• Mammogram screening and overdiagnosis: tumor size an issue?

    Hologic Imaging MachineDOTmed.com – Health Care Business Daily News
    Written by: Thomas Dworetzky , Contributing Reporter

    A just-published study of breast cancer data has raised the issue of overdiagnosis from mammography screening – and puts tumor size squarely in the middle of the debate.

    That’s because many “small breast cancers have an excellent prognosis because they are inherently slow-growing,” according to Yale Cancer Center experts in a June 8th New England Journal of Medicine report, which weighed in on the benefits of breast cancer early detection.

    Frequently these smaller tumors come from slow-growing cancers that may not become an issue during a patient’s lifetime, they noted. [Read More…]

  • The Radiant Health Show with Dr. Christine Horner – Carla Garcia, C.T., D.O.M

    Is Thermography a Mammogram Alternative?
    Part 1 and 2
    September 14, 2016

    Dr. Carla Garcia

     

     

    My guest this week is Dr. Carla Garcia, a board certified Doctor of Oriental Medicine with more than 30 years of experience in Integrative Medicine and an expert in thermography.

    In this 2-part interview, she discusses thermography, how it is useful for breast tissue examination and how it differs from mammography.

    http://www.spreaker.com/show/the-radiant-health-shows-tracks

  • From the ED: Breast Cancer Mammograms: Overrated – and Over-diagnosing Women

    Posted on June 23, 2014
    by Caitlin C.
    Posted at:  Breast Cancer Action

    Editor’s Note: You may have seen Karuna’s article back in April of this year when it was published in The Guardian. The piece generated a lot of discussion – over 1,000 people shared it on their Facebook page and over 150 people commented on the article itself. Many of you who have been through several iterations of these debates are used to the controversy that arises from publicly challenging routine mammography screening. What’s new this time around is the growing agreement that the benefits of routine mammography screening have long been overstated, and the harms long underestimated. Ten years ago, our challenge to the conventional position that “early detection saves lives” and “early detection is your best protection” was highly unpopular. Our independent position was a hard truth for many to hear even though it was grounded in evidence because it went against the grain of pretty much every mainstream breast cancer organization—many of which were and still are heavily invested (both in terms of funders and core values) in the “early detection saves lives” philosophy. We’ve reached a tipping point recently and now increasingly we hear more discussion about this issue and less unquestioned acceptance of the earlier screening messages.Karuna-Jaggar-headshot-2014-150x150

    By Karuna Jaggar, Executive Director

    How will we ever hope to make desperately needed progress in the breast cancer epidemic when the mainstream breast cancer movement continues to push an outdated and scientifically debunked agenda? The evidence has been mounting that the time has come to radically re-think the tenets of the breast cancer awareness movement because it is clear that the fundamental philosophy behind “early detection” is flawed. [Read More…]

  • Are the Harms of Mammography Underestimated?

    April 08, 2014

    By Kristen Fischer

    More controversy has emerged surrounding mammograms ever since a new report in JAMA recommended that the test be performed based on a woman’s risk and preferences.
    Dr. Lydia Pace and Dr. Nancy Keating both of Brigham and Women’s Hospital in Boston, conducted a systematic review of data spanning 50 years. They examined about 450 studies from 1960 through the present to look for evidence on the benefits and harms of the diagnostic test.

    According to their report, annual mammograms lower mortality from breast cancer by about 19 percent, though the benefits vary based on a woman’s risk and age. Approximately 1,904 women in their 40s would have to undergo a mammogram to prevent one death, while the same would be true for 377 women in their 60s. The disease is more common as a woman ages. At 40, the risk for breast cancer in the next 10 years is 1.5 percent, but that rises to 2.3 percent by age 50, and 3.5 percent by age 60. [Read More…]

  • Annual screening does not reduce risk of death from breast cancer

    Wednesday 12 February 2014 – 12am PST

    Written by David McNamee

    Copyright: Medical News Today

     

    According to a study conducted by researchers in Canada and published in the BMJ, annual screening for breast cancer does not reduce likelihood of dying from cancer any more than physical examination or usual care do in women aged 40-59.

