Would you believe me if I told you that a growing number of researchers have come to the conclusion that routine mammogram screening for breast cancer in women who are not in a high risk category does not reduce the overall death rate from breast cancer in the general population and can even be harmful?

And would it surprise you to learn that the Swiss Medical Board no longer recommends routine breast cancer screening and that they are actively dismantling their mammogram screening programs?

These statements will surely raise some eyebrows because they fly right in the face of what we’ve been told for decades. And for the small percentage of women diagnosed with potentially lethal breast cancers who owe their lives to early detection, these statements might sound offensive. So, let’s take a breath and see what all this means.

Mammograms are x-rays that are used for breast cancer detection. If you are a woman—or a man with a mother, wife, sister, or daughter—then sooner or later the subject of mammograms will probably make its way into the conversation.

Facts About Breast Cancer

Breast cancer is the most commonly diagnosed cancer in the US. The most common cause of death from cancer in women is lung cancer, with breast cancer close behind in second place. About 1 in 8 U.S. women—about 12%—will develop invasive breast cancer over the course of her lifetime. 

The American Cancer Society’s estimates for breast cancer in the United States for 2016 are the following:

1. About 246,660 new cases of invasive breast cancer will be diagnosed in women this year.

2. About 61,000 new cases of carcinoma in situ (CIS) will be diagnosed (Carcinoma in situ means the cancer remains in one place, is non-invasive and is the earliest form of breast cancer).

3. About 40,450 women will die from breast cancer.

4. The chance that a woman will die from breast cancer in her lifetime is 3%.

About 85% of breast cancers occur in women who have no family history of breast cancer. These cancers occur due to genetic mutations (abnormal changes in the gene) that can result from toxins in the environment, excessive radiation—including radiation from medical scans such as mammograms and CT scans, lifestyle factors, and spontaneous mutations that come from aging.

About 10-15% of breast cancers can be linked to gene mutations inherited from one’s mother or father. Mutations of the BRCA1 and BRCA2 genes are the most common. Women with the BRCA gene mutation have a significantly elevated lifetime risk of developing breast cancer. Breast cancer that is positive for the BRCA1 or BRCA2 mutations tends to develop more often in younger women.

The women in my medical practice often ask me if they need to get a mammogram and how often. Usually I answer these questions with a lengthy discussion about mammography, including the “standard of care” in mainstream medicine, along with the research that does not support that “standard of care.” After they hear the conflicting data, I urge them to make their own decisions.

I begin the discussion by relaying to them the guidelines of the U.S. Preventive Services Task Force, whose advice helps set government policy on screening tests.

In January 2016, the US Preventive Services Task Force (USPSTF) issued its most recent recommendations on breast cancer screening. The guidelines include the following:

• Biennial screening mammography (every two years) is recommended for women aged 50 to 74 years.

• Women aged 40-49 should talk with their doctor to see whether the benefits of mammography outweigh the potential harm.

• There is insufficient evidence to assess the additional benefits and harms of screening mammography in women aged 75 years or older.

However, many cancer groups have refused to adopt these new, more lenient guidelines, and still recommend that women over the age of 40 be screened annually. These groups include the American Cancer Society, the National Cancer Institute, and the American College of Radiology.

Growing Voices of Dissent 

While mainstream organizations that set U.S. public health policy argue heatedly over the recommended frequency of screening mammography, a growing number of researchers have expressed serious doubts about the value of routine mammogram screening.

In 2014, the British Medical Journal published one of the largest and most rigorous evaluations ever done on mammography, involving 90,000 women, spanning 25 years.

In the study, Canadian women aged 40-59 were randomly assigned to have either regular mammograms or breast exams by trained nurses—without the mammograms. The researchers wanted to determine whether there was any advantage to finding breast cancers when they were too small to feel. The researchers concluded that the answer was a clear “no.” http://www.bmj.com/content/348/bmj.g366

The study revealed that the death rates from breast cancer were the same in women who got mammograms and those who did not get mammograms and relied exclusively on clinical and self-breast exams.

In addition, the screening actually had some harmful effects due to overtreatment. One in five cancers that are found with mammography and treated are not a threat to the woman’s health and do not need treatments such as surgery, chemotherapy, and radiation.

If the researchers included a precancerous condition called ductal carcinoma in situ, the over diagnosis rate would be closer to one in three cancers, said Dr. Anthony B. Miller of the University of Toronto, the lead author of the paper.

Researchers now recognize that many cancers grow slowly, or not at all, and do not require treatment. Some cancers even shrink or disappear on their own. But once cancer is detected, it is impossible to know if it is dangerous, so doctors treat them all.

