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Safe Breast Self Exam by Young Women vs. Dangers of Mammography

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Critics of a Bill promoting training secondary school students to do breast self examinations to detect cancer are ignoring the risks of premenopausal mammography.

On March 26 this year, Representatives Debbie Wasserman-Schultz (D-FL) and Amy Klobuchar (D-MN), supported by other leading Representatives introduced the Breast Cancer Education and Awareness Requires Learning Young, EARLY, Act of 2009. The object of this Act is "to increase awareness of the risks of breast cancer in young women, and to provide support for those diagnosed with breast cancer." The bill has 260 co-sponsors, enough to guarantee passage by the House. However, the measure has stalled in the Senate.

The Bill met with a storm of protests by "experts in breast cancer prevention." These included Dr. Donald Berry, chairman of the Department of Biostatistics at the M.D. Anderson Cancer Center, who warned that the bill is misguided. "I leave politics to the politicians, why can't they leave science to the scientists? Except for family history, there are no important risks ... for women younger than 40."

Dr. Leslie Bernstein, director of the City of Hope Comprehensive Cancer Center, also claimed that "We have no known environmental causes of breast cancer other than radiation . . . except when you are having a mammogram," a surprising and damaging admission.

However, these and other critics of EARLY are unaware of the scientific evidence on a wide range of avoidable causes of breast cancer. These include the Pill, estrogen replacement therapy, and living close to hazardous waste sites and nuclear plants.

Not surprisingly, the American Cancer Society (ACS), a strong proponent of routine premenopausal mammography, failed to comment on EARLY. In 1984, with its October flagship National Mammography Day, the ACS inaugurated the National Breast Cancer Awareness Month. This assured women that annual mammography starting at the age of 40 "results in a cure nearly 100 percent of the time." However, and still denied by the ACS, screening mammography poses significant dangers of radiation.

The routine practice of taking two films of each breast annually over 10 years, results in approximately 0.5 rad (radiation absorbed dose) exposure. This is about 500 times greater than exposure from a single chest X-ray, broadly focused on the entire chest rather than narrowly on the breast. Moreover, the premenopausal breast is highly sensitive to radiation. Each rad exposure increases risks of breast cancer by about 1%, with a cumulative 5% increased risk for each breast over a decade's screening. So, a premenopausal woman having annual mammograms over 10 years is exposed to roughly 5 rads. This is the approximate level of radiation received by a Japanese woman a mile or so away from where the Hiroshima or Nagasaki atom bombs were exploded.

Radiation risks are increased by fourfold for the 1% to 2% of women who may be unknowing and silent carriers of the A-T (ataxia-telangiectasia) gene, and thus highly sensitive to the carcinogenic effects of radiation. By some estimates, this accounts for up to 20% of all breast cancers diagnosed annually.

Of additional concern, missed cancers are common in premenopausal women due to the density of their breasts. Mammography also entails tight and often painful breast compression, particularly in premenopausal women. This may lead to the rupture of small blood vessels in or around small undetected breast cancers, and the lethal distant spread of malignant cells.

That most breast cancers are first recognized by women themselves was even admitted as early as 1985 by the American Cancer Society (ACS), the world's largest "non-profit" organization. At least 90 percent of women who develop breast cancer discover the tumors themselves."

As detailed in my 1999 publication in the prestigious International Journal of Health Services, the ACS is knee deep in conflicts of interest with the mammography industry. Five radiologists have served as ACS presidents and, in its every move, the ACS promotes the interests of the major manufacturers of mammogram machines and films, including Siemens, DuPont, General Electric, Eastman Kodak, and Piker. The mammography industry also conducts "research" for the ACS, to which it donates considerable funds. This blatant conflict of interest is hardly surprising. The Chronicle of Philanthropy, the world's leading charity watchdog, warned in 1993 that the ACS is "more interested in accumulating wealth than saving lives."

Not surprisingly, ACS promotion continues to lure women of all ages into mammography centers, leading them to believe that mammography is their best hope against breast cancer. An ACS communications director, questioned by journalist Kate Dempsey, admitted in an article published by the Massachusetts Women's Community's journal Cancer, "The ad isn't based on a study. When you make an advertisement, you just say what you can to get women in the door. You exaggerate a point . . . Mammography today is a lucrative [and] highly competitive business."

Furthermore, an analysis of several 1993 studies showed that women who regularly performed monthly breast self-examination (BSE) detected their cancers much earlier than those who failed to do so. However, the ACS and radiologists still claim that "no studies have clearly shown any benefit of BSE."

Apart from the importance of self-empowering women, the costs of BSE are trivial compared to the inflationary impact of mammography. The estimated annual costs for screening pre- and post-menopausal women are in excess of $10 billion, equivalent to about 14 percent of Medicare spending on prescription drugs. Costs of digital mammography, enthusiastically supported by radiologists and the radiology industry, are approximately four-fold greater, even in the absence of any evidence for its improved effectiveness.

Finally, and not surprisingly, premenopausal mammography is practiced by no nation other than the United States. As recently reported by the British journalist Liz Savage, "Earlier this year, The Times of London published a letter, signed by two dozen physicians and patient advocates, reprimanding the UK's National Health Service for not providing women with adequate information about the risks of screening mammography." The letter described "the harms associated with early detection of breast cancer by screening that are not widely acknowledged. The most important of these harms are over-diagnosis -- and its frequent consequence, over-treatment."

Samuel S. Epstein, M.D. is Professor emeritus of Environmental & Occupational Medicine at the University of Illinois at Chicago School of Public Health; Chairman of the Cancer Prevention Coalition; and author of over 200 scientific articles and 15 books on cancer, including the groundbreaking The Politics of Cancer (1979), and Toxic Beauty (2009).