THE MOSS REPORTS Newsletter (11/13/05)

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13 Nov 2005 23:50:03 -0000

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THE MOSS REPORTS Newsletter (11/13/05)

 

 

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

Newsletter #210 11/13/05

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HERE AT THE MOSS REPORTS

 

 

This week I conclude my six-part discussion of screening mammography.

 

While mammography is acknowledged to be the best screening tool

currently available for breast cancer, it is far from perfect, and

this series

has examined the ways in which mammography falls short.

 

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

http://www.cancerdecisions.com/111305.html

 

 

 

--Ralph W. Moss, PhD

 

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This week I conclude my six-part discussion of screening mammography.

 

While mammography is acknowledged to be the best screening tool

currently available for breast cancer, it is far from perfect, and

this series has examined the ways in which mammography falls short.

 

It is not my intention 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 screening 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 SIX

 

Alternatives and Adjuncts to Mammography

 

 

Thermography, or digital infrared imaging (DII), is a technique that

uses infrared technology to identify abnormalities. It is able to

detect subtle differences in the heat emitted by different areas

within the breast tissue. Because malignant tissue has a higher

metabolic rate than normal tissue, thermography picks up these areas

even when they are extremely tiny – long before they are detectable on

mammography, in fact.

 

As a screening method, thermography is not a replacement for

mammography, but a useful adjunct to it. As noted earlier in this

series, screening and diagnosis are two different things. Screening is

intended to pick up possible abnormalities in otherwise healthy

individuals, whereas diagnosis is the method whereby an abnormality,

often initially detected by screening, is more closely examined in

order to identify its true nature (i.e., what its origins are, and

whether the abnormality is benign or malignant, for example). The

characteristics that make a good screening test are not by any means

the same as those that are needed for diagnostic purposes.

 

The major advantages of thermography are that it does not involve

compressing the breasts, and that it does not use ionizing radiation.

As noted above, it can also detect abnormalities at an earlier stage

than mammography. However, heat changes in breast tissue can result

from many different processes, not just from malignancy, and a

positive thermogram is not specific for cancer. False positives, in

other words, are an inherent problem with thermography just as they

are with mammography. Another problem is the fact that thermography

cannot locate the precise anatomical position of a lesion with

accuracy; it still takes a mammogram or other diagnostic technique to

pinpoint the exact site of an abnormal area within the breast.

 

The best use of thermography is therefore as a technique that can be

used in conjunction with mammography and CBE/BSE. Because it can

detect abnormalities earlier than mammography, it is particularly

useful in identifying the need for further investigations (including

mammography), and since it is so non-invasive and so safe, it is an

ideal method for routinely monitoring women who are at added risk for

breast cancer. It is particularly useful, too, for younger women and

those with dense breast tissue. For such women mammography is not only

an inadequate imaging technique but also carries added risks,

including lifetime cumulative radiation exposure, and the danger of an

increased, rather than a decreased, risk of death from breast cancer

(the so-called 'mammography paradox').

 

Although thermography has been approved by the US Food and Drug

Administration (FDA), relatively few doctors know about it and the

profession as a whole is not yet generally willing to accept its

conclusions. In addition, few insurance companies will pay for this

procedure.

 

Ultrasound, or sonography, which uses sound waves to create an image

of the internal structure of the breast, is again typically used a

diagnostic rather than a screening tool, although clinical trials are

currently in progress to assess its value in screening. One of the

drawbacks of older ultrasound techniques was that the hallmark

'microcalcifications' that accompany early breast cancer were not

typically visible. However, newer techniques such as Doppler

ultrasound have largely overcome this problem. In addition, ultrasound

can be very useful not only in imaging dense breast tissue (something

mammography does not do well) but also in distinguishing between

benign and potentially malignant lesions, thus sparing many women the

need for a biopsy. It seems very likely that this non-invasive

technique will come to occupy a prominent place in early detection of

breast cancer, perhaps even supplanting mammography.

 

MRI (magnetic resonance imaging) is another technique whose value in

breast cancer screening has perhaps still not been fully harnessed. In

clinical trials MRI has proved to be more sensitive than mammography,

ultrasound or CBE in detecting early cancers. However, it has also

proved to be even more susceptible to false positives than

mammography. So while MRI, like thermography, has advantages in that

it does not involve breast compression or exposure to radiation, it is

not a replacement for mammography either. It does, however, have a

definite role to play in screening, as an adjunct to CBE and

mammography, particularly for younger women with denser breast tissue,

and for those whose family history suggests an increased risk of

developing breast cancer.

 

PET (positron emission tomography) scanning has not yet found a

definitive place in breast cancer screening. PET is indeed a very

sensitive method of detecting aggressive cancers and does not give

rise to as many false positives as most of the other imaging methods.

In the detection of recurrences in women who have been previously

treated for breast cancer it has been shown to be superior to other

techniques. However it is still not particularly useful for

identifying marginally invasive lesions. In addition, PET involves the

use of an injected radioactive contrast medium, and while the

half-life of this material is extremely short – i.e., the exposure to

radioactivity is relatively small – it is certainly not a procedure to

be undertaken on a regular basis for screening purposes. Nor is PET by

any means universally available or affordable.

 

An Ounce of Prevention

 

 

While mammography screening is universally portrayed as essentially a

preventive practice, it is in fact nothing of the sort. It is a means

of detecting lesions that are already present and growing. Before a

lesion becomes detectable on a mammogram it has typically been present

for an average of 8 years. The best that can be said for the role of

mammography is that it is a modestly effective tool in the service of

damage control.

 

Every cancer avoided is a triumph, and every cancer death a tragedy.

While mammography may indeed be a useful (though far from perfect)

screening tool, it cannot stop women developing breast cancer, and

neither can it reliably prevent the majority of deaths from the

disease. Yet the American Cancer Society, the National Cancer

Institute and the medical profession at large (all of which have

strong ties to the multi-billion dollar mammography industry) continue

to focus their education efforts exclusively on the detection of

existing breast cancer via screening mammography (Epstein 2001). If

instead of doing this, they were to throw their considerable political

and financial weight wholeheartedly into the effort to find and

control the environmental triggers that contribute heavily to the

incidence of this dread disease, we might see more substantial progress.

 

 

 

 

 

 

 

 

 

 

IMPORTANT DISCLAIMERS

 

The news and other items in this newsletter are intended for

informational purposes only. Nothing in this newsletter is intended to

be a

substitute for professional medical advice.

 

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