http://www.counterpunch.org/gardner11202009.html
November 20-22, 2009
*Mammography Pushes Back*
*By FRED GARDNER*
"Clinical Guidelines" advising women not to start getting annual mammograms
at age 40 were published online in *Annals of Internal Medicine*, Nov. 16.
Opponents of Obama's health reform bill immediately raised the specter of
"the government coming between you and your doctor," and the
administration's top health official, Kathleen Sebelius, announced that the
federal government had no intention of heeding its own experts' advice.
Maybe the reason the proponents of fewer mammograms got TKOed in the first
round is that we, the people, have been systematically denied information
about the dangers of mammography. The new guidelines certainly downplay
them, and media reports tended to ignore them completely. For example,
readers of Gina Kolata's front-page story in the New York Times Nov. 17
("Panel Urges Mammograms at 50, Not 40") would have thought the problem with
mammograms was false positives. Kolata wrote, "While many women do not think
a screening test can be harmful, medical experts say the risks are real. A
test can trigger unnecessary further tests, like biopsies, that can create
extreme anxiety. And mammograms can find cancers that grow so slowly that
they never would be noticed in a woman's lifetime, resulting in unnecessary
treatment." Is that all there is?
Kolata, whose sister Judi Bari died of breast cancer, ignored the one
sentence in the new guidelines pointing to *direct harm caused by mammograms
*.
In defense of Judi's sister, that sentence was easy to ignore, mealy-mouthed
and defensive (the authors of the new guidelines being medical-establishment
types): *"Radiation exposure may increase the risk for breast cancer, but
usually only at much higher doses than those used in mammography, although
regular mammography could contribute to cumulative radiation doses from
additional imaging for other reasons."*
*Jeffrey Tice, assistant professor of medicine at UCSF, was more specific in
a statement to the San Francisco Chronicle: "Radiation causes one death for
every 2,000 women screened annually at age 40, according to a study
published in 2005 in the British Journal of Cancer. Another study shows that
each mammogram increases the risk of breast cancer by two percent." *
**
*Flashback: A Preventable Disease*
"The recently growing incidence of breast cancer is not mysterious," wrote
the late *John Gofman in a 1993 report for the Committee on Nuclear
Responsibility. "Breast cancer is a largely preventable disease... A large
share of recent breast cancer in the United States is certainly due to past
medical irradiation of the breasts with x-rays -at all ages, including
infancy and childhood. Such irradiation is preventable, without any
interference with necessary diagnostic radiology, and hence many future
breast cancers need not occur.*
*"Our finding is that about three quarters of the clinical annual incidence
of breast cancer in the United States is being caused by past irradiation,
primarily from medical sources."*
Gofman acknowledged that "pesticide byproducts, hormone pills, diet,
exercise, electro-magnetic fields, and several additional factors have been
implicated by epidemiologic studies as potential contributors to recent
rates of breast cancer. Do we dismiss these other forces? Not at all...
There is no inherent conflict or competition between carcinogens. The
multi-step genetic model of cancer development 'permits' contributions even
to a single case of cancer, from heredity, ionizing radiation, viruses, and
chemicals."
**
*The Next Big Thing: "Breast Density"*
A breast-cancer specialist at California Pacific Medical Center, Steven
Cummings, has been pitching the wonders of "advanced digital mammography" to
measure "breast density." Last winter I heard him address an audience of
about 100 middle-aged women in San Francisco. Dr. Cummings is a big man with
the softest, gentlest, most reassuring voice you would ever want to hear.
His overarching goal is to spread terror -individualized, science-tinged
terror.
"...So our vision, the vision that drives the research that we're now doing
is that women can learn their risk when they have a mammogram. You answer
just a few questions about your risk factors and the breast density will be
measured automatically from the mammogram. And then we would use computer
software built into the machines to calculate your risk factors and density.
And the result would be a report of risk be it one percent in your lifetime
or 10 percent in the next five years. And the report would go to you and
your doctor. Based on that report. Let's say you're at high risk you could
get serious about changing your lifestyle. Or you might decide that an MRI
is an appropriate screening tactic. Or you would talk to your doctor about
the preventive treatments such as raloxifene. If you're at average risk,
continue your mammograms. If you were at very low risk -that would be
reassuring- and perhaps you could consider mammography less frequently.
“So what we're doing now at the Breast Health Center at CPMC is measuring
breast density and collecting risk factors from women who are having
mammograms. So far, 60,000 women have contributed to this research through
the CPMC Breast Health Center. How do we measure your breast density? My
colleagues and I have invented a little device which allows us, when put on
the mammogram plate, to tell us exactly the volume of the breast, that's
very important to know how much tissue there is, and it also allows us to
very accurately tell the density of the breast. So if you go in to have your
mammogram you'll see a little device on the side, Our goal is to measure
density and risk factors in a quarter of a million women. A quarter of a
million women having mammograms at CPMC and similar centers around the
United States. With that data in hand we plan to develop a simple device
that could be installed on all digital mammography machines and it would
give a woman her risk of breast cancer and allow her to make choices. But
our big goal is, within 5-10 years, most women who want to know can know
their risk.”
Some $3.3 billion was spent on mammograms last year in the U.S.... The more
conservative approach, given what the word means, would be to advocate fewer
mammograms. But the more conservative approach, given what the word has come
to mean politically, is mammogram-on-demand. These spin-masters can make
your head spin.
*Fred Gardner* edits *O'Shaughnessy's, The Journal of*
*Cannabis in Clinical Practice.* He can be reached at f...@plebesite.com
