Quantifying the Benefits and Harms of Screening Mammography

Invalid messages about screening mammography can be detrimental to women

JAMA Internal Medicine, the journal of the American Medical Association, published the findings of a brief online survey of middle-aged Americans.Most had previously been screened for either breast or prostate cancer but about half said they would not choose to start screening if the test resulted in more than one overtreated person per one cancer death averted.

ABSTRACT

Quantifying the Benefits and Harms of Screening Mammography
The Journal of the American Medical Association, published since 1883, is an international peer-reviewed general medical journal published 48 times per year

Like all early detection strategies, screening mammography involves trade-offs. If women are to truly participate in the decision of whether or not to be screened, they need some quantification of its benefits and harms. Providing such information is a challenging task, however, given the uncertainty—and underlying professional disagreement—about the data. In this article, we attempt to bound this uncertainty by providing a range of estimates—optimistic and pessimistic—on the absolute frequency of 3 outcomes important to the mammography decision: breast cancer deaths avoided, false alarms, and overdiagnosis. Among 1000 US women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly. We hope that these ranges help women to make a decision: either to feel comfortable about their decision to pursue screening or to feel equally comfortable about their decision not to pursue screening. For the remainder, we hope it helps start a conversation about where additional precision is most needed.
Cancer screening involves trade-offs. Screening offers the potential benefit of avoiding advanced cancer and subsequent cancer death. It also produces the harms of false alarms, overdiagnosis, and unnecessary treatment. Because different individuals value these benefits and harms differently, there is no single calculation to answer the question of what to do. Instead, each of us needs information about both the benefits and harms to arrive at our own decision.

Simply knowing that there are benefits and harms to screening is not sufficient to make the decision; information about their relative magnitude is essential. If 100 people benefit by avoiding a cancer death at the expense of the harms of 50 false alarms and 10 overdiagnoses with the ensuing unnecessary treatments, then the decision is easy. However, if for the same harms, the benefit is only 1 person avoiding a cancer death, the decision may be considerably more difficult. In this article we quantify the benefit-harm trade-off for screening mammography.

  • METHODOLOGICAL APPROACH: GENERAL PRINCIPLES
  • HOW MANY BREAST CANCER DEATHS ARE AVOIDED BY SCREENING MAMMOGRAPHY?
  • HOW MANY FALSE ALARMS ARE CAUSED BY SCREENING MAMMOGRAPHY?
  • HOW MANY WOMEN ARE OVERDIAGNOSED BECAUSE OF SCREENING MAMMOGRAPHY?
  • PERSPECTIVE AND LIMITATIONS
  • CONCLUSIONS – ARTICLE INFORMATION – ARTICLE INFORMATION – REFERENCES

Read Quantifying the Benefits and Harms of Screening Mammography, The JAMA Network, December 30, 2013

Study analysis: Breast Cancer Screenings: What We Still Don’t Know, TheNrwYorkYimes, December 29, 2013

Related Posts:

Routine Screening Mammography: how Important is the Radiation-Risk Side of Benefit-Risk Equation?

Low doses of low-energy X-rays produce an increased risk per unit dose of about a factor of 2

Abstract:

Routine screening mammography: how important is the radiation-risk side of the benefit-risk equation?
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.

The potential radiation hazards associated with routine screening mammography, in terms of breast cancer induction, are discussed in the context of the potential benefits. The very low energy X-rays used in screening mammography (26-30 kVp) are expected to be more hazardous, per unit dose, than high-energy X- or gamma-rays, such as those to which A-bomb survivors (from which radiation risk estimates are derived) were exposed. Based on in vitro studies using oncogenic transformation and chromosome aberration end-points, as well as theoretical estimates, it seems likely that low doses of low-energy X-rays produce an increased risk per unit dose (compared with high energy photons) of about a factor of 2. Because of the low doses involved in screening mammography, the benefit-risk ratio for older women would still be expected to be large, though for younger women the increase in the estimated radiation risk suggests a somewhat later age than currently recommended–by about 5-10 years–at which to commence routine breast screening.

Sources: NCBI, PMID: 12556334
Int J Radiat Biol. 2002 Dec;78(12):1065-7.

Full Article:

Routine screening mammography: how important is the radiation-risk side of the benefit-risk equation? CEM, int. j. radiat. biol 2002, vol. 78, no. 12.

Related Posts:

No Mammo ?

Livre enquête sur le dépistage du cancer du sein

No Mammo ? Enquête sur le Dépistage du Cancer du Sein
Rachel Campergue: Comment sont posées les questions? That is THE question…

Chaque année, au mois d’octobre, notre environnement se pare de rose et de placards innombrables appelant à partir en croisade contre le cancer du sein grâce à la mammographie.

