THE MOSS REPORTS Newsletter (10/30/05)

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31 Oct 2005 00:25:35 -0000

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THE MOSS REPORTS Newsletter (10/30/05)

 

 

 

 

http://www.cancerdecisions.com/103005.html

 

 

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

Newsletter #208 10/30/05

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HERE AT THE MOSS REPORTS

 

 

It 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 FOUR

This week I continue my series on screening mammography.

 

 

Cornelia J. Baines, MD, of the University of Toronto, deputy director

of the prestigious Canadian National Breast Screening Study, has

written several papers that are critical of screening mammography. She

writes: " An unacknowledged harm [of screening mammography, ed.] 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?

 

It is a phenomenon well known to researchers that the removal of the

primary tumor can trigger the sudden growth of tiny clusters of cancer

cells (called `micrometastases') that have until that point lain

dormant in distant sites. Researchers have shown that the primary

tumor inhibits the ability of these subsidiary distant deposits to

grow, perhaps by releasing powerful biologically active substances,

such as angiostatin and endostatin, which prevent tumors from

stimulating the development of their own blood supply (a process known

as angiogenesis).

 

Without the ability to generate a new and adequate blood supply,

tumors, even tiny, clinically invisible tumors, cannot grow, and while

the primary tumor is still in place, and still secreting these

angiogenesis-suppressing substances, the micrometastases remain

dormant. But once the primary tumor – the " conductor of the cancer

orchestra, " so to speak – has been removed, the restraints on growth

are removed and the microscopic malignant deposits in distant sites

suddenly acquire the power to induce their own blood supply and grow

independently.

 

Much of the pioneering work on the role of angiogenesis in tumor

growth was done by Judah Folkman, MD, of Harvard University, winner of

the American Society of Clinical Oncology's (ASCO) highest honor, the

Karnofsky Award (1996). Working alongside Prof. Folkman, Dr. Michael

Retsky and other researchers have studied the question of the

mammography paradox and have suggested that not only is the removal of

the primary tumor the spur to proliferation of dormant metastases, but

also that surgery itself, by creating a physical wound, independently

triggers the release of growth factors that, in addition to assisting

healing of the surgical wound, also promote tumor growth. This effect

is particularly marked in younger women with node-positive disease.

 

The fact that the mammography paradox is confined to younger (as

opposed to older) women undergoing mammography is a reflection of the

biological differences between pre- and postmenopausal women, Dr.

Retsky and his colleagues suggest. In premenopausal women, the

hormonal environment may encourage the estrogen-driven proliferation

of breast cancer cells, putting younger women at an extra disadvantage

in terms of their susceptibility to aggressive metastatic cancer growth.

 

For a previous newsletter on the subject of Retsky's work on the role

of surgery in stimulating cancer growth, please click or go to:

http://www.cancerdecisions.com/073105.html

 

In a 2001 paper on the subject of the mammography paradox, published

in the journal Breast Cancer Research and Treatment, Dr. Retsky and

colleagues state that " Each woman should be informed of the risks and

benefits [of mammography] and decide for herself whether to undergo

screening mammography. Young women are, however, not routinely warned

that screening and resection may accelerate breast cancer mortality "

(Retsky 2001).

 

This sentiment is echoed by the University of Toronto's Dr. Baines,

who asks, " Shouldn't women aged 40-49 years know that, 3 years after

screening starts, their chance of death from breast cancer is more

than double that for unscreened control women? Shouldn't they be

informed that it will take 16 years after they start screening to

reduce their chance of death from breast cancer by a mere 9 percent? "

 

Dr. Baines, the author of 70 PubMed-listed scientific articles, also

points out that there is an almost willful silence both within and

outside the medical profession on the subject of the dangers and

ineffectiveness of screening mammography. Although the mammography

paradox was originally identified in an article published in 1997 in

the Journal of the National Cancer Institute, this important news was

cited only 8 times in the ensuing 6 years – and four of these

citations were by the same group of researchers (Cox 1997).

 

Contrast this peculiar absence of debate with the deafening clamor

from all sides in favor of mammography screening – and with the

mounting chorus in support of the recommendation that women should

begin annual mammography at the age of 40 - the very group of women

most likely to be harmed, rather than helped, by mammography.

 

It is often fear that drives women to seek screening mammography, a

fear that is fostered, actively and tacitly, by a medical profession

(and a highly profitable screening industry) that is doing little to

inform women of their real risks, nor what gain, if any, they can

really expect from mammography.

 

The risk of developing breast cancer is 11 percent (1 in 9) over a

woman's lifetime. While women tend to believe that almost 40 percent

of all deaths among women are due to breast cancer, in reality the

actual percentage is 4 percent. In a survey of 1000 American women, 71

percent expressed the belief that screening reduces breast cancer

deaths by 50 to 100 percent (Domenighetti 2003).

 

Meanwhile, several rigorous clinical trials have shown that

mammography not only does not confer a clear survival benefit, but may

in fact have the opposite effect, contributing to an increased, rather

than a reduced risk of dying in premenopausal women. Despite these

stark facts, raising questions about the value of mammography has come

to be seen as " un-American, " one epidemiologist reportedly remarked

(Baines 2005).

 

As journalist and medical writer Gina Maranto pointed out succinctly

in a Scientific American article on the subject:

 

" Physicians, radiologists, statisticians and public health officials

have made claims and counterclaims and with sometimes startling

emotion have accused one another of misreading or misrepresenting

data, of performing faulty analysis and of perpetuating myths that

have dire consequences for women. Some specialists, as well as cancer

societies, women's health advocates and manufacturers of mammography

machines, have argued that mass screening saves lives; others on the

clinical front lines and in policy-setting roles have contended that

evidence from a number of randomized controlled trials does not

support such a claim " (Maranto 1996).

 

The National Institutes of Health, the National Cancer Institute and

most of the other public agencies charged with formulating

recommendations for screening based on scientific evidence routinely

go out of their way to discredit studies that cast doubt on the

usefulness of mass mammography screening. Mammography is a cornerstone

of the American `war on cancer.' That these national policy makers

cannot even bring themselves to publicly acknowledge misgivings about

the procedure, much less to re-examine their recommendations in the

light of the alarming truth about the mammography paradox is little

short of staggering.

 

 

TO BE CONCLUDED, WITH REFERENCES, NEXT WEEK.

 

 

 

 

 

 

To read this week's newsletter, please click or go to:

http://www.cancerdecisions.com/103005.html

 

 

 

--Ralph W. Moss, PhD

 

 

 

 

 

 

 

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