Mammograms may cause breast cancer

Cebula,  I added my opinion on the other links (I believe in DCIS) so instead of posting here I will just say.. I had a mammo, ultrasound, digital mammo and all were negative then a week later I had a breast MRI and there was the DCIS.  Also, with me the ultrasound was done again after the finding of DCIS as the first bc surgeon was not convinced and he came up with nothing!  So even though he knew exactly where to look with his equipment he still did not turn up the DCIS.

PSK07:  There are years of info that shows mammo's are risk factors as well as lung x-ray, ct scans and all radiographic are dangerous to the development of cancer.  One alone or even just mammo's over a lifetime is probably very low risk, but as was stated here and the other thread we are not just exposed to mammo's, we have background exposures etc.. etc.. so to put mammo's directly on top of that is a bigger risk.  Just do a search on Mammography + risk. 

I have never suggested that TODAY we not do mammo's but keep our eye's peeled and even ask for breast MRI's.

Take a look of just one of the pings I got back from mammograms + risk

http://www.preventcancer.com/patients/mammography/ijhs_mammography.htm

This is just one representation of information about risk and it is taken from research all across the world.  Just one at the very tops of the search.. and it references many studies... 

Deirdre, sorry to be blunt, but in my opinion the article from preventcancer is garbage.  A lot of the "facts" stated in the article are the findings from one study that were refuted in many other studies.  And the authors have twisted other facts to the point where they no longer bear any resemblance to the truth.  I understand that the primary author is a doctor who focuses on preventing environmental causes of cancer; he is respected in his field but he does have a pretty obvious bias.

Since I know most about DCIS, I've dug into a few of the points the author has made about DCIS.  For example, he says "However, some 80 percent of all DCIS never become invasive even if left untreated (18)."  Well, there may be one study somewhere that showed that but the fact is that nobody knows what percent of DCIS will become invasive and even the most conservative estimates are usually higher than 20%.  Most estimates are in the range of 50% and personally I think the number is higher.  The fact is that even when removed & treated, DCIS turns into IDC in 50% of cases where there is a recurrence.  Add to this the fact that approx. 13% of cases of DCIS are not found until there is already an invasive component (cases such as mine, although technically we are Stage I, not Stage 0).  So there is no way that the "80 percent" statement is true. 

About DCIS he also says that "the breast cancer mortality from DCIS is the same- about 1 percent- both for women diagnosed and treated early and for those diagnosed later following the development of invasive cancer. (17)"  Excuse me?  The mortality rate for women diagnosed with invasive cancer that is believed to have developed from DCIS is only 1%?  Since approx. 80% of IDC is believed to have started as DCIS, and since the mortality rate from IDC is higher than 1%, this "fact" simply can't be correct. Since this statistic confused me, I went back to look at the original article from which the information was taken; it seems the original author was referring to the 1% mortality rate of DCIS women who are treated for their DCIS but then have a recurrence in the form of IDC.  He was not referring to what would happen if the DCIS has not been detected and the cancer had not been found until it was full blown IDC. 

Something to keep in mind is that this article is from 2001 and the data that's quoted is from the 1980s and 1990s.  New, more current information refutes a lot of what is said.  It's also interesting that the focus of the author is on breast self exam as an alternate to mammography.  Well, how about what these studies say?

To date, 2 largerandomized controlled trials, a quasi-randomized trial, a largecohort study and several case-control studies have failedto show a benefit for regular performance of BSE or BSE education,compared with no BSE. In contrast, there is good evidence ofharm from BSE instruction, including significant increases inthe number of physician visits for the evaluation of benignbreast lesions and significantly higher rates of benign biopsyresults.  http://www.cmaj.ca/cgi/content/abstract/164/13/1837    

It is a staple of women's health advice and visits to the OB/GYN: the monthly breast self-exam to check for lumps or other changes that might signal breast cancer. However, a review of recent studies says there is no evidence that self-exams actually reduce breast cancer deaths.....In the two large studies of 388,535 women in Russia and China included in the review, women who used self-breast exams had 3,406 biopsies, compared with 1,856 biopsies in the group that did not do the exams. At the same time, there was no significant difference in breast cancer deaths between the two groups.  http://www.cancerfacts.com/Home_News.asp?NewsId=2337&CB=14&CancerTypeId=4

I notice that the author did not mention MRIs as an alternative to mammograms and that's because MRIs are a relatively new tool for breast cancer screening.  There is much that we don't know yet about MRIs.  To my earlier post, the comment I made about MRIs being quite rare until about 10 years ago was not a Canadian statement but a global statement, supported by the fact that this article doesn't even reference MRIs.  Hopefully MRIs will be the answer and over the long term they will be proven to be safe.  But we're not there yet.

