“Clinical Guidelines” advising women not to start getting annual mammograms at age 40 were published online in Annals of Internal Medicine, Nov. 16. Opponents of Obama’s health reform bill immediately raised the specter of “the government coming between you and your doctor,” and the administration’s top health official, Kathleen Sebelius, announced that the federal government had no intention of heeding its own experts’ advice.
Maybe the reason the proponents of fewer mammograms got TKOed in the first round is that we, the people, have been systematically denied information about the dangers of mammography. The new guidelines certainly downplay them, and media reports tended to ignore them completely. For example, readers of Gina Kolata’s front-page story in the New York Times Nov. 17 (“Panel Urges Mammograms at 50, Not 40”) would have thought the problem with mammograms was false positives. Kolata wrote, “While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.” Is that all there is?
Kolata, whose sister Judi Bari died of breast cancer, ignored the one sentence in the new guidelines pointing to direct harm caused by mammograms. In defense of Judi’s sister, that sentence was easy to ignore, mealy-mouthed and defensive (the authors of the new guidelines being medical-establishment types): “Radiation exposure may increase the risk for breast cancer, but usually only at much higher doses than those used in mammography, although regular mammography could contribute to cumulative radiation doses from additional imaging for other reasons.”
Jeffrey Tice, assistant professor of medicine at UCSF, was more specific in a statement to the San Francisco Chronicle: “Radiation causes one death for every 2,000 women screened annually at age 40, according to a study published in 2005 in the British Journal of Cancer. Another study shows that each mammogram increases the risk of breast cancer by two percent.”
Flashback: A Preventable Disease
“The recently growing incidence of breast cancer is not mysterious,” wrote the late John Gofman in a 1993 report for the Committee on Nuclear Responsibility. “Breast cancer is a largely preventable disease… A large share of recent breast cancer in the United States is certainly due to past medical irradiation of the breasts with x-rays -at all ages, including infancy and childhood. Such irradiation is preventable, without any interference with necessary diagnostic radiology, and hence many future breast cancers need not occur.
“Our finding is that about three quarters of the clinical annual incidence of breast cancer in the United States is being caused by past irradiation, primarily from medical sources.”
Gofman acknowledged that “pesticide byproducts, hormone pills, diet, exercise, electro-magnetic fields, and several additional factors have been implicated by epidemiologic studies as potential contributors to recent rates of breast cancer. Do we dismiss these other forces? Not at all… There is no inherent conflict or competition between carcinogens. The multi-step genetic model of cancer development ‘permits’ contributions even to a single case of cancer, from heredity, ionizing radiation, viruses, and chemicals.”
The Next Big Thing: “Breast Density”
A breast-cancer specialist at California Pacific Medical Center, Steven Cummings, has been pitching the wonders of “advanced digital mammography” to measure “breast density.” Last winter I heard him address an audience of about 100 middle-aged women in San Francisco. Dr. Cummings is a big man with the softest, gentlest, most reassuring voice you would ever want to hear. His overarching goal is to spread terror -individualized, science-tinged terror.
“…So our vision, the vision that drives the research that we’re now doing is that women can learn their risk when they have a mammogram. You answer just a few questions about your risk factors and the breast density will be measured automatically from the mammogram. And then we would use computer software built into the machines to calculate your risk factors and density. And the result would be a report of risk be it one percent in your lifetime or 10 percent in the next five years. And the report would go to you and your doctor. Based on that report. Let’s say you’re at high risk you could get serious about changing your lifestyle. Or you might decide that an MRI is an appropriate screening tactic. Or you would talk to your doctor about the preventive treatments such as raloxifene. If you’re at average risk, continue your mammograms. If you were at very low risk -that would be reassuring- and perhaps you could consider mammography less frequently.
?So what we’re doing now at the Breast Health Center at CPMC is measuring breast density and collecting risk factors from women who are having mammograms. So far, 60,000 women have contributed to this research through the CPMC Breast Health Center. How do we measure your breast density? My colleagues and I have invented a little device which allows us, when put on the mammogram plate, to tell us exactly the volume of the breast, that’s very important to know how much tissue there is, and it also allows us to very accurately tell the density of the breast. So if you go in to have your mammogram you’ll see a little device on the side, Our goal is to measure density and risk factors in a quarter of a million women. A quarter of a million women having mammograms at CPMC and similar centers around the United States. With that data in hand we plan to develop a simple device that could be installed on all digital mammography machines and it would give a woman her risk of breast cancer and allow her to make choices. But our big goal is, within 5-10 years, most women who want to know can know their risk.?
Some $3.3 billion was spent on mammograms last year in the U.S…. The more conservative approach, given what the word means, would be to advocate fewer mammograms. But the more conservative approach, given what the word has come to mean politically, is mammogram-on-demand. These spin-masters can make your head spin.
FRED GARDNER edits O’Shaughnessy’s, The Journal of
Cannabis in Clinical Practice. He can be reached at email@example.com