Navigating Breast Health without Mammograms – Taking Action- #7
Breast Health and avoiding breast cancer is a controversial topic due to the money, politics and power that big business wishes to have here. Your tax dollars have been used to engage the Health & Human Services arm of our government to explore this topic through science yet when the answer didn't sit well with big business your own government told women to ignore the science and go get your mammogram.
Here are shorthand notes of what we will discuss based on what the SCIENCE tells us:
Mammograms CAUSE breast cancer. Radiation drives cancer
Mammograms have NOT been shown to extend life expectancy.
Mammograms do NOT discover cancer in its “early” stage.
Mammograms encourage more DCIS to occur and enhance risk for DCIS to become invasive breast cancer.
Mammograms are an 8 BILLION dollar a year industry and doctors receive financial incentives to promote it.
There are safer, healthier, inexpensive ways to reduce breast cancer risk and potentially reverse DCIS from becoming invasive.
Lifestyle greatly affects risk, and we will tell you exactly what lifestyle habits benefit you and reverse your risk.
Ultrasound, thermogram and MRI are all imaging modalities that are free of any radiation, offer equal or greater sensitivity at detecting cancer, and are safer options overall.
Minute 3:50
Samual Epstein MD, director of the Cancer Prevention Coalition shares these insights:
1950 – breast cancer was 1 in 20, now its 1 in 8
Canadian study 1980-1988 found a 52% increase in early breast cancer deaths in women aged 40-50 who had 10 annual mammograms.
National breast cancer awareness month was funded in 1984 by Imperial Chemical Industries and its spin off Zeneca Pharmaceuticals – they funded this in conjunction with the Am. College of Radiology.
ICI produces petrochemicals and organochlorines
Zeneca manufactures Tamoxifen
Their sponsorship gives them control over all posters, promotions and dialogue.
The A-T gene (Ataxia Telangiectasia gene) present in 1.5% of women are more radiation sensitive and thus at higher risk of cancer from mammograms.
Estimated that gene causes 10,000 breast cancer cases per year.
Minute 5:15
Chelsea shares that she has a BRCA gene:
- More discussion of the BRCA gene occurs at minute 48:15
- Occurrence of BRCA gene is 1 in 600 women or LESS
- BRCA-1 accounts for overall 1.7% of breast cancers below age 70
- BRCA-1 prevalence as source of cancer
- Below age 40 = 5%
- Age 40 to 49 = 2%
- Above age 50 = 1%
Minute 8:20
History of Mammograms and the USPSTF recommendations
- US Preventive Services Task Force – a government agency examined the evidence on mammograms and offered recommendations in 2009:
- Women age 40–49: recommended against routine screening
- Harm outweigh the benefits
- Women aged 50–74: screening every 2 years. NOT annual.
- Women aged 75 and older: insufficient evidence to make recommendation
- Miglioretti Study – 2016 showed the following and demonstrated that less radiation, starting later in life and getting mammograms less often was far superior.
- For biennial (every other year) screening from age 50–74,
- 23 breast cancer deaths averted for each radiation-induced breast cancer.
- 140 breast cancer deaths averted for each radiation-induced breast cancer death
- For annual screening from age 40–74, (earlier and more often = higher risk)
- Only 8 breast cancer deaths averted per radiation-induced cancer
- 59 breast cancer deaths averted per radiation-induced death
- Extra radiation offers danger that exceeds the benefit.
- Radiation-Induced Breast Cancer Incidence and Mortality from Digital Mammography Screening: A Modeling Study. Miglioretti, Lange, et al. Annals of Internal Medicine, 2016
Minutes 12:00
Radiation Exposure:
- Basic Mammo is 4 views and gives radiation dose of 0.2mSv units
- Dense breast require a higher dose of radiation
- Young breast (<age 50) – more sensitive to Rads
- Breast implants require more radiation (displacement views)
- Call backs for extra views = more radiation. 61% of women over 10 years
- 3D is additional radiation
- A-T Gene mutation = higher sensitivity to Rads.
- European smarter - one view per breast every 3 years
Minute 15:35
Global View of mammogram recommendations
- Swiss Medical Board Abolished Mammograms - New Engl J Med – 2014
- Swiss state they will no longer any mammogram screening programs stating “From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify.”
- Canadian National Breast Screening Study: Miller 2014
- Results: During the five year screening period, 666 invasive breast cancers were diagnosed in the mammography arm (n=44,925 participants) and 524 in the controls (n=44,910)
- Death from breast cancer over 25 year follow up: 180 women in the mammography arm and 171 women in the control arm.
- Conclusion: Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available.
- Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.
- Norwegian Breast Cancer Screening Program: Study of >200,000 women over 6 years. Age 50 to 64, receiving mammogram every 2 years vs control (unscreened)
- RESULT: Unscreened women had fewer occurrences of invasive breast cancer – 22% reduction in occurrence.
- Cochrane Database – 2013 review
- Cochrane review of 10 trials involving more than 600,000 women showed there was no evidence suggesting a benefit of mammography screening on overall mortality.
