The gold-standard in breast cancer prevention is currently the mammography, or simply, a breast X-ray. Some less endearing labels I have heard are: “the compactor,” the “breast vise,” and the “can compressor”. A diagnostic procedure that is so infamous it has nicknames — it must be good, right? Many joke that if we have a similar examination technique for the men that it would not be as ubiquitous in the medical field as the breast mammography. I can’t help but laugh and cringe at the same time when I hear this, but it does raise a serious question. Can we do better as a medical community in keeping these women out of harms way without the use of this ingrained procedure?

We now have to start questioning, “is annual mammography enough or even necessary?” With a 50 year track record, we would expect this integral tool in breast cancer “prevention” would lower the incidence of breast cancer. However, we are seeing the contrary, simply because a mammography does NOT prevent cancer.

Brief history on the mammogram.

manogramIt was invented by….you guessed it…a MAN (see testicle comment above) in the early 1900’s. It became a standard of care for woman to receive a radiograph of their breast annually in the 1960s to early 1970s. With a procedure this wide-spread, let’s look at the current data and research.

Mammography is a form of radiograph that examines breast tissue for micro-calcifications. Calcium is attracted to the breast tissue via inflammation. This inflammation can be caused by hormone imbalances, heavy metals, insulin resistance, environmental pollutants, and a prolonged stress response. These calcifications that the mammography detects sometimes go undetected by a manual breast exam. Why? Well, they are simply too small. Smaller cancer cells have a much better prognosis than larger ones. In fact, we may be doing more harm than good treating these small cancers rather than allowing the immune system to take care of them. These small cancers are termed “cancers of low malignant potential.” Commonly these are undetected and left untreated and will self-remit. In fact, menopause seems to be sort of a protective phase in females. As estrogen drops, in menopause, those cancers of low malignant potential resolve.

One autopsy study of 110 pre or peri-menopausal women, ages 20-54, uncovered 38% had multi-malignancy, yet only 6.5% were diagnosed as cancer.

This would lead us to think maybe our definition of “cancer” is too broad and encompasses too many minor inflammatory incidents, which causes an over-reaction and possibly more harm from the treatment. This is the very argument posed to those “in charge” of your health – to change the definition of cancer. The National Institute of Health estimated breast cancer cost nearly $216.6 billion in 2009, so limiting the definition of cancer would then shrink the population who has it, thus lowering the amount paid to large health institutions, big pharma, etc. We will leave politics out of this one, but I did want to point out that medicine, unfortunately, is not always based on science. So my guess is the definition will remain for now.

mammogram-460cHere are some stats:

  • If you have cancer – 10-25% of the time it was missed on the previous studies
  • 1 in 2000 women who have annual mammograms for 10 years will find a significant cancer that can be treated timely; the rest are either detected too   late to make much of an impact or are those of low malignant potential.
  • Mammograms can induce up to 100 times more radiation to the breast tissue than a single chest X-ray; which can itself cause tissue mutations.
  • There is a significant amount of anxiety and stress leading up to and pending results which alters different hormones in the body, which can lead to inflammation (in our stressed society we do not need more stress; esp. if the extra stress delivers little benefit).

Another example of low malignant potential breast cancer can be seen in autopsy studies of elderly women. These groups of slow growing cancers, if left untreated, were less likely to result in death of the female than other causes given her age. This is unless, of course, she has a mammography, then we run the risk of over treatment – chemo, surgery, etc.

One Swedish study published in 2012 looked at data from 1960 to 2009. They were looking at breast cancer mortality trends to see if mammography had an impact on the decline in breast cancer mortality in Sweden. They concluded that the mammography image showed little to no impact on the mortality of breast cancer in Sweden.

1017306dba4a46797b17dc5781f8d50cb4b382dThe Canadian National Breast Screening study was recently published in the British Medical Journal, 2014. They took almost 90,000 women, ages 40-59, and randomly assigned them into 2 arms of the study. One would get mammography studies (1 per year for 5 years) the other arm of the study will receive no mammography imaging (control arm). During the 5 year period, 666 invasive breast cancers were diagnosed in the mammography arm and 524 in the control arm. Of the 666, 180 women in the mammography arm and of the 524 in the control arm, 171 women died from breast cancer in the 25 year follow-up. The conclusion of the study was that mammography performed in women ages 40-59 does not reduce mortality from cancer beyond that of the less invasive physical exam. So the idea that mammography prevents women from breast cancer is nonsense; it detects inflammation of the tissue, which has attracted calcium and an already existing mass.

The other argument is that mammography is an early detector and prevents death when compared to traditional methods. In the same study mentioned above over the entire study period: 500 died in the mammography arm and 505 died in the control group. This is a negligible difference, esp. when we’re looking at a risk/benefit ratio. So, what is the problem with early detection? In my opinion it is stirring the pot of an otherwise controlled situation. These growths that are often not palpable in an examination are those of low malignant potential and with proper body balance will go away on their own. In 2011, 2 researchers review the most current literature on mammography vs. no mammography. The result — 8 studies were included with the conclusion that mammography led to 30% over diagnosis and over treatment. The authors are quoted stating:

“…for every 2000 women invited for screening throughout 10 years, one will have her life prolonged and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily.  Furthermore, more than 200 women will experience important psychological distress for many months because of false positive findings. It is thus not clear whether screening does more good than harm.”

So what is the modern way of screening for breast cancer?

Actually, the most modern way to screen for breast cancer is not to look for it at all, but rather concentrate on PREVENTING it from a very early age in all individuals – male and female. The advancements in genomics (the study of the human genetic code) has enabled us to look at gene sequences that may predispose an individual to poor detoxification, low nitric oxide production, mitochondrial dysfunction etc. all which lead to inflammation, thus cancer cells. Nutritional epigenetic modulation is at the 01free-preventive-services-will-free-make-a-big-enough-difference--article-3901forefront of this movement in prevention. How does this work?

A doctor will prescribe a genetic test (for some of or all of your genes), the test is then interpreted and a proper lifestyle and nutritional regimen is created to support fully functioning processes or alter those in which you have a deficiency or mutation. There is also thermography, MRI and specific blood testing that can be done to assess current cancer status or overall risk. We will go into detail in part 2 of this article on the detection methods and research based treatments.

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 Works Cited:
Miller AB, Wall C, et alBMJ 2014:348:g366
Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane
Database Syst Rev. 2011 Jan 19;(1):CD001877.
Mammography Screening and Breast Cancer Mortality in Sweden: 10.1093/jnci/djs272