  • Pourquoi une telle volonté des responsables de santé publique, des médecins, des associations ou des laboratoires?
  • Les femmes sont-elles réellement bien informées des risques qu’elles encourent en se soumettant à un tel dépistage?
  • Et les bénéfices qu’on leur fait miroiter existent-ils vraiment?

Révoltée par l’obstination des gynécologues à lui imposer la mammographie, Rachel Campergue a mené sa propre enquête.
Ce qu’elle découvre est effarant:

  • Infantilisant les femmes, les pouvoirs publics promeuvent la confusion entre prévention et dépistage.
  • Les médecins ne disposent pas des connaissances adéquates garantissant que les consentements qu’ils arrachent à leur patientes sont effectivement «informés».
  • Quant aux associations, elles sont les agents d’un business juteux qui profite avant tout aux fabriquants de biens de santé.

La conclusion de ce travail foisonnant, précis et non dénué d’humour, est sans appel: une mammographie n’équivaut pas à une vie sauvée, et, si vous choisissez d’en passer une tous les deux ans, faites-le en toute connaissance de cause.

Expertise citoyenne – les coulisees de No Mammo – le livre sur Amazon

Related Posts (in English):

On Flickr®

Nipple Aspirate Test is Not an Alternative to Mammography

The nipple aspirate test and breast cancer screening

Some companies are marketing a new test—the nipple aspirate test—as the latest and greatest tool in early breast cancer screening. But FDA warns that the nipple aspirate test is no substitute for a mammogram.

FDA Abstract :

Nipple Aspirate Test is No Substitute for Mammogram
The FDA says: ” don’t substitute new nipple aspirate test for mammogram, no matter what companies claim

Product:
A nipple aspirate device is a type of pump used to collect fluid from a woman’s breast. A nipple aspirate test can determine whether the fluid collected from the breast contains any abnormal cells.

Purpose:
The FDA is alerting the public, including women and health care providers, that a nipple aspirate test is not a replacement for mammography, other breast imaging tests, or breast biopsy, and should not be used by itself to screen for or diagnose breast cancer. The FDA is not aware of any valid scientific data to show that a nipple aspirate test by itself is an effective screening tool for any medical condition including the early detection of breast cancer or other breast disease.

The FDA, other public health agencies, and national medical and professional societies agree that mammography is the most effective method for detecting breast cancer in its earliest, most treatable stages. These organizations include the American Cancer Society, the American College of Radiology, the Centers for Disease Control and Prevention, the National Cancer Institute, and the Society for Breast Imaging. The National Comprehensive Cancer Network (NCCN) 2013 guidelines state that the clinical utility of nipple aspiration is still being evaluated and it should not be used as a breast cancer screening technique.

Summary of Problem and Scope:
Certain manufactures are promoting the use of nipple aspirate tests as a stand-alone evaluation tool for screening and diagnosing breast cancer, claiming they are an alternative to biopsy or mammography. They also claim that a nipple aspirate test can detect pre-cancerous abnormalities and diagnose breast cancer before mammography with just a sample of a few cells. The FDA is concerned that women will believe these misleading claims about a nipple aspirate test and not get mammograms and/or other needed breast imaging tests or biopsies. This may lead to serious adverse health consequences.

Possible health consequences include false negative test results, indicating the absence of breast cancer when cancer exists, and false positive test results, indicating the presence of breast cancer when none exists. False negative results may lead to delayed diagnosis and/or delayed treatment of breast cancer, with increased risk of serious illness or death. False positive results may lead to needless patient anxiety, along with unnecessary additional testing and treatment.

Recommendations for Patients:

  • Remember that a nipple aspirate test, such as Atossa Genetics Inc.’s Mammary Aspiration Specimen Cytology Test (MASCT) and/or ForeCYTE Breast Health Test systems, or the HALO Breast Pap Test, is not a substitute for mammography, other breast imaging tests, or breast biopsy, and should not be used by itself for breast cancer screening or diagnosis.
  • If you have had a nipple aspirate test as a stand-alone evaluation tool for screening and diagnosing breast cancer, you should request a mammogram from your health care provider to get accurate results.
  • Undergo regular mammograms according to screening guidelines or as recommended by your health care provider.

Recommendations for Health Care Providers:

  • Do not use a nipple aspirate test as a substitute for mammography or by itself for breast cancer screening or diagnosis.

FDA Activities:
The FDA has taken action against certain manufacturers promoting nipple aspirate tests as a stand-alone tool for screening and diagnosing breast cancer.

