That is The Question
At some point in your life, you may find yourself scheduling a mammogram. Maybe because someone told you, you need one. Maybe you remember the women in your family diligently mammogram-ing. Or maybe it’s because your 40. Maybe you were in for your yearly checkup and your doctor asked you if you’d had one yet. Yet? And maybe then, you asked yourself: Do I need a mammogram?
As women, it’s something we’ve all been programmed to believe is a necessity in life. After all, wouldn’t it be ridiculously irresponsible to ignore the possibility of breast cancer? Before we answer that question, let’s find out:
What is a Mammogram? What Purpose Does it Serve?
A mammogram is an x-ray picture of the breast. Screening mammograms are used to look for breast changes in women who do not appear to have breast problems. An x-ray is a form of electromagnetic radiation used to take images of the human body. The National Breast Cancer Foundation refers to the mammogram as the gold standard for early detection.
While radiology has been used to visualize cancer of the breast since 1913, the compression used in the modern mammogram was not introduced until 1949. It gained widespread acceptance for detection of breast cancer in the mid-1960s. The first large-scale controlled study of the role of the mammogram in reducing deaths indicated mammography reduced breast cancer death by one-third. By 1976, mammograms were being recommended by the American Cancer Society for women with no symptoms. While the incidence of breast cancer was still increasing by about 1% per year from 1940-1980, an increase of 32% was reported between the years 1980-1987. This coincided with the increased use of mammography in asymptomatic women.
Between 1983-1997, The American Cancer Society was recommending that women aged 40-49 be screened for breast cancer using the mammogram every 1-2 years, and every year after age 50. That’s a recommendation for at least 16 mammograms in 20 years. Between 1997-2015, the recommendation was bumped to yearly for all women over 40. That’s a lot of mammograms. That’s a lot of radiation.
In 2015, the recommendation was changed again. Women aged 40-44 were now to be advised of the risks of screening as well as of the potential benefits. 45-54 was now a yearly recommendation, and 55 and over, every 2 years as long as the woman continued to be in good health. It should be noted that the risks of screening are outlined by the American Cancer Society as “pain, anxiety, and other side effects,” and claims that the benefits of mammography outweigh any possible harm from the exposure to radiation.
Do x-rays cause cancer? Even the American Cancer Society says: Yes. The National Cancer Institute agrees that repeated x-rays have the potential to cause cancer. Other listed risks of mammography are false-positive results, overdiagnosis, and overtreatment, false-negative results, and that finding breast cancer early may not reduce a woman’s chance of dying from the disease.
Despite the results of the first study and the growing use of the mammogram, incidences of death by breast cancer continue to rise. In fact, breast cancer is now the number one cause of death in American women aged forty to fifty-five.
While the mammogram looks for changes in breast tissue, is it possible that it can cause changes to the breast tissue?
Cancer occurs when some of your cells start to act differently. Instead of the normal cell turnover that all of your cells experience (completing a life cycle), cancer does not die and instead spreads and in some cases, invades otherwise healthy organs. Cancer cells are scary and deadly because they are out of control. Causes of cancer are everywhere. Exposure to carcinogenic substances (substances that cause cancer) contributes to your risk. There are a lot of contributors to cancer, especially breast cancer. But let’s not dismiss the fact that radiation is one of those substances that cause cancer. So yeah, exposing yourself to the x-rays of a mammogram every year for ten or more years will increase your risk for breast cancer.
Is It Worth The Risk?
According to a recent study which included 90,000 women and 25 years, mammograms did not reduce mortality from breast cancer beyond that of physical examination. And 22% of screen-detected invasive breast cancers were overdiagnosed.
According to The New England Journal of Medicine, screening mammography has been associated with a doubling of the number of cases or early stage breast cancer that are detected each year. This is an increase of 122 cases per 100,000 women. Only 8 of the 122 additional early-stage cancers diagnosed were expected to progress to advanced disease. Using Surveillance, Epidemiology, and End Results data, The New England Journal of Medicine estimated that breast cancer was overdiagnosed in 1.3 million U.S. women in the past 30 years. And in 70,000 women in 2008, which accounted for 31% of all breast cancer diagnosed that year.
