Tag Archives: mammogram

Breast Cancer Action Webinar Discusses Screening Mammography and Breast Cancer Overdiagnosis

Photo courtesy of freedigitalphotos.net and stockimages
Photo courtesy of freedigitalphotos.net and stockimages

Breast Cancer Action Webinar

I sat in on a webinar today given by Breast Cancer Action, a group I greatly admire and support for the work they are doing in breast cancer advocacy.  You can find out more about BCA by clicking on the link (above) which will take you to their website, or in the article I wrote last August , “Support Breast Cancer Action – A Good Cause“.

Today’s webinar was titled “The Oversimplification of Early Detection: Screening Mammography and Breast Cancer Overdiagnosis”.  They are running it again on Thursday, March 14, 2013 at 9:00 am PST, 12:00 PM EST.  You can sign up for the webinar by using this link.

Presenting the webinar were Sahru Keiser, BCA’s Education and Mobilization Coordinator; Dr Tracy Weitz, BCA Board Chair and Director of Advancing New Standards in Reproductive Health at UCSF; and Dr H. Gilbert Welch, Professor of Medicine at the Dartmouth Institute for Health Policy and Clinical Research, and co-author of the study “Effect of Three Decades of Screening Mammography on Breast Cancer Incidence.”

They began the webinar with a quotation from Otis Brawley, Chief Medical Officer for the American Cancer Society, who admitted that American medicine has overpromised when it comes to cancer screenings.

Dr Weitz made the point that breast cancer is intensely personal, but also highly political, highly commercialized, and highly confusing.  I was thinking that I couldn’t agree more.

Challenging Old Ways of Looking At Breast Cancer

Dr Weitz said we need to be challenging the old way of thinking about breast cancer, which view has been that breast cancer is a progressive disease that gets more deadly over time.  Based on that old belief, American medicine adopted the approach that early detection is the best way to save lives.

But that approach, and mammography in particular, has not given us the results we have hoped for.  Now we know that:

1.   Not all breast cancers are alike;

2.  Not all breast cancer tumors can be found;

3.  Not all breast cancer can be cured;

4.  The type of tumor matters more than the size;

5.  Not all breast cancers need to be treated;

6.  Screening and treatment for breast cancer comes with its own risks and benefits.

Several times during the webinar it was pointed out that they were primarily discussing breast cancer screening, which refers to the testing of otherwise healthy women with NO breast symptoms.   Diagnostic mammograms still definitely have a role to play when a lump has been perceived and one needs to find out what it is. 

Screening Mammography Benefits and Risks

The greatest benefits of screening mammography are seen in populations with a higher prevalence of disease and with the type of disease that responds to treatments.  The problem, however, is how many false positive tests there are – women who needlessly undergo a battery of tests only to find there is no cancer present.  They also mentioned the associated risks from radiation, because that in itself increases a woman’s chance of getting breast cancer. 

An interesting fact: women in the United States were exposed to SEVEN TIMES more radiation in 2006 than they were in the 1980’s.

Turtles, Bears and Birds

Dr Weitz had an interesting way of classifying breast cancer, she said there were 3 basic types:

Turtles – Those who had non-aggressive, slow moving tumors that would never be life-threatening (which is much of DCIS)

Bears – Those whose tumors lie in hibernation, wake up suddenly and can be deadly

Birds – Those whose tumors fly quickly, were very aggressive, and no matter how small when found, cannot be effectively treated

Apparently screening mammography is better at finding turtles.  If we hadn’t gone looking, we wouldn’t have found them and no harm would be done.  I feel terribly sad for the women in this category who have chosen to have mastectomies out of utter terror of a report that says “cancer”, even though their particular tumor would have stayed localized and not amounted to anything.

1.3 Million Overdiagnosed

Dr Welch noted that in future, screening must advance the time of diagnosis of the cancers that are destined to cause death, that finding these sorts of tumors earlier was absolutely paramount.  He stated that screening mammography has not changed late stage cancer detection but it is finding many more early stage cancers.  He estimated that 1.3 million women in the US have been overdiagnosed and overtreated.

Dr Welch stated that the breast cancer death rate is falling, but that was because it was being treated more effectively, not because of early screening.  He stated that the rates of metastatic breast cancer had not changed, that it appears not to have been affected by early screening at all.