In February 2013, the FDA sent a warning letter to Atossa Genetics, Inc. for the marketing and promotion of a nipple aspirate test for uses that had not received FDA marketing clearance or approval. In this warning letter, the FDA instructed the manufacturer to immediately stop making inappropriate claims about nipple aspirate tests.

In October 2013, Atossa Genetics Inc. initiated a voluntary recall to remove the ForeCYTE Breast Health Test and the Mammary Aspiration Specimen Cytology Test (MASCT) from the market. The FDA classified this recall as Class I, which means that the product is dangerous or defective and has a reasonable chance of causing serious health problems or death.

The FDA will continue to monitor the promotional activity of nipple aspirate test manufacturers, and keep the public and practitioners informed as new information becomes available.

FDA Resources :

For DES Daughters, and in the UK

 

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The Mammogram Myth

The Independent Investigation Of Mammography The Medical Profession Doesn’t Want You To Know About

The Mammogram Myth, on Flickr
An independent investigation
by Rolf Hefti

“The Mammogram Myth”, the result of an independent investigation by Rolf Hefti, dismantles – error by error- the official medical claims about the value of mammograms, such as that they are very safe, and greatly reduce breast cancer mortality.

This (e)book describes the “inconvenient” research data that has been dismissed and disregarded by the traditional medical profession (such as the true risks of medical radiation). It is the largely ignored but factual scientific evidence against the use of mammograms.

The official medical claims made by orthodox medicine about mammography appear convincing to both doctors and the public at large. Yet, the theory and claims promoting the screening practice are based on flawed research data and sustained by omitting and discounting relevant dissenting scientific evidence. Mammography is a case of “dogma over science” says the author of ” The Mammogram Myth”.

In the foreword to “The Mammogram Myth”, Ray Peat, PhD stated, “Women concerned about the risk of breast cancer will obviously want to read it, and if doctors who regularly advise their patients to have mammograms decide to read it looking for justification of their policy, they will encounter information about cancer in general and health in general that should change their life.”

Related posts:

More images:

  • Watch the Diaporama, and the DES books photo set on flickr®  DES Diethylstilbestrol's photostream on Flickr
  • If you already have a flickr® account, add us as a contact.
    Email your photos to des.daughter@gmail.com with a short description and title :-)

Thermography is Not a feasible Method for Breast Cancer Screening

The only study performed long ago for evaluating thermography technology in the screening setting demonstrated very poor result

Abstract:

Thermography is not a feasible method for breast cancer screening
Thermography uses heat sensitive infrared cameras to image the body and measure heat emission

Breast cancer is a common malignancy causing high mortality in women especially in developed countries. Due to the contribution of mammographic screening and improvements in therapy, the mortality rate from breast cancer has decreased considerably. An imaging-based early detection of breast cancer improves the treatment outcome. Mammography is generally established not only as diagnostic but also as screening tool, while breast ultrasound plays a major role in the diagnostic setting in distinguishing solid lesions from cysts and in guiding tissue sampling. Several indications are established for contrast-enhanced magnetic resonance imaging. Thermography was not validated as a screening tool and the only study performed long ago for evaluating this technology in the screening setting demonstrated very poor results. The conclusion that thermography might be feasible for screening cannot be derived from studies with small sample size, unclear selection of patients, and in which mammography and thermography were not blindly compared as screening modalities. Thermography can not be used to aspirate, biopsy or localize lesions preoperatively since no method so far was described to accurately transpose the thermographic location of the lesion to the mammogram or ultrasound and to surgical specimen. Thermography cannot be proclaimed as a screening method, without any evidence whatsoever.

Sources: Thermography is not a feasible method for breast cancer screening, NCBI, June 2013 ;37(2):589-93. – full study PDF

Related post: Is thermography a valid tool for breast cancer screening or snake oil? by Jen Gunter, 04 Oct 2013

For DES Daughters, and in the UK

What the Medical Industry fails to tell Women about Mammograms

What Every Woman Ought to Know About Mammography But Usually Doesn’t

Starting with a quote from Mark Twain:

Whenever you find yourself on the side of the majority, it’s time to pause and reflect

What Every Woman Ought to Know About Mammography But Usually Doesn’t
What the Medical Industry fails to tell Women about mammograms

Author Rolf Hefti covers the following points on NaturalNewsBlog:

  • Here Is What The Medical Industry Fails To Tell Women About Mammograms
  • Medical Research: Vehicle For Commercial Advertisements
  • Most Doctors (Unwittingly) Misinform Their Patients About Mammograms
  • Breast Cancer Awareness Groups & The Mainstream Media Are Complicit In Spreading The Medical Orthodoxy’s Disinformation On Mammography
  • Acting According To The Teaching Of A Famous Saying

