You probably think mammograms save a lot more lives than they actually do.
Mammograms save, at most, one additional life for every 1,000 people screened, a recent review of the medical literature found. We tend to think they do a lot more: one survey of 50-year-old American women found them to think an additional 80 lives are saved for the same 1,000 screenings.
The chart comes from the Swiss Medical Board, which recently recommended that the country phase out mammography screening programs. Their recommendation caused an uproar, but the board still stands by it.
“It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer,” members of the board wrote in the New England Journal of Medicine. “We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so.”
The board’s defense follows a 25-year follow-up to the original Canadian National Breast Screening Study that found mammograms do not reduce the fatality rate of breast cancer more than physical examination and other forms of care. And as The New York Times pointed out in its analysis of the study, the findings mean a lot of women are overdiagnosed for breast cancer and get unnecessary treatments as a result.
The New England Journal Of Medicine, 2012, Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence, By: Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H., 2012; 367:1998-2005 November 22, 2012.
“We estimated that in 2008, breast cancer was overdiagnosed in more than 70,000 women; this accounted for 31% of all breast cancers diagnosed. This approach suggests that the excess detection attributable to mammography in the United States involved more than 1.3 million women in the past 30 years.”
Why Mammography Screening is being Abolished in Switzerland
Swiss Medical Board, December 15, 2013, Systematic Mammography Screening
After a year of reviewing the available evidence regarding Mammography and its implications, the Swiss Medical Board noted they became “increasingly concerned” about what they were finding. The “evidence” simply did not back up the global consensus of other experts in the field suggesting that mammograms were safe and capable of saving lives.
On the contrary, mammography appeared to be preventing only one death for every 1,000 women screened, while causing harm to many more. Their thorough review left them no choice but to recommend that no new systematic mammography screening programs be introduced, and that a time limit should be placed on existing programs.
The report caused an uproar among the Swiss medical community, but it echoes growing sentiments around the globe that mammography for breast cancer screening no longer makes any sense.
New England Journal of Medicine, 2014; 370:1965-1967, May 22, 2014
Abolishing Mammography Screening Programs? A View from the Swiss Medical Board
Nikola Biller-Andorno, M.D., Ph.D., and Peter Jüni, M.D.
“It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors. We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify. Providing clear, unbiased information, promoting appropriate care, and preventing overdiagnosis and overtreatment would be a better choice.”
British Medical Journal 2014, BMJ 2014;348:g366
Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial, By: Miller et al
One of the largest and longest studies of mammography to date — involving 90,000 women followed for 25 years.
It found that mammograms have absolutely NO impact on breast cancer mortality.
Over the course of the study, the death rate from breast cancer was virtually identical between those who received an annual mammogram and those who did not, while 22 percent of screen-detected invasive breast cancers were over-diagnosed, leading to unnecessary treatment. The experts noted: “This means that 106 of the 44,925 healthy women in the screening group were diagnosed with and treated for breast cancer unnecessarily, which resulted in needless surgical interventions, radiotherapy, chemotherapy, or some combination of these therapies.”
25 year study.png
Cochrane Database of Systematic Reviews 2013;6:CD001877.
Screening for breast cancer with mammography.
By: Gøtzsche PC, Jørgensen KJ.
A Cochrane Collaboration review also found no evidence that mammography screening has an effect on overall mortality, which, taken together, seriously calls into question whether mammography screening really benefits women. According to the authors of the Cochrane review: “If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings.”
British Medical Journal, 2009; 339: b2587
Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends.
By: Gøtzsche PC, Jørgensen KJ.
“One in three breast cancers detected in a population offered organised screening is overdiagnosed.”
“up to 31% of all breast cancer diagnoses in 2008 were overdiagnoses.”
The New Zealand Breast Cancer Foundation
A 2007 systematic review in Lancet Oncology found the proportion of overdiagnosis of invasive breast cancer among women in their 50s was up to 54%. Biesheuvel C, Barratt A, Howard K, Houssami N, Irwig L. Effects of study methods and biases on estimates of invasive breast cancer overdetection with mammography screening: a systematic review. Lancet Oncol 2007;8:1129-38.
