Dangers and Unreliability of Mammography: Part 1
by Samuel Epstein, MD

Contrary to popular belief and misleadingly assurances by the media, the National Cancer Institute (NCI), and American Cancer Society (ACS), mammography is not a technique for early diagnosis. In fact, a breast cancer has usually been present for about eight years before it is usually detected.

Mammography poses major risks of which women still remain uninformed. Radiation from routine mammography poses cumulative risks of breast cancer. Contrary to misleading 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 screened annually over ten years are exposed to about 10 rads for each breast.

The premenopausal breast is also highly sensitive to radiation with each rad exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of screening; risks are still greater for "baseline" screening at younger ages, for which there is no evidence of future relevance. Furthermore, cancer risks are up to fourfold greater for the 2 percent of women who are unknowing carriers of the A-T gene, and thus highly sensitive to radiation; estimatedly, this accounts for 20 percent of breast cancers annually.

Mammography entails tight and often painful compression of the breast, particularly in premenopausal women. This can lead to distant and lethal spread of malignant cells by rupturing small blood vessels around small undetected breast cancers. As increasing numbers of premenopausal women are responding to ACS's aggressively promoted screening, imaging centers are becoming flooded and overwhelmed. Resultingly, patients referred for diagnostic mammography are now experiencing up to several months dangerous delays.

Missed cancers are particularly common in premenopausal women owing to the dense structure of their breasts and proliferation late in their menstrual cycle. Missed cancers are also common in post menopausal women on estrogen replacement therapy, as about 20 percent develop breast densities making their mammograms as difficult to read as those of premenopausal women.

About one-third of all cancers, and more of premenopausal cancers, which are aggressive, and more likely to metastasize, are diagnosed in the interval between successive annual mammograms. Premenopausal women, particularly, can be lulled into a false sense of security by a supposedly negative annual mammogram. Mistakenly diagnosed cancers are particularly common in premenopausal women, and also in postmenopausal women on estrogen replacement therapy, resulting in needless anxiety, more mammograms and unnecessary biopsies. Women with multiple high risk factors, including a strong family history, prolonged use of the contraceptive pill, early menarche, and nulliparity are most strongly urged to have annual mammograms, the cumulative risk of false positives increases to "as high as 100 percent" over a decade's screening.

Overdiagnosis and subsequent over-treatment are among the major risks of mammography. The widespread and virtually unchallenged acceptance of screening has resulted in a dramatic increase in the diagnosis of ductal carcinoma-in-situ (DCIS), a pre-invasive cancer, with a current estimated incidence of about 40,000 annually, and is generally treated by lumpectomy plus radiation or even mastectomy and chemotherapy. However, over 80 percent of all DCIS never become invasive even if untreated. Furthermore, the breast cancer mortality from DCIS is about 1 percent, both for women diagnosed and treated early and for those diagnosed later following the development of invasive cancer.

Despite long-standing claims, evidence that routine screening allows early detection and treatment of breast cancer, thereby reducing mortality, is at best highly questionable. In fact, the overwhelming majority of breast cancers are unaffected by early detection, either because they are aggressive or slow growing. There is supportive evidence that the major variable predicting survival is the virulence of the individual tumor and the host's immune response, rather than early detection.

Claims for the benefit of screening mammography in reducing breast cancer mortality are based on eight international trials involving about 500,000 women. However, recent authorization analysis of these trials revealed "there is no reliable evidence that screening decreases breast cancer mortality-not even a tendency towards an effect." No nation other than the United States routinely mammograms premenopausal women. The US mammography overkill mentality extends to the standard practice of taking two or more mammograms per breast annually in postmenopausal women. This contrasts with the more restrained European practice of a single view every two to three years.

Samuel Epstein, MD is the author of the new book “CancerGate: How to Win the Losing Cancer War (BaywoodPublishing Co; 2005; $24.95; http://baywood.com 1-800-638-7819). Epstein is author of the controversial 1978 book “The Politics of Cancer” which revealed how the US government had been corrupted by industrial polluters. For more info, email Dr. Epstein at epstein@uic.edu or visit www.preventcancer.com

“Cancergate” reveals how the National Cancer Institute and the American Cancer Society have betrayed America’s public health since they have largely ignored strategies for preventing cancer. In the course of one generation, cancer has increased 50% in men and 20% in women. After reading “Cancergate”you will wake up to the cold reality that our government and so called health organizations are actually compounding the cancer epidemic in America. Read this book! For more info, visit http://baywood.com or call 631-691-1270.