A breast cancer screening program in the Netherlands, started in 1989, which now includes 800,000 women, found no mortality reduction in the first nine years of the program.
These aren’t the only studies that come to this conclusion. In fact, more studies are finding that overdiagnosis and overtreatment are so common that overdiagnosis itself is being found more harmful than the tiny tumors only a mammogram can detect in the first place. An alarming number of those tumors would never have developed into life-threatening cancers had they been left alone, let alone never detected in the first place.
Despite the claims of The American Cancer Society that mammograms are low-dose x-rays, mammograms actually expose your body to very high levels of radiation, can lead to a lethal spread of any existing malignant cells, and can be 1,000 times greater than that of a chest x-ray. Compression used in mammography can also lead to a lethal spread of any existing malignant cells.
At an Ask-the-Expert Online Conference posted on BreastCancer.Org, an expert stated, “diagnostic radiation from mammography in women under 40 or possibly in women before menopause, in general, may well carry an increased risk of cancer associated with radiation alone.”
A study published in The New England Journal of Medicine found breast exposure to radiation also contributed to increased risk for heart disease.
The mammogram is excellent at detecting DCIS (ductal carcinoma in situ), a stage zero cancer (pre-cancer) in which malignant cells are found in the milk ducts of the breast only. Left undetected and untreated, this cancer would never be noticed, never spread, and never lead to an early death. DCIS is not invasive cancer. Exposing DCIS to mammogram compression and radiation increases the risk that it will become invasive cancer. Finding them in the first place increases the risk that they will be subject to standard cancer treatments which further increases the risk of disease progression.
Mammograms are especially dangerous for carriers of the oncogene AC who are very sensitive to even the smallest amount of radiation. Research suggests that a significant amount of American women have this gene and that regular mammography could greatly increase the risk of breast cancer. It is estimated that 10,000 carriers of the oncogene AC will die of breast cancer annually because of their mistaken belief that regular mammograms will protect them.
Another set of genes, BRCA1 and BRCA2 have also been linked to an increased chance of breast cancer. Due to increased awareness as well as widespread access to genetic testing, women have been able to find out if they have mutations well before the age of which standard mammogram screenings would be recommended. The presence of a mutation does not indicate the presence of cancer. But a lot of women who are worried when they find out they have the mutation have been getting mammogram screenings well before age 40.
Research published by the British Medical Journal in 2012 concluded that among carriers of BRCA1/2 mutations, exposure to diagnostic radiation before age 30 was associated with an increased risk of breast cancer at dose levels considerably lower than those at which increases have been found in other cohorts exposed to radiation.
Considering the efficacy and risks, is it possible that women are being subjected to an extreme amount of unnecessary procedures, exposure to radiation potentially causing or exacerbating cell abnormalities, treatments for conditions which would have never needed to be treated if never detected, and which are leading to unnecessary stress, lessening of quality of life, as well as financial burden?
Who is Still Recommending Mammograms, and Why?
The Susan G. Komen Organization
You can sign up for mammogram reminders, here, or donate here, or fundraise here. As for the why in this case? I looked and couldn’t find a good reason. I can only assume that because they are a non-profit whose CEO makes a lot of money, they need to represent the position of the people who donate, which currently remains, pro-mammogram.
Why? I won’t say part of it isn’t due to some assumed lack of knowledge on why they shouldn’t, but I’ll admit that is quite disturbing.
But, the other reasons have to do with how your doctor gets paid. Yes, one of the ways your doctor gets paid is through financial incentives. If you think about that for a moment, you might realize that this is not generally going to be in your best interest.
