We’ve written to you many times in the past about mammograms. Despite the fact that this breast cancer screening procedure is painful and risky the mainstream still chooses to cling to it like it’s a long lost child.

In recent years, mounting evidence has challenged the validity and safety of mammograms in breast cancer prevention… Now, a recent study by Southampton University researchers has found that too many screening programmes, including mammograms, lead to misdiagnosed results and the overtreatment of harmless breast lumps.

Weighing up the pros and cons

When it comes to cancer, an early diagnosis is absolutely imperative and screening programmes are supposedly designed to save lives through early diagnosis of cancer. The question now is, has the mainstream got it wrong?

Back in 2001, a controversial report, published in the medical journal The Lancet, concluded that breast cancer screening, offered to all women in the UK over the age of 50, does not reduce deaths. Even back then some experts felt that screening may do more harm than good.

Now, 10 years later, the latest study, published in the British Medical Journal, echoes exactly the same sentiment. The Southampton researchers say that the negative outcomes of screening programmes cancel out up to half of the benefits that others get from living longer lives.

In short, this means that while a positive result after screening may give an extra year of life to one breast cancer victim, it could result in six months’ worth of suffering due to unnecessary treatment for another patient.

Previous research has shown that for every 2,000 screenings, 200 women will have a “false positive” result and 10 of those women will have unnecessary surgery, but only one life will be saved.

The lead researcher of the Southampton study, Prof James Raftery, said: “To save one life, that woman will have surgery, but 10 more will have surgery that do not need it. The reason is they have lumps that are diagnosed as cancer but… most of those lumps would not have gone on to become cancer or to have killed a person.”

Needless surgery cuts the benefits

In 1986, the Forrest Report led to the introduction of breast cancer screening in the UK. According to the Forrest Report, the effectiveness of these screening programmes would be measured in “quality of life years” (QALYs) — the extra years of life patients gain as a result of screening.

Back then, it was estimated that screening programmes would gain patients 3,301 QALYs over a 20-year-period. However, this estimate did not take into account the potential harm of false positive results. As a result, the damaging impact of false positive diagnoses and needless surgery cut the expected QALYs of 3,301, by more than half to 1,536 QALYs, according to the results of the latest study.

The researchers added that for the first eight years, women were more likely to be harmed than to enjoy any benefit. Only 20 years after screening do the net benefits for patients really begin to accumulate.

Prof Raftery said: “”There are lots of women who have had surgery who believe their lives were saved when in fact only around one in 10 has had their life saved.”

Lay out the options

Of course, this does not mean that women should stop being screened for breast cancer altogether. However, patients should be warned about the possible negative effects of screening and have a better understanding of the risks of unnecessary treatment before they are screened. Yet this is clearly not happening…

A damning report from the Cochrane Collaboration, published in 2010, said that women are being seriously misled by health officials who dramatically downplay the risks of mammography X-rays while overstating the benefits. The report also questioned the prevailing view that mammograms save lives and says that this is based on shoddy and biased science.

Women should also be given the option to choose the method of screening they prefer. As I mentioned earlier, mammograms are extremely painful and invasive procedures. The real kicker is that a breast cancer tumour is only detected by a mammogram after it’s grown for several years, and achieved more than 25 doublings of the malignant cell colony. So, by the time you get a warning from your mammogram the tumour may already be at a growth-stage where it is too difficult and too late to treat. Worse still, the compression required for mammograms can actually break down cancer tissue and rupture small blood vessels that support the cancer, causing it to spread.

Luckily, there are safer and less painful screening options, like thermography or thermal imaging. Mammograms look at anatomical changes in the breast, as they detect masses or lumps in the breast tissue. Thermograms, on the other hand, look at vascular changes in the breast, as they detect blood flow patterns, inflammation and asymmetries, which allows them to detect irregular patterns in the breast before a noticeable lump is formed.

In the case of inflammatory cancer, there are no detectable lumps, which makes self-examination and mammograms pointless. However, thermography will certainly help in these cases with an early detection.

Thermal imaging does not cause pain, is non-invasive and quick – your multi-image examinations usually take less than 15 minutes. Plus, it makes no contact with your body – no compression (unlike mammograms) and it emits absolutely NO radiation.

It all adds up: No radiation, no squashing and bruising, early detection, quicker diagnoses and prevention and a healthier cancer-free you!