A 2010 Australian study estimated the breast cancer overdiagnosis rate was at least 30%. Morrell S, Barratt,A, Irwig L, Howard K, Biesheuvel C, Armstrong B. Estimates of overdiagnosis of invasive breast cancer associated with screening mammography Cancer Causes Control 2010;21:275-82.
A 2012 Norwegian study calculated the breast cancer overdiagnosis rate at 15-25%.
26 Kalager M, Adami H, Bretthauer M, Tamimi R. Overdiagnosis of invasive breast cancer due to mammography screening: results from the Norwegian screening program. Ann Intern Med 2012;156:491-9.
Archives of Internal Medicine, 2008;168(21):2311-2316.The Natural History of Invasive Breast Cancers Detected by Screening Mammography, By: Zahl et al.
This study demonstrated that breast cancer rates increased significantly in Norway after women began getting mammograms every two years. The study showed that the start of screening mammography programs throughout Europe has been associated with increased incidence of breast cancers.
“The introduction of screening mammography has been associated with sustained increases in breast cancer incidence…the natural course of some screen-detected invasive breast cancers is to spontaneously regress…our findings simply provide new insight on what is arguably the major harm associated with mammographic screening, namely, the detection and treatment of cancers that would otherwise regress.”
25% or more of screening detected lung cancers may be overdiagnosed
Thorax, 2008; 63: 377-83.
A critical appraisal of overdiagnosis: estimates of its magnitude and implications for lung cancer screening. By: J M Reich
“Approximately 25%, possibly more, of radiographically (chest x ray) diagnosed LC (Lung Cancer) appears to be overdiagnosed”
Much of the observed increase in Thyroid cancer may be overdiagnosis
Journal of The American Medical Association, May 10, 2006, Vol 295, No. 18, pages 2164-2167, Increasing incidence of thyroid cancer in the United States, 1973-2002.
By: Louise Davies, MD, MS; H. Gilbert Welch, MD, MPH
“increasing incidence reflects increased detection of subclinical disease, not an increase in the true occurrence of thyroid cancer.”
A South Korean study concurs.
New England Journal of Medicine 2014; 371:1765-1767, November 6, 2014
Korea’s Thyroid-Cancer “Epidemic” — Screening and Overdiagnosis, By: Ahn et al
In 1999, the government initiated a national screening program for cancer and other common diseases. In 2011, the rate of thyroid-cancer diagnoses was 15 times that observed in 1993. The chart below illustrates hat even as the number of diagnoses have skyrocketed, thyroid-cancer related death rates held constant. It is an epidemic of overdiagnosis.
Even the National Cancer Institute admits that Mammograms cause overdiagnosis and harm!
National Cancer Institute Breast Cancer Screening–for health professionals (PDQ®)
Overview section LINK
“Of all breast cancers detected by screening mammograms, up to 54% are estimated to be results of overdiagnosis…6% to 46% of women with invasive cancer will have negative mammograms…annual mammograms in women aged 40 to 80 years may cause up to one breast cancer per 1,000 women…Approximately 50% of women screened annually for 10 years in the United States will experience a false-positive, of whom 7% to 17% will have biopsies.”
There are a ridiculous number of false positives in cancer screenings
Cancer Epidemiology, Biomarkers & Prevention, December 2004 13; 2126
The Economic Impact of False-Positive Cancer Screens, By: Lafata et al.
1,087 individuals participating in a cancer screening trial received a battery of tests for prostate, ovarian, colorectal and lung cancer, 43% had at least one false positive test result. That’s almost half of the patients who were tested!
“The reality is that false-positive findings among those undergoing cancer screenings are relatively common, usually constituting the large majority of all positive findings and often leading to follow-up investigations that do not result in a cancer diagnosis.”