    Cancers of the breast detected in screening (or “mammography”) are, on average, smaller than breast cancers that can be detected through physical examination. And experts know that women with small breast cancers have a better chance of long-term survival than women with large breast cancers.

    But experts cannot be sure that this better chance of survival is because of screening, or if this increased survival is influenced by other factors.

    These include factors called “lead time bias” and “over-diagnosis.” Lead time bias is when testing increases perceived survival time without affecting the course of the disease. Over-diagnosis is the clinical term for the detection of harmless cancers that will not result in symptoms during a patient’s lifetime or cause them to die.

    As breast cancer screening occurs annually for some women as part of an effort to lower breast cancer mortality rates, the researchers behind this new study wanted to measure how effective annual screening is in preventing death from breast cancer.

    “It is true that if you find cancer early it could be at a more treatable stage,” study author Prof. Anthony B. Miller told Medical News Today. “But there is no evidence that early detection affects the inherent biology of the cancer. Indeed it is possible that finding the cancer at an earlier stage will result in undertreatment. There is some evidence that is so.”

    “In our study, and in some other screening studies, those whose cancers were detected by mammography seemed to have more rapidly progressive disease. In addition, the mere fact that a cancer is detected by screening does not guarantee a benefit from detecting that cancer.”

    This was a large, long-term study across six Canadian provinces that followed 89,835 women between the ages of 40 and 59 over a period of 25 years. These women were randomly divided into two groups. The mammography group received one screening every year for 5 years, whereas women in the control group were screened only once.

    Over the entire 25-year study period, a total of 3,250 women in the mammography group and 3,133 in the control group were diagnosed with cancer. In the mammography group, 500 women died, compared with 505 women in the control group. So the mortality rates in both groups were similar.

    The authors say that an excess of 142 cancers were recorded in the mammography group during the 5 years of the screening period, with 106 excess cancers recorded after a period of 15 years. From this, the authors deduce that 22% of the cancers in the mammography group were over-diagnosed.

    “These cancers – comprising half of those found by mammography alone – could not have affected the woman’s lifetime,” said Prof. Miller, “instead there were adverse consequences that she had to endure, living with the knowledge that she had had breast cancer, though in fact that detection did not benefit her at all.”

    “So stopping mammography screening will not result in lives lost, but lives lived with greater quality of that life,” he added.

    What did other studies find?

    In 2013, Medical News Today reported on a UK-based study that also found breast cancer screening does not reduce deaths from the disease.

    But the findings of this study do contradict findings from some other similar studies. A Swedish study attributed a 31% reduction in mortality to mammography. But the authors of the Canadian study think that the Swedish trial was flawed and the difference is down to “an initial imbalance of the compared groups, not a benefit of screening mammography.”

    A large systematic review of data from 1976 to 2008 also had different findings to the Canadian study, estimating that 31% of all breast cancers were over-diagnosed. The Canadian researchers think this difference was due to that review taking a wider age range into account than their study, which looked at women between the ages of 40 and 59 only. They think that over-diagnosis is more common in people older than this, as there are more potential causes of death as individuals age.

    The researchers also admit that the result of the Canadian study may not be generalizable to all countries.

    Rationale for mammography should be ‘reassessed’

    Although Prof. Miller and his team assert that education, early diagnosis and clinical care remain priorities in treating breast cancer, they say that mammography does not result in a reduction in breast cancer-specific mortality for women aged 40-59 beyond that of physical examination alone or usual care in the community.

    The authors say that annual breast cancer screening should be urgently reassessed by policy makers, but they anticipate resistance from medical groups with “vested interests.”