Sources:

‘Breast cancer screening could cause more harm than good’ published online 09.12.11, telegraph.co.uk

Dr. Peter Leando, the founder of Meditherm, Inc. has worked in the thermography industry for over 20 years. He shares with us the evolution of thermography and how it provides opportunities for early intervention. Women are looking for choices for protecting their breast health, so they will appreciate his candid information about what to look for in a thermography service. Thermologyonline.org provides a complete list of thermography services available in the US. Don’t miss this thermography 101 session!

Podcast: Download

Click here to visit WebTalkRadio.net and listen to the Podcast there.

Women with dense or non-fatty breast tissue may need additional breast cancer screening, a U.S. researcher says.

Dr. Roshni Rao, assistant professor of surgery at the University of Texas Southwestern Medical Center in Dallas, said one woman’s personal battle with breast cancer was the inspiration for Henda’s Law — a Texas law named for Henda Salmeron that requires women to be informed about their breast tissue’s density and the limitations of mammography in certain cases.

Rao, Salmeron’s breast surgeon, said radiologists use a grading system to describe the density of breast tissue based on the amount of fat (non-dense) and connective (dense) tissue. Research is under way into why some women have denser breast tissue, but as women age, their breast tissue generally becomes more fatty, Rao said.

“Breast tissue that has minimal or no fat may appear white, or dense, on a mammogram. This sometimes makes it difficult to identify cancers, which also typically appear as small white spots,” Rao said in a statement. “Many factors contribute to a woman’s risk of breast cancer. Having dense breast tissue may be one of them, but your doctor considers other factors — age at which a women had her first child, family history of cancer or age at the onset of menstruation, among others — when evaluating your risk and tailoring your screening program.”

Digital mammograms may be best at finding cancer for women with dense breast tissue. Other tests, including breast magnetic resonance imaging and ultrasound and breast thermography, may be helpful, but only in addition to mammograms, Rao said.

Copyright United Press International 2011

The California State Legislature passed a bill last Friday requiring doctors to inform women if they have dense breasts after a mammogram, making California the second state this summer and the third state so far to have passed a so-called breast density law.

The bill, SB 791, passed the state Senate 35-1, and is now going before Gov. Jerry Brown to get signed.

When he signs it, starting next year, Calif. radiologists will have to send women with dense breasts, as determined by an American College of Radiology-developed system, this text:

Because your mammogram demonstrates that you have dense breast tissue, which could hide small abnormalities, you might benefit from supplementary screening tests, depending on your individual risk factors. A report of your mammography results, which contains information about your breast density, has been sent to your physician’s office and you should contact your physician if you have any questions or concerns about this notice.

Texas Gov. and Republican presidential hopeful Rick Perry signed into law a similar bill, Texas Act HB 2102, or Henda’s Law, in June. And breast density legislation was also passed in Connecticut in 2009.

New Hampshire, Massachusetts, New York and Florida all have similar legislation pending.

The American College of Radiology Imaging Network says that around 40 percent of women getting screening mammograms have dense breasts, with younger women typically having denser breasts.

Dense breasts are less fatty, with more connective tissue. The connective tissue appears white on a mammogram, just like the cancer, making it harder to diagnose, according to Are You Dense, an advocacy group.

A January 2011 study by the Mayo Clinic found three-quarters of cancers in women with dense breasts are missed by mammograms.

“When it comes to your health, ignorance is not bliss. What you don’t know can hurt you,” State Sen. Joe Simitian, a Democrat from Palo Alto who authored the bill, said in a statement.

The idea for the bill came from by Amy Colton, a registered nurse who had breast cancer not discovered by a mammogram, and who learned she had dense breasts only after her cancer was diagnosed, according to Are You Dense. She suggested the bill in Simitian’s “There Oughta Be a Law” contest.

However, the bill met some opposition from the California Medical Association. Writing about an earlier incarnation of the bill, SB 173, the CMA warned that it could bring legal and practical problems for Calif. doctors.

“Because the scope of who must receive the notice is so broad, women will be ‘scared’ into thinking they need these expensive additional screenings when it isn’t at all warranted, leading to increased costs and pressures on a physician’s practice,” the group wrote in a notice on its website. “Moreover, because the grading of the condition that may/may not lead to their receipt of the prescribed notice is subjective in nature, the absence of the notice could lead to lawsuits against doctors if a patient is later diagnosed with breast cancer.”

But the bill was backed by several other groups, including the California Nurses Association, the Breast Cancer Fund, the California Association of Health Underwriters and California NOW.

SACRAMENTO, Calif. (AP) — It took seven years of annual mammograms and a cancer diagnosis for Amy Colton to learn something her doctors had realized from the beginning: Her breast tissue is so dense that it could have masked tumors on earlier exams.

