For over forty years, women have been told the best way to lower their risk of dying of breast cancer is by getting a yearly mammogram. But recently, several well-designed studies have found this recommendation may not be true. Researchers say the value of mammograms has been overrated and their harms severely underrated. So much so, that in truth the harm they cause appears to outweigh their benefits.
In 2013, a landmark study was published in the Cochrane Database System Review which combined the data from ten of the best mammography studies. This meta-analysis—a study which combines the data from multiple studies—was considered highly significant because it included an exceptionally large number of women: 600,000! After pooling and analyzing all of the data, the researchers concluded that there is “no evidence that mammography screening reduces overall mortality.”
In addition, they found an extremely significant problem with this screening tool. Thirty percent of the “early breast cancers” detected by mammograms in reality weren’t breast cancers at all and would never have become a problem! In other words, for every 2,000 women invited for screening for 10 years, the researchers stated that only one will avoid dying of cancer while ten healthy women will be unnecessarily treated with potentially harmful surgery, radiation, and chemotherapy.
Another major study published in 2012 in the prestigious New England Journal of Medicine entitled, “Effect of three decades of screening mammography on breast-cancer incidence,” came to a similar conclusion.
The researchers said, “Despite substantial increases in the number of cases of “early-stage breast cancer” detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer. Although it is not certain which women have been affected, the imbalance suggests that there is substantial over-diagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer.” The researchers added, “We estimated that breast cancer was over-diagnosed in 1.3 million U.S. women in the past 30 years. In 2008, breast cancer was over-diagnosed in more than 70,000 women; this accounted for 31% of all breast cancers diagnosed.”
This past February, another landmark study was published in the British Medical Journal which reported the results of a randomized screening trial which analyzed breast cancer incidence and mortality over 25 years.
At the beginning of the study, women were randomly assigned into 2 groups in which half the women were to receive annual screening mammography and the other half only annual physical examinations. The reason this study is so significant is because of the way it was designed and length of follow up. A prospective, randomized trial is considered the “gold standard” as a study design because it gives the most accurate scientific data. When it comes to breast cancer mortality statistics, twenty years of follow up are required.
This study followed women for 25 years—the longest of any mammography study to date. The results of this study were the same as other studies: There was “no evidence that mammography screening reduces overall mortality.”
Mammograms: The problems outweigh the promise
There are many problems with mammograms that have been under-reported leading to a false sense that mammograms are a much better test than they actually are. Mammograms aren’t perfect and therefore, should never have been recommended as a stand-alone test. Their accuracy is actually quite poor.
Mammograms:
• Are not a good screening tool for large groups of women, including those who are young (less than 40 years old) or have breasts that are
o Dense
o Small
o Large
o Reconstructed
o Augmented with implants
• Produce ionizing radiation which can cause breast cancer
• Miss 20-30% of breast cancers
• Have high false positive rates—80% of what mammograms call “suspicious” and need to be biopsied are actually benign
• Over-diagnose in 21% to 30% leading to unnecessary treatment with potentially serious complications
• Are not preventative—the only find cancers that are already growing
Swiss Medical Board Takes the Lead
Because of all the shortcomings of mammograms, the Swiss Medical Board published a statement in the February 2014 issue of the New England Journal of Medicine recommending that mammography screening programs be phased out. They said, “From an ethical perspective: a public health program that does not clearly produce more benefits than harms is hard to justify.”
Alternative Tests That Are Both Safe And Effective
Fortunately, there are several excellent alternative tests that can be used for breast cancer screening. First, know that no test is perfect. However, research shows the best results come from doing a combination of three examinations including thermography, ultrasound, and physical exam.
Thermography
Before a tumor starts to grow, new blood vessels grow into the area. But, these blood vessels are not normal. They grow in abnormal patterns and produce excessive heat. Thermography is a completely safe infra-red picture that can “see” these physiological changes years before they become cancerous. Infra-red technology is completely safe. It is simply a picture that does not use radiation. Thermography does not have any of the limitations that mammography does. It is effectives for all ages, breast sizes and densities, and isn’t hindered with the presence of implants, or reconstruction.
Ultrasound
Ultrasound technology uses harmless sound waves to evaluate the physical properties of the breasts. More sophisticated ultrasounds include “elastography ultrasound” (EU) and 3-D ultrasound. EU uses a color mode to show the difference between stiffer cell membranes associated with cancer, and normal flexible cell membranes. A 3-D ultrasound is particularly useful for women with dense breasts.
Compared to mammography, 3-D ultrasounds are three times more sensitive than mammograms in finding cancers in dense breast tissue. In other words, 3-D ultrasounds find many cancers that mammograms miss—in fact, 300% more!
What should you do?
Research shows beyond any doubt that the value of mammograms has been greatly overestimated, and the harms underestimated. Mammograms do not improve mortality from breast cancer over simple physical exam, and are fraught with serious problems.
I agree with the Swiss Board—screening mammography should no longer be recommended from an ethical standpoint. Instead, a combination of ultrasound, thermography and physical examination are a much better choice. For certain women, an MRI scan which uses a magnet rather than radiation may also be appropriate.
Most important, rather than focusing on the screening, put more of your attention on prevention. Research shows that over 95% of breast cancers could be prevented through simple but profound diet and lifestyle techniques, along with some key nutritional supplements.