Dear Dr. Pam: There has been a lot of news lately about the lack of effectiveness for mammograms and even some safety issues. It seems like health care professionals are disagreeing about whether or not women should have them; if I don't get a mammogram, what should I do instead?

Actually there have been concerns about mammography for a very long time. I'm going to answer your question in two parts: this issue will deal with the latest news about mammograms and how health care professionals are responding to it. Next week I'll give you some advice that can help you to make informed choices about your own care.

The U.S. Preventive Services Task Force is the latest group to question the conventional wisdom that women should begin having annual mammograms at the age of 40. The 16-member panel analyzed several studies including a Swedish study involving 70,000 women; results of a British study involving over 160,000 women; and data from more than 600,000 women extracted from the U.S. Breast Cancer Surveillance Consortium. The task force also commissioned a study in cooperation with the National Cancer Institute that looked at the risks and benefits of 20 cancer screening strategies.

The group found that the potential harms of mammography beginning at the age of 40 outweigh the benefits; recommended against breast self-examination; and stated that there was insufficient evidence to continue mammography after the age of 74.

The task force concluded that for every 1904 women who get mammograms for 10 years starting at age 40, only one breast cancer death would be prevented. For every 1000 women screened, 480 would get a false positive and 33 would undergo needless biopsies.¹ This is a sound recommendation by the task force based on the evidence.

The task force did not even take into consideration the number of women who are treated for what we now know is "pseudo cancer;" conditions like carcinoma in situ, which usually do not progress to aggressive cancers requiring treatment. Women diagnosed with carcinoma in situ generally undergo surgery, radiation and are placed on highly toxic drugs like Tamoxifen. A growing number of health care professionals believe that this constitutes over-treatment for non life-threatening conditions, and these treatments themselves can adversely affect the health and quality of life of patients.

Many other studies have cast doubt on the value of mammograms. A study published in the Journal of the American Medical Association² reported a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. The results were similar with prostate cancer.

If breast and prostate cancer screening really worked, the researchers correctly noted, they should have resulted in incurable cancers being found early and treated when they could be cured. A large increase in the detection of early-stage cancers should have been accompanied by a decline in late-stage cancers. But this did not happen.

Dr. Otis Brawley, chief medical officer for the American Cancer Society told the New York Times in response to the earlier JAMA study that the organization would post a message on its website next year saying that screening for breast, prostate and certain other cancers results in the over-treatment of non-aggressive cancers while often missing more aggressive deadly cancers.

"We don't want people to panic," he said, "But I'm admitting that American medicine has over-promised when it comes to screening. The advantages to screening have been exaggerated."

The U.S. Preventive Services Task Force continues to insist that women at higher risk for breast cancer should continue to get mammograms, but research does not really support mammograms for those women either. A study published in the February 24, 2009 issue of the Journal of the National Cancer Institute concluded that mammography screening may increase the risk of breast cancer for women who are carriers of the BRCA 1 or BRCA 2 genes. Researchers looked at data from 22 pedigree studies (meaning they were done on the entire family, not just one person) involving 8139 subjects and stated that mammography screening beginning at 25 to 29 years of age results in increased risk of breast cancer due to an increased lifetime radiation exposure, and that mammography may have a net harmful effect for these patients.³

So how has the medical community responded to this information? When questioned about the U.S. Preventive Services Task Force report, the American Cancer Society, which consistently offers the worst advice to cancer patients, condemned the recommendations. The group's official reponse is that mammography is beneficial.

Dr. Brawley, in a curious statement that contradicted his earlier statements about screening, said that mammography had risks as well as benefits but that the society's experts had looked at "virtually all" the task force and additional data and concluded that the benefits of annual mammograms starting at age 40 outweighed the risks. Clearly the society is not concerned with the evidence and is viewed by many as an organization the does not consider the public's best interests.

Other groups have denounced the findings by stating that this is all a plot to reduce spending on health care by depriving people of valuable medical services like mammography. It is true that the new recommendations could result in insurance companies and Medicare opting not to pay for mammograms for women between the ages of 40 and 49. About $5 billion is spent on mammograms every year which could be used in much more productive ways. Meanwhile the cancer industry has long understated scientifically proven dietary methods. If even a portion of that money were redirected toward public education about diet and lifestyle, we would see a much better return on our investment.

There are many major problems facing consumers in making good choices about diet, health and medicine. The biggest by far is the refusal of health care professionals and institutions to use evidence in making recommendations to patients. The recommendations made by the U.S. Preventive Services Task Force are a step in the right direction. Nevertheless it's important for patients to become educated in order to avoid being subjected to unproven and sometimes even dangerous diagnostic tests, drugs and procedures.

¹U.S. Preventive Services Task Force "Screening For Breast Cancer: U.S. Preventive Services Task Force Recommendation." Ann Intern Med November 17, 2009 151:1716-1726

²Laura Esserman, MD, MBA; Yiwey Shieh, AB; Ian Thompson, MD "Rethinking Screening for Breast Cancer and Prostate Cancer" JAMA. 2009;302(15):1685-1692.

³A Berrington de Gonzalez et al, "Estimated Risk of Radiation-Induced Breast Cancer From Mammographic Screening for Young BRCA Mutation Carriers." J. Natl. Cancer Inst. 2009 101: 205-209; doi:10.1093/jnci/djn440

Article printed with permission from Dr. Pamela A. Popper and taken from Newsletters Vol 7 Issue 47 November 23, 2009. Dr. Popper is the founder and Executive Director of The Wellness Forum, a chain of health and wellness centers located throughout the United States and the Far East.