In a study published in The Lancet Oncology, scientists analyzed the effectiveness of breast cancer screening in Great Britain. The researchers concluded that mammograms beginning at age 40 or 41, as opposed to the recommended age 50 by the NHS, were associated with a relative reduction in breast cancer mortality.
They noted that a 2010 study found that early screening in ages 40 or 41 to 48 resulted in an 18.1 percent false positive rate which resulted in cytology and surgical and nonsurgical biopsies in women who ended up not actually having cancer. Even so, they still reported that their own study showed a statistical reduction of mortality in the first 10 years.
Other experts found the data from this study showed no statistical differences, and even the study’s researchers noted that “the absolute reduction remained constant.” They also admitted that “after more than 10 years of follow-up, no significant reduction was observed” and that “overall, there was no significant difference” in breast cancer deaths—just as their critics said.
According to the American Cancer Society, 73 percent of women over 45 had a screening mammogram within the past two years. In the United States, these percentages add up to an overwhelming number of women. There were 61.91 million women from age 40 to 70 in July 2019.
Assuming a woman stops having mammograms at age 70, there may have been 45.19 million women who have had a mammogram in the past two years. When you consider the average cost of a mammogram is $100, the total revenue generated may be close to $4.5 billion. Although your out-of-pocket expense may not be $100 per test, someone is paying the charges.
No Answers From New Study About Early Mammograms
The UK Age trial was designed to compare annual mammograms in women who begin getting the test at age 40 to those beginning at age 50, against cancer mortality. The first results of the trial were published in The Lancet in 2015 after 17 years of follow-up.The study enrolled 160,921 women from October 1990 to September 1997. Of these women, 53,883 joined the intervention group in which they received a mammogram nearly every year until age 48. Another 106,953 women were in a control group who received usual medical care, in which they didn’t receive their first mammogram until at least age 50.
The results published after a median follow-up of 17 years were similar to those published five years later in the final results. While the participants were randomly assigned to the intervention or control group, the researchers chose to include 33.5 percent in the intervention group and 66.5 percent in the control group.
From the start of the study until February 28, 2017, the women were followed for a median of 22.8 years. During this time, the researchers believe their statistics showed a reduction in breast cancer mortality at 10 years of follow-up but no significant reduction after age 50.
“No difference in mortality from breast cancer was found between the group that began yearly mammography screening at age 39-41 years until they entered the National Health Service (NHS) Breast Screening Programme at age 50-52 years and a group that did not begin mammography screening until they entered the NHS Breast Screening Programme.”
“... overall there was no mortality reduction in the intervention group compared to the control group by the end of follow-up.”
Data Show Screening Asymptomatic Women Isn’t Saving Lives
The third response to this research paper, also published in the BMJ, was written by Hazel Thornton, honorary visiting fellow, department of health sciences at the University of Leicester. In it, she also finds the statistics don’t support the conclusion reached. She has been a long-term critic of overscreening and explained why in her testimony before the United Kingdom’s House of Commons Health Committee on breast cancer services as a witness in 1995.She was asked why she thought the NHS Breast Screening Programme was “a costly trawl of an asymptomatic public group ... creating huge costly psychological and physical morbidity.” To which part of her answer was because it “focuses on the women who benefit, in other words, the one life that is saved, and it overlooks the hundreds of women that go through the process and in some cases suffer psychological harm for that one. It is unbalanced and disproportionate and should be reviewed, in my opinion, at the moment.”
In 2014, the BMJ published a 25-year follow up from the Canadian National Breast Screening Study in which the researchers found 22 percent of the screening-detected invasive breast cancers were overdiagnosed.
“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,” they concluded.
In a Cochrane review of the literature to analyze the efficacy of screening mammograms, researchers found eight trials that met the review criteria, which included 600,000 women from ages 39 to 74. After an analysis of the data, they discovered that—as Thornton testified—for every 2,000 women screened over 10 years, one avoids dying of breast cancer, and 10 will be treated unnecessarily.
Overdiagnosis, Overtreatment, and Overexposure
In 2012, The New England Journal of Medicine published a research paper by two scientists who examined more than 30 years of data trends looking at the incidence of early- and late-stage breast cancer in women 40 years and older. What they found caused some controversy, which led one of the authors to produce a short video explaining the results.The expectation that doctors would find a greater number of early-stage cancers should have been accompanied by a comparable reduction in the number of women who presented with advanced cancer. This wasn’t the case, suggesting there is a substantial number of women who are overdiagnosed, and that “screening is having, at best, only a small effect on the rate of death from breast cancer.”
In this video, the presenter makes the point that nearly “half of screen-detected breast cancer now represent overdiagnosis.” The harm from overdiagnosis doesn’t stop with the psychological distress it causes a woman and her family. It also leads to overtreatment, and treatment often begins with a biopsy.
The most common type of biopsy for breast cancer is a needle biopsy. The doctor has a choice between a fine needle aspiration (FNA) or a core needle biopsy of the breast tissue. According to the American Cancer Society, a core needle biopsy is the preferred type when breast cancer is suspected since it removes more tissue than an FNA without needing surgery.
“Manipulation of an intact tumor by FNA or large-gauge needle core biopsy is associated with an increase in the incidence of SN [sentinel node] metastases, perhaps due in part to the mechanical disruption of the tumor by the needle.”
False-positive mammograms cost the United States $4 billion each year when treatment has started after a misdiagnosis, including chemotherapy and mastectomies, only to find the tumor is benign. This places an extraordinary emotional, mental, and financial burden on the woman and her family.
You Have Choices
Although mammography is most often recommended, women have choices for diagnostic tests that don’t use radiation. Women should be provided with information to make informed decisions and be allowed to use their choice. Other potentially safer options include self and clinical breast exams, thermography, ultrasound, and MRI.Thermography and ultrasound use no radiation and can detect abnormalities that mammograms may miss, especially in women who have dense breast tissue. While effective, these tests can be difficult to access in the United States.
It’s also important to understand that screening doesn’t prevent breast cancer. Instead, prevention involves healthy lifestyle choices, avoiding toxins, and paying attention to certain nutritional factors. Vitamin D is a vital nutritional factor that can radically reduce your risk of breast cancer.
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