    Prof. Miller told Medical News Today:

    “The greatest resistance will come from radiologists, who are convinced that finding cancers results in benefit, and who also benefit financially from that belief. We have demonstrated that is not so. Others whose advice resulted in the establishment of breast screening programs will also feel threatened.

    It is unfortunate that although we maintain we should practice evidence-based medicine, when that evidence is produced, there will be many who will seek the means to discredit that evidence because it is against their vested interests.”

    Rather than annual breast screenings, the authors of the study would like to see funding diverted into better public education programs to convince women to seek skilled advice if they detect an abnormality in their breast, and professional education programs that ensure doctors are familiar with the latest advances in research.

  • Mammography: Are There Pros, or is It Just a Con?

    By Johnnie Ham, MD, MBA

    Original Article at Mercola.com

    Many women are completely unaware that the science backing the use of mammograms is sketchy at best. As was revealed in a 2011 meta-analysis by the Cochrane Database of Systemic Reviews, mammography breast cancer screening led to 30 percent overdiagnosis and overtreatment, which equates to an absolute risk increase of 0.5 percent.

    There’s also the risk of getting a false negative, meaning that a life-threatening cancer is missed.

    Unfortunately, even though some high-profile people agree that mammography has limitations as well as dangers, others prefer to ignore the science and continue to campaign for annual screenings without so much as a hint at the risks involved.

    Now, they’ve unrolled “new and improved” 3D TOMOSYNTHESIS mammogram, which still requiring mechanical compression, and delivers 30 percent more radiation!

    In order to make better informed decisions, I provide my patients with all of their screening options, their strengths and weaknesses, and I reinforce that they have a right to utilize those options. Some of the options may include; self and clinical breast exams, thermography, ultrasound and/or MRI. My role as a doctor is to diagnose and treat, but I am also an educator. I want my patients’ focus to be on prevention to improve their health and well-being.

    The Industry of Cancer

    Breast cancer has become big business, starting with the multi-billion dollar goliath, mammography. No other medical screening has been as aggressively promoted. My passion is providing integrative primary care as an MD for hundreds of patients. I also have over 23 combined years of military experience as an OB/GYN, trauma surgeon, experimental test pilot, and master army aviator.

    My training prepared me to navigate through challenging, and sometimes life threatening situations. Unfortunately, most women do not have the training I received, yet they could certainly use some of it to help navigate through the fear based methods of the breast cancer industry.

    The tide of thought on mammography’s benefits is rapidly changing as evidenced by recently published studies in the Archives of Internal Medicine,1 the Lancet Review,2 the British Medical Journal3 and the Nordic Cochrane Center;4 and the fact that the US Preventative Services Task Force5 and the Canadian Task Force on Preventative Health Care.6

    Why are Nearly All Health Care Professionals Not Following Current Mammogram Recommendations?

    Nearly every woman age 40 and older continues to be told by their primary care physician, their gynecologist, the media, self-proclaimed advocacy groups, and even their medical insurance carrier, “get your annual mammogram!” despite the fact that nearly every recent authoritative study concludes that women should know all of the facts before agreeing to a mammogram screening. Yet nearly all health care professionals insist on mammograms. If a woman dare refuse, she may be chastised or worse, threatened. These efforts have gone beyond persuasion to guilt and even coercion, “I can’t be your doctor if you don’t get a mammogram.” Women need to stop this runaway train, not only for their sake, but for the sake of their daughters.

    In November 2012, the New England Journal of Medicine published a study by Dr Archie Bleyer, MD from The Oregon Health Sciences Center, and his co-author, Dr H. Gilbert Welch, M.D., M.P.H., from Dartmouth, challenging the validity of mammogram screenings and concluded that mammograms have little to no influence in the reduction of the number of women who ultimately die of breast cancer.7

    Thirty years of US government data studied found that as many as 1/3 of cancers detected by mammography may not have been life threatening, and that over 1 million women have been over-diagnosed; leading to unnecessary treatments involving disfiguring surgeries; radiation and chemotherapy. They also showed that mammogram screenings have increased from about 30 percent of women 40 and older in 1985, to about 70 percent of women screened, proving how effective we have been at convincing women they need to get a mammogram.