“I requested a copy of the report sent from my radiologist to my primary care physician, and every single one said, ‘Patient has extremely dense breast tissue,’” the registered labor and delivery nurse said. “I was really outraged that I didn’t know this.”

About 40 percent of women over 40 have breast tissue dense enough to mask or mimic cancers on mammograms, but many of them don’t know it. Mammogram providers in California will be required to notify those patients, and suggest that they discuss additional screenings with their doctors based on their individual risk factors, if Gov. Jerry Brown signs a bill that the Legislature passed this month. Similar laws have passed in Texas and Connecticut in the past two years but no data is available yet from either state on the effect of the legislation.

“The notice in the bill is a two-sentence notice that gets added to a letter,” said the bill’s author, Democratic state Sen. Joe Simitian of Palo Alto. “I believe these two sentences can save thousands of lives.”

Brown has not given his opinion about the bill, but many doctors oppose it. Researchers studying breast density, a relatively young field, said such requirements may end up causing undo anxiety in millions of women and lead to unnecessary and expensive ultrasound or MRI screenings.

The California Medical Association, which represents 35,000 doctors, recommended a public education campaign instead of individual notifications, and said there isn’t enough evidence to support the idea the extra money spent on additional screenings will save more lives.

Those tests could cost the state more than $1 billion, and many women wouldn’t be able to afford them, said Dr. Karen Lindfors, a professor of radiology and chief of breast imaging at the University of California, Davis Medical Center in Sacramento. She testified against the bill before a legislative committee.

“I just don’t think that at this point we have the ability to meet the kind of demand either financially or in terms of manpower that this is going to create, and we also don’t have proof that it’s going to save lives,” she said.

The women who would receive the notifications have more tissue than fat in their breasts. As women age, their breasts become more fatty. Fat appears black on a mammogram, making it easier to spot cancer, which shows up as white.

Doctors agree that high breast density is an increased risk factor for cancer, but researchers say the issue needs more study to determine whether the risk is great enough to justify a higher level of screenings for women who have it.

Pre-menopausal women are more likely to have dense tissue, regardless of whether they are at high risk for breast cancer, said Celine Vachon, an associate professor of epidemiology at the Mayo Clinic in Rochester, Minn. She said women who get the notifications required by the California bill could be frightened into seeking additional screenings, such as MRIs or ultrasounds, which can pick up false positives and cost thousands of dollars.

“If women want their breast density information, that’s their right,” Vachon said. “However, breast density is not yet a risk factor that’s used clinically, so what women will do with this information is not clear. We need improved density measurements as well as models that do a better job of predicting women’s risk. Everyone wants density to be this silver bullet, but to date, it’s not.”

Colton, who got the California legislation rolling by contacting Simitian’s office, said women ought to be told whether their breast density could make cancer difficult to detect.

She said she practiced self-exams monthly, had no family history of breast cancer and thought she was among the lucky cohort of women at a low risk for breast cancer. But five surgeries, six weeks of daily radiation and 15 rounds of chemotherapy later, she is angered that she went years without being told about her dense breast tissue.

“I don’t want anyone to think this is a rare story. There are countless women like me, and many with worse diagnoses,” she said.

Dr. Judy Dean, a diagnostic radiologist in Santa Barbara who specializes in breast imaging, supports the effort. She said 20 of her patients have found cancers through ultrasounds after she informed them that their dense tissue might be hiding tumors in a mammogram.

“Negative doesn’t mean negative; you could still be positive,” she said.

All radiologists agree that a mammogram — an X-ray image of the breast — is the best way for a woman to discover whether she has dense tissue, but few agree on how to proceed with that information.

Researchers have been experimenting with new breast imaging techniques that might provide the same answers as an MRI or ultrasound for women with a high risk for cancer, but with less expense. 3-D X-ray images known as “stereo mammograms” and molecular breast imaging are two techniques that are better than traditional mammograms at spotting cancers and cost much less than MRIs.

Some say a notice about the hidden risks of dense tissue should be sent to all women receiving the results of their mammogram, not just those with dense tissue. That way, everyone can be armed with the available information, said California state Assemblywoman Linda Halderman, a former breast cancer surgeon.

She said the bill would end up giving women with low breast tissue density false assurances they are not at risk for cancer.

“We’re offering something to women that doesn’t help improve their care or shed any light on the best way to assess their risk for breast cancer,” said Halderman, a Republican from Fresno. “Unfortunately, breast density is just one of those things we don’t know about yet.”