Read What Every Woman Ought to Know About Mammography But Usually Doesn’t, by Rolf Hefti, 24 Oct 2013

Related post: Mammography Screening: Truth, Lies and Controversy

Mammography Screening: Truth, Lies and Controversy

2012 book by Peter C Gøtzsche

Mammography screening,  Truth, Lies and Controversy, by Peter C Gøtzsche, on Flickr
Why mammography screening is unlikely to be effective today…

Mammography screening is one of the greatest controversies in healthcare, and the extent to which some scientists have sacrificed sound scientific principles in order to arrive at politically acceptable results in their research is extraordinary.

In contrast, neutral observers increasingly find that the benefit has been much oversold and that the harms are much greater than previously believed.

This groundbreaking book takes an evidence-based, critical look at the scientific disputes and the information provided to women by governments and cancer charities. It also explains why mammography screening is unlikely to be effective today. ”

Breast Cancer Screening in Women exposed in Utero to DiEthylStilbestrol

The majority of DES-exposed women do not perform monthly breast-self examinations

DES Follow-up Study Summary

National Cancer Inst logo image
The majority of DES-exposed women do not perform monthly breast-self examinations.

The purpose of this paper was to determine if women exposed in utero to Diethylstilbestrol (DES) are more likely than unexposed women to receive recommended or additional breast cancer screening examinations.

Data from the study cohort were used to assess the degree of recommended compliance of breast cancer screenings was found in 3,140 DES exposed and 826 unexposed women. Participants were enrolled at four sites: Houston, Boston, Rochester, and Los Angeles. The data from the mailed questionnaires that included the reported frequency from 1990 through 1994 of breast-self examinations (BSEs), clinical breast examinations (CBEs), and mammograms was analyzed.

The results showed that the DES-exposed women exceeded annual recommendations for CBEs among women without a history of benign breast disease compared with unexposed women. There were no other statistically significant differences between exposed and unexposed women who reported performing BSEs, CBEs (less than 40 years of age), and mammographies, regardless of benign breast disease history.

Although this study showed that the majority of DES-exposed women receive breast cancer screenings at least at recommended intervals, it also showed that over two thirds do not perform monthly BSEs. It is recommended that Future efforts should be focused on further educating this and other at-risk populations through mailed reminders and during patient consultations on the benefits of screening examinations.

2009 Study Abstract

Purpose:
To determine if women exposed in utero to diethylstilbestrol (DES) are more likely than unexposed women to receive recommended or additional breast cancer screening examinations.

Methods:
1994 Diethylstilbestrol-Adenosis (DESAD) cohort data are used to assess the degree of recommended compliance of breast cancer screenings found in 3140 DES-exposed and 826 unexposed women. Participants were enrolled at four sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data that included reported frequency over the preceding 5 years (1990-1994) of breast-self examinations (BSEs), clinical breast examinations (CBEs), and mammograms.

Results:
DES-exposed women exceeded annual recommendations for CBEs (aOR 2.20, 95% CI, 1.04-4.67) among women without a history of benign breast disease (BBD) compared with unexposed women. There were no other statistically significant differences between exposed and unexposed women who reported performing BSEs, CBEs (<40 years of age), and mammographies, regardless of BBD history.

Conclusions:
The majority of DES-exposed women receive breast cancer screenings at least at recommended intervals, but over two thirds do not perform monthly BSEs. Future efforts should be focused on further educating this and other at-risk populations through mailed reminders and during patient consultations on the benefits of screening examinations.

Sources

  • Breast cancer screening in women exposed in utero to diethylstilbestrol,NCBI, PMID: 19361323, 2009 Apr;18(4):547-52. doi: 10.1089/jwh.2007.0580. Full text PMC2857514.
  • NCI, DES Follow-up Study Published Papers.
Related posts
More DES DiEthylStilbestrol Resources

Breast Cancer Screening is important, but Patients should be seen by an experienced Doctor or Nurse too

Mammograms are important, but they’re not the whole story

Nurse-with-patient
Mammograms are not the whole story…

” … What would have happened if I had simply undergone a mammogram, with no access to a doctor or trained breast nurse? I would have received the all-clear and an invitation for another mammogram in three years time. Although I would have found a lump sooner than that (I hope), the cancer would have been much more advanced and more radical surgery and treatment would have been necessary. I fear this must happen to far too many people… 

Read Mammograms are important, but they’re not the whole story
by Judith Potts.

For DES Daughters

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