The Most Revolutionary Act

Diverse Ramblings of an American Refugee

Dr Stuart Jeanne Bramhall

Dr Stuart Jeanne Bramhall
Location
New Plymouth, New Zealand
Birthday
December 02
Bio
Retired psychiatrist, activist and author of 2 young adult novels - Battle for Tomorrow and A Rebel Comes of Age - and a free ebook 21st Century Revolution. My 2010 memoir The Most Revolutionary Act: Memoir of an American Refugee describes the circumstances that led me to leave the US in 2002. More information about my books (and me) at www.stuartjeannebramhall.com

FEBRUARY 4, 2013 4:53PM

How Mammograms Don't Save Lives

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mammogram

 

According to the co-author of a recent New England Journal of Medicine study, mammograms are largely ineffective in preventing deaths from breast cancer. What the retrospective study by Drs H Gilbert Welch and Dr Archie Bleyer revealed, in essence, was that the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than previously recognized.

As Dr H. Gilbert Welch wrote in a recent New York Times oped, the effect of three decades of mammogram screening has been the diagnosis of 1.5 million women with early stage breast cancer. While this number might seem impressive, mammography has only reduced the number of women presenting with late-stage (fatal) breast cancer by 0.1 million. What this means, in other words, is that aggressive efforts by public health officials to coerce women to undergo routine mammograms only slightly reduce their risk of dying of breast cancer.

Dr Welch blames the discrepancy on an epidemic of overdiagnosis: his study revealed more than a million women who underwent mammograms were told they had early stage cancer. In most cases this led to unpleasant, invasive and unnecessary treatment (surgery, chemotherapy or radiation) for a non-lethal “cancer.”

In his editorial, Dr Welch laments the misleading statements issued by the Komen Foundation and public health officials that early screening (by mammography) saves lives. The message they should be giving women is that they have a choice. While no one can dismiss the possibility that screening may help a tiny number of women, there’s no doubt that it leads many, many more to be treated unnecessarily for non-lethal cancers. Women have to decide for themselves about the potential benefit and risks. One serious potential risk Dr Welch doesn’t mention is the burden of radiation exposure from a lifetime of unnecessary mammograms.

He recommends instead of screening all women with mammography, health professionals should only target women with a strong family history or genetic predisposition to breast cancer.

Read more here

photo credit: windsordi via photopin cc

Crossposted at Daily Censored and The Most Revolutionary Act

 

photo credit: SpectrumHealth via photopin

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Sadly, a lot of us suspected this was a scam back in the 80s when we learned that breast sonograms were not only safer but more effective in diagnosing breast cancer. Back then the levels of radiation mammograms exposed you to were even higher than they are now. My mother and I made a pact that we would stick with self-exam. It was one of the best decisions I ever made. People shouldn't get their teeth routinely xrayed, either, unless the dentist covers their thyroid with a "thyroid apron."

The cancer causing effect of radiation is cumulative. In other words, the more you expose yourself to the more likely you are to develop cancer.
There is only one thing which has consistently been shown to increase average health - money.

Doctors visits don't do it, diagnostics don't do it - only money (on average).

That's in America. I don't know if this applies worldwide to other industrialized or modernized nations.
Are you really a doctor?

I was one of those "tiny number of women". When you hear the words, "you have breast cancer", you are immediately a statistic, one woman in eight. I do not have the BRCA 1 or 2, had zero lifestyle factors, and yet.

Good luck feeling for lumps. If you are really a doctor, then you know that breast cancer often does not present as a lump. It can be cells spread throughout the breast, it can be an inverted nipple, it can be an area of density. If feeling for a lump makes you feel safe, then by all means, and of course it is your choice.

Please be more cautious though, about claiming to be a doctor and telling women not to get a mammogram. Some might listen. Breast cancer and everything that goes along with it is much more complicated than you are making it sound. Any woman reading this with concerns should see a real doctor, one connected to a cancer center if possible, and listen to what they have to say.

