For every life saved by mammography, two to ten women are overdiagnosed and unnecessarily become breast cancer patients with all the harm associated with chemotherapy, radiation or surgery, without the benefits.
What impact did the 2009 amendment by the US Preventive Services Task Force (USPSTF) on the recommendations to postpone routine mammography screening until the age of 50? Ironically, the rates of women in their 40s getting a mammogram may actually be elevated. It is believed that all of the media attention surrounding the change in recommendations may have only reminded women of mammography screening, underscoring the need to better translate evidence into practice.
The new USPSTF recommendations bring the US is getting closer to European standards that recommend mammograms every few years from the age of 50 onwards Do Mammograms Save Lives?, recommended Annual mammography screening from the age of 45 and subsequent change to every other year at the age of 55. ACS suggested that this would decrease the lifetime risk of dying from breast cancer from 2.7 percent to less than 2 percent, based in part on a systematic review carried out the Cochrane Collaboration, a highly respected bastion of evidence-based medicine. However, the authors of the Cochrane review reported that the American Cancer Society had used the wrong number. If you look at the studies that their review finds “appropriately randomized”, there does not appear to be any significant mortality benefit from mammograms at all. In addition, they claimed that “the data available certainly does not support the popular idea that” [breast cancer] Screening saves lives. The ACS is a political organization with financial ties to companies involved in the multi-billion dollar breast cancer mammography industry. “
The Cochrane Review closed: “The studies that provided the most reliable information showed that screening did not reduce breast cancer mortality.” If that’s true, that changes everything. “We believe the time has come to re-evaluate whether universal mammography screening should be recommended for every age group.”
And that is exactly what the Swiss Medical Board has did. Explaining their position, they stated, “We were surprised at how the benefits of mammography screening did not obviously outweigh the harm … It is easy to promote mammography screening when the majority of women believe there is a risk of developing breast cancer , prevents or reduces. ”and saves many lives through the early detection of aggressive tumors. Unfortunately, they are not, and we believe that this should be told to women. From an ethical standpoint, a public health program that does not clearly do more good than harm is difficult to justify. “
It is not surprising that their “report” caused a commotion. “Critics argued that” the report unsettled women, but we wonder how we can not unsettle women, given the evidence available “.
What did the women say when asked what they think are the benefits of regular mammography screening? As you can see in mine at 2:36 Video, She think it cuts the risk of dying from breast cancer in half and saves the lives of about 1 in 12 women. In reality, however, the numbers are completely different. First, the risk of dying from breast cancer regardless of screening is lower than most women think, and the risk reduction from screening is much lower, with about 5 in 1,000 women dying of breast cancer without screening and 4 in 1,000 dying with screening . Isn’t it worth saving the life of even one woman in a thousand? Imagine if you were a member of this family of one thousand whose mother was saved. But even that cannot be true.
That is, “systematic mammography screening could prevent, say, one breast cancer-related death for every 1,000 women screened. [but] There was no evidence that all mortality was affected, “which means that in fact no life is saved. There have been ten randomized mammogram screening trials, and none have ever existed shown an overall mortality benefit. How does that make sense? If mammograms prevent one in a thousand women from dying of breast cancer, then the only way to not save a life is by somehow getting mammograms done LED to the death of one in a thousand healthy women. But that’s absurd, isn’t it?
Let me introduce the concept of overdiagnosis. The fact is, some of the tiny tumors found on mammograms may never have appeared advanced and some may even have disappeared alone. So if these tumors had not been discovered during the screening, the women would not have been smarter and never have been affected by them or even have known they had them. But once Is cancer recognized if you have a mammogram, you have to treat it because you don’t know what it’s going to do. And in the overdiagnosed cases where it would never harm you, you are treating the breast cancer unnecessarily.
But how common is it? “For every life saved by mammography, there are around two to ten women overdiagnosed. ”This means that they become unnecessarily breast cancer patients. “Women who are overdiagnosed cannot benefit from unnecessary chemotherapy, radiation, or surgery. Everything they experience is damage. ”And this damage can contain Death. Indeed, “with more overdiagnosis, there is increased mortality from the damage of radiation and chemotherapy in healthy women.” Imagine if you were in the family whose mother was killed in this case.