    I have witnessed this strategy for decades and I have seen the profound psychological effect it has had on many of my patients. This paradigm has seriously misled women regarding the actual effectiveness, and the benefits vs. potential dangers of mammograms. They also have women confused about the erroneous belief that mammography is their only tool. Some women actually believe mammograms can prevent cancer, or do not realize they have the right to say, no!

    Most women comply with the current “gold standard” in fear of the ravages of breast cancer, convinced their annual mammogram will save their life through early detection. It is nearly impossible for them to negate decades of slick marketing, annual reminders from radiology imaging centers and the exploitation of October’s Breast Cancer Awareness month blitz. All of these efforts beautifully packaged, tied up with a pretty pink ribbon.

    I take my oath to do no harm very seriously. After many years of research, clinical practice; and due to my wife’s personal experience with mammography, I cannot in good conscience recommend mammograms. I inform my patients that mammograms are considered the current “gold standard”, but I also make certain they know the facts about the screening and that there are other screen tools available.

    Facts and Persisting Concerns: Mammograms

    More women are refusing mammograms. This is reflected in the dramatic decline of 4.3 percent in 2010. Previously, mammography use had increased annually by 1 percent between 2005 and 2009. Mammograms:

    1. Are incorrect 80 percent of the time (providing a false negative or false positive)
    2. Require repeated ionized radiation that can cause cancer
    3. Use compression, which can damage breast tissue or potentially spread cancer
    4. Are not effective for up to 50 percent of women (women with dense breasts or implants)
    5. Can lead to over-diagnosis and over-treatment of non-invasive cancers
    6. Can lead to the disturbing practice of “preventative” double mastectomies

    What is Mammography Industries Solution?

    The “new and improved” 3D TOMOSYNTHESIS mammogram, still requiring mechanical compression, and 30 percent more radiation! We know all levels of ionizing radiation can cause cancer but, astonishingly, radiologists still want you to have your traditional mammogram screening first, followed by tomosynthesis mammogram for those with dense breasts or an area of suspicion. When my local Radiology Community approached me in an effort to disprove my concerns, I posed one simple question: Can you show me, one well-designed study that proves screening mammography has improved ultimate survival rates? I am still waiting for their answer.

    We cannot prove that screening mammography improves the ultimate survival rate. A quick look at the SEER data would suggest treatment has improved, by a decline in the death rate since 1998 of 1.9 percent.8 For every 1,000 women in this country, today 125 will ultimately be diagnosed with breast cancer. Of those 125, over 40 will be over-diagnosed, and receive treatment they never needed, and suffer the potential psychological consequences of a cancer diagnosis. That leaves about 80, of which 28 will die of breast cancer. The decline since 1998 in the death rate means that for our 28 women who would have otherwise died from breast cancer, 2 more out of 1000 women diagnosed with breast cancer survived due to over a decade of treatment advances.

    But, we really don’t know what actually saved those 2 women, of the 125 diagnosed with breast cancer for every 1,000 women in our group. If we attribute anything to lifestyle changes we have emphasized recently (which has been shown repeatedly to work), then either we wipe out any improved survival rate from decades of treatment advances, or worse, we cause death to some of those 40 women who were over-diagnosed!

    If You Have Dense Breasts it is Even Worse

    Breast density laws have now been passed in California,9 Connecticut, New York, Virginia and Texas making it mandatory for radiologists to inform their patients, who have dense breast tissue (40 to 50 percent of women) that mammograms are basically useless for them. Dense breast tissue and cancer both appear white on an X-ray, making it nearly impossible for a radiologist to detect cancer in these women. It’s like trying to find a snowflake in a blizzard. A law is now being considered at a Federal level as well.