P.S. You are right about late stage and mammograms, but one reason for this, is women who avoid having one until late stage. They have a lump and don't go to the doctor for years sometimes, because they are so misinformed and terrified of breast cancer.

signed,
Eleven Year Survivor
[r] I hate to think and say this, but I did a blog a while back on how dangerous back surgeries were being done because the corporate vendors who made the metal or plastic or porcelain or whatever gizmos to be placed in the body had been so gosh darn generous to doctors wooing them through medical school with gifts and money and kicking back when dangerous surgeries were performed and their gizmos were used.

Even though the patient was worse off with the drastic surgery and the doctors knew it. Repeat the doctors knew it.

You would like to think your doctor has honor and is not using your body for profit especially it being gratuitously dangerous for you. But .... sociopathy exists. And money money money is one of the roots of evil.

Professional cronyism and economic ambition. How it can erode morality.

Playing around with breast cancer fear for profit. why not? certainly consistent with so much else going on.

best, libby
I am among the "tiny number of women" helped by a routine mammogram: negative for the BRCA, no family history of breast cancer, a lump that was almost impossible to feel (and this from a woman who was very familiar with her breasts), 47 years old, stage 2. "Unpleasant" and "invasive" procedures followed. Now cancer-free for 4 years. Needless to say, I am not a proponent of the hands-off-when-it-comes-to-early-detection philosophy that is gaining popularity. Women will die because of this philosophy. Period.
I appreciate the information here to make an informed decision and your helpful recommendation to protect the thyroid during dental xrays with a thyroid apron.
Your title loses credibility though - mammograms can and do save lives through early detection, even according to this post. But not as much as we've been led to understand. A distortion contributed to by overdiagnosis. I did appreciate the information on the risks of mammograms, which included overdiagnosis.
Greenheron, I am a real doctor. So is Dr Welch. And the New England Journal of Medicine, which published his peer reviewed study, is one of the most prestigious medical journals in the US. If you read the blog very carefully, I am not telling women they shouldn't have mammograms. Neither is Dr Welch. What he is saying is that the number women who have been harmed by overaggressive treatment of slow growing "in-situ" cancers is far greater than the number who have had lethal cancers detected via mammograms.

He is advocating that women be fully informed that there are both benefits and risks associated with mammograms - in other words, that they have a choice about having them.

I strongly suggest that you, Susan and Maria follow the links I provided to the New York Times oped and the original study. According to all the best research evidence, it's improved treatments - not mammograms - that are saving lives.

Susan, I don't really think it's early detection that's at issue here. We have known for 30 years that breast sonograms were far safer (owing to zero radiation exposure) and far better at detecting breast cancer. Breast thermography, a newer technology, is better still at early detection. Yet women aren't offered a sonogram unless they have a "borderline" mammogram that needs a more sensitive test.

If the real issue were early detection, we would be using sonograms and/or thermography for our mass screenings, instead of subjecting women to repeated, unnecessary radiation exposure. So why aren't all women given the choice of sonograms and/or thermography? Because a massive for-profit industry has built up over providing mammograms to millions of women worldwide - regardless of the cumulative radiation risk and overdiagnosis of in-situ cancers.
I appreciate the clarification. I must remember that - sonograms and thermography.
greenheron and susan mihalic have it right. i had a tiny in-situ early ductal cancer removed decades ago because it was detected by mammogram. i have no family history and no risk factors for cancer. if some doctor had told me (after detecting it either thru mammography, tactile exam or voodoo) that i had an in-situ "cancer" (something you and dr. welch inexplicably use in your text, those quotes) that "wasn't likely to kill me," i'd have to think for, oh, about ten seconds before making a decision that i would still like it taken the hell out, thank you very much.

i'm not being snarky, but i will point out that your medical specialty is psychiatry. i realize you probably took the standard overview in med school on internal medicine, but you don't seem to have any hands-on experience in that specialty or in oncology, pathology or nuclear medicine.