There is concern that unnecessary radiation treatments kill as many as are saved, so there is no evidence of a net mortality benefit. Irradiation of the chest increase the risk of dying from heart disease and lung cancer. Those can be acceptable risks if you actually do have Breast cancer that would otherwise kill you, but treatments “that are beneficial to real patients can be fatal to healthy overdiagnosed people” – those who should never have been treated.
Even if mammograms don’t save your life, could they save your breast? If you discover a tumor early enough, could you avoid a mastectomy? The opposite can be true. The Cochrane researchers explain: “We published the report mainly because we believe that it is important for women to be aware of this screening increases their risk of losing a breast. “
“The mammography screening was up promoted to the public with three simple promises that all appear to be wrong… screening does not seem to prolong women’s lives… ”Instead, it may be“ increased ”unnecessarily Mastectomies; and cancer is not detected early, but very late. ”It can take decades for a tumor to develop grow large enough to be included in a mammogram. And even if they are picked up, they may not grow any further, which is why we are concerned, “they are too” Caught in too great a number. There are so many overdiagnoses “that if a woman really doesn’t want to become a breast cancer patient, she should“ avoid screening altogether ”. But if you have breast cancer, don’t you want to know?
“The low probability that a woman can avoid breast cancer death must be” weighed against the more likely scenario of having a false positive result and potentially unnecessary follow-up testing (including invasive testing); a false negative result with false confirmation or belated diagnosis; or most critically the diagnosis and treatment of cancer, which otherwise would not threaten her health or would have even caught her eye. “
There is just so much confusion on this subject, coupled with the corrupting commercial interests of a multi-billion dollar industry. As with any major health decision, everyone should be fully informed about the risks and benefits and form their own opinion about their own body. This is the fourth in a 14-part series on mammograms that also includes:
THE CENTRAL THESES
- Despite the recommendation by the US Preventive Services Task Force (USPSTF) panel of experts to postpone routine mammography screening until the age of 50, the rate of women in their 40s receiving mammograms may have increased, likely due to media attention that the shift in guidance.
- European standards recommend mammograms every few years from age 50, and the American Cancer Society (ACS) recommends annual screening from age 45.
- The Cochrane Collaboration, a highly respected bastion of evidence-based medicine, noted that mammograms did not appear to have any significant mortality benefit, claiming that the “available data certainly does not support the popular idea that” [breast cancer] Screening Saves Lives “and concluded that” the time has come to reevaluate whether universal mammography screening should be recommended for every age group “. She also identified the ACS as a political organization with a conflict of financial interests, as it has ties to companies associated with the multi-billion dollar mammography industry.
- Perceived benefits of regular mammograms include cutting the risk of dying from breast cancer in half, which can save about 1 in 12 women. In reality, the risk of dying from breast cancer regardless of screening is less than most women think, and the risk reduction from screening is much less, with about 5 in 1,000 women dying of breast cancer without screening and 4 in 1,000 with Screening.
- For every life saved by mammography, up to two to ten women are overdiagnosed and unnecessarily made breast cancer patients, with all the harm of chemotherapy, radiation or surgery without the benefit.
- Unnecessary radiation can kill as many people as can be saved, and radiation to the chest increases the risk of death from heart disease and lung cancer.
- The Cochrane Collaboration Review: “The small likelihood that a woman can avoid breast cancer death must be weighed against the more likely scenario of having a false positive and potentially unnecessary follow-up testing (including invasive testing); a false negative result with false confirmation or belated diagnosis; or most critically, the diagnosis and treatment of cancer, which otherwise would not threaten her health or would have even caught her eye. “
You can find more information about breast cancer in my videos Oxidized cholesterol 27HC can explain three secrets of breast cancer, Eggs and breast cancer and Flashback Friday: Can Flaxseed Prevent Breast Cancer?
I was able to cover colon cancer screening in just one video. If you missed it, see Should we all have a colonoscopy over the age of 50?
You can also find information on medical check-ups here Flashback Friday: Is It Worth Getting an Annual Health Checkup and Physical Exam?, Are annual health checks worthwhile? and Is it worth doing an annual physical exam?.
Michael Greger, MD
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