    Some radiologists already provide density information to their patients, and encourage them to utilize other options like thermography, ultrasound and/or MRI. I believe it reasonable for a woman to trust that her radiologist is not withholding vital density information. Unfortunately, many have kept this potentially lifesaving data from women for decades, and our government agencies have failed to protect them from this unethical practice.

    I know it is extremely difficult to navigate through all of the contradicting information and study findings. It would better serve women if efforts, money and resources were utilized on educating women on cancer prevention, being that 95 percent of disease is lifestyle related. Yet 40,000 women continue to die of breast cancer each year. The only way to reduce this number is through utilizing preventative therapies.

    Basic Cancer Prevention Strategies

    As mentioned above, many women are completely unaware that the science backing the use of mammograms is sorely lacking, and that more women are being harmed by regular mammograms than are saved by them. Many also do not realize that the “new and improved” 3D tomosynthesis mammogram actually delivers even MORE ionizing radiation than the older version. This is not a step forward…

    Please understand that there are other screening options, each with their own strengths and weaknesses, and you have a right to utilize those options. Also remember that in order to truly avoid breast cancer, you need to focus your attention on prevention.

    A few simple, yet great options to assist in your efforts to avoid breast cancer are: making sure you are getting enough vitamin D, K2 and iodine; that you utilize lymphatic massage; use stress management techniques, exercise often, and balance your hormones naturally. It is also wise to eat a Mediterranean diet consisting of organic foods. Avoid processed and GMO foods; and toxic environments.

    In my practice, I recommend breast thermography, even for young women to get a baseline, but also combine the imaging not only with a review of the findings, but more importantly, as a venue to educate women on breast health. It is far more effective to prevent breast cancer, than it is to wait until it is there and then treat it. We are all different so make sure you consult with your doctor and do your own research before utilizing any of these suggestions.

    The advice I give all of my patients is to be your own health advocate, do your own research and always ask questions before agreeing to any therapy or treatment, screening and/or procedure.

    About the Author:

    Dr. Johnnie Ham, MD, former Lieutenant Colonel of the US Army Medical Corps, is the Medical Director of Coastal Prestige Medical Services, Pismo Beach, CA. Coastal Prestige Physicians offer top-notch comprehensive healthcare, with an emphasis on evidence-based primary care and preventive health for all ages.

  • Mammograms have led to over one million women being unnecessarily treated for breast cancer according to a new study. Are yearly breast exams actually hazardous?

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  • Professors: Komen overstating benefits of mammograms (CNN News)

    By Saundra Young, CNN Sr. Medical Producer
    updated 1:33 PM EDT, Tue August 7, 2012

    (CNN) — A national breast cancer charity is being accused of using misleading statistics to convince women to have mammograms, according to a paper published Thursday in the British Medical Journal.

    Susan G. Komen for the Cure‘s mammography campaign during breast cancer awareness month last October has come under fire from professors Steven Woloshin and Lisa Schwartz at the Dartmouth Institute for Health Policy and Clinical Practice, who say the foundation overstated the benefits of the procedure and totally ignored the risks.

    “The ad implies that mammograms have a huge effect, but the only evidence that they use is the five-year survival rate for breast cancer when caught early is 98% and when it’s not, 23%,” Woloshin said. “The problem is that in the context of screening survival, statistics are meaningless.”

    “To make an informed decision, you not only have to know the benefits you have to know the harm. And the ad does not say anything about harm, it just gives you this exaggerated benefit statistic,” Woloshin said.“Screening is a genuine decision people need to make and they can only make it if they have the facts. It doesn’t mean that screening is not good, it means it does good and it does harm. Some people can benefit and some will get hurt, and the harm is just as real as the benefit.”

    A teaching moment about politics and Komen

    Woloshin and Schwartz write a series that highlights exaggerations, distortions and selective reporting in advertising, news stories and medical journals that are misleading. They say the problem in Komen’s case is using survival statistics to determine the benefit of screening.

    [Read More…]