Additional studies support this finding…
1. Barton MB, Moore S, Polk S, et al. Increase Patient Concern after False-positive Mammograms. JGIM 2001;16:150 – 6.
2. Woolf SH, Rothemich SF. Screening for prostate cancer: the roles of science, policy, and opinion in determining what is best for patients. Annu Rev Med 1999;50:207 – 21.
3. Simon JB. Fecal occult blood testing: clinical value and limitations. Gastroenterologist 1998;6:66 – 78.
4. Gambert SR. Prostate cancer. When to offer screening in the primary care setting. Geriatrics 2001;56:22 – 31.
After decades of wrongful cancer diagnoses and treatments, and millions harmed, the National Cancer Institute and the Journal of the American Medical Association finally and quietly admit they were wrong.
Back in 2012, The National Cancer Institute convened an expert panel to evaluate the problem of cancer’s misclassification and subsequent overdiagnosis and overtreatment, determining that millions may have been wrongly diagnosed with “cancer” of the breast, prostate, thyroid, and lung, when in fact their conditions were likely harmless, and should have been termed “indolent or benign growths of epithelial origin.” No apology was issued. No major media coverage occurred. And more importantly, no radical change occurred in the conventional practice of cancer diagnosis, prevention, or treatment. The report appeared in JAMA in 2013.
Essentially, in one sleight of the semantic hand, entire swaths of the U.S., and global population, who thought they had “lethal cancer,” and were subsequently treated for it, often with violent procedures and treatments, were being told that “oops… we got that wrong. You never had cancer after all.”
If you look at the problem through just breast cancer overdiagnosis and overtreatment in the U.S. over the past 30 years, it has been estimated that approximately 1.3 million women were wrongly treated. Most of these women still have no idea they were victims, and many have identified with their “aggressors” in Stolkholm syndrome like fashion, because they think their “lives were saved” by unnecessary treatment, when in fact the side effects, both physical and psychological, have almost certainly reduced both the quality and duration of their lives. Just think of all those women who wear their pink ribbons and are so proud to be a survivor, who never had cancer at all… I can assure you, it is very easy to cure cancer when someone doesn’t have it.
When the National Cancer Institute report was released, it was a sort of vindication for those of us who had been advocating the position that a commonly diagnosed form of so-called “early breast cancer” known as ductal carcinoma in situ was in fact not inherently malignant and should not have warranted the conventional treatments of lumpectomy, mastectomy [especially here in Phil], radiation, and chemotherapy. I based this position on available research on the natural history of DCIS, and the extremely high survival rates from DCIS, as well as the fact that breast cancer-related mortality has not declined in pace with the expansion of so-called “zero” or “early stage” cancers detected through mammography screenings, as would be expected if these diagnoses actually represented harmful clinical entities.
To learn more about this still under-reported tragedy in women’s healthcare, watch Dr. Gilbert Welch’s video.
Since then, I have watched the problem of overdiagnosis and overtreatment closely. I get daily updates from pubmed.gov on the topic, and increasingly, high impact and gravitas journals are reporting on this highly concerning phenomenon. Particularly relevant is a review published late last year in JAMA which shows an astounding number of medical procedures have no benefit, and even harm.
The JAMA study found that a wide range of standard medical procedures and interventions that millions are subjected to annually, are not evidence-based, as commonly assumed, and have little to no benefit, and may even be causing significant harm. As a result, I now believe that good medicine often involves doing as much nothing as possible. I also think that people should be aware that any conventional cancer diagnosis has the ability to exert lethal harm via the nocebo effect, regardless of its accuracy (i.e., even a misdiagnosis can result in lethal consequences because the power of belief).
Thyroid Cancer Epidemic Caused by Misinformation, Not Cancer
Another topic I have been trying to spread awareness about is thyroid cancer overdiagnosis and overtreatment. A series of compelling studies from around the world revealed that the rapid increase in diagnoses in thyroid cancer reflected their misclassification and misdiagnosis. As was the case with screening detected breast and prostate “cancers,” and even many ovarian “cancers,” the standard of care often required the removal of the organ, as well as irradiation and chemotherapy — two interventions known to promote, not inhibit cancer.
