefits of screening after age 74. The panel also found no evidence that breast self-exams lead to fewer deaths. The new recommendations do not apply to a small group of women with a gene mutation that puts them at greater risk for breast cancer.

“I think it’s shocking to basically spell out in such a bold and callous way which groups of women they no longer care to find cancer in,” said Dr. Linda Gordon, imaging director at the Carol Ann Read Breast Health Center at Alta Bates Summit Medical Center in Oakland and Berkeley, Calif.

The American Cancer Society and the American College of Radiology both state that they were staying with their guidelines, advising annual mammograms starting at age 40. However, several breast cancer advocacy groups, including Breast Cancer Action in San Francisco, supported the recommendations.

“There’s really no evidence to support routine mammography for women who are premenopausal [and] who are at normal risk for breast cancer,” said deputy director of Breast Cancer Action. “The fact that women have been led to believe mammography at those ages would overall be something that would save lives has been oversold.”

Fran Visco, president of the National Breast Cancer Coalition, said this is an opportunity to look beyond emotions. “These are the people we should be listening to when it comes to public health messages.”

The task force is an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services. It is an influential group that provides guidance to doctors, insurance companies and policy makers.

A recent study in the Journal of the American Medical Association analyzed breast and prostate cancer screening, and questioned the legitimacy of such screenings in saving lives. Dr. Otis W. Brawley, chief medical officer of the American Cancer Society, told The New York Times that the supposed benefits of screening have been “exaggerated.” Dr. Brawley’s comments fueled a firestorm of controversy, since they fly in the face of what the organization has been saying for years.

The new U.S. recommendations are more in line with international guidelines, which call for screening to start at age 50.

In countries with public breast cancer screening programs, one in every three diagnosed with invasive breast cancers would never have produced symptoms in a patient before she died of other causes, according to a recent study published in the British Medical Journal.

“Screening for cancer may lead to earlier detection of lethal cancers but also detects harmless ones that will not cause death or symptoms,” wrote the researchers from the Nordic Cochrane Center in Denmark. “The detection of such cancers, which would not have been identified clinically in someone’s remaining lifetime, is called overdiagnosis and can only be harmful to those who experience it.”

When all forms of breast cancer were taken into account, the rate of overdiagnosis after public screening programs were introduced ranged from a low of 46 percent (in Sweden) to a high of 59 percent (in Canada). When only invasive breast cancers were taken into account — cancers that have spread beyond the mammary tissue and are more likely to be lethal and thus more likely to be treated aggressively — the average rate of overdiagnosis was still 35 percent, or more than one in three.

The cancer industry is a $200 billion-a-year business in the United States. It has been reluctant to switch away from mammography to the safer thermography, even though the only acknowledged cause of cancer by the American Cancer Society is radiation. Many radiologists are invested in mammography. The Susan G. Komen Foundation owns stock in General Electric, one of the largest makers of mammogram machines in the world.

Thermography is the safer form of screening. No radiation, no painful compression. And best of all, earlier detection. A normal thermography scan, as shown here, has good thermal symmetry with no suspicious thermal findings.

Cancer cells are typically in the body 10 to 20 years before the mass gets large enough to be noticed. When a tumor is forming, it develops its own blood supply to feed its accelerated growth, and this increased blood flow can increase the surface temperatures of the breast. Pre-cancerous tissues can start this process well in advance of the cells becoming malignant. Thermography measures the skin’s autonomic response to that inflammation — its “heat signature” — and can detect suspicions of cancer formation a decade earlier than mammography.

Modern thermography is the cancer society’s answer to screening that can help raise suspicions of breast cancer at an early stage, when there is still a chance of complete cure.

The subject almost no one is talking about, though, is prevention. Two years ago, the Susan G. Komen organization quietly issued a study that found breast cancer to be an environmental disease. Women are unwittingly exposed every day to radiation and scores of toxic and hormone-disrupting substances that are probable or possible carcinogens, including pesticides, plastics, consumer-product additives and industrial byproducts.

The Breast Cancer Fund publishes “State of the Evidence: The Connection Between Breast Cancer and the Environment,” an annual summary and explanation of scientific research. Yet mainstream media articles mentioning breast cancer’s environmental connections during Breast Cancer Awareness Month are rare. “It wasn’t for lack of trying,” said Shannon Coughlin of the Breast Cancer Fund. “Chemical regulation goes by the idea that a chemical is innocent until proven guilty, which places a terrible burden on us to prove harm.”

 

Mary Budinger is an Emmy award-winning journalist. She is a freelance writer who focuses on alternative and complementary medicine. 602-494-1999.

Reprinted from AzNetNews, Volume 28, Number 6, Dec 2009/Jan 2010.

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