African American Woman At Higher Risk

Sahru Keiser made the point that African American women have a higher risk of dying from breast cancer, that they are 40% more likely to die than white women because of differences in tumor characteristics, because of inability to obtain a good standard of medical care, and that for this group of women, the risk was greater for those who were premenopausal, and that increases in mammography screening had not led to a reduction in mortality.

I think these are shameful statistics.

5 Good Reasons to Rethink Mammograms

All in all, BCA felt that mammograms were not the best screening tool for these reasons:

1.  Mammograms were less effective in premenopausal women

2.  Mammograms were less effective for those with dense breast tissue

3.  Mammography created another set of problems because of the radiation associated with them

4.  Mammography is finding cancers that really should not be found and are nothing to worry about

5.  Mammography isn’t particularly good at finding cancers that really did need to be found.

Here Are 6 Things We CAN Do

1.  BCA advocated being proactive about prevention.  I agree with that and many of the articles on this blog are written with prevention in mind.

2.  Know your body – the shape, the size, the feel of your breasts – so that you will know if something unusual is taking place within the breast.

3.  It was recommended to start having screening mammograms at menopause, and then have them only every other year until the age of 75, at which point your health professionals could made recommendations suitable for your particular health situation. 

4.  It was also recommended that clinical breast exams be performed every year by an experienced health professional – that’s the exam where your doctor has you lie on your back and feels for any notable lumps in the breast.  I would add to that to learn how to do this yourself – there are plenty of websites that teach how to do a breast exam and your doctor will teach you as well.  Do it monthly, after your menstrual cycle if you are premenopausal.  I recommend placing a sticky note reminder on your calendar – or if you have an iPad or smart phone, put that reminder in your calendar to do this monthly.

5.  Read through my site to find out what I recommend for breast health and stress reduction, because I truly believe that stress plays a big role in the development of many cancers.  Sign up for my newsletters, they are free and contain my best recommendations about prevention and healing from breast cancer.

6.  My personal favorite breast screening method is thermography.  If you are lucky enough to have a Thermal Imaging center in your city, I strongly recommend them, I have utilized thermal imaging for myself and found it to be very pleasant, completely safe, and no SQUISH.  For more information, see my page Breast Health – What Is Thermography?  You will find more information in my article titled Breast Screening Without the SQUISH.

BCA recommended two books for further information: Overdiagnosed: Making People Sick In The Pursuit of Health by Dr H. Gilbert Welch, and The Big Squeeze:  A Social and Political History of the Controversial Mammogram by Dr Handel Reynolds.

The bottom line is that if you want to have mammogram screenings, you should continue to do so, but if you don’t want them you should not be coerced into it, and you have every right to do as you wish, it’s your body.

If you would like my help with getting through breast cancer (or avoiding it) in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com).  It is my honor and my goal to help you through this.

Ian Gawler Cites Surprising British Medical Journal Research About Breast Screening

Ian Gawler Cites Surprising British Medical Journal Research About Breast Screening
Photo courtesy of freedigitalphotos.net and PinkBlue

Ian Gawler, one of my thought leaders, is a cancer survivor, author of many books on mind-body medicine (my favorite is “You Can Conquer Cancer“) and formed the Gawler Foundation in 1983.

Today on Ian Gawler’s blog, he cites some surprising research just released by the British Medical Journal that says, in effect, that we are being over-medicalized.   Now, that news is really NOT so surprising when you think about it – what’s surprising is that the eminent BMJ is admitting it.

Ian’s blog stated today “Research claims over half [of] breast cancers would amount to nothing if left untreated, and raises questions about breast screening.  Writing in the prestigious British Medical Journal, academics from Australia and Canada claim up to 54% of breast cancers detected in women in their 50’s by breast cancer screening would never have manifested clinically.”

Now isn’t THAT interesting?

Dr Gawler stated: “The article goes on to identify the phenomenon of over-medicalisation, saying healthy people are increasingly harmed by a barrage of unnecessary tests, procedures and drugs. The tendency to over-screen, over-diagnose and over-treat has become rampant in modern medicine, and poses a ‘significant threat to human health’.”

Arrive At Your Own Truth

As interesting as all of that is – and I will let you draw your own conclusions about it – my absolute favorite part of Dr Gawler’s blog puts into words exactly what I’ve been trying to impart to my readers about arriving at your own truth.  He says “Please do not believe what I say, just because I said it!”

That’s exactly the point I’m trying to make here – my focus is to provide you with information which will empower you to make your own decisions.  Don’t blindly follow any course of action just because someone says you must!  This is your journey, you have every right to choose the therapies that make sense for YOU.

