update 20/12/12      Dr Giske Ursin of the Norwegian Cancer Registry has just published   thoughts on collaboration – not anger for and against risky xray mammography – needed to move the field forward on avoiding breast cancer, to defend the integrity of women’s breasts. 

this column has previously reviewed mammography screening


A new paper – from the USA National Cancer Institute no less- writes about the fraud of alarmist marketing of cancer screening/treatment.

Another new paper, from Wisconsin University,   What Is the Optimal Threshold at Which to Recommend Breast Biopsy? notes that with an annual incidence of breast biopsy  of 0.626% there (ie about 6 per 1000 women of the ~18 000 screened over 5 years ),  1 in 4 biopsied  ie about 0.15% of those screened will be proven to have some degree of (pre)cancer..  They confirm the 2% risk threshold at which radiologists recommend biopsy.

Of well women, perhaps <1 in 20 justify screening breast imaging except in those women with relevant anxieties ie the worried well.

But screening xray mammography often uncovers clinically silent ie preclinical breast cancer which otherwise might never cause problems in lifetime; and such irradiation and crushing may activate and  spread dormant precancer cells.
Just as cardiograms are electrical-, echo- or angio- images of the heart, mammograms MGMs are widely different technology images of the breasts.

But unlike heart disease, no living imaging technique diagnoses with certainty cancer that is not already clinically pretty obvious.

The breast carcinogenic radiation risks from X-rays have been known for a century and yet it’s heavy usage is often inappropriate, profit-driven.

When patient’s history and  physical  exam suffice to exclude significant risk of breast cancer with practical certainty, it is unnecessary to crush, irradiate, needle or cut. Low risk women expose themselves to a greater risk with lower-dose  screening X-ray MGMs and more invasive costly tests. For the common “silent” cancers (e.g. prostate/breast), statistics do not support that routine invasive screening of the apparently healthy saves lives.

As with all technology, many ‘grams – imaging methods – have evolved for the breasts. Like the infants they are built to nourish, breasts are extremely sensitive to irradiation. The lower the X-ray dose, the worse the subtle genetic damage that may occur – even decades later. We know this from follow-up consultations with women with initially healthy breasts >15 years earlier who had repeated xray mammograms, versus their sisters who had xray mammograms only when suspicions arose; and from controlled laboratory experiments on rodents and human breast cells.

Objective statistical analyses since the Canadian breast X-ray screening trial more than 20 years ago, show no benefit, but show instead an increasing risk of more breast cancer, more breast surgery and more premature deaths in well women repeatedly xrayed. .

ALTERNATIVE BREAST SCANS available include no-touch photographic thermo-mammography, gentle ultrasound;

and gentle mechanical tactile imaging (MTI), which may be  better than xray or ultrasound MGM show early warning signs such as thickening of tissue and lumps. These signs may be reversed with diet, supplements and lifestyle changes.

From international studies and  local experience, MTI (e.g. Sure Touch Mammography) has become the best at outpatients, to document the physical exam findings with three-dimensional characteristics mapped.. With this simple process, perhaps  < 1 in 30 healthy women may need referral for ultrasound, and perhaps < 1 in 100 cases justify biopsy, and as the Wisconsin study shows, <1 in 1000 found to have significant breast cancer. It has been validated as at least as effective as (if not better than) other breast imaging  in studies in USA, England, China and India.
MTI is recommended by CANSA, which says that from 2005 data    about 1:29 women will be diagnosed in their lifetime with breast cancer. .

Studies confirm the obvious, that the more experts with vested interests (in XRMGM and breast cancer management) who draw up Guidelines, the more likely that Panel is to encourage mass XRMGM and intervention. So instead of perhaps 1 in 30 woman justifying breast imaging, the Breast Disease Industry – including the USA Breast Cancer Association the Industry funds – wants every woman X-ray screened regularly ideally from age 40years for the rest of their lives. But despite rage from the $8billion a year USA breast screening industry, Authorities have steadily cut back the age of starting mass screening XRMGM from age 40 to 50 years and to every 2nd or 3rd years.

No preclinical imaging diagnoses cancer. The only sure diagnosis is lump excision histology – if not multiple biopsies with their risk of needle spread.

Talk about unsubtle seduction. This year – despite massive financial (including stock-market) and marketing pressure- even mammography wine and food parties at USA radiology centers  to persuade women to submit  -two books  never mind a flood of scientific journal papers have just  been published questioning routine xray mammography of the well:

Dr Peter Gotzsche and the Danish Cochrane epidemiology team have published the evidence from all over the world – from at least 14 countries- against universal XRMGM for all, against the myth of the benefits and safety of regular xray mammography..   and 

The Big Squeeze: A Social and Political History of the Controversial (XRAY) Mammogram (Culture and Politics of Health Care Work) by radiologist Dr Handel Reynolds 2012  


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