Analyzing the Mammogram
The American Cancer Society recommends a yearly mammogram when women reach 45 and one every other year for women age 55 and older.
Before you get a mammogram, you should know its pros and cons.
Basic mammogram facts:
- Mammography is an X-Ray of the breast that uses two plates to flatten the breast to spread the tissue apart so the X-rays can more easily see the tissue.
- The goal of mammography is to detect earlier invasive tumors that would be lethal. [1]
- Mammography screening is used as an early detection tool, not as a preventative tool.
Risks of a mammogram:
- Overdiagnosis, false positives, overtreatment
- Overdiagnosis can occur because a tumor regresses, doesn’t progress to clinical stage, or because the woman would die from other causes before the breast cancer harmed her.
- A radiologist reading 1,000 mammograms a year would prolong or save one life over that time but burden one woman each year with overdiagnosis [1].
- There is also the risk of a false positive diagnosis, which is as high as one in two after ten mammograms.
- The risk with a false positive is mainly psychological, the damage which seems to take at least three years to dissipate in many women. Being declared cancer-free generally took six months to two years– when no cancer was ever present [2].
Over-treatment Risks
- Overdiagnosis and false positives can lead to overtreatment. Overtreatment can involve biopsies, surgeries, radiation therapy, as well as chemotherapy. These treatments carry risk. Radiation therapy increases the risk of cardiac death, and chemotherapy may be cardiotoxic. [2] Both can weaken the immune system, allowing easier for second cancers to develop, and chemotherapy may cause abnormal cells in bone marrow, which can lead to second cancer.[3]
- Radiation Exposure
- Mammogram radiation exposure can be deadly to younger women with a genetic predisposition to breast cancer. This group of women should begin screening early, and can also use alternative screening methods. [4] Every day we are exposed to radiation through food, soil, television, and computers. The majority of our “extra” exposure comes from types of medical scans—the most common being X-rays, mammograms, and CT scans—which we are now exposed to more than ever before. [5] The radiation emitted from many of these scans is low, but accumulates. This radiation can damage DNA cells, and DNA mutations can form cancer if the body does not correctly repair them [6]. The effects of radiation can take years to appear, so we can’t know the actual damage done until it is done. The National Cancer Institute estimated in 2009 that radiation exposure from CT scans caused 2%, or 29,000 cancer diagnoses in 2007[5]. CT scans emit much more radiation than a mammogram, but radiation effects over time are still worth considering.
Benefits of mammography:
- Early Detection = Less invasive/less intense therapies
- If breast cancer can be identified in its early stages, the treatment should be significantly less invasive and less intense. However, there is a large increase in ductal carcinoma and localized invasive breast cancers, with a minimal decrease in cancers with metastases (meaning cancer that spread to a different body part from where it started). If screening didn’t cause a reduction in the incidence of advanced cancers, and the increase of localized cancers appears to coincide with the first screening, then you have to consider the effectiveness of screening. The increase in localized cancers is likely due to overdiagnosis, not early diagnosis.[1]
- One Norway study concluded that if untouched, many screening detected cancers would have regressed spontaneously. Norway found an increase in diagnosis of Stage I cancer by 58%, Stage II by 22%, but found no reduction in the diagnosis of Stage III or Stage IV breast cancers in women participating in mammography screening programs. ALL of these women would receive surgery and most of them Stage II or higher would also be advised chemotherapy. In countries with mammography screening programs, invasive breast cancer incidence rates of diagnoses keep increasing consistently, further supporting that early detection is not reducing the intensive amount of treatment required when these invasive breast cancers are found[2]. Mammography screening programs data doesn’t support the claim that they reduce the intensity or invasiveness of therapies.
- Reduction of breast cancer-related deaths
- Mammography was evaluated in randomized trials before it was widely implemented. The Cochrane Review, the gold standard in evidence-based healthcare, in 2000 indicated that based on those randomized trials, mammography screening had little effect. Among 1,000 women participating in biennial mammography screenings from age 50 to 70, 2-3 women will be prevented from dying of breast cancer. Over 12 years, screening would prevent one death, but the total number of deaths from breast cancer would increase by six! [2] Furthermore, currently no data shows the detection of DCIS, a form of non-invasive or pre-invasive breast cancer, saves lives, but the incidence of DCIS has increased with screening. Results of autopsy studies suggest less than 50% of DCIS lesions progress.[1]
- We must consider the lives lost to overdiagnosis and overtreatment. While screenings may have reduced mortality, so has increased awareness of breast cancer. Greater awareness dropped the average tumor size diagnoses to 9-mm smaller from 1979-1989. Just demonstrating self-awareness and choosing our healthcare makes a difference, and is worth our time. We only have one body.
What’s the point?
Don’t be afraid to spend more hours researching possible life-or-death decisions than you do on your next car or vacation. There are alternatives or conjunctive therapies to mammography that have less risk and no radiation, including ultrasounds and MRIs; but most providers will not prescribe these as stand-alone screening tools.
Another option is thermography, which uses an infrared camera to take a picture of your body, measuring the temperature of the skin, and annual pictures allow you to see how your health is changing over time. Thermography uses NO radiation and is based on two ideas:
- 1): because cancer cells grow and mutate quickly, blood flow and metabolism are higher in a cancer tumor.
- 2): higher blood flow and metabolism yield a higher skin temperature.[7]
Thermography detects subtle changes that could indicate infections, underlying disease, fibrocystic disease, or even cancer.
Thermography is especially useful in women under 50 since mammography may not have satisfactory results until after age 50. Thermography can be used in conjunction with mammography as well. If you aren’t sure if your physician is familiar with thermography, Insight Thermography can help you find a physician. At Insight, Erin and Mandi can help get you on a path to healing, wherever you are—it’s never too late to step out and feel your best!
Acknowledgements:
[1] https://pubs.rsna.org/doi/10.1148/radiol.11110210
[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4415291/
[4] https://www.radiologyinfo.org/en/news/target.cfm?ID=401
[6] https://www.health.harvard.edu/cancer/radiation-risk-from-medical-imaging