Of 207 SBC's (women suspicious of breast cancer), 71% were under age 45,
and 60% had abnormal images while 31% had normal findings.

They were spared of radiation from mammography or invasive biopsies. 

Of 47 WBC's (women medically diagnosed with breast cancer), 68% were age 45 and above.

and 94% expectedly had abnormal images but surprisingly, 4% had normal breast findings.

They were given a safe and non-invasive method to monitor themselves.

Breast Cancer Brouhaha: Mammograms Oversold

by Andrea Ravinett Martin  (1946-2003)

Founder of The Breast Cancer Fund in San Francisco, California

Once again, research has exposed the inadequacies of mammography. This may come as shocking news to the millions of women who believe the relentless marketing campaign for mammograms which reaches a deafening din in October, National Breast Cancer Awareness Month.  However, a large, long term research study provides compelling evidence that mammograms are oversold.

A 13-year Canadian study of more than 39,000 women has shown that annual mammographic screening for breast cancer in women ages 50 to 59 does not reduce the rate of death from breast cancer when compared to women having only annual clinical breast examinations. The women in the study were divided into two groups.  One group received mammography and clinical breast examinations. The other group received only clinical breast examinations.  After 13 years, 622 invasive tumors and 107 deaths occurred in the mammography group compared with 610 invasive tumors and 105 deaths in the physical examination only group. The researchers emphasized that they were not comparing mammography with no screening, but with "competent clinical breast examination."

Published in the Journal of the National Cancer Institute, this study created an instant brouhaha.  Leading radiologists leaped to the defense of mammography, calling the study flawed, criticizing the quality of the films and implying fraud on the part of those who randomized the patients. Whether those criticisms are valid depends on whom you ask.

            What may get lost in the tumult and shouting about this study are five critical messages:

            First, detection is not prevention, and mammography will not save us from breast cancer.  Nor does breast cancer found through mammography represent true early detection.  By the time a breast tumor is detected on x-ray, experts believe it has been growing 8 to 10 years.

 It is not the intent of The Breast Cancer Fund to discourage women from having mammograms.  It is the best method we have at this time for screening large numbers of women.  We believe that any woman who chooses to have a mammogram should have one and that her insurance should pay for it, but she also needs to be aware of the technologies limitations.

            Second, mammography is not a risk-free procedure. To imply otherwise defies established science.  Mammography is radiation, a known cause of breast cancer. According to the U.S. Environmental Protection Agency, there is no safe dose of radiation.  Furthermore, radiation dosage is cumulative throughout life, and there is no program in place to monitor patients cumulative lifetime radiation exposure, even though the technology exists.

            Both The National Cancer Institute and The American Cancer Society recommend that regular mammography screening begin at age 40, despite the recommendations of a 1997 NCI consensus panel to the contrary.  Women who follow those guidelines will be exposed to radiation for an additional 10 years, not an insignificant risk. 

Third, U.S. physicians and nurses need better training in clinical breast examination.  The 60 second flutter that too often constitutes clinical breast examination is grossly inadequate and a far cry from "competent" clinical breast examination as defined in the Canadian study. A thorough clinical breast examination should take a minimum of 10 minutes on each breast, a standard of care beyond the limitations of managed care.

            Fourth, most breast cancers in the United States are found by women themselves, either during self breast examination or by accident, while showering for example.  Finding a lump sends most women to their doctors for mammograms and other tests.  Too often, if a mammogram shows no abnormality, the woman is sent home without further investigation.

 Fifth, during the last half of the 20th century, almost every area of medicine saw extraordinary advances in technology. Yet mammography--a 50-year-old technology--is all we have to screen women for breast cancer. As the disease continues its relentless march into younger and younger bodies, mammography is proving less and less effective in detecting tumors in time for treatment to be successful.  Even in older women, mammograms are not foolproof, missing up to 20 percent of breast cancers.

This long-standing neglect of a vital womens health issue must end.  The government and large cancer organizations must stop putting more resources into refining mammograpy an ultimate dead-end in screening technology and begin focusing on research that will yield a safer, more reliable test. 

It is simply unacceptable to use a carcinogen to detect breast cancer, and to market the technology to young women for whom it is least effective and most dangerous.  It is long past time for a breast cancer detection method that will be effective for women of all ages without exposing them to years of radiation or compression.            

The Breast Cancer Fund believes that unless and until a fully informed public demands that breast cancer detection move beyond mammography, this will not become a priority on the national research agenda.  It was public pressure that led to the passage and funding of the Mammography Quality Assurance Act, ensuring that all facilities offering mammography met federal standards.  By educating women to the urgent need for a more effective method of early detection, we hope to help that pressure build and invite others to join us in that effort.