I could pick a lot more holes into the article but I won't spend my time doing that.  The fact is that if there is case that you want to make about something, there will always be information available to help you make that case.  But there is good science and bad science, there is good research and bad research, and even good research can be misinterpreted and twisted to mean something that was never intended.  All the reliable, unbiased sources that I've found suggest that the risk from mammograms is very small, and the benefit in terms of breast cancer detection and reduction of mortality is significant. 

mumayan,

While ultrasounds are a great tool for masses and lumps, they unfortunately do not see calcifications, nor does thermography. I caution you on the use of either of these modalities for your only method of screening, you also need a screening modality that will pick up calcifications, now you are looking at either mammography or MRI.

Hilarious, Kimber!

Though I'm sure it wasn't funny while it was happening.

Mammograms are barbaric. If you think they're disagreeable with small breasts, consider what they must be like with large ones.  You can't imagine what bizarre positions and shapes human flesh can be forced into until you've experienced a mammogram with big breasts and been subjected to additional "views," as I was when I was diagnosed.

Disagreeable as mommograms are, I'm sure they didn't cause my cancer, since i've had very few  of them. The first one I can remember I had during menopause. Since I couldn't remember when I had had my last period, the person in charge insisted on my having a blood draw to rule out pregnancy.  As a result of this I got phlebitis, and stayed away from mammograms for some time thereafter, finally doing two at the urging of my PCPs.  The second was the one which led to my diangosis by ultrasound-guided biopsy..

Since then I have been extensively exposed to radiation--five more mammogram views, a bone scan which required me to be radioactive for 24 hours, several X-rays, a CT scan of my chest and abdomen,  Though I don't necessarily trust doctors, I have every intention of following up my  treatment with frequent mammograms, because unpleasant as mammograms are, they can't compete with the brutality of an under-anesthesized vacuum assisted biopsy and an axillary node dissection, not to mention the other pleasures of treatment that I'm still anticipating.The possible gain in avoidance of worse experiences more than outwieighs the small risk and comparatively mild discomfort of a mammogram..

Kimber, sorry to hear your biopsies were so awful, l was very fortunate that my biopsy and they took 13 samples then came back for 5 more, was very simple. The worst part-my neck was not in a comfortable position to start with and l didn't say anything. The pre set up was a bit uncomfortable too as they had to get way back on the chest wall and that took about 4 tries to get there. My needle localization, they had to take a second run at it. No freezing as the rad didn't believe in a needle poke then another poke with the loc needle, l agree, it was simple, just pressure. Now maybe l had an advantage because l personally knew both rads who did my procedures as well as the technologists. l had all the faith in the world in these people and knew when they had to do things a second time or pulled hard they were doing it for my benefit.

As for those who have a difficult time with mammography, there are four things you can do to make your procedure a little more comfortable. 1. take an analgesic before you go whether it be tylenol or ibuprofen, 2. stop caffiene 24-48 hours prior to exam,as it makes the breasts tender 3. try a topical cream, where l am from you can get Emla cream over the counter, 4. and this is huge believe it or not -relax, let the technologist do her thing, let her manipulate you, don't fight back as this makes it worse for both of you then the tech has to more forcefully push you around. Also with compression if you stiffen up, the tech has to compress tight muscle before she actually gets to the breast. Trust me here, l know what l am talking about.

Hopefully that will help some of you.

Beesie, Sorry I didn't get back to you on this sooner but I don't want there to be any confussion.. 

If you just take a look at my post you will see I was suggesting that that was only one "ping" on the internet that occurred with typing in "mammography + risk".. it was not presented as an absolute anything.. that being said I don't need to support the suggestion that "radiation and mammography" carry risk.  Every medical review on this subject that I have read suggests that mamo's carry risk.  If you believe the risk to be acceptable to you well fine - take that risk.. but it is indeed a risk.  And I was addressing the question here, not the question in a scientific arena.

I do understand that you have a strong background in research, but the reason for confussion in DCIS treatment is because the research is all over the place (not per me but per the experts)..  So I respect your interpretation of the data and I hope you will respect my concerns about those interpretations.