- Benefit if present was so small that it was canceled out by deaths caused by coexisting conditions or by the harms of screening and associated overtreatment.
- The benefit if present is so small that the risk of incurring serious harm is 10 fold higher than the potential benefit.
Minute 22:00
Ultrasound vs Mammogram in study by Chen, Zhou, et al.
- Ultrasound is superior to mammogram in women with dense breasts.
Minute 24:00
Sensitivity of Mammogram on average is 72% which means that it misses a cancer that is present 28% of the time. If you have dense breast tissue then that sensitivity is even worse, down to 48%. Under ideal conditions with fatty breast tissue mammogram is still only 85% sensitive.
- Dense breast tissue – a Bi-Rads rating of fatty = “A” and then there are increasing grades of B, C and lastly “D” for the most dense breast. Ask your radiologist to give you your score. Am I an A-B-C-D?
- Dense breast group younger, leaner, and on hormone replacement therapy
- Ultrasound is a better tool than Mammogram for dense breasts.
Minute 26:50
Compression – mammograms apply 44# of pressure to your breast tissue. The concern has been whether that pressure causes cancer cells that are present to enter the circulation and spread elsewhere in the body. The study by Fornvik measured that very element and showed that indeed tumor cells and tumor DNA was found to be at higher levels in the blood stream immediately after a mammogram in women who had a breast mass.
- Detection of circulating tumor cells and circulating tumor DNA before and after mammographic breast compression in a cohort of breast cancer patients scheduled for neoadjuvant treatment. Förnvik, Aaltonen, et al. Breast Cancer Research and Treatment (2019).
Minute 29:00
Metastasis from small breast cancer masses.
- Primary breast cancer is not what kills women. It is the metastasis that leads to death.
- Aggressive cancer types tend to spread early on in their course when they are smaller in size than mammogram can pick up.
- In other words mammogram is best at detecting less aggressive cancers that are growing more slowly and of less threat than it is at finding smaller aggressive metastatic cancer types.
Minute 31:00 *** KEY Discussion
SIZE – understanding the natural history of tumor growth:
- Most breast cancers when they are discovered my mammogram are already >20 years old so to say that mammograms find cancer “early” is not actually true.
- On average, one single tumor cell has to double in size 29 times before a mammogram has a chance of detection. That = 1 billion cells = 1cm big (10mm)
- A 10-mm diameter tumor has 1 billion cells after 29 doublings, and (average doubling time of 260 days), is about 20.7 years old.
- In the United States, the median symptomatic (no mammo screening) invasive tumor is about 21mm (20mm= 32 doublings, 22.8 years)
- Median screen-detected invasive tumor is 16mm (16mm= 31 doublings or 1 cm, 21.4 years).
- The difference is 5mm or 1.4 years between mammogram detection vs self-exam detection.
Minute 36:20
Screening Tools: Mammogram vs Ultrasound vs Thermogram vs MRI
- Dr Google says: Mammography is the gold standard for early breast cancer detection, and the benefits of early detection outweigh the risks.
- The standard recommendation is for women to get an annual mammogram starting at age 40. However, you should talk to your healthcare provider about your breast cancer risk factors to see if you should start mammograms earlier.
- I find this recommendation to be false, inaccurate and driven by politics, power, fear and an $$8 billion dollar industry.
- Ultrasound - Study by Chen shown above shows ultrasound to be more sensitive and safer.
- Thermogram, the study by Omranipour showed thermogram to be equally sensitive to mammograms. Other studies so similar or even better results. No perfect by any means but worthy of consideration and is FDA approved.
- Comparison of the Accuracy of Thermography and Mammography in the Detection of Breast Cancer. Omranipour, Kazemian, et al. Breast Care - 2016
- MRI is 90% sensitive – more sensitive than mammogram but will also provide more false positives. Worthy option that has no radiation and no compression of breast.
Minute 38:30
Cost of scans – ultrasound, thermogram and MRI
- Ultrasound – 2 options. No prescription needed.
- HerScan $300 https://www.herscan.com/
- ProScan $200 (October thru December)
- Thermogram – typically costs around $300
- MRI – Proscan offers a special price every October of $399 without contrast.
Minute 42:20
My Doctor – why don’t they recommend alternatives beyond mammogram?
- Doctors are financially incentive to offer mammograms and penalized if they don’t.
- Peer pressure and fear are also drivers.
Minute 44:45
MRI – pros and cons
- No radiation but gadolinium contract is used.
- More false(+) reports
- Dense breast tissue is not a problem for MRI
- You need a prescription from a doctor.
Minute 47:00
Metastatic disease, DCIS & Invasive breast cancer – Mammograms problematic.
- The Keen study shows clearly that when mammograms were used as a regular part of screening programs we saw a clear and obvious increase in the amount of DCIS and invasive breast cancer occurrence.
- Metastatic disease rates didn't budge.
- Screening participants increased lumpectomy rates 30% and mastectomies increased 20%.
Keen, Kasten, et al. Journal of Women’s Health – 2015
Minute 48:15
BRCA discussion
- Clinical clues to look for to gauge your risk for having an abnormal BRCA gene
- Strong family history of breast, ovarian or prostate cancer in first degree relatives.