one last point. when i read articles that drone on and on about how there's this epidemic of overdiagnosis and overtreatment of some illness or condition and that we are wasting hundreds of millions of dollars on this or that diagnostic tool, they're usually written by insurance companies.
Women aren't given the choice of sonograms or other because they are used for diagnostic vs. screenings - focusing on a small area. They do not image the entire breast. That's what mammagrams are for; they are used for screening of the entire breast to catch problems. At least that's what I was told by the Director of Nursing for a statewide women's health group told me when I called her to ask.
Femme Forte, is shooting the messenger a form of snarkiness? I think they call it ostrich syndrome. You seem to be suggesting that when studies like this are done, the information should be buried instead of being made available to women to allow them to make informed choices.

I don't think the issue here is my qualifications, but of the doctors who did the study and of the doctors at the New England Journal of Medicine who deemed it worthy of publication. The New England Journal doesn't publish studies financed by insurance companies.

I think you miss the whole point of the study and Dr Welch's oped. The point he is making is that mammograms have side effects (radiation exposure) and that breast cancer treatment has side effects that are also potentially fatal. All he's saying is that instead of pressuring all women to have mammograms, we should inform them of the potential benefits and risks and let them choose.

Onisland time, I think your Director of Nursing is misinformed. Sonogram is another word for ultrasound (the same procedure they use during pregnancy). Many doctors use ultrasound in preference to mammograms in women under 35 because their breast tissue is too dense for mammograms to detect tumors.
dr. bramhall, i explicitly wasn't being snarky and said so, and i never said dr. welch's study should be buried. i disagree with the conclusions *you* drew from the statistical information his study found. i know a great deal about medicine and specifically cancer, and i always read and research things before i form opinions. implying that i'm a person who keeps her head in the sand makes me laugh. if you only knew.

i'll stand by what i said earlier, all of it. you might want to read the comment again since it didn't say any of what you seem to think it did.

i didn't miss that you believe the exposure to the levels of radiation from routine mammograms is harmful. before i stop having mammograms and certainly before i would suggest that *other women* stop having them as a means of detecting breast cancer - i'd like to see statistics that show more women die or must undergo painful and health-threatening treatment because of exposure to that radiation than from undetected breast cancer. if you can point us to that information, please do.
Femme forte, I think if you compare my post to Dr Welch's oped, I am merely reiterating his conclusions, not drawing conclusions of my own. Thus my comment about shooting the messenger. I also think you are generalizing from your own personal experience - clearly having a mammogram was right for you - to Welch's recommendation that women be given a fully informed choice about having mammograms.

He's certainly not recommending that women not have mammograms - neither am I. However I happen to agree with him that women should know they have choices - one of them being to ask for ultrasound or thermography screening in place of a mammogram.

The kind of research you propose - linking specific cases of cancer directly to mammograms isn't possible. Americans, in general, are exposed to way too much radiation, which many epidemiologists believe contributes to the current epidemic of all types of cancer, not just breast cancer. You can't point to one single exposure and say that exposure caused the cancer. The effect is cumulative and every new exposure increases the likelihood that cancerous cells won't be destroyed by the immune system.

I happen to subscribe to the Precautionary Principle, which is the standard in the European Union. It stipulates that scientists and doctors have an obligation to prove technologies are safe before they make them widely available to patients. If you put the obligation on the patient to offer statistical proof they are harmful, tens of thousands of patients have already been harmed by the time the proof becomes statistically significant.
Dr. Stuart, if I could rate this post twice, I would. I just read a synopsis of the New England study as presented by Dr. Mercola and I instantly remembered the first alert you gave me to the risks of mammograms. I, for one, appreciate being informed of the risks of my choices so I can make an informed decision. I had no idea, until your post here and the reinforcement of its message with Dr. Mercola's, that there was any risk at all with mammograms or dental xrays - my dentist has been very trigger happy with xrays and I will insist on greater discretion from now on.
So thank you for willing to be the messenger of an unpopular message.

