Causes of Breast Cancer may Include Mammograms / Environment News Service

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Causes of Breast Cancer may Include Mammograms / Environment News

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Avoidable Causes of Breast Cancer May

Include Mammography

WASHINGTON, DC, February 20, 2002 (ENS) - Mammography

centers around the country have been scaling back operations and

closing their doors for the past two years because of inadequate

insurance reimbursements. The trend comes at a time when a growing

population of older women is increasing the demand for the radiological

breast exams. But a prominent cancer prevention physician warns that

mammography is a risky, unreliable, profit driven technology.

Breast cancer is the second most common cancer affecting

women in the United States, with over 200,000 new cases diagnosed each

year.

Currently, the average cost of a mammogram is between $90

and $100, and Medicare only reimburses $82 for the procedure. The

private insurance reimbursement rate is somewhat lower. According to

the American College of Radiology, nearly 400 mammography programs

nationwide have been forced to close since March of last year, 40 of

them in New York State.

 

New York Senator Chuck Schumer (Photo courtesy Office

of the Senator)

"Thousands of women across Westchester County could be

forced to wait months for mammograms because there aren't enough

radiology centers that can afford to screen them," said New York

Senator Chuck Schumer, a Democrat.

The New York senator is co-sponsoring legislation with

Senator Tom Harkin, an Iowa Democrat, that would raise Medicare

reimbursement rates to more accurately reflect the cost of the

procedure. "The bottom line is that we need to raise reimbursement

rates, which would keep mammography centers open and provide incentives

to attract the next generation of radiologists," Schumer said.

But cancer prevention physician Dr. Samuel Epstein,

professor of environmental and occupational medicine at the University

of Illinois-Chicago School of Public Health, says mammograms are at

best ineffective in detecting cancers, and at worst, may themselves

trigger cancers. The safe, effective, low cost route to cancer

prevention, he says, is monthly breast self examinations (BSE) coupled

with annual clinical breast examinations (CBE) and education about the

avoidable causes of cancer.

"Mammography poses a wide range of risks of which women

worldwide still remain uninformed," warns Dr. Epstein who is chairman

of the Cancer

Prevention Coalition.

 

Dr. Samuel Epstein (Photo courtesy Naturally

Healthy)

In a September 2001 article published in the International

Journal of Health Services, Dr. Epstein claims that radiation from

mammography "poses significant cumulative risks of initiating and

promoting breast cancer."

"Contrary to conventional assurances that radiation exposure

from mammography is trivial - and similar to that from a chest X-ray or

spending one week in Denver - about 1/1,000 of a radiation absorbed

dose (rad) - the routine practice of taking four films for each breast

results in some 1,000 fold greater exposure, one rad, focused on each

breast rather than the entire chest," Dr. Epstein writes.

Premenopausal women who get annual mammograms for 10 years

are exposed to a total of about 10 rads for each breast, "each rad of

exposure increasing breast cancer risk by one percent," he writes.

New experimental findings reported this week by Lawrence

Berkeley National Laboratory cell biologist Mary Helen Barcellos-Hoff

support Dr. Epstein's warnings.

Barcellos-Hoff showed that exposure to ionizing radiation

creates a microenvironment in the tissue surrounding breast cells that

can cause even nonirradiated cells and their progeny to become

cancerous. "Radiation exposure can cause breast cancer by pathways

other than genetic mutations," said Barcellos-Hoff who presented her

study in Boston this week at the annual meeting of the American

Association for the Advancement of Science.

Barcellos-Hoff and her team focused on the signaling -

crucial to normal functioning - that takes place between a cell and the

microenvironment of its surrounding tissue. The director of Berkeley

Lab's Life Sciences Division, Mina Bissell, has shown that breakdown in

these communications can initiate the cancer process.

"Our data is pointing to the tissue surrounding breast cells

as a primary target of ionizing radiation damage," Barcellos-Hoff said.

 

Radiation damage to this surrounding tissue generated

signals that changed how the breast cells' genomes were expressed. A

new cell type was created with physical characteristics that were cued

to act cancerous by the signals coming from outside the cell.

 

A normal breast as it appears in a mammogram (Photo

courtesy McGill

University School of Medicine)

The discovery suggests new and possibly more effective means

for preventing breast cancer. "Repairing damaged tissue so that it once

again suppresses instead of promotes carcinogenesis is a simpler

strategy for stopping the cancer process, compared to trying to repair

individual damaged cells," says Barcellos-Hoff.

But Senator Schumer says he is concerned for the health of

New York women who must wait as long as four or five months to get a

mammogram. "Early detection is the key to treating the disease

effectively and routine mammograms reduce the risk of dying from breast

cancer by 40 percent."

"These shortages are putting thousands of Westchester County

women at risk because delayed diagnoses often result in tumors being

detected at less treatable stages," the senator says.

"We need to push this bill through Congress and get it to

the President's desk immediately because when it comes to treating

breast cancer, every day counts," Schumer said of the Assure Access to

Mammography Act, first introduced in March 2001.

But mammography is "not a technique for early diagnosis,"

says Dr. Epstein, who points out that the radiological screenings miss

many cancers, and mistakenly diagnose other conditions as cancer,

particularly in premenopausal women.

"Overdiagnosis and subsequent overtreatment are among the

major risks of mammography," he warns.

"Despite long-standing claims, the evidence that routine

mammography screening allows early detection and treatment of breast

cancer, thereby reducing mortality, is at best highly questionable,"

writes Dr. Epstein. He quotes a 1997 study by M. Napoli published as a

monograph by the Journal of the National Cancer Institute that

concluded, "the overwhelming majority of breast cancers are unaffected

by early detection, either because they are agressive or slow growing."

 

 

This is a fine needle aspirate of a breast mass that

contains both benign (left) and malignant (right) cell clumps. The

benign cells are small, uniformly sized and shaped. The cancerous cells

are larger and vary in size and shape. (Photo courtesy University

of Wisconsin-Madison, Dept. of Surgery, Dr. William Wolberg Tutorial )

No nation other than the United States routinely screens

premenopausal women by mammography, although professional associations

are divided on the need to do so. The American Cancer Society

acknowledged in 1985 that most breast cancers are found by the women

affected. "We must keep in mind the fact that at least 90 percent of

the women who develop breast carcinoma discover the tumors themselves,"

the society said.

Effective self examination for breast cancers "critically

depends on careful training by skilled professionals," and confidence

is enhanced with annual clinical breast exams by experienced

professionals, Dr. Epstein emphasizes.

A "large-scale crash program" for training nurses in how to

perform clinical breast exams and how to teach breast self examination

is immediately needed, particularly for underinsured and uninsured

women in the United States and in developing countries, he urges.

Clinics offering this training "could be established nationwide, and

eventually worldwide" in schools, community hospitals, churches,

synagogues and mosques, he envisions.

These clinics could also serve as sources of reliable

information on how to reduce the risks of breast cancer. "From an

environmental standpoint," says Dr. Epstein, "the most important thing

is the contamination of animal and dairy fats with carcinogenic

industrial pollutants. That's a very major source. Living near

hazardous waste sites in another major thing, living near industry."

"In your body fat and in my body fat, there's probably about

150 to 200 carcinogenic industrial pollutants," he said. "And animal

and dairy fats, they concentrate the stuff. They are mainly chlorinated

hydrocarbon pesticides, PCBs, they're aldrin, dieldrin, chlordane,

heptachor, DDT which have permeated the totality of our environment,

our air, our water, our workplace, in the North Pole you find them."

 

GE 800T mammogram system at Memphis, Tennessee's Delta

Medical Center (DMC) (Photo courtesy DMC)

In the senator's view, the problem is financial. "The

average increase in the Medicare rate - 1.5 percent per year between

1997 and 2000 - has lagged far behind the medical inflation rate. Since

other government insurance programs and private insurers base their

reimbursement rates on Medicare, low Medicare rates create a ripple

effect which lead mammography clinics to receive insufficient

reimbursements from private and government insurers alike," he said.

Dr. Epstein too acknowledges that the costs of mammography

are high and rising. "The dangers and unreliability of mammography

screening are compounded by its growing and inflationary costs," he

writes, citing an annual cost of $10 billion if all women, both before

and after menopause were screened annually.

"Such costs will further increase some fourfold if the

industry, enthusiastically supported by radiologists, succeeds in its

efforts to replace film machines, costing about $100,000, with the

latest high tech digital machines, approved by the FDA [Food and Drug

Administration] in November 2000, costing about $400,000," he writes.

But while the senator would fund the increasing costs of

mammography, the doctor would have women utilize low cost breast self

examinations supplemented by annual clinical exams and education about

the environmental factors that contribute to the disease.