The first one is called capitation. According to the American College of Physicians, capitation, is a fixed amount of money per patient per unit of time paid in advance to the physician for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided.
Physicians involved in capitation agreements are paid based on providing a set of primary services, such as preventative, diagnostic and treatment services, injections immunizations and medications administered in the office, outpatient labs, health education and counseling, etc. Physicians are also sometimes paid an additional capitation fee for diagnostic test referrals and subspecialty care. Alternatively, some plans pay for test and subspecialty referrals via fee-for-service arrangements but are more typically paid via contractually agreed-upon fee schedules that are discounted 10% to 30%, compared to the local usual and customary fees.
The other way your doctor gets paid is a financial incentive called fee-for-service. Fee-for-service is the most common payment model in the United States and, is fairly self-explanatory. Fee-for-service encourages doctors to maximize the amount and cost of the services they provide. Eliminating the fee-for-service model would significantly reduce the cost of healthcare as well as reduce the routine recommendations for screenings that have been found to be inefficient and harmful. Being that the mammogram is a source of income for your doctor, and viewed as a valuable tool that may save lives, there aren’t many criteria that need to be met for recommending a mammogram, or convincing that you need one: Oh, you’re 40 (or older)? Let’s get that mammogram taken care of and schedule for once a year here on out.
Is There a Safe Alternative to The Mammogram?
Instead Of Mammogram Do One Of These
Thermography is quick, not painful, non-invasive, and more effective than a mammogram. It measures inflammation in the body and provides detailed information on the vascular function in the breast. Thermograms screen for subtle changes before a large mass or lump will show up on a mammogram. Cancer growth can be identified by thermography an estimated 10 years before a mammogram would show a tumor.
ONCOblot is a highly sensitive blood test for the detection of ENOX2, a protein which has been demonstrated to be produced by malignant cells. The ONCOblot test is also able to reveal the origin of the malignant cells. This means it will not only tell you if you have cancer, it will tell you where.
Ultrasound has a much higher sensitivity than a mammogram. While some entities continue to recommend mammogram screenings they do acknowledge this fact.
Why are Women Still Getting Mammograms?
Because it’s what your doctor recommends and what your insurance will pay for.
I’m not going to doctor bash. But the difference between being a doctor and a patient is that a doctor sees thousands of patients and you see only one doctor. You are making a mistake when you leave your fate in the hands of your doctor. Your life and health are your responsibility, and your doctor knows that. Think about that. I’m not saying your doctors aren’t there to help, of course, they are. Ultimately, the words said and advice given may comfort you. But they are not necessarily the best you can get. It is the most important thing in the world that you take responsibility for your own health. The information you need to take care of yourself is out there, all you have to do is look for it.
Doctors don’t like it when patients come in questioning standard recommendations and referring to information they found on the internet. They like patients that cooperate and don’t ask questions. I do realize that it’s unfair to lump all doctors into one category. No, not all doctors are the same. But why are women still getting mammograms despite overwhelming evidence that they are inefficient, harmful, and there are several other safe alternatives? The answer is because for some reason it’s still being recommended by someone.
And while doctors don’t like it, the fact is, the best education teaches us to question everything. And you should. It could be the difference between asking about thermography and getting a mammogram-a-year for the next twenty plus. Do you really wanna roll the dice with that much radiation and compression?
Is it worth the risk?
Consider this: It’s your life. And even when the roadblocks seem to make it impossible to do what you want, it is still your decision.
Is it Ridiculously Irresponsible to Ignore the Possibility of Breast Cancer?
There are no guarantees that avoiding environments, behaviors, screenings, treatments, etc. or opting for others will prevent you from getting or cure you of breast cancer. Cancer is currently regarded as incurable. Taking responsibility for our own health is the best we can do. Odds of good and bad outcomes increase and decrease based on choices, decisions, and lifestyles. Information in this article is informative only and not meant to prevent, treat or cure any disease. Information in this article is not advice. Sources used for this article are listed on the next page.