If you’re a woman you might be aware that in most countries there are programmes in place to allow women over 40 to have regular mammograms to allow early detection, and subsequently treatment if required, of malignant lumps.
There’s been a particularly strong push for this among women where there’s been a history of breast cancer in the family.
A paper just published in EClinical Medicine, part of the Lancet group, means that this advice might be moved to younger women from the age of 35 upwards.
What you may not have been told
We’d like to offer a few alarm calls that are not going to be communicated by those trying to enlarge the group of women to whom mammography is being offered:
This latest paper involves key authors from previous studies that have shown apparent benefits (reduced breast cancer mortality) of mammography for women 40 years and over. These studies have subsequently been found to be erroneous. Reductions in cancer rate, it turns out, are linked to changes in breast cancer risk factors and not the mammography screening itself. Read about what Cochrane (and Prof Peter Gøtzsche) had to say about this back in 2013.
Screening increases risk of over-diagnosis and over-treatment. That means women who might have small lumps that pose no risk of early death are subjected to biopsies, surgery, radiotherapy or chemotherapy – or combinations thereof – that either increase their risk of death or adversely affect their quality of life. Look at what the UK’s leading breast cancer specialist, Prof Michael Baum, had to say about this back in 2013. A few years on, following a very large Danish study (by Karsten Jørgensen and Peter Gøtzsche from the the Nordic Cochrane Centre, along with Norwegian co-authors, published in the Annals of Internal Medicine, the picture is a little different. A major US study published in the New England Journal of Medicine in 2016 showed that “Women were more likely to have breast cancer that was overdiagnosed than to have earlier detection of a tumor that was destined to become large”. All these years on, it seems, the counter-intuitive riddle of greater risks than harms for mammography screens is still unresolved.
False positives from mammograms can increase anxiety and depression - so reducing quality of life. While radiologists have conducted studies to show these effects are short-term only, the mammography risks versus harms debate has been laced with studies by those with vested interests finding more benefits than harms, and those who are independent finding more harms than benefits.
Proper informed consent – in which all the available and relevant information on harms and benefits, as well as “access to choice and decision support”, is rarely provided to women prior to mammography screening.
What else can you do?
In any debate on informed choice, especially when the evidence is so contradictory and confused, it is essential to provide alternate options. This is one of our biggest beefs about how population-wide mammography screening programmes are run.
The big alternates that aren’t being given enough attention are:
Self -examination. Yes, it might not just be you that does the manual exam, but it needs to be done and regularly. The Coppafeel charity in the UK, founded by the extraordinary stage IV breast cancer patient Kris Hallenga and her twin sister Karen, is a global leader in communicating this incredibly important message to young women. Please read this testimonial
Computer-assisted thermography allows a 15 minute, painless, non-invasive, state of the art, clinical test without any exposure to radiation or compression of breast tissue. Thermography provides an indirect measurement of the metabolic activity of breast tissue, abnormal tissue is identified on a thermogram as focal ‘hot spots,’ disturbed cooling response and abnormal blood vessel patterns. Find out more from London’s leading thermography clinic.
Diets and lifestyles that minimise the risk of breast cancer. The World Cancer Research Fund (WCRF) and American Cancer Society (ACS) cancer prevention guidelines recommend maintaining a healthy weight, undertaking at least 150 minutes of moderate intensity exercise per week, limiting alcohol consumption, and eating a plant-based diet.
For any woman over 35 – please understand there is no crystal clear view on the science on the harms and benefits of mammography. When looked at as a whole, the science is a dingy shade of grey, no doubt some of the conflict in views stemming from which bodies have funded the science.
For those under 35 – self-examination is the way to go. Please check out Coppafeel if you haven’t already!
Breast cancer is the most common cancer in women in most parts of the world, industrialised and less-industrialised. According to figures from Cancer Research UK, one in 8 women, and 1 in 870 men, develop it at some point during their lifetime. It must be taken very seriously.
But contrary to the views being issued by many health authorities and primary care clinics – mammography is far from the only answer. And, looking at the available data as they stand today, the evidence suggests that mammography might actually increase, rather than reduce, overall risks, including the risk of premature death from cancer.
Please help to circulate this article among those who might not yet have heard the wider, controversial evidence around routine mammography and the risks of over-diagnosis and over-treatment.