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the major cause of cancer, including breast cancer, as well as heart —_—s more testing, requiring women to be exposed to additional X-rays, disease in the US." creating a more stressful environment and possibly even leading Dr Samuel Epstein warns: "There is clear evidence that the to unneeded surgery. breast, particularly in premenopausal women, is highly sensitive A large-sample, long-term Canadian study, published in to radiation, with estimates of increased risk of up to 1% for every September 2000, proved that an annual mammogram was no more rad (radiation absorbed dose) unit of X-ray exposure. This pro- effective in preventing deaths from breast cancer than periodic jects up to a 20% increased cancer risk for a woman who, in the physical examinations for women in their 50s. In the study of 1970s, received 10 annual mammograms of an average two rads almost 40,000 women aged 50 to 59, half received periodic breast each. In spite of this, up to 40% of women over 40 have had examinations alone and half received breast examinations plus mammograms since the mid-1960s, some annually and some with mammograms. All learned to examine their own breasts as well. exposures of 5-10 rads in a single screening from older, high- By 1993, 13 years after the study began, there were 610 cases of dose equipment. Even for low-dosage exposure of two rads or invasive breast cancer and 105 deaths in the women who received less, this exposure can add up quickly for women having an annu- only breast examinations, compared with 622 invasive breast can- al mammography. More recent concern comes from evidence that cers and 107 deaths in those who received breast examinations 1% of women or over one million women in the United States and mammograms."* alone carry a gene that increases their breast cancer risk from radi- "They found smaller cancers, but ultimately the mortality rate ation fourfold." was the same," said Suzanne Fletcher, Professor of Preventive According to Sharon Batt, author of Medicine at Harvard Medical School. She Patient No More: The Politics of Breast added that cancer screening programs are Cancer, in her keynote address at the built on the assumption that "finding it earli- Second World Conference on Breast Cancer er is finding it better", but this study "ques- in 1999: "The depths of the mammography " . Waa! tions that assumption".'° deceit began in the early 1970s. It was con- The bottom line, said "The bottom line," said Cornelia Baines, cocted by insiders at the American Cancer Cornelia Baines, co-author of the study and Professor of Society and their friends at the National Public Health Sciences at the University of Cancer Institute. The number of women co-author of the study Toronto, "is that the addition of annual mam- ofthis nefarious scheme is not own but | 2N@ Professor Of PUBle | ere cor on breast canoer survival” estimated to be huge. In 1978, Irwin J.D. Health Sciences at the To add to the mammography controversy, Bross Diet of Bios at o-vell | University of Toronto, — | ty mbt inh pesos Zona Research, commented about the cancer "is that the addition of that mammography screening for breast screening program: cancer offers only minimal gains in life "'The women should have been annual mammography expectancy for women beyond the age given the information about the haz- screening to physical of 69—a factor which should be taken examination has ards of radiation at the same time they into consideration when elderly women were given the sales talk for mammog- . are deciding about breast cancer screen- no impact on breast cancer survival." raphy. Doctors were gung-ho to use it ing. Mammography offers the greatest on a large scale. They went right potential benefit for women between 50 ahead and X-rayed not just a few and 69 years old; beyond that, the bene- women but a quarter of a million fits are pretty small, according to the women. A jump in exposure of a quar- study.'* ter of a million persons to something Another problem with mammograms which could do more harm than good is that interpretation is often wrong. In was criminal and it was supported by 1996, the journal Archives of Internal money from the federal government Medicine published results of a test of and the American Cancer Society. 108 radiologists throughout the United States. The test used a set "'The National Cancer Institute was warned in 1974 by of 79 mammograms where the diagnosis had been verified by Professor Malcolm C. Pike, at the University of Southern subsequent biopsies, surgeries or other follow-up. The radiolo- California School of Medicine, that a number of specialists had gists missed cancer in 21% of the films, thought 10% of the concluded that "giving a women under age 50 a mammogram on a women with no breast disease had cancer and thought 42% of routine basis is close to unethical". Repeat... The experts in the benign lesions were cancerous.” government were told not to do this to healthy women in the year Another study looked at the records of 8,779 postmenopausal 1974!" women who had undergone mammography, and found that The Lancet reported in 1995 that, since mammographic screen- women taking oestrogen had 33% more false positives (mammo- ing was introduced in 1983, the incidence of ductal carcinoma in grams showed an abnormality but none could be found) and 423% situ (DCIS), which represents 12% of all breast cancer cases, has more false negatives (mammograms which missed an abnormality increased by 328%, and 200% of this increase is due to the use of _ that showed up later) than women not taking oestrogen.” mammography. This increase is for all women. Since the incep- Further, mammograms are not diagnostic and too frequently tion of widespread mammographic screening, the increase for lead to unnecessary breast biopsies—an expensive, invasive surgi- women under the age of 40 has gone up over 3,000%."* cal procedure which causes extreme anxiety, some pain and often In addition, mammography provides false tumour reports physical harm to many women who do not have cancer. between 5% and 15% of the time. False positive results mean According to the 1998 edition of the Merck Manual, for every "The bottom line," said Cornelia Baines, co-author of the study and Professor of Public University of Toronto, “is that the addition of annual mammography screening to physical examination has APRIL — MAY 2001 NEXUS = 43 Health Sciences at the no impact on breast cancer survival." www.nexusmagazine.com