With Health Care being paid for by taxpayers now, one needs to expect more “avoid getting screened” propaganda (and save taxpayer money).

The “big money” screening programs are about prostate cancer and breast cancer.

In breast cancer, mammograms allow one to pick up small lesions (that of a small pearl versus that of  those found on exams: a large pea, or even larger if one is “full figured”)

When I started medical school 40 years ago, breast cancer was found only by women, the “cure” rate was 40%. But now, lumps are found earlier, and the cure rate is much lower.

The following are based on studies of a 5 year survival rate.

  • Stage 0: 100%
  • Stage I:100%
  • Stage IIA: 92%
  • Stage IIB:81%
  • Stage IIIA:67%
  • Stage IIIB:54%
  • Stage IV:20%

So when a major newspaper publishes an article against screening, it makes me thing “HUH?”

Ah, but if you read the article until the end, you find the “expert” is an internist who works at a think tank, not a surgeon or gynecologist or oncologist who sees these people every day. Believe me, if you are a doc, and the “think tanks” tell you X, but you have to cope with the patient harmed by the think tank’s ideas, you soon change your practice. Yes, it might be “better” from a scientific standpoint to do X, but if you just “wasted” money and did “Y”, maybe Mrs. SoAndSo would not be dying painfully of her cancer today.

  The employer of the author has as website with  half a dozen or more articles placed in the press that says the same thing….

To understand the real controvery, you need to know that hormones make the cancer grow faster (they might also cause the cancer, but that’s another story).

So if you are pre menopausal, it grows faster than in post menopausal women. And, to make things worse, they tend to metastasize when they are still small.

So a lump in a younger woman might not be there for the mammogram, but grow so fast that three months later she feels it. But being “reassured” by the “normal” mammogram, she ignores the lump. There is also a question about radiation in younger women, could it cause cancer having all those mammograms? Finally, younger women have more “lumps”, so more biopsies will be done, most of which won’t show cancer.

The dirty little secret is that the fast growing cancers in younger women grow so fast and metastasize so early that “routine” mammograms might not make much of a difference, but for the “over 50” crowd, where the majority of breast cancers occur, this is simply not true.

Yet although rare, mammograms as now done do lower the death rate of younger women in many studies.

Here is a summary of an article from Massachusetts General , published in 1992:

Great uncertainty exists about the benefit of detecting breast cancer by mammography in women under 50 years of age.

We have reviewed the survival of patients aged 49 years or less whose cancers were detected by mammography alone…

Five-year survival for all mammographically detected cancer patients was 95%, whereas for women with palpable cancers the survival was 74% (p < 0.00005).

If DCIS is not included, the corresponding survivals are 91% for mammographically detected infiltrating cancers and 72% for palpable infiltrating cancers.

Only 1 woman who died among those with palpable cancer had had a mammogram before diagnosis.

Our data contradict the suggestion that women under 50 are put at a survival disadvantage by undergoing mammography. We believe that investigators who have reported negative results in this age group must examine other causes for their results.

There is a lot less controversy about mammograms in older women, because the breast cancer rate goes up with age:

From the AAFP:

At least eight prospective controlled trials and five historically controlled trials have examined the value of serial screening mammography in asymptomatic women.18 In the majority of these trials, screening mammography led to a 20 to 30 percent reduction in the breast cancer mortality rate for women 50 to 65 years of age.

but then there is this problem:

The benefits of mammography in women older than 65 years have been less well established, primarily because this age group was excluded or underrepresented in most of the trials.

The American Geriatric Society currently recommends that screening mammography be performed in older women up to 85 years of age if their life expectancy is three years or longer. This approach has been supported by a recent decision analysis.19

translation: Old women don’t get screened, probably because they think that their risk is low. It’s actually higher. True, it tends to grow slower, but I’ve seen two “advanced” cases of breast cancer that never got diagnosed because the women though they were  “Too old” to worry about that lump that has been there for years.

Another question is about “cancer in situ”, cancer that is small but not invading nearby tissues. Do all these small cancers turn into cancer, or does the body’s immune system destroy it, so that a lot of these women never would get cancer? In other words, are we “curing” a lot of lesions that would never go on to kill the patient?

Another thing not being mentioned: The lowest rate of breast cancer is in women who have a lot of kids, start having kids early, and breast feed them. (i.e. in traditional societies).

Now, if you really want controversy, start asking why the breast cancer rate has soared in recent years, and ask if carcinogens in the environment, or chemicals that mimic estrogen in the environment, or if birth control pills and post menopausal hormones, or having fewer children, or having a couple abortions will increase your rate.

From the NIH website:

  • Reproductive and menstrual history―Women who had their first menstrual period before age 12 or who went through menopause after age 55 are at increased risk of developing breast cancer. Women who had their first full-term pregnancy after age 30 or who have never had a full-term pregnancy are also at increased risk of breast cancer.
  • Long-term use of menopausal hormone therapy―Women who use combined estrogen and progestin menopausal hormone therapy for more than 5 years have an increased chance of developing breast cancer.

Mammograms lower the death rate, but with the government takeover of medicine, we will have the “death panels” pick and choose what we get screened for, and so probably you won’t get screened by mammogram below age fifty.

As for reports about chemicals, including birth control hormones, being part of the problem. The chemical industry is here to stay, and few of us want to go back to the “good old days” of no plastic bags, lead pipes instead of PVC pipes, and of course, eight kids.


Nancy Reyes is a retired physician living in the rural Philippines. This is an edited version of a post on HeyDoc Xanga Blog.

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