As is typical of research that undermines the conventional standard of care, there has been little reporting on the topic. That is, until now.
On April 14th 2016, in an article titled “Its Not Cancer: Doctors Reclassify a Thyroid Tumor,” the New York Times reported on a new study published in JAMA Oncology which should forever change the way we classify, diagnosis and treat a common form of “thyroid cancer”:
An international panel of doctors has decided that a type of tumor that was classified as a cancer is not a cancer at all.
As a result, they have officially downgraded the condition, and thousands of patients will be spared removal of their thyroid, treatment with radioactive iodine and regular checkups for the rest of their lives, all to protect against a tumor that was never a threat.
Their conclusion, and the data that led to it, was reported Thursday in the journal JAMA Oncology. The change is expected to affect about 10,000 of the nearly 65,000 thyroid cancer patients a year in the United States. It may also offer grist to those who have been arguing for the reclassification of some other forms of cancer, including certain lesions in the breast and prostate.
The reclassified tumor is a small lump in the thyroid that is completely surrounded by a capsule of fibrous tissue. Its nucleus looks like a cancer but the cells have not broken out of their capsule, and surgery to remove the entire thyroid followed by treatment with radioactive iodine is unnecessary and harmful, the panel said. They have now renamed the tumor. Instead of calling it “encapsulated follicular variant of papillary thyroid carcinoma,” they now call it “noninvasive follicular thyroid neoplasm with papillary-like nuclear features,” or NIFTP. The word “carcinoma” is gone.
Many cancer experts said the reclassification was long overdue. For years there have been calls to downgrade small lesions in the breast, lung and prostate, among others, and to eliminate the term “cancer” from their name. But other than the renaming of an early stage urinary tract tumor in 1998, and early stage ovarian and cervical lesions more than two decades ago, no group other than the thyroid specialists has yet taken the plunge.
In fact, said Dr. Otis Brawley, chief medical officer at the American Cancer Society, the name changes that occurred went in the opposite direction, scientific evidence to the contrary. Premalignant tiny lumps in the breast became known as stage zero cancer. Small and early-stage prostate lesions were called cancerous tumors. Meanwhile, imaging with ultrasound, M.R.I.’s and C.T. scans find more and more of these tiny “cancers,” especially thyroid nodules.
“If it’s not a cancer, let’s not call it a cancer,” said Dr. John C. Morris, president-elect of the American Thyroid Association and a professor of medicine at the Mayo Clinic. Dr. Morris was not a member of the renaming panel.
Dr. Barnett S. Kramer, director of the division of cancer prevention at the National Cancer Institute, said, “There’s a growing concern that many of the terms we use don’t match our understanding of the biology of cancer.” Calling lesions cancer when they are not leads to unnecessary and harmful treatment, he said.
The article goes on to discuss the fact that, while some major medical centers are starting to treat encapsulated thyroid tumors less aggressively, this is still not the norm in the rest of the country. It is a consistent pattern that there is a lag of over a decade between changes in evidence and the clinical practice of medicine, which therefore makes medical practice far less “evidence-based” than is commonly claimed and/or assumed.
Clearly, the truth about cancer’s true nature, and the cancer industry’s misrepresentations, are beginning to come to light via the very institutions like JAMA and the major media who have been responsible, historically, for generating so many commonly held misconceptions on the topic.
An at-risk group for mammograms are women with the BRCA 1/2 mutation, which is associated with an increased risk of breast cancer. Results published in BMJ in 2012 showed that women carrying this mutation are particularly vulnerable to radiation-induced cancer.
British Medical Journal, 2012
Exposure to diagnostic radiation and risk of breast cancer among carriers of BRCA1/2 mutations: retrospective cohort study (GENE-RAD-RISK) BMJ 2012;345:e5660
By: Pijpe Anouk, Andrieu Nadine, Easton Douglas F, Kesminiene Ausrele, Cardis Elisabeth, Noguès Catherine et al.
