by Jeffrey Dach MD
October is Breast Cancer Awareness Month, an advertising campaign for screening mammography with the assumption of benefit. As you will read below, this assumption many not be correct. We now have many studies showing screening mammography does little to reduce mortality from breast cancer. (1-8)
Above left image: Pink Ribbon, courtesy of Wikimedia commons.
The latest is the July 2011 study by Autier published in the British Medical Journal showing that screening mammography had no impact on mortality from breast cancer in screened populations. (1) The authors found that breast cancer mortality was “comparable” in three pairs of similar European countries despite a 10-15 year difference in implementing screening mammography.
“Countries of each pair had similar healthcare services and prevalence of risk factors for breast cancer mortality but differing implementation of mammography screening, with a gap of about 10- 15 years. ” (1)
“From 1989 to 2006, deaths from breast cancer decreased by 29% in Northern Ireland and by 26% in the Republic of Ireland; by 25% in the Netherlands and by 20% in Belgium and 25% in Flanders; and by 16% in Sweden and by 24% in Norway.” (1)
“Breast cancer mortality in paired European countries with similar socioeconomic status and access to treatment were comparable after 1989, despite a 10-15 year difference in implementation of mammography screening” (1)
These conclusions had already been found in previous studies (5-8)
John Keen, MD, attending radiologist at Cook County Hospital in Chicago, Illinois says: (11-12)(4):
“The problem here is that screening has not decreased the incidence of advanced cancer. Screening inherently misses the fast growing and catches the slow growing; hence, screening causes overdiagnosis with little mortality benefit,” (11-12)
Dr Keen explained further.
“Overdiagnosis of small screen-detected tumors that would never become clinically evident results in overtreatment with drugs and needless radiation, which can cause heart disease and increase future deaths,”
Dr. Keen added.
“The trials have not shown any overall mortality benefit, nor is there any trial evidence to justify aggressive annual screening. Screening also increases overall mastectomies and lumpectomies because of over diagnosis. ” (11-12)
Rather than rely on screening mammography which cannot prevent or reduce mortality from breast cancer, the real preventive program includes Iodine supplementation and the following:
(note: requires Iodine level and physician’s supervision)
2) Vitamin D Supplementation is preventive of breast cancer.
Buy Vitamin D3 (note: requires Vitamin D level and physician’s supervision)
4) Progesterone Deficiency is a risk factor for breast cancer.
Bio-Identical Progesterone is cancer protective .(9-10)
Update 2014: Swiss Medical Board on Screening Mammography:
Swiss Medical Board Screening Mammography Report advises against introducing any new screening programs, and a time limit on existing programs which will then be fazed out.
Article in New England Journal 2014:
Abolishing Mammography Screening Programs? A View from the Swiss Medical Board Nikola Biller-Andorno, M.D., Ph.D., and Peter Jüni, M.D. April 16, 2014DOI: 10.1056/NEJMp1401875: Quote:
The Swiss Medical Board’s report was made public on February 2, 2014 . It acknowledged that systematic mammography screening might prevent about one death attributed to breast cancer for every 1000 women screened, even though there was no evidence to suggest that overall mortality was affected.
It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors.4 We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify.
Recommendations of the Swiss Medical Board:
1. It is not recommended that systematic mammography screening programs be introduced.
2. A time limit is to be set on existing systematic mammography screening programs.
3. All forms of mammography screening are to be evaluated with regard to quality.
4. Likewise, for all forms of mammography screening, a previous thorough medical evaluation and a comprehensible clarification with presentation of the desirable and undesirable effects are recommended.
Link to pdf of Swiss Medical Report: Swiss_Medical_Board_Mammography_screening_Report_2013-12-15
Articles with related interest:
Links and References
Published online 2011 July 28.
Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database
BMJ. 2011; 343: d4411. Philippe Autier, research director,1 Mathieu Boniol, senior statistician,1 Anna Gavin, director,2 and Lars J Vatten, professor3 1International Prevention Research Institute, 95 Cours Lafayette, 69006 Lyon, France 2Northern Ireland Cancer Registry, Belfast, Northern Ireland, UK 3Department of Public Health, Norwegian University of Science and Technology, Trondheim, Norway
To compare trends in breast cancer mortality within three pairs of neighbouring European countries in relation to implementation of screening.Design Retrospective trend analysis.
Setting Three country pairs (Northern Ireland (United Kingdom) v Republic of Ireland, the Netherlands v Belgium and Flanders (Belgian region south of the Netherlands), and Sweden v Norway).Data sources WHO mortality database on cause of death and data sources on mammography screening, cancer treatment, and risk factors for breast cancer mortality.
Main outcome measures Changes in breast cancer mortality calculated from linear regressions of log transformed, age adjusted death rates. Joinpoint analysis was used to identify the year when trends in mortality for all ages began to change.
Results From 1989 to 2006, deaths from breast cancer decreased by 29% in Northern Ireland and by 26% in the Republic of Ireland; by 25% in the Netherlands and by 20% in Belgium and 25% in Flanders; and by 16% in Sweden and by 24% in Norway. The time trend and year of downward inflexion were similar between Northern Ireland and the Republic of Ireland and between the Netherlands and Flanders. In Sweden, mortality rates have steadily decreased since 1972, with no downward inflexion until 2006. Countries of each pair had similar healthcare services and prevalence of risk factors for breast cancer mortality but differing implementation of mammography screening, with a gap of about 10- 15 years.
