Breast Cancer Screening

My hope with this article is to give women information that may help them make informed decisions regarding the types of screening for breast cancer they choose to use. The current common methods of breast tissue screening are self-examination, mammography, ultrasound and MRIs. As MRIs are not readily available, they will not be included in the discussion below.

Mammography is familiar to most women. It can pick up lesions as small as 0.5 cm, which you are usually not able to feel, and detects approximately 85% of cancers. An experienced doctor can pick up 61-92% of lumps. One of the shortcomings for mammograms is that they are less effective in the following cases: dense or fibrocystic breasts, small or very large breasts, women under age 50, postoperative scarring, exposure to acute/chronic radiation, and if receiving hormone replacement. They will miss cancers 9-20% of the time in younger women with dense breasts and up to 25% of tumors in women 40-49 years old.

Prolific author Dr. John Lee, MD points out that the “lag time between cancer inception and diagnosis, even by mammograms, may well be over eight years… [and] diagnosis by palpation (self breast exams) can be made about one year later.” He questions that if cancer is prone to spreading (metastasis), would this not likely occur during years prior to the mammogram? He suggests that the evidence that this one-year difference in time of diagnosis will make any difference is lacking. He concludes that the jury on mammograms is still out, but his hunch is that a good self-exam would be as effective as a mammography.

Risks of Radiation. Radiation from a mammogram is classified as 0.2 or a low dose; it is equal to radiation received from a transcontinental flight, only that this amount is all focused on the breasts. Some authors claim there is no safe dose, others disagree. Dr. John Gofman, MD, Phd and author of “How to Estimate a Personal Radiation Risk from Mammography” calculates the lifetime risk of 15 mammograms for a woman, beginning at the age of 50. The result is a lifetime risk of 1 in 136 of contracting radiation-induced breast cancer. His findings are based on his own research and assumptions.

The Mortality Paradox. Dr. Cornelia Baines, MD, in the Journal of the national Cancer Institute 2003 published an article highlighting the results of two Canadian trials and five Swedish trials which together suggest that “up to 11 years after the initiation of screening in women aged 40-49 years, screened women face a higher death rate from breast cancer than unscreened control women.” She also sites a 2001 study showing that surgical removal of primary breast tumors from premenopausal women with involved lymph nodes may trigger the growth of temporarily dormant micrometastases in 20% of patients. In 1996 a panel of experts for the National Institute of Health concluded that there was not enough evidence to support a recommendation that women in their forties should get routine mammograms. Please see the website http://jncicancerspectrum.oxfordjournals.org for Dr. Baines article as well as Dr. Alfred Berg’s article with counterpoints to her article.

Well known author Dr. Christiane Northrup, MD admits that doctors push mammograms because of the lawsuit-driven medical system. While she does prescribe regular mammograms she admits she cannot guarantee their absolute safety and that she respects the informed decision of her patients who opt out of mammograms. Dr. Northrup further admits that when it comes to mammograms “fear and the feeling of helplessness are indeed very detrimental to health” in the context of both a diagnosis for cancer as well as the reports often seeming “punitive and confusing”.

The DCIS Dilemma. Mammograms can detect early abnormalities that may never become invasive, often know as ductal carcinoma-in-situ (DCIS). Dr. H. Gilbert Welch cites a study showing that in breasts of women who died from other causes, “40 percent had microscopic precancerous changes in their breasts.” He adds that it is well documented that most women diagnosed with DCIS do not develop invasive breast cancer. The Journal of American Medical Association reports that the incidence of DCIS has increased dramatically due to mammography screening, but the value of its detection is still unknown. The proportion of these cases treated by mastectomy may be inappropriately high. What is being suggested here is that early screening may be leading to unnecessary treatments in women that would otherwise have survived without detection? This is a true dilemma.

What Other Choices do Women Have? High-resolution breast ultrasound may be a good alternative for some women. It is very effective at distinguishing between a benign cyst and a solid mass and is 98% effective in distinguishing between a benign lesion and malignant one. This may be a great option for women for whom mammograms are less accurate for the reasons described earlier. There is no radiation from ultrasound.

What about Thermography? This technique of breast screening is often supported by alternative practitioners. Unlike current tools (mammography, ultrasound, MRIs) that detect structural changes, thermography uses digital infrared cameras and a computer program to take heat pictures of the breast tissue. This monitors functional changes of the breast tissue based on skin temperature changes that reflect the metabolic character of underlying tissues. It can detect breast tissue changes 5-8 years prior to the development of a mass large enough to be seen with mammography or ultrasound. It is completely safe and non invasive. Thermography is not diagnostic of breast cancer and must be followed by conventional methods if an abnormality is found. Its main advantages are that it is equally useful for all types of breasts regardless of age, density or use of hormones. Please see http://www.medthermonline.com for more details.

Preventing Breast Cancer. I would like to emphasize that breast self-exams and mammograms are not preventative measures. These practices may give many women a false sense of security. Key to breast cancer prevention is diet, exercise, quitting smoking, limiting the amount of chemicals we expose our bodies to, limiting radiation exposure, and cultivating a peaceful relationship with our bodies. This is where naturopathic medicine plays a very valuable role. While I hope this article was helpful I suggest that it be used only as a guide to spark your own further research. My only wish is that women’s decisions are informed, no matter what those decisions may be.

BREAST HEALTHY FOODS
Here is some juicy information about the healthy breast salad so good. Tomatoes contain lutein which protects against cell damage. Onions contain quinines that neutralize some carcinogens and allyl sulfides that help the liver remove toxins from the body. Super broccoli decreases the estrogen subtype correlated with breast cancer, and is a great antioxidant blocking cell damaging free radicals. Radish contains isothiocyanates that prevent DNA damage and block production of tumors. Citrus fruit rinds contain cancer cell fighting limonoids.

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