Some radical ideas and the basics

Some advice on mammography from The Breast Cancer Fund (a San Francisco-based environmental group):

http://www.breastcancerfund.org/site/pp.asp?c=kwKXLdPaE&b=3959151



Mammography is the most common tool used for detection of breast tumors. It is may be unreliable for premenopausal women since many have dense breasts.

Among younger women, breast self exam (BSE) is the way most discover a lump. Since all women with lumps are given mammograms, it is believed by many that this makes the rate of detection by diagnostic mammograms look better than it really is. However there is NO question that some women only find a tumor with mammography.

Screening is the term used when healthy women with NO SIGN of disease go and get a test. A diagnostic mammogram is when a woman finds a lump or some other change in her breast and goes to find out what is going on there.

Screening mammograms are tricky because of the following:

1)In women under the age of 50, 5% of the mammograms will suggest a need for further testing but the vast majority- 93% are false positives. This means that 93% of the women told they have a suspicious mammogram DO NOT HAVE a malignant tumor. They usually have had a biopsy to confirm this, meaning excess surgery and scar tissue (which can intefere with the next mammogram). FYI, in some, scar tissue will dissolve with the use of cocoa butter. (we have advice on that on this site).

2) Negative results do not necessarily mean no cancer. The mammogram is the tool we have, but it is nowhere near as sensitive as we really need for detection.

An article entitled "Mammographic Assessment of Human Breast Cancer Growth and Duration" in Cancer 71 (1973)2020-2026 pointed out that in general 40 doublings of the breast cancer cells can create a potentially lethal burden in the body. Mammograms cannot detect a mass until 25-30 such doublings have happened. Thus, it is not really 'early' detection.

A known cause of breast cancer is ionizing radiation, the kind we get from x-rays and mammograms. We have no direct studies advising us of the risk of annual exposure that starts at any age. We are told that the exposure amount is so much less than in the past, but Ann knows of women who participated in the original NCI study and they were told it was a safe dosage. It is only lower compared to the past, not the future. The National Action Plan on Breast Cancer, Etiology Working Group sponsored a workshop that pointed to the dangers of ionizing radiation. It is especially damaging to young girls. Avoid chest xrays in adolescent or pre-pubescents.

We have NO studies on the effect of continual mammograms for women with BRCA1 or BRCA 2. These are the inherited genes that may lead to breast/ovarian cancer. We do not know if these women are more susceptible to radiation damage. There is a gene called AT that does make a person more susceptible. It is not currently being tested for in the female population.

And of course, no one knows what it means in the future to be tested from the age of 30 or 35 as has been suggested for the "high" risk women with family histories.

A concern has been raised that the compression of a mammogram may even cause spread of cancer.

Mammograms are good at detecting ductal carcinom in situ.

Reporting in the March 27 issue of the Journal of the American Medical Association, the researchers estimate that more than 23,000 cases of DCIS were diagnosed during 1992 in the United States--200 percent higher than might be expected from rates in 1983 and from trends between 1973 and 1983.

(Ernster, et al, in JAMA in 1996) said , "This increase correlates with the widespread adoption of modern mammographic screening."

Only recently have women with this very early stage disease been treated with lumpectomies. It used to be that they received automatic mastectomies while those of us with invasive cancer could 'choose' between the surgeries.

Something new is available, with FDA approval. Check out http://www.mammopad.com/mammo.html for more information on "a breast cushion designed by a female breast surgeon to make mammography more comfortable." Posted 1/05


From Mammography Matters

An FDA/CDRH publication Fall 1999

SECOND Opinion w/Mammography

Radiological Soc of NA, 12/03

Breast Density A Factor

Study in JNCI shows errors in reading film, more likely- 7/00

HRT Increases Breast Density
Mammographic Densities & Breast Cancer Risk
Mammographic Density:Biomarker/Isoflavone
ACS Guidelines for Early Detection

Ca Cancer J Clin, 2000 (excerpts)

Concordance of Breast Imaging & Assessments: Screening Mammo
Screening Mammo Yes/No? Survival Benefit?

9/00 Journal of National Cancer Institute

Cochrane Reassessement of Mammo-No Survival Benefit
Studies Are Conflicting:Mammo & More
Researcher States Mammography Saves Lives
National Breast Cancer Coalition's Position
Value of Cancer Screening
Open Letter From Maryann Napoli
Mammograms' Hidden Risks
Swedes Look at Two Counties Trial
World Health Organization (WHO) Concludes Mammos for Over 50
Mammography Screening Trials-Commentary on Olsen/Gotzsche
Clinical Breast Exam/Mammo?

Discussion from the British Medical Journal 10/00

Cancers Found by Screening Versus Not:Better Results???
Mammography Fails in Most Younger Women

03/23/2001 Cancer Online

False Positives (Two Versions on a Study)

J General Internal Medicine, April, 2001

Mammography: Experience Equals Skill
Double Reading Effective
1/3 of Breast Ca Operations UNNECESSARY:Norway
Breast Cancer Grade-Evidence From Screening

Breast Cancer Research and Treatment, 10/01

Neg Predictive Value of Sono w/Mammo

Am J of Roentgenology, 10/01

TrueScan Technology

Information and a link

Timing  & Mammography

ABC News - Good Morning America

Radiation Risk From Screening Mammos

J Natl Cancer Inst Monogr, 1997

Breast Compression & Radiation Dose
Scintimammography: A Review

The Breast

Danger & Unreliability of Mammos: Breast Exam?

Intl J of Health Services, 2001

Position Helps Mammograms Detect

Am J Roentgenology, 4/02

Screening Tests-How They Work/or Not

New Republic Magazine, 4/22/02

Fibromyalgia & Mammography=Pain

10th World Conference on Pain, 8/02

Invasive Lobular Ca & Mammos

Radiology, 10/02

Women w/BRCA 1/2 Needing Mammograms More Often?

J Cancer, 4/04

Annie Appleseed Project asks the author
Mammopad by Woman's Touch

LINK to site for "soft foam cushion designed to enhance comfort during mammography"


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