Best

I enjoyed reading the disclaimer that is on the science blog linked in the above post:

"This is a personal web log, reflecting the sometimes prickly opinions of its author. Statements on this blog do not represent the opinions of anyone other than the author. They most definitely do not represent the opinions or position of the author's hospital, university, cancer institute, surgical practice, partners, or research colleagues. The information on this blog is intended for discussion and entertainment purposes only and not as recommendations about how to diagnose or treat illnesses. Any personal medical issues the reader may have should be referred to the reader's physician. If the reader freely chooses to follow the opinion of a pseudonymous blogger like the author (who has also not done a proper history or physical examination and whose credentials cannot be verified) over that of his or her own personal physician, it is the reader's decision alone, for which the reader must bear full responsibility."

I know that my BC was not caused by mammograms, as I was one of those people that never made time for them.  I only had one when I was about 35 or so, and then put it off until a good friend bugged me so much I finally made the time and had one at age 50.  Well, it found IDC and now I've had a lumpectomy and am going through chemo.  If only I had had one earlier, I might have found the lump before it was 2.3 cm. and I wouldn't be going through chemo!

Deirdre, I'm sorry, I hope I didn't suggest at any point in any of my posts that I don't agree that there may be some risk associated with having a mammogram. I think I've said the opposite.  It's radiation, so yup, there probably is some risk.  But my belief from everything I've read is that the risk is very small and personally I feel that the benefit from mammograms outweighs the risks.  But I wouldn't say that this is absolutely no risk.

My most recent response was simply addressing the points in the article for which you provided the link.  In the few areas where I know the facts, the facts in the article clearly seemed to be wrong.  That led me to believe that in all likelihood, the facts throughout the article were probably wrong.  But I understand that this is one of many articles one can find on the internet and I wasn't suggesting that because I disagree with that article, I disagree will all of them and they are all wrong. 

I have to admit I'm a little confused about your comment that you were "addressing the question here, not the question in a scientific arena".  Isn't the whole question about mammogram risk one of science?  Opinions are fine, but ultimately if anyone is going to say on a public discussion forum that mammograms are risky and perhaps should be avoided, I would hope that there is science behind it.  As for the facts about DCIS being confusing, I couldn't agree more!  There is a lot of different information about DCIS out there; my point was only that the author of that article was way out in left field to the point that few in medical science would agree with what he said.

In any case, I agree with you that we all have a right to interpret information as we see fit.  And I firmly believe that we all must decide what's right for ourselves.  I think this whole thread has been very interesting and I've learned a lot from it.  My only concern is a fear that some of this discussion might lead someone to not have their mammogram, and that could lead to a missed diagnosed which in the end could lead to a more serious case of cancer.  I enjoy many of the back and forth discussions that we have on this board, but I always keep in mind that there are many more viewers than commenters, and I'm always conscious of how we might be influencing some of these viewers. 

Ok, I know this is ingorant, but I have a question that bugs me -- since radiation is known to cause cancer, why do they treat cancer with radiation?  Somehow it seems odd...

For some breast cancers,we can do some other things besides cut, burn, and poison.  For example, herceptin targets a gene that is multiplied too many times in some breast cancers.  Tamoxifen, and other anti-hormonals, aren't 'poison', though I guess some people would regard any medication as poison.

But in breast cancer, they do try to minimize the exposure to the affected area, and they use specific energies of radiation. 

With radiation, there is usually not an all-or-nothing effect curve.  The dose and frequency are important. Age is important.  (You want to avoid chest radiation to the breast buds at least in older children.)  So there usually is some % of cells that might be killed, and some % of cells that might be mutated, and some % of cells that may not be immediately affected. Again, it is risk vs benefit. There are different energies of radiation that kill cells, and other energies of radiation that may not kill the cells but be more likely to mutate cells, and some energies that will probably do nothing.  For example, they use ultrasound imaging  (sound waves) even on unborn babies.

Ionizing radiation (which is of high enough energy to tear parts of molecules apart) tends to affect the fast growing cells more than the slower growing cells.  That's because the most lethal way of killing cells is to affect their DNA and RNA, and these are in their greatest use when cells replicate and grow.  Chemotherapy and radiation tend to hit the fast growing cells, so if your hair or gut is exposed to the treatment, they are more likely to die than other parts of your body. So they tend to be more effective in fast growing tissues/cancers than in slow growing tissues.

"Breastcancer.org's  discussion board is made up of many people and it is designed to accommodate everyone's experience's. I was suggesting that we shouldn't have to "cite" every comment on medicine or science that we make because this could lead to a situation where there would be very little room for people's experiences and voices."

I agree.  The value of sharing our experiences is critical.  By sharing our experience, we help others make it through the diagnostic process and breast cancer treatment. By sharing information about how we made our own treatment decisions, we help other women realize what's important or not important to them as they make their own treatment decisions.  But where I think we have to be extremely cautious, where we start to cross the line, is when we stray into the area of medicine and start offering opinions and recommendations.  I know there's a lot that's uncertain about the diagnosis and treatment of breast cancer but there are accepted treatment guidelines and standards. These may change in the future as new medical data becomes available but they are the best that medical science has today. I worry when I see women here recommending treatment that contradicts current medical practices.  We're not doctors or medical researchers; who are we to advise someone to do something that is contrary to medical standards?  I worry when I see treatment recommendations based on personal preferences. Why would anyone think that what was right for them is right for everyone (or even anyone) else?  If someone has a choice of treatments, it's one thing to explain why you made the choice you did; it's something else all together to say "I did xyz and I can't imagine why anyone would do abcd." The first is sharing your experience; the second is offering a medical advice. 

What it comes down to for me is that because this is a peer-to-peer discussion board, I think sharing our experiences can be very helpful but I don't think we should be offering medical advice. Whenever I see a post where someone is asking for medical advice, my approach is to provide a framework for making the decision (here are some of the things you would want to consider...), then I provide whatever medical data I can (scientific data, research studies, etc.) and then I direct the woman, facts in hand (and often a list of questions too), to her doctor.

As for questioning conventional medical wisdom, I think that's an interesting & educational thing to do.  But personally I don't think these types of discussions have a place in forums where those who are going through the diagnostic process or those who are newly diagnosed are hanging out.  In these forums, the risk of scaring someone or the risk of unintentionally influencing someone is too great.

Vivre, I need to do some research on thermogram's too - I only heard about them after my dx!  You make a great point about the doc's and tech's being good at reading scans and x-rays.. By now you would thing they could be experts at reading them, since they (radiography + radiographic tests) have been with us for a long time!  And yes most research today is funded by someone who has vested interest as apposed to true pure science (available in only very small doses now) ..  So it certainly leave us vulnerable.. and our vulnerability is what makes us look for other answer IMO.

Beesie, I do understand that when patients are most vulnerable about your dx they can be influenced by what people here say and I try to be very careful with my responses - But that is the point of this portion of the site IMO.  And I know you are very scientific oriented.. but if you think about the entire site (breastcancer.org) it does have places for the most recent science models, "standard of care" models and absolute complete explanation of "what will happen next" and "how to read the biopsy report"  all incredibly important in making any decision, but the people come to this portion for reassurance that they will be OK but also if there are other models that perhaps the medical community might not bring up they want to hear them.. and let's not forget that there are complementary practioner's right on the board here so all is considered acceptable if it is that individual decision after looking at ALL the models.. 

Alternative medicine can be held up to a higher standard too and often it has been put through the same rigors as conventional medicine and yet the outcomes are not used within the models of "standard of care".  I receive, for example, a newletter by doc's who recieve no compensation for their work either by the drug companies, supplement manuf. or other source of potential cures and I use that CAREFULLY when trying to balance this process (they often refer to research, data and models used in other countries that supports their position too)..  But using all the information carefully is the way I reach a balance.

I completely appreciate your voice here as a reminder and a pointer back to those conventional medical models for someone who might have walked in without any info at all.  Your posts are always clean and right on point (and kind I might add).. so it's always good to hear your voice!

Best 

I want to alter what I said about science a bit.. I do believe that there are scientists who want to do good science, true science.. but I believe they cannot find the funding to back them without the strings attached.  Dr. Slamon was an example of an individual scientist/doctor who was frustrated with the drug company that allowed him to start the herceptin tests only to want to pull the plug when it was convenient for them - it wasn't cost effect and he/Dr. Slamon had to find his own financial backing for the research... when did this go so terribly wrong?  Look how many lives that has saved!!! 

Beesie, I don't see a great deal of what you call pressure tactics and scare mongering except in the medical community where I received my dx.. so I agree with you and certainly do not have any intention of pressuring anyone!  I am just trying to put options out there that might not have been considered and these are based on my experiences as well as my fathers in this difficult path of breast cancer!

And I think you under estimate you opinion within this body of 42,000 - I think many, many of use value your opinion very much!  You voice is of great value here!