THE MOSS REPORTS Newsletter (10/23/05)

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THE MOSS REPORTS Newsletter (10/23/05)

 

 

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Ralph W. Moss, Ph.D. Weekly CancerDecisions.com

Newsletter #207 10/23/05

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http://www.cancerdecisions.com/102305.html

 

 

 

 

THE MOSS REPORTS CANCER DECISIONS NEWSLETTER

 

 

t is a modern day mantra, widely repeated and unquestioningly

accepted, that screening for cancer offers the best chance of early

detection and therefore saves lives. But is this really true?

 

This week I continue my examination of the rationale for, and the

scientific basis of, screening mammography. Mammography is

acknowledged to be the best screening tool currently available for

breast cancer. However, it is far from perfect, and it is my intention

in this series to examine the ways in which mammography falls short. I

do this not to discourage women from being screened for breast cancer

– to the contrary, I believe that vigilance and early detection are

extremely important. However, it is vital for women to have a full

understanding of the procedure and realistic expectations as to what

it can, and cannot, do. This is the true basis of informed consent. As

one group of researchers, writing in the British Medical Journal, put it:

 

" Scientists continue to argue about the benefits of breast screening,

but ultimately decisions about screening should be made by women

themselves. To make this decision, however, women need to fully

understand both the benefits and the potential harms " (Thornton 2003).

 

Over my long career in the field of cancer I have seen many theories

arrive in a blaze of glory only to be discredited and quietly

discarded a short time later. The profit-driven nature of cancer

therapeutics has only added to the confusion. Drug companies and the

manufacturers of expensive scanning and screening equipment have a

strong interest in promoting the sale of their products, and the voice

of reason all too often gets drowned out in the face of their massive

advertising, lobbying and public relations efforts.

 

By going to primary sources and carefully studying the scientific

literature itself, I aim to provide my readers with the best possible

synopsis of the current state of knowledge in the sphere of cancer

prevention and treatment. In my writings, my goal, and that of my

organization, Cancer Communications, Inc., is to maintain the sort of

consistent, reliably objective analytical standard that will allow my

readers to make truly informed decisions.

 

In the past 30 years I have written and published extensively on the

subject of cancer and its treatment, including compiling a

comprehensive series of individual reports on more than 200 different

cancer diagnoses – The Moss Reports – each one of which examines both

the standard treatment options that are likely to be offered for a

particular cancer diagnosis, and the possible alternative and

complementary approaches to that disease.

 

If you would like to order a Moss Report for yourself or someone you

love, you can do so from our website, www.cancerdecisions.com, or by

calling 1-800-980-1234 (814-238-3367 from outside the US).

 

I also offer phone consultations to clients who have purchased a Moss

Report. A phone consultation can be enormously helpful in drawing up

an effective treatment strategy and getting one's options clearly

prioritized. To schedule an appointment, please call 1-800-980-1234

(814-238-3367 from outside the US).

 

We look forward to helping you.

 

MAMMOGRAPHY – THE HIDDEN DOWNSIDE, PART III

 

False Negatives

 

 

Mammograms can and do sometimes miss cancers entirely. A woman may

have a normal mammogram at one screening but still develop a so-called

`interval cancer' before her next examination. As we have seen in our

previous newsletters, this kind of cancer tends to be the most deadly.

The `false negative' rate – that is, the rate at which mammography

gives a clean bill of health to those who in reality do have cancer,

has been estimated to be somewhere between 10 and 15 percent (Welch 2004).

 

The Problem of DCIS

 

 

Meanwhile, the number of cases of premalignant, non-invasive lesions

such as ductal carcinoma in situ (DCIS) being diagnosed by mammography

has increased by 900 percent in the US over the past 20 years. It has

now reached the point where almost 20 percent of all breast cancer

diagnoses involve DCIS.

 

Some people interpret this as a good thing, i.e., a sign that cancer

is being caught in its earliest stages. Treated early or late, DCIS

has a low mortality rate (around 1 percent). Precisely what percentage

of these latent, precancerous lesions might eventually progress to

become truly invasive is unknown, although it has been estimated that

almost 50 percent of all `in situ' cancers will never progress and

would be better left undetected and therefore untreated (Handler 2003).

 

Perhaps one day in the future there will be a way of distinguishing

between those women whose DCIS poses an imminent threat of

invasiveness and those whose lesions are harmless, so that treatment

can be directed only towards those who truly need it. Currently,

though, such a test does not exist.

 

Undoubtedly mammography is having the effect of labeling a substantial

number of women as having breast cancer, and channeling them towards

aggressive treatment, when in fact they have a pseudodisease – i.e., a

benign condition that poses no threat to life.

 

In one large-scale Canadian study of screening mammography it was

found that DCIS was diagnosed in more than double the number of women

who were given mammography than in those given careful clinical breast

examinations (CBE) by qualified providers (i.e., 71 such women in the

mammography group compared with 29 in the breast examination group).

Another large Canadian study found that 71 mammography patients were

given a diagnosis of DCIS compared with only 16 in the breast

examination group. Meanwhile, a careful analysis of the outcomes of

both these studies concluded that mortality rates from breast cancer

were unaffected by screening mammography: the women in these studies

experienced no survival benefit whatsoever from mammography even after

10 years of follow up (Miller 2000).

 

Radiation and Other Hazards

 

 

Another important factor that is largely ignored by the medical

profession and the media is the radiation danger inherent in screening

mammography, particularly to younger women (i.e., women in the

premenopausal age range of 40-50 years). Breast tissue is highly

sensitive to radiation: an annual exposure to 1 cGy, or centigray (the

dosage involved in taking a standard mammogram) increases the risk of

cancer by 1 percent, and over a 10-year period of annual mammography

screening this could augment a woman's cancer risk by 10 percent. The

risk may be even greater – up to a 20 percent increased risk - for

those women who carry certain genetic mutations (Swift 1994).

 

In addition, annual mammography exposes the breast tissue to repeated

doses of low-energy X rays. Contrary to what one might expect,

low-energy X rays are actually more damaging to DNA than their

high-energy counterparts, according to a study performed at Columbia

University's Center for Radiological Research (Brenner 2002).

 

For younger women in particular, whose breasts are denser and who have

a longer projected lifespan ahead of them than postmenopausal women,

the additional exposure to X-rays posed by annual mammography

beginning at the recommended age of 40 could pose a significantly

increased risk of cancer. The Columbia University article concluded:

 

" There is evidence that low energy X rays as used in mammographic

screening produce an increased biological risk per unit dose relative

to higher energy photons. At low doses, the increased risk appears to

be of a factor of 2….For older women, the benefit is still likely to

outweigh the radiation risk. For women less than 50 years of age,

however, this increase in the estimated radiation risk might indicate

a somewhat later age than currently suggested, by about 5-10 years, at

which to recommend commencement of routine breast screening " (Brenner

2002).

 

This paper is significant – and unusual - in that it both acknowledges

the risks involved in repeated radiation exposure to the breast

through mammography and urges a re-examination of current

recommendations concerning the appropriate age to begin regular

screening. Most discussions of mammography are not as frank.

 

Another hidden hazard in mammography is the physical compression of

the breasts that is necessary to obtain a readable radiographic image.

This physical compression can result in the rupture of small blood and

lymphatic vessels, which, if they are in close proximity to a tumor –

even a tiny tumor – may result in the release of malignant cells into

the general circulation (Rosser 2000).

 

The Mammography Paradox

 

 

That mammography is not as effective in saving lives as its promoters

have insistently claimed is bad enough, but more alarming by far is

the little-publicized fact that in women aged 40-49, mammography is

actually associated with an increased, rather than a decreased, risk

of death- a phenomenon known to researchers as the " mammography paradox. "

 

Yes, you read that right: mammography in younger women (ages 40-49)

may actually accelerate, rather than reduce, breast cancer mortality.

 

This increased death rate from breast cancer in younger women who

undergo screening mammography has been documented consistently in

screening trials across different countries, settings and populations.

It is a fact known to many researchers in the field, yet it remains

largely unknown to the general public – and it certainly not a danger

of which women are routinely made aware by their healthcare providers.

 

One critic of exclusive reliance on screening mammography is Cornelia

J. Baines, MD., of the University of Toronto. Dr. Baines is hardly an

outsider to the field. She is deputy director of the prestigious

Canadian National Breast Screening Study, and the author of 70

PubMed-listed journal articles. She has also written an important

paper that is frank in its discussion of this issue. In this paper,

aptly titled " Mammography screening – Are women really giving informed

consent? " Dr. Baines says: " Many women remain unaware of the extent to

which efforts to achieve breast cancer control through mammography

screening may be doing harm as well as good. An unacknowledged harm is

that for up to 11 years after the initiation of breast cancer

screening in women aged 40-49 years, screened women face a higher

death rate from breast cancer than unscreened control women, although

that is contrary to what one would expect " (Baines 2003).

 

How could this happen? How can it be that instead of saving their

lives, earlier detection might actually result in a greater likelihood

of death in these women?

 

 

TO BE CONCLUDED, WITH REFERENCES, NEXT WEEK

 

 

 

 

 

 

--Ralph W. Moss, PhD

 

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informational purposes only. Nothing in this newsletter is intended to

be a

substitute for professional medical advice.

 

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