Mammography appears to be preventing only one death for every 1,000 women screened, while causing harm to many more. The results of the study elicited well-founded doubts about the value of the mammograms for screening women of any age.

These results have led to a deepening divide. On one side of the divide are the growing numbers of researchers who doubt that regular mammography saves lives. On the other side of the divide are the patients with aggressive breast cancers and their advocates who staunchly support early breast cancer detection through mammography.

The use of mammograms for breast cancer screening remains a controversial topic. The Medical Board in Switzerland has even suggested that the mammogram screening be halted entirely. Although no other country has followed their lead, the Swiss Medical Board present sound reasons for discontinuing routine mammograms.

Dr. Peter Juni, a former member of the Swiss Medical Board, said one of the concerns was that mammography was not reducing the overall death rate from the disease, but increasing over diagnosis and leading to false positives and needless biopsies.

The New England Journal of Medicine published an article called “Abolishing Mammography Screening Programs? A View from the Swiss Medical Board.” By reading this article, you might find that the Swiss authors make a very compelling case for abolishing the mammography screening programs. http://www.nejm.org/doi/full/10.1056/NEJMp1401875#t=article

Inconsistencies in cancer screening recommendations: 

Although lung cancer is the leading cause of death in women, there are no screening programs with yearly chest x-rays. The “standard of care” is to wait until respiratory symptoms develop and then begin testing. Have you ever wondered why there is such a big difference in recommendations between breast and lung cancer screening?

And what about the differences in the recommendations for prostate cancer and breast cancer screening?

There are some distinct similarities between men’s prostates and women’s breasts. The same hormone-mimicking environmental toxins that cause breast cancer also cause prostate cancer in men. One is seven men will be diagnosed with prostate cancer. One in eight women will be diagnosed with breast cancer.

Of all the men who are diagnosed with prostate cancer, approximately 7% of them will have a lethal form of the cancer, similar to the percentage in women diagnosed with breast cancer. The statistics on prostate cancer and breast cancer are remarkably similar, yet the approach to the cancer is remarkably different.

The prostate cancer-screening test for men is a simple blood test, the prostate-specific antigen (PSA). The prostate cancer screening for men can be compared to the breast cancer screening in women, except that the PSA screening test does not involve radiation and is inexpensive.

Because of the same issues with over diagnosis and over treatment of men with prostate cancers that are non-lethal, the US Preventive Task Force has stopped recommending routine prostate cancer screening for men because it concluded that the screening did not reduce the death rate from prostate cancer and caused needless treatment in the majority of men diagnosed with prostate cancer whose cancer was non lethal and would remain indolent during the men’s life span.

So, now that we have hard data showing that routine breast cancer screening does not reduce the overall death rate from cancer, it remains unclear to me why the routine breast cancer screening with mammography remains the “standard of care.” This protocol is actually a puzzling double-standard of care since the prostate cancer screening test is no longer recommended.

Some men continue to ask to have the PSA blood test in spite of the US Preventive Task Force recommendations because, like women, they are worried that they might be in the very small percentage of people who have the aggressive type of cancer that could be lethal and are hoping for early detection and treatment to save their lives. They are willing to put up with the multiple biopsies, scans, the risks of false positive diagnoses and unnecessary and possibly harmful treatments.

Dr. Kalager, whose editorial accompanied the Canadian study in the British Medical Journal, titled “Too Much Mammography,” compared mammography to prostate-specific antigen (PSA) screening for prostate cancer, using data from pooled analyses of clinical trials. It turned out that the two screening tests were almost identical in their over diagnosis rate and had almost the same slight reduction in breast or prostate deaths. “I was very surprised,” Dr. Kalager said. She had assumed that the evidence for mammography must be stronger since most countries support mammography screening and most discourage PSA screening.

Making Choices in the Face of Fear 

The thought of cancer often provokes fear and anxiety. Getting an actual cancer diagnosis can result in a state of terror. Even healthcare practitioners often operate from a place of fear when giving recommendations to the patient newly diagnosed with cancer.

When making a decision on what steps to take, it’s important to strive for a place a peace within which a plan of action can be made with all one’s faculties intact, including one’s intuition. When the brain is bathed in cortisol and adrenaline, it becomes difficult to make sound decisions. The default mode is to do exactly what your doctor tells you to do without questioning if that is the right route for you.

Above all, be an informed consumer and learn about all your options before jumping into action.

Stay tuned for Part II of the two-part Mammography Series to read more about the pros and cons of mammography, the types of breast cancer screening tests that are available without radiation, like MRI and ultrasound, and the risks and benefits of these tests.

Getting mammograms does not prevent breast cancer. It is a method of breast cancer detection only. In the next post I’ll also discuss breast cancer prevention.