A quote from what I read today:

"Last November, the New England Journal of Medicine also published a shocking analysis of the effects of breast cancer screening in the US over the past three decades, which found that 1.3 million women were misdiagnosed and mistreated as a result. The number of early-stage breast cancers detected have doubled over the past 30 years since the advent of mammography, from 112 to 234 cases per 100,000. Late-stage cancer incidence has decreased by eight percent in the same time frame, from 102 to 94 cases per 100,000.

According to the authors:

“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 overdiagnosis, 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 recap:

"According to recent findings by the Nordic Cochrane Center, only ONE out of 2,000 women screened regularly for 10 years will actually benefit from screening due to early detection of breast cancer.
Meanwhile, 10 healthy women (out of those 2,000 screened for a decade) will be misdiagnosed, turned into cancer patients, and will be treated unnecessarily. These women will have either a part of their breast or the whole breast removed, and will typically receive radiotherapy and/or chemotherapy. This treatment (for a cancer that was non-existent) subsequently increases their risk of dying from complications from the therapy and/or from other diseases associated with radiation and chemo, such as heart disease and cancer. So, to recap, in order for mammographic breast screening to save ONE woman's life:

2,000 women must be screened for 10 years
200 women will get false positives, and
10 will receive surgery and/or chemotherapy even though they do not actually have cancer "

So the empowerment this information offers me is that if I don't want the radiation exposure risks of the mammograms, I could look for alternative screenings. And if I decided to accepted that risk, and was diagnosed with breast cancer I would take extra precautions to reduce the next risk of a false diagnosis.

And the ultimate empowerment is that there are life style choices I can make to reduce my risk of even developing breast cancer. I want to focus my energy on prevention.
source - http://articles.mercola.com/sites/articles/archive/2013/03/02/3d-tomosynthesis-more-risky.aspx?e_cid=20130302_PRNL_art_1&utm_source=prmrnl&utm_medium=email&utm_content=art1&utm_campaign=20130302#_edn4
Hi Maria, thanks for the link and your excellent summary.
I just read through all the comments responding to the Mercola article and culled four alternative diagnostic screening methods, that seem to carry no risk, worth exploring:

1) ULTRASOUND. Since it is often used to verify mammogram results when they are suspicious, why not go straight for the ultrasound. There were a lot of comments about mammograms not being effective as a screening tool for high density breast tissue anyway, and based on this alone you can request for an ultrasound instead.

2) Ultrasound test called ELASTOGRAPH which distinguished harmless lumps from malignant ones. See "elastrography.com.

3) The AMAS (Anti-Malignin Antibody Serum) test data, by Oncolab, Inc., - A blood draw test.
...shows that it detects cancer "regardless of site or tissue type" (= any kind of cancer, anywhere in the body) with 95% sensitivity and specificity on the first determination and 99% sensitivity and specificity on the second and successive determinations. (Disadvantages of the AMAS are that it must be shipped to Boston overnight (24-hour) on dry ice, so you must make arrangements for that and never ship late in the week).
The CA15.3, another blood draw.

4) Breast THERMOGRAPHY, a non-toxic, non-invasive digital infrared imaging of the breasts.

I repeat - suggestions for exploring to determine if they would be better alternatives to the mammogram. Most of these suggestions were made by survivors of breast cancer. It seems no one method my be perfect and so having a combination of options presented the possibility of greater strength in pro-action. I think early detection is important, but would prefer diagnostic methods that carry less risk.

The lifestyle changes recommended were very informative. Especially for me - I had no idea of the risks of unfermented soy products, as very different from fermented soy products. I just made the decision to stop eating fake vegetarian meat and to drink a lot less soy milk, and to focus instead on tempeh and tofu. Reading of the risks of unfermented soy used in the fake meat stuff has given me the resolve to stick with my decision (or to cheat a lot less!). One step at a time.