Peter C Gøtzsche and Karsten Juhl Jørgensen of the Nordic Cochrane Centre urge for “more honesty” from the NHS BSP (Breast Screening Programme). They believe that harm has been understated, and that information issued to the public has in general been unaffected by “repeated criticism and pivotal research” which has expressed reservations regarding screening benefits and registered considerable over-diagnosis.

Their paper, “The Breast Screening Programme and Misinforming the Public”, is published in the Journal of the Royal Society of Medicine.

The authors say:
“Spokespeople for the Program have stuck to the beliefs about benefit that prevailed 25 years ago and continue to question the issue of over-diagnosis.

Women therefore cannot make an informed choice whether to participate in screening based on the information the Program provides. This must be changed.”

The report explains that information is largely embellished, regarding the lives that have been saved through the screening program.

Professor Peter Gøtzsche, co-author of the paper and Director of the Nordic Cochrane Center, explains:
“The claim that death rates have fallen ‘in part from earlier diagnosis associated with screening’ is astonishingly misleading.

Deaths from breast cancer are falling because treatment is improving. There’s been a similar fall in the age-groups not invited to screening. In this respect, and many others, the Program persists in misinforming the public. It was forced to revise its leaflet inviting women for mammography but the new leaflet and their latest Annual Review continue to repeat incorrect mortality estimates.”

The program estimates that one breast cancer death for every 400 women is prevented by being screened on a regular basis over a ten year period – arguing against this the authors say:
“(the figure) is wrong by a factor of five. We have been unable to find any evidence for this estimate in reports from the Program or elsewhere. The 1993 meta-analysis of the Swedish trials reported that one breast cancer death was avoided for every 1000 invited women after ten years. The number is 2000 if we use the more realistic estimates of a 15% reduction in breast cancer mortality.”

They also stress that contradictory information about over-diagnosis is being provided by the NHS BSP.
“The (2010) Review has reverted to repeating the much too low estimate regarding over-diagnosis from the 2006 Review, but it is obscure as to where this figure comes from. The new leaflet never uses the term over-diagnosis, and although it talks a lot about ‘benefits’ it does not use the equivalent term ‘harms’ but just speaks about ‘downsides’, which is far less negative.”

In the report they explain that “the only hint at over-diagnosis” in the invitation leaflet is the sentence ‘Screening can find cancers which are treated but which may not otherwise have been found during your lifetime’. They believed this is vague and readers may understand that screening can only be good, as it detects cancers which would otherwise be hard to find.

The researchers tried out the sentence on a group of fourth year medical students – by this time in their training they still would now have had lectures about screening. They discovered almost half did not understand the sentence and one third believed it was bad for women to have these cancers detected.

The researchers said:
“There is no quantification of over-diagnosis in the leaflet and no estimate of the balance between benefit and harm.”

The Programs 2010 Annual Review was criticized by the authors for using sentences, such as..:
“If a breast cancer is found early, you are less likely
to have a mastectomy.”

..claiming that the program encouraged belief that screening will reduce the chances of the women needing to have a mastectomy. The authors express:
“But such claims are seriously misleading. Danish data has demonstrated that because of over-diagnosis, screening increases the use of mastectomies substantially.”

Written by Grace Rattue

Dr. Mercola – Breast Thermography

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Dr. Peter Leando – Meditherm, Inc.

Computer-aided detection (CAD) technology, which analyzes mammography images and marks suspicious areas for radiologists to review, has been widely hyped and pushed on women as a way to insure invasive breast cancer is spotted on mammograms. And it has grown into a huge industry, adding millions of dollars to the cost of healthcare.

The problem is, CAD simply doesn’t work — at all. That’s right. Despite the fact CAD is now applied to the large majority of screening mammograms in the U.S. with annual direct Medicare costs exceeding $30 million (according to a 2010 study in the Journal of the American College of Radiology), new research by University of California at Davis (UC Davis) scientists shows the expensive technology is ineffective in finding breast tumors.

But it does something extremely well. It causes enormous stress by greatly increasing a woman’s risk of being called back for more costly testing following a CAD analyzed mammogram.

The new research, just published in the Journal of the National Cancer Institute, used data from the Breast Cancer Surveillance Consortium to analyze 1.6 million mammograms. Entitled “Effectiveness of Computer-Aided Detection in Community Mammography Practice,” the study specifically looked at screening mammograms performed on more than 680,000 women at 90 mammography facilities in seven U.S. states, between the years of 1998 and 2006.