If you would like my help with getting through breast cancer in an inspiring and ultra-healthy way, please sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com).  It is my honor to help you through this.

Breast Screening Without the SQUISH!

Thermal Imaging

Thermal (infrared) imaging for breast cancer screening seems to me to be a fantastic, SQUISH-free method of discovering whether something diabolical is happening within the breast.  When I lived in Australia, there was a top-notch thermal imaging facility that I attended every year after my diagnosis of breast cancer (wish I’d gone before!).

Current research indicates that 1 in every 8 women in the US will get breast cancer in their lifetime, sobering statistics.

While mammography, ultrasound, MRI, and other breast imaging devices rely primarily on finding a physical tumor, thermal imaging detects the heat produced by increased blood vessel circulation and metabolic changes associated with a tumor’s genesis and growth (called neoangiogenesis). By detecting tiny variations in normal blood vessel activity, infrared imaging may find thermal anomalies suggesting a pre-cancerous state of the breast or the presence of an early tumor that is not yet large enough to be detected by physical examination, mammography, or other types of structural imaging.

Thermal imaging uses ultra-sensitive medical infrared cameras and sophisticated computers to detect, analyze, and produce high-resolution images of these temperature variations (see photo above).

The extreme sensitivity of thermal imaging may be the best device for indications of neoangiogenesis and a developing tumor.  And as we know, early detection means LIFE.

According to breastthermography.com, “Studies show that an abnormal infrared image is the single most important marker of high risk for developing breast cancer, 10 times more significant than a family history of the disease (P. Haehnel, M.D., M. Gautherie, Ph.D. et al; Long-Term Assessment of Breast Cancer Risk by Thermal Imaging. In: Biomedical Thermology, 1980; 279-301)” (bold type added by me).

Better yet, it doesn’t hurt!  Unfortunately, the medical profession as a whole still hasn’t completely accepted thermal imaging and few insurance companies will cover the cost of it, at least in the USA.  Here in Colorado, the fee for first-time patients is around $300.  Be that as it may, I believe it’s a fantastic method of discovering problems early on and well worth the price, especially if you consider yourself in a high risk category or have found a breast lump that ordinary mammography hasn’t picked up.

 If you’d like to stay connected, sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com) and I’ll do my utmost to keep you informed and empowered on your healing journey… and beyond.

3-D Mammograms Come to a Breast Near You!

Mammography vs Tomosynthesis

The latest 3-D Mammogram, called Digital Breast Tomosynthesis, for Breast Cancer Screening

Breast imagers around the world are beginning to use digital breast tomosynthesis, or DBT, to perform three-dimensional mammography for breast cancer screening and diagnosis.

The DBT system uses a digital x-ray that records a series of low-dose, high-resolution images of the breast while traversing a small (15°) arc around the compressed breast. As the projection angle changes, images are recorded at slightly different depths and thicknesses, from one surface of the breast to the other. Both mammography and DBT need a similar (about 4 seconds) compression time.

Each DBT image can be magnified or manipulated to better reveal tiny details and reveal more accurate interpretations of breast changes.  Radiologists are excited because DBT offers images with a clarity and degree of detail substantial enough to reduce some of the false-positives and false-negatives associated with 2-D mammographic imaging. In small series studies, researchers have reported reducing the false-positive callback rate by as much as 30-40%.

There are some drawbacks to DBT:

  • The approved indications for DBT state that it must be used as an adjunct to standard digital mammography. This means that the radiation dose for women having DBT is slightly higher than it would be with standard digital mammography. Even with the addition of DBT, however, the dose remains lower than the maximum allowed with older, analog mammography.
  • Because DBT is a new platform, techniques for best use are still evolving.  Various studies are being carried out to determine whether the dose of DBT can be reduced without losing image integrity.
  • To date, no substantial trials of DBT have been performed in the U.S., though a large trial is currently being planned. A large-scale population-based study is ongoing in Europe. These trials are very hard to do, and must involve many thousands of women to show a significant benefit in cancer detection of tomosynthesis over routine mammography.

Now if they’d just create a device that didn’t squish us to bits!  Actually there is one – thermal imaging.  See my article on thermal imaging screening – (my preferred method).

If you’d like to stay connected, sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com) and I’ll do my utmost to keep you informed and empowered on your healing journey… and beyond.