Conclusions The contrast between the time differences in implementation of mammography screening and the similarity in reductions in mortality between the country pairs suggest that screening did not play a direct part in the reductions in breast cancer mortality.
Conclusions and policy implications
The contrast between the timing of breast cancer screening being implemented and the similarity in mortality reduction between the country pairs do not suggest that a large proportion of the mortality reduction after 1990 can be attributed to mammography screening. Improvements in treatment and in the efficiency of healthcare systems may be more plausible explanations.
Our study adds further population data to the evidence of studies that have used various designs and found that mammography screening by itself has little detectable impact on mortality due to breast cancer.14 44 51 52
What is already known on this topic Breast cancer mortality is decreasing in many countries but the association with mammography screening is difficult to appraise
Cervical cancer mortality decreased earlier and more strongly in those Nordic countries that implemented nationwide screening programmes compared with delayed screening
What this study adds
Breast cancer mortality in paired European countries with similar socioeconomic status and access to treatment were comparable after 1989, despite a 10-15 year difference in implementation of mammography screening
The downward trends in mortality started before or shortly after the implementation of the screening programme The greatest reductions were in women aged 40-49, regardless of the availability of screening in this age group; reductions in women aged 70-79 were highly variable and did not correlate with the timing of screening in younger age groups
Mammograms Not Effective In Lowering Breast Cancer Mortality
Are screening mammograms effective in reducing deaths from breast cancer?
The mainstream media and the medical-industrial complex would have you believe that mammograms are the best thing you can do to diagnose breast cancer at an early stage. The theory is that an early diagnosis leads to a better treatment outcome. In order to answer the above question, researchers compared the trends in breast cancer mortality within three pairs of neighboring European countries in relation to mammogram screening. The participants were grouped into three pairs; Northern Ireland (U.K.) v. Republic of Ireland, the Netherlands v. Belgium and Flanders, and Sweden v. Norway. Each paired group had one country that was using mammography screening since 1990 while the other country did not adopt screening recommendations until years later. The World Health Organization mortality database along with data sources on mammography screening and cancer treatment were used for analysis.
Is Breast Cancer Screening Actually Beneficial?
It is the expected norm within the medical community that women — especially those over 40 or with a family history of breast cancer — should get their annual mammography without fail. But how effective of a tool is it in actually saving lives? According to a recent study by an international team of researchers at various European institutions, the answer is that it’s not especially effective.
Breast cancer screening was not shown to have a major impact on the reduction of breast cancer mortality in the recent past.1
While the mortality rates from breast cancer have certainly gone down in most developed countries in the last two decades, it would seem that the lower numbers might not be attributable to mammography.
MAMMOGRAMS ARE MISSING CANCERS! Dr. Sanford Pinna Aug 05, 2011
Benefit is Controversial Dr. John Keen Weighing in with his opinion, John Keen, MD, attending radiologist at Cook County John H. Stroger Hospital in Chicago, Illinois, supported Dr. Autier’s assertion that the benefit of mammography is controversial. “As usual, Dr. Lee won’t accept the evidence and remains the key mammography marketer for the ACR,” he told Medscape Medical News. “I noticed her new line of reasoning — that ‘therapy cannot cure advanced cancers.’ The problem here is that screening has not decreased the incidence of advanced cancer. Screening inherently misses the fast growing and catches the slow growing; hence, screening causes overdiagnosis with little mortality benefit,” he explained.
“Overdiagnosis of small screen-detected tumors that would never become clinically evident results in overtreatment with drugs and needless radiation, which can cause heart disease and increase future deaths,” Dr. Keen added. “The trials have not shown any overall mortality benefit, nor is there any trial evidence to justify aggressive annual screening. Screening also increases overall mastectomies and lumpectomies because of overdiagnosis. The greatest benefit-to-harm ratio occurs for women in their 60s, which is what radiologists should be telling women.”
Dr. Autier, Dr. Destounis, and Dr. Keen have disclosed no relevant financial relationships. Dr. Lee is a spokesperson for the American College of Radiology.
Kalager M, Zelen M, Langmark F, Adami HO. Effect of screening mammography on breast-cancer mortality in Norway. N Engl J Med
Autier P, Héry C, Haukka J, Boniol M, Byrnes G. Advanced breast cancer and breast cancer mortality in randomized controlled trials on mammography screening. J Clin Oncol 200927:5919-23.
Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA 2009;vol302:1685-92.
Jørgensen KJ, Zahl PH, Gøtzsche PC. Breast cancer mortality in organised mammography screening in Denmark: comparative study. BMJ 2010;:c1241.
Conclusions We were unable to find an effect of the Danish screening programme on breast cancer mortality.
Roles for estrogen and progesterone in breast cancer prevention
D Joseph Jerry Breast Cancer Research 2007, 9:102
The protective side of progesterone. Gianluigi Ferretti*, Alessandra Felici and Francesco Cognetti Division of Medical Oncology A, Regina Elena Cancer Institute, Rome, Italy Breast Cancer Research 2007, 9:402
Screening Mammography Benefits and Harms in Spotlight Again by Nick Mulcahy
BMC Med Inform Decis Mak. 2009 Apr 2;9:18.
What is the point: will screening mammography save my life? by Keen JD, Keen JE.
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