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Mammograms Identify Small Breast Cancers But do They Save Lives?

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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.

No matter how many different ways I questioned cancer screening, Mary (not her real name) continued to fall back on the often made statement that “mammograms save lives!” Mary is an intelligent, well-educated close friend and former co-worker who had a mammogram that revealed a tumor in her breast. She then made the decision to have a double mastectomy. Like many women, Mary was convinced that a mammogram and subsequent double mastectomy had saved her life.

Illustration of stage I breast cancer

Maybe the mammogram saved Mary’s life and maybe it didn’t. We will never know. The trouble with cancer studies is that they deal with anonymous, faceless groups.  Mary is an actual person. A real, living breathing person. If a doctor tells you that you have cancer growing inside you, most people will take dramatic steps to remove the cancer completely including surgery, toxic chemotherapy and radiation.

I am a survivor of an “incurable” cancer and cancer coach. Personal experience and research has taught me that cancer management is about both conventional and evidence-based non-conventional therapies.

If you would like to look beyond conventional breast cancer thinking please scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

Recommended Reading:


Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial

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.”

“Should I be Tested for Cancer?” Maybe Not and Here’s Why

Cancer Screening is Losing Luster, Says Critic

“After 50 years of being enthusiastically promoted and used, cancer screening has entered an era that is characterized by “skepticism,” according to a commentary published online August 18 in JAMA Internal Medicine…

 “For years, cancer screening has been oversold,” he said, echoing a comment made by Otis Brawley, MD, chief medical officer of the American Cancer Society, in 2009, which caused a firestorm of controversy at that time…This declaration has become less controversial since a variety of commentators have described screening as being the subject of promotion instead of education.

Unlikely to Benefit, Older Americans Still Get Cancer Screening

“A substantial proportion of older people in the United States continue to undergo cancer screening, even though they are unlikely to benefit from it. A large population-based study that used data from the National Health Interview Survey (NHIS) found that more than half of all people 65 years and older who had a life expectancy of less than 9 years had received prostate, breast, cervical, or colorectal cancer screening…

“These results raise concerns about overscreening in these individuals, which not only increases healthcare expenditure but can lead to patient net harm,” the researchers write…People with a shorter life expectancy have less time to develop clinically significant cancers after screening tests and are more likely to die from other causes..”

Perspectives on the Overdiagnosis of Breast Cancer Associated with Mammographic Screening

Overdiagnosis of breast cancer refers to the screen detection and diagnosis of breast cancer that would not have progressed to symptomatic cancer during a woman’s lifetime.

Screening mammography, like all screening tests, will result in some overdiagnosis that is attributable to competing causes of death occurring during the lead time (the time period between asymptomatic screen detection and clinical detection) and detection of very indolent cancer.

The primary harm of overdiagnosis relates to subsequent (unnecessary) treatment. Importantly, overdiagnosis concerns must be balanced with the lifesaving and morbidity benefits of screening mammography and the prevention of some invasive cancer by detection and treatment of ductal carcinoma in situ.

Reasonable estimates of overdiagnosis of women aged 40–80 years are in the order of 1%–10%, with lower values when overdiagnosis is restricted to invasive cancer and among younger women. Prospective identification of an overdiagnosed invasive cancer is not currently possible. Delaying screening until age 50 years or screening biennially rather than annually will not substantially reduce the amount of overdiagnosis of invasive cancer. The clinical significance of overdiagnosis will continue to be minimized as advances in personalized medicine further reduce treatment-associated morbidity.

 

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4 comments
Sharon Hutchinson says 7 years ago

First off, I like the name-Galen Foundation. Too many people do not know who this remarkable man was.

I had a full-blown robotic hysterectomy 2 1/2 years ago, all because they claim to have found a .03 cm “well and moderate differentiated” endometrial cancer. It was supposedly encased in a polyp and after surgery it was written “superficial invasion of uterine muscle”. For this I endured 4 hours of surgery, most of which was at a 45 degree angle with my head facing the floor. Also despite the fact that I repeatedly told anyone who would listen that I had RSD and major surgery unless life saving was contraindicated.

Nothing else was found–some lymph nodes removed and biopsied, pelvic wash etc. No further treatment. Stage 1, grade 1a.

To make a long story short, although I was past menopause in the time since the surgery my health has deteriorated immensely. Not to bore you as there is a laundry list of after effects, the worst of which has been intensification of the RSD, disruption of nerve function to bowels and the destruction of the support system of everything from naval on down. I now have a log roll of flesh that will be with me the rest of my life as it lost the ligaments that used to hold those tissues in place. A tummy tuck I cannot afford would be the only solution.

I am writing all this because I was experiencing very slight vaginal spotting. I went through an ultrasound and then a hysteroscopy. The result of polyp removal was seen scrutinized by the surgeon, who said it was benign. Three weeks later upon my office visit, all of a sudden it was “malignant” and necessitated the removal of all my female internal organs.

I went from benign to malignant, the surgeons and the hospital made good money to help pay for their DaVinci Robot, and my life as I knew it is over. Before surgery, I was able to do 1700 reps on a cardioglide 3x a week. Now 3 minutes is the max I can stand as the muscles involved are no longer supported and can’t do their job.

Sorry for the rant, but I wish I never had the surgery done; in fact, I regret going to a gyn or perhaps choosing that one. A D & C would have solved the problem nicely. Thank you for caring.

Reply
    David Emerson says 7 years ago

    Hi Sharon-

    Thank you for your post. You clearly have had to deal with A LOT of dysfunction from your doctors. You are able to convey both cynicism with a dose of humor with just a hint of anger. I wish I could write as well as you do.

    As for Galen I chose this as the namesake and sort of spiritual guide when I first planned the nonprofit I hoped to launch. As it turned out no one, not even directors, knew who Galen was. So now I tell people that I am the director of the Galen Foundation dba PeopleBeatingCancer. And people get that cancer is what we do. You are the first person EVER to know who Galen was… Fun Fact to Know and Tell- the first thing that caught my attention when I was first reading about Galen was that he trained on Gladiators as a young man. Galen patched them up so they could fight some more.

    But I digress. If I understand your post you are concerned about “slight vaginal spotting” 2-1/2 years post hysterectomy. Two things, according to my online research. You should get it checked out, just in case. I think your experience will prevent you from allowing doctors from doing something to you that you don’t like.
    Lastly, I linked what I believe are comments from women with similar concerns. You may learn from their comments.

    http://www.hystersisters.com/vb2/showthread.php?t=449497

    I enjoyed your rant. Please reply to ask any more questions, have me do more research for you, whatever.

    thanks very much,

    David Emerson-
    Director of the Galen Foundation dba PeopleBeatingCancer

    Reply
Ann Gross says 7 years ago

My mother in law had pancreatic cancer at the age of 67 now she is 85 she had chemo therapy for a whole year fed directly into her belly all day long with a tube.Then did radiation for a year after that….It has not come back and she still gets scanned every 3 yrs because she wants to know if it ever comes back because she wants to live to be 100. If she had not done the chemo and radiation she would of died and missed all these wonderful yrs…….

Reply
    David Emerson says 7 years ago

    Dear Daughter-in-law-
    Living with pancreatic cancer for the past 18 years is remarkable. And she wants to get a scan every three years so that she knows if the cancer returns? The question is whether or not aggressive therapy such as chemo or radiation at 85+ would be healthy for her if the cancer ever does return. Good luck to you and your MIL. Let me know if you ever have any questions. David Emerson

    Reply
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