Women carrying this mutation who were exposed to diagnostic radiation before the age of 30 were twice as likely to develop breast cancer, compared to those who did not have the mutated gene. They also found that the radiation-induced cancer was dose-responsive, meaning the greater the dose, the higher the risk of cancer developing. The authors concluded that: The results of this study support the use of non-ionizing radiation imaging techniques (such as magnetic resonance imaging [MRI]) as the main tool for surveillance in young women with BRCA1/2 mutations.”
Despite these findings, the National Cancer Institute reports that the American Cancer Society and the National Comprehensive Cancer Network, now recommend annual screening with mammography and MRI for women who have a high risk of breast cancer.
National Cancer Institute BRCA 1 and BRCA 2 Cancer Risk and Genetic Testing Reviewed April 1, 2015
This is the exact scenario that the British Medical Journal study found doubles their breast cancer risk!
Maybe your diagnosis wasn’t even correct…
BMJ Quality & Safety, 2014; 23 :727–731
The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations, By: Singh et al
“Our population-based estimate suggests that diagnostic errors affect at least 1 in 20 US adults…or approximately 12 million US adults every year.”
NBC News– “Misdiagnosed: Docs’ Mistakes Affect 12 Million a Year”
CBS News- “Study: 12 Million Americans Misdiagnosed Each Year”
UK Mail– “TWELVE MILLION Americans receive the wrong medical diagnosis every year”
BMJ Press release “At least 1 in 20 adult outpatients misdiagnosed in US every year “
The 2009 Consumer Reports National Research Center Patient experience Questionaire put the rate of diagnostic errors at “more than 10 percent”.
- More than one-in-ten respondents reported a diagnostic mishap—
- 7% have had diagnostic procedures done over because the first one was lost.
- 12% reported that they have had diagnostic procedures that were not done properly.
- 11% reported a medical professional misinterpreting a diagnostic procedure.
- 9% of reported being given the wrong medicine when they filled their prescription.
- 7% reported a severe reaction in combination with another drug they were taking.
- 40% had to fill out a medical history more than once for the same doctor or hospital.
- 13% have had their medical records lost or misplaced.
- 13% said that incorrect information had been entered into their medical record.
Even the National Cancer Institute publishes grave overdiagnosis data
Journal of the National Cancer Institute 2010; 102:605–613
Overdiagnosis in Cancer, By: H. Gilbert Welch, William C. Black
“We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen–detected prostate cancers.”
According to a landmark Danish report from the British Journal of Cancer, 39% of forensic autopsies of women age 40–49 show clinically occult breast cancer, a number much larger than the lifetime risk of breast cancer of 12.4% in US and 6.5% in Denmark [1,2]. Based on this information alone, it could legitimately be argued that mammography should not be routinely recommended for women age 40–49. This clearly demonstrates that breast cancer is not neccesarily deadly.
1. Nielsen, M.; Thomsen, J.L.; Primdahl, S.; Dyoreborg, U.; Andersen, J.A.; Breast cancer and atypia among young and middle-aged women: a study of 110 medicolegal autopsies. Br. J. Cancer 1987, 56, 814–819.
2. National Cancer Institute FactSheet. Probability of Breast Cancer in American Women. 2012. Available online at http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer
Even cancer testing procedures can be deadly.
“Of the nearly 27,000 people who got 3 CT scans, 40% had an abnormal finding. They received additional diagnostic tests ranging from repeat CT scans to more invasive bronchoscopy (a tube placed in the mouth, down the throat and into the lungs), or even more invasive needle biopsies of the lung. More than 95% of these additional tests did not result in a cancer diagnosis.
Among those who got CT screening, a total of 16 participants died within 60 days after an invasive diagnostic procedure that was done to find out more about their abnormal finding (positive screen). Six of the 16 ultimately did not have lung cancer. It is not certain how many of these people died specifically due to the invasive procedure, but it does remind us that a screening test can lead to some dangerous diagnostic tests.”
Dr. Otis W. Brawley, M.D., F.A.C.P., chief medical officer for the American Cancer Society from the report: