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Good morning, distinguished members of the Mammography Awareness Group, good morning, dear Ladies. It is a pleasure and an honor to speak to you about methods of screening and diagnosing breast cancer.
could be further from the truth. In every speech, lecture and interview I ever gave I always emphasized the urgent need to establish precise, accurate, and safe breast cancer screening, and to make such a screening system available to all women. Others said that I am dead set against mammography. In that, they were absolutely correct; I most certainly am.
primary goal is to promote mammography. However, the observer would miss a vital point, because the primary goal of your group is not to promote, or oppose any specific technique or procedure. Your goal is to fight breast cancer, and you are promoting what you perceive as the best tools available for women.
fight. This lecture is offered as my contribution to your efforts.
international oncological community - as the saviour of women. We are told that it is safe and effective. Here, in Italy, the overall compliance rate among women is approximately 65% in 2007. In other words, two third of all Italian women participate in the mammogram screening program. This underlines the importance of determining just how safe and how effective this procedure is. What do research scientists say about it? Originally, the concept of mammography has been conceived in the United States. Interestingly, the USA is also the place where some very strong opposition to the procedure is voiced. Samuel S. Epstein, M.D., Chairman of the Cancer Prevention Coalition and Professor Emeritus of Environmental and Occupational Medicine, University of Illinois, has this to say about the efficacy of mammography:
unreliability. Contrary to popular belief and assurances by the U. S. media and the cancer establishment, mammography is not a technique for early diagnosis. In fact, a breast cancer has usually been present for about eight years before it can finally be detected.
of women, found that mammograms not only produce unreliable results, but that they cause cancer in 10 to 20% of the patients screened. His conclusions were published in the "The Lancet" in October 2006. Dr. Gotzsche also quotes results from a study concerning, among other things, the informed consent of Italian women who underwent mammogram screenings. The authors of the study raised doubts about informed consent procedures since 68% of women believed screening reduced their risk of contracting breast cancer, 62% that screening at least halved mortality, and 75% that 10 years of screening saved 10 of 1000 participants, which is 10 times the most optimistic estimates. Other studies have shown that only 8% of women were aware that participation has the potential to harm healthy women, and that one third think screening detects more than 95% of breast cancers. His findings confirm the general opinion among medical analysts that in addition to failing to offer protection, mammograms — which involve exposing patients to cumulative radiation — do significantly increase women's risk of cancer.
Michael Baum of University College in London.
and 49 who have regular mammograms are twice as likely to die from breast cancer as women who are not screened.
may rupture blood vessels, causing cancer to spread to other parts of the body and actually increasing a patient's risk of death. William Campbell Douglass, M.D., has said: "I find it maddeningly contradictory that medical students are taught to examine breasts gently to keep any possible cancer from spreading, yet radiologists are allowed to manhandle them for a mammogram." Dr. Epstein writes: Since 1928, physicians have been warned to handle "cancerous breasts with care -- for fear of accidentally disseminating cells" and spreading the cancer. Nevertheless, mammography entails tight and often painful breast compression, particularly in premenopausal women, which could lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small undetected breast cancers. Different international studies show that mammograms fail to detect cancer 30-40 percent of the time in women aged 40 to 49. In addition, it can take eight years before a breast tumor is large enough to detect, by which time the cancer could have spread to other parts of the body. This, of course, destroys the credibility of the claim of an early detection, and the claim of prevention.
University Hospital, Sweden, the authors finished saying, "We conclude on the basis of our experience that for every life saved between 1 and 2 women were overdiagnosed through screening." A large percentage of "overdiagnosed" women are talked into a completely needless mastectomy. (Overdiagnosis means: The false positive result of the application of diagnostic criteria that would not have given symptoms during the lifetime of a patient.) A USA National Cancer Insitute study found that approximately 33% of breast cancers detected by screening mammograms represent overdiagnosis. Estimated to occur in 50% of women screened annually for 10 years, 25% of whom will have biopsies. Up to 46% of women with invasive cancer will have negative mammograms, especially if young, with dense breasts, or with mucinous, lobular, or fast-growing cancers. Concerning radiation hazard, the study states, "radiation-induced mutations can cause breast cancer, especially if exposed before age 30 years. Latency is more than 10 years, and the increased risk persists lifelong." These difficult to find, and seldom mentioned data come from the American National Cancer Institute, that is one of the strong proponents of mammography. Isn't that remarkable? You can find this report on the internet if you go to Google, and type in the search term, <overdiagnosed breast cancer screening>.
program. Dr. Gianfranco Domenighetti of the Swiss Network for Health Technology Assessment said the decision was heavily influenced by the Danish research, and by other international studies.
promoting breast cancer. Contrary to conventional assurances that radiation exposure from mammography is trivial - and similar to that from a chest X-ray - about 1/ 1,000 of a rad (radiation-absorbed dose)- the routine practice of taking four films for each breast results in some 1,000-fold greater exposure, 1 rad, focused on each breast rather than the entire chest. Thus, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads for each breast. As emphasized some three decades ago, the premenopausal breast is highly sensitive to radiation, each rad of exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of premenopausal screening (20 percent in case of twice-a- year screening), usually from ages 40 to 50; risks are even greater for "baseline" screening at younger ages, for which there is no evidence of any future relevance. Furthermore, breast cancer risks from mammography are up to fourfold higher for the 1 to 2 percent of women who are silent carriers of the A-T (ataxia-telangiectasia) gene and thus highly sensitive to the carcinogenic effects of radiation.
misdiagnosis, mutilation and mortality among Italian breast cancer patients.
Mammography is not a technique for early diagnosis as breast cancer is rarely detectable by it until about eight years old. Evidence that screening allows early detection and treatment of breast cancer is tenuous based on analysis of two large trials. Danish researchers writing in the Lancet recently concluded: "There is no reliable evidence that screening decreases breast cancer mortality. Mammograph screening is unjustified." The Canadian National Breast Screening Study recently reported on a trial on some 39,000 postmenopausal women. Half of the women performed monthly breast self-examination, following instruction by trained nurses, had annual clinical breast examinations by trained nurses and also annual mammograms. The others practiced self-exams and had annual clinical exams but no mammograms. The authors of the study concluded that the mammographic detection of non-palpable cancers did not improve survival rates. False-negative mammograms are particularly common in premenopausal women because of their denser breast structure, and also in postmenopausal women on estrogen replacement therapy as some develop breast densities, making mammograms difficult to read. About one-third of all breast cancers and more still of the aggressive premenopausal cancers are discovered in the interval between successive annual mammograms. Premenopausal women particularly can thus be lulled into a false sense of security and fail to seek medical advice. False-positive mammograms, common in premenopausal and postmenopausal women on estrogen replacement therapy, result in needless anxiety, additional mammograms or unnecessary biopsies - even mastectomies. For some, the cumulative risk of false positives can reach as high as 100 percent over a decade of screening. Screening poses cumulative cancer risks. The routine of taking four films for each breast results in one rad (radiation absorbed dose) exposure, about 1,000 times more than a chest X-ray. Less well recognized dangers are posed by forceful breast compression during premenopausal mammography, which may rupture blood vessels in or around small undetected cancers and result in the spread of malignant cells. A recent study of 663 cancerous women published in the Archives of Surgery reveals that those subjects whose cancerous breast tumors were needle biopsied - in other words, intentionally ruptured for diagnostic purposes - were 50% more likely to subsequently develop cancer of the lymphatic nodes located under the armpit. I repeat: twice as likely to develop lymphatic cancer after disruption of the cancerous tumor. A mammogram procedure qualifies the description of unintentionally rupturing tumors for diagnostic purposes.
at Roswell Park Memorial Institute for Cancer Research commented about the cancer screening program: "The women should have been given the information about the hazards of radiation at the same time they were given the sales talk for mammography... Doctors were gung ho to use it on a large scale. They went right ahead and X rayed not just a few women but a quarter of a million women... A jump to the exposure of a quarter of a million persons to something which could do more harm than good was criminal and it was supported by money from the federal government and the American Cancer Society."
"The benefit is marginal, the harm caused is substantial, and the costs incurred are enormous..."
findings to a meeting of European screening experts at the 4th European Breast Cancer Conference in Hamburg in March 2004. He was concerned that changing lifestyle patterns have resulted in more post-menopausal women having dense breast tissue. ‘This makes it harder for mammograms to pick up tumors or early signs of breast cancer and may lead to unnecessary biopsies because of uncertainties in reading the results’. His research took a random sample of 2,000 from 54,000 women, who are screened every two years in Holland. The research classified the tissue as dense if more than a quarter of the tissue was dense. Otherwise it was classified as lucent. The research found that 25 per cent of 50-69 year olds and 17 per cent of 65-69 year olds had dense breasts. They then looked at cancer rates, comparing total cancers with those detected by the mammograms, i.e. the ability of the mammogram to actually correctly detect a cancer. In the lucent group it was 67 per cent. (33% false negatives) In the dense group it was 59 per cent. (41% false negatives)
oncologist will say, "because there is nothing better, or even as good as mammography. It is still the best screening method for breast cancer." This, of course, is completely false. There are several better methods available. The most sensitive and reliable is thermography. It is safe, accurate, legal, and it has been around since over 30 years. It is able to detect cancer formation in the breast 8-10 years earlier than mammography, MRI, PETscan, etc. It is a non-invasive, gentle procedure, with no radiation involved.
thermography, as well as the dangers and the unreliability of mammography? This, I am afraid, is a question that is beyond the scope of this lecture.
If you have questions, I will be glad to hear them.
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| LECTURE 4 (excerpts) |