- Family history of being diagnosed with breast cancer before age 50, having multiple breast cancers, or having breast cancer in both breasts
- Having a close relative with a known BRCA mutation
- Ashkenazi Jewish ancestry
- Having male breast cancer, or having pancreatic or prostate cancer in combination with breast cancer or ovarian cancer
Minute 50:30
Top 10 Actions to reduce breast cancer risk:
Vitamin D - one study showed women with vitamin D levels <20 ng/mL = 45% higher risk of breast cancer.
Plastics – mess with your hormones, studies show strong correlation (GH says >10% risk increase)
Sugar & Insulin resistance / diabetes – increases risk by 10-20%
Organic food – 14,000 food additives and >250 have been linked to breast cancer
Trans Fats & Hydrogenated Oils – avoid processed foods & fast foods (14% incr risk)
Cruciferous vegetables – veggies in general affects estrogen metabolism (Reduce risk by 15%)
Alcohol – moderate drinker (0.5-1/day) 23% incr, heavy drinkers (8/week) 60% increase.
Exercise – reduces risk by 15-20%
Obesity - For every 5-point increase in BMI, the risk of breast cancer increases by 12%.
Stress & Sleep – strong correlation with accelerated growth. Night shift. Apnea.
Weakens immune system status – less vigilant – reduce killer cell pop.
Chelsea’s “B’s” – Bars (booze) – Bras (tight) – Bottles (plastics) – Broccoli (detox)
Huber Personalized Medicine is offering our comprehensive breast health package that provides every aspect of our talk today with the key elements to ensure the safest path forward with regard to breast health. Call our office for more details.
- If you want to sit with Chelsea and design your own personalized approach then make an appointment by calling our office at Phone: 513-924-5300.
Comments from experts from around the world:
Michael Baum, professor of surgery at the University College, London, was involved in setting up the breast cancer screening program in the UK 20 years ago. Now he is an outspoken critic against mammography.
He states, “I have watched with increasing alarm as evidence has accumulated that suggests the initial estimates of benefit were exaggerated and the initial estimate of harm was, frankly, ignored. What has gone wrong is that we would never have predicted how many of these cancers detected at screening lack the potential to threaten the woman’s life.”
Peter Gotzsche, M.D., author of Mammography Screening: Truth, Lies and Controversy, states,
“Screening saves probably one life for every 2,000 women who go for a mammogram. But it harms 10 others. Cancerous cells that will go away or never progress to disease in the woman’s lifetime are excised with surgery and sometimes (six times in 10) she will lose a breast. Treatments with radiotherapy and drugs, as well as the surgery itself, all have a heavy mental and physical cost. I believe the time has come to realize that breast cancer screening programs can no longer be justified.”
Dr. H. Gilbert Welch, Dartmouth Institute for Health Policy,
ARTICLE: “The trouble with mammograms” “For too long, we’ve taken a brain-dead approach that says the best test is the one that finds the most cancers – but that’s wrong. The goal of routine breast cancer screening is to prevent women from dying of breast cancer. Yet studies have shown that the popular claim ‘early detection saves lives’ is not actually true.”
Eric Topol, M.D.
Medscape Editor-in-Chief and practicing cardiologist at Scripps in California
ARTICLE he wrote: “Time to End Routine Mammography.”
States, “All of the data now available point to significant net harm—far more risk than benefit— for routine mammography. If this were a drug, the US Food and Drug Administration (FDA) would never approve it. Last year, the Swiss Medical Board, after reviewing all of the data, recommended abolishing mammography.”
Samuel Epstein, M.D. – chairman of the Cancer Prevention Coalition, and author of 270 scientific articles and 15 books on the causes and prevention of cancer states:
“Radiation from routine mammography poses significant cumulative risks of initiating and promoting breast cancer. Contrary to conventional assurances that radiation exposure from mammography is trivial – and similar to that from a chest X-ray or spending one week in Denver, the routine practice of taking four films for each breast results in some 1,000-fold greater exposure. Premenopausal women undergoing annual screening over a ten-year period have an increased breast cancer risk by 1 percent per year resulting in a cumulative 10 percent increased risk over ten years.”
REFERENCES
Chemicals in our food = Breast cancer risk.
Application of the Key Characteristics Framework to Identify Potential Breast Carcinogens Using Publicly Available in Vivo, in Vitro, and in Silico Data
https://ehp.niehs.nih.gov/doi/10.1289/ehp13233
Compression causes spread of cancer cells: Fornvik 2019
Detection of circulating tumor cells and circulating tumor DNA before and after mammographic breast compression in a cohort of breast cancer patients scheduled for neoadjuvant treatment
Sensitivity of Ultrasound vs Mammogram - Chen 2021
Comparison of the sensitivity of mammography, ultrasound, magnetic resonance imaging and combinations of these imaging modalities for the detection of small (<2cm) breast cancer
DCIS Increase after Mammogram programs initiated - Keen 2015
Four Principles to Consider Before Advising Women on Screening Mammography