The results are being hailed as the most definitive findings to date on whether the super popular mammography tool is effective in locating cancer in the breast. The findings? CAD is a waste of time and money.

The false-positive rate increased from 8.1 percent before CAD to 8.6 percent after CAD was installed at the medical centers in the study. What’s more, the detection rate of breast cancer and the stage and size of breast cancer tumors were similar regardless of whether or not CAD was used.

“In real-world practice, CAD increases the chances of being unnecessarily called back for further testing because of false-positive results without clear benefits to women,” Joshua Fenton, assistant professor in the UC Davis Department of Family and Community Medicine, said in a statement to the media. “Breast cancers were detected at a similar stage and size regardless of whether or not radiologists used CAD.”

This isn’t the first time the CAD technology has been questioned by researchers. The current study follows a previous study of the computer aided mammography tool that was published by Dr. Fenton in the New England Journal of Medicine in 2007.

That examination of mammography screening results in 43 facilities, including seven that used CAD, found that CAD was actually linked to reduced accuracy of mammogram screenings and produced no difference in the detection rate of invasive breast cancer.

“In the current study, we evaluated newer technology in a larger sample and
over a longer time period,” Fenton noted in a statement to the press. “We also looked for the first time at cancer stage and cancer size, which are critical for understanding how CAD may affect long-term breast cancer outcomes, such as mortality.”

CAD software was first approved by the Food and Drug Administration back in 1998, but its use only skyrocketed after Medicare began covering it in 2001. According to 2009 Medicare data, using CAD adds another $12 to the costs of having a mammogram (about $81 for film mammography and $130 for digital mammography), representing a 9 percent to 15 percent additional cost for CAD use.

J OANN  G. E LMORE , M.D., M.P.H., M ARY  B. B ARTON , M.D., M.P.P., V ICTORIA  M. M OCERI , P H .C., S ARAH  P OLK , B.A., P HILIP  J. A RENA , M.D.,  AND  S UZANNE  W. F LETCHER , M.D.

A BSTRACT Background The cumulative risk of a false positiveresult of a breast-cancer screening test is unknown. Methods We performed a 10-year retrospective co-hort study of breast-cancer screening and diagnosticevaluations among 2400 women who were 40 to 69years old at study entry. Mammograms or clinicalbreast examinations that were interpreted as indeter-minate, aroused a suspicion of cancer, or promptedrecommendations for additional workup in women inwhom breast cancer was not diagnosed within thenext year were considered to be false positive tests. Results A total of 9762 screening mammogramsand 10,905 screening clinical breast examinationswere performed, for a median of 4 mammograms and5 clinical breast examinations per woman over the 10-year period. Of the women who were screened, 23.8percent had at least one false positive mammogram,13.4 percent had at least one false positive breast ex-amination, and 31.7 percent had at least one falsepositive result for either test. The estimated cumula-tive risk of a false positive result was 49.1 percent (95percent confidence interval, 40.3 to 64.1 percent) after10 mammograms and 22.3 percent (95 percent confi-dence interval, 19.2 to 27.5 percent) after 10 clinicalbreast examinations. The false positive tests led to870 outpatient appointments, 539 diagnostic mam-mograms, 186 ultrasound examinations, 188 biopsies,and 1 hospitalization. We estimate that among wom-en who do not have breast cancer, 18.6 percent (95percent confidence interval, 9.8 to 41.2 percent) willundergo a biopsy after 10 mammograms, and 6.2 per-cent (95 percent confidence interval, 3.7 to 11.2 per-cent) after 10 clinical breast examinations. For every$100 spent for screening, an additional $33 was spentto evaluate the false positive results.

To read the rest of the study, click here to download the PDF.

© 2003 Wiley-Liss, Inc.

Publication of the International Union Against Cancer

Infrared imaging has frequently been used in the past to detect changes in skin surface temperature associated with breast cancer. Usually a 1–2° C elevation in skin surfacet em-perature is observed at the tumour periphery, and it has been proposed that this change is due to hypervascularity resulting from tumour-associated angiogenesis. In our study, we used the rat mammary adenocarcinoma 13762 MAT, a tumour that has been used to identify antiangiogenic drugs, to investigate whether infrared imaging can detect angiogenesis in malignant tumours. If successful, it was hoped that this technique would represent a simple, noninvasive, procedure for monitoring the activity of antiangiogenic drugs.  To read the rest of this article, click here to download the PDF file of this study.