Mammography seeks to diagnose breast cancer earlier, with the hope that more timely initiation of treatment will lead to better outcomes. All this makes sense, but there are facts about mammography which do not make it the ‘no-brainer’ many doctors and researchers would have us believe it to be.
Claims are often made that mammography saves lives. However, you can read here about research which found that reductions in death rates on the introduction of mammography were actually smaller than those in areas where mammography was not offered to women. The implication here is that reductions in death on the introduction of mammography were nothing to do with mammography at all, but due to other factors such as improvements in breast cancer treatments.
And there’s something else that women need to know about mammography too: it very often leads to the detection of lesions that turn out to be ‘nothing’, as well as cancers that would not have troubled the women over their natural lives. As a result, many women are subjected to stress and unnecessary investigations and treatments. Sometimes, these treatments cost women their lives. This is most certainly not a trivial matter.
In recent years, some researchers and doctors have been keen to provide some balance to the mammography debate. They have called, if nothing else, for women to be given both sides of the mammography story, and for its deficiencies and pitfalls to be explained to women so that they can make more informed decisions about whether to attend for screening. However, in response to this, proponents of mammography have generally responded with intransigence, restating the supposed benefits of the practice despite the concerns about it.
The ante was upped again this week on the publication of a paper in the Journal of the Royal Society of Medicine written by two mammography researchers who, again, point to evidence that mammography’s true ability to save lives is dubious at best [1]. The paper is critical of scientists attached to the NHS (National Health Service) Breast Screening Programme in the UK. The claim is that they are clinging to beliefs formed 25 years ago, despite good evidence coming to light which shows these beliefs to be scientifically untenable.
The paper also points out that new evidence regarding the ineffectiveness of mammography and the problem of over-diagnosis have not been reflected in an information leaflet for women published last year.
You can read here how Professor Peter Gotzsche, the paper’s lead author, claims:
“Senior researchers who are affiliated with the UK screening programme continue to distort the facts even though we, and others, have pointed out their errors.
“I can only speculate why, but when you have believed in something for a long time and your career is built on that belief, it is very difficult to change. These people, in a scientific sense, are behaving outright dishonestly and doing women a great disservice.”
Yet, the Breast Screening Programme here in the UK is set to be expanded.
In January this year I wrote a blog post which highlighted the fact that more than half of American women do not attend for scheduled mammograms. I speculated that at least some of these women have weighed up the facts (found on the internet, most likely) and decided it’s just not for them. Despite the intransigence of the British Government and many of the scientists advising it, I wouldn’t be surprised if we see a similar trend in non-attendance over here.
References:
1. Gøtzsche PC et al. The Breast Screening Programme and misinforming the public J R Soc Med 2011;104(9):361-369
Wrote 2 blogs about this my self recently highlighting the lack of information available to women to make an informed decision. Michael Baum, with others, is incensed sufficiently as to be asking for judicial review of the content of the leaflet used to promote the protocol.
There is mysogyny here, however covert it may be, and it does seem that most involved, though not all, are indeed men. Women are not stupid, and to deny them the tools to inform, what is a significantly hazardous and sometimes painful procedure, involving ionising radiation at a level of 1000x more than a chest X-Ray, is tanatamount to treating them as children.
It must be at least 15 years since the Danish medical research said exactly the same about mammograms that has been stated above. The item about the lesions was the point that made me stop. Since that day I’ve never had another mammogram. My sister in Oz said her doctors do not perform mammograms but they have scans and have had for many years. Why is it that here in UK we seem to have made some doctors Gods, and now they sadly believe it. NOT ALL I may add but some of them.
I was called back twice after mammograms which turned out to show only extra thick healthy tissue. Needless to say, the stress of being recalled was awful and no amount of apologies from the embarrassed hospital staff compensated. I’ve made my own ‘informed decision’: it hurts and it’s a waste of time. No more!
Now that I’m over 40 in age, my insurance company has been sending me reminders to get a mammogram. I find it very annoying.
With no history of breast cancer in the family I stopped my mammograms about 6 years ago believing them to be extremely dangerous. I had always had ‘lumpy’ breasts which had smoothed out as I aged but one growing lump remained so I was persuaded to have a mammogram 18 months ago and it was cancer! Chemo and Radiotherapy followed – a nightmare for me! I’m in good health again now and if I can afford it when I have my annual check-up next year I will be looking at alternative options to a mammogram. All I would say is if you have a lump don’t wait to have it checked out. l nearly left mine too long don’t make that mistake please.
I took my mother for a mammogram a year or so ago and was horrified at how brutal and archaic the procedure was. I decided at that point never to put myself through such torture! Would they squash a penis like that? I think not!
Is it possible to have thermography on the NHS? From what I have read, this procedure is a) x-ray free, b) better at detecting cancer cells and c) far less painful. Until thermography is available, I will decline to have any more mammograms.
I am 64yrs old and have had 2 mammograms in the past, but now I just refuse to go. This is because each time I’ve had a mammogram it has resulted in an abscess which I was told was most likely caused by the trauma to the breast tissue. I was also told that because of this history I could opt for a scan instead – my GP just laughed at the idea and said “no way”. So there you go – I recently had gene testing (for other reasons) and it showed I had a decreased risk of breast cancer so that’s good enough for me.
The same thing happens in pap testing.
A double standard exists – men get the facts and their informed consent is respected. Women are told whatever it is they think we need to hear to get us to use their vastly expensive screening machines – and satisfy all of the vested and political interests. We’re told we MUST or SHOULD screen and one article I read recently referred to women who decline pap tests as “wilful”!
All cancer screening is elective, but our programs are considered compulsory. That is unacceptable and it certainly isn’t cancer screening. It’s about paternalism, power, control, profits and politics.
I’ve watched cancer screening over the last 30 years with horror and outrage. How could they treat women like this and get away with it over and over again? The UK is fortunate to have so many great advocates for informed consent for women in cancer screening. The crickets are chirping here in Australia – doctors either go along with it for the target payments or are not prepared to stick their head above the parapet and take on the powerful screening lobby.
Cervical screening – our program is harmful and operates outside the law and ethical standards. Few women are giving informed consent for pap testing. (or breast screening) It’s impossible given the “information” released to women. We’re counted like sheep – how many women feel they can freely refuse pap tests?
I did almost 30 years ago and because I did my own research, I can stand up for myself in the consult room. Coercion is the norm in the States and Canada with women unable to get the Pill without a completely unnecessary pelvic and breast exam and cancer screening. The only clinical requirements for the Pill is your medical history and a blood pressure test. I’m in my early 50’s now, but I clearly recall the days when coercion was also used here to force women into screening.
Risk information is suppressed, benefits of testing are inflated – the information we receive is biased and incomplete. Scare campaigns are also used by Papscreen – how disrespectful can you get?
ALL cancer screening carries risk and that’s why we must give our informed consent. I’m not persuaded to have screening because a woman gets a rare cancer – I want the facts and a chance to assess my own risk profile
On the basis of information NOT released to women I’ve always rejected pap testing and more recently also rejected breast screening.
I look to the UK and Finland for honest information – the Nordic Cochrane Institute released a summary after criticizing the brochures provided by Breast Screen in various countries, including Australia, “The risks and benefits of mammograms” is at their website.
Prof Michael Baum has also called for the UK screening program to be scrapped after more damning evidence emerged – the fall in the death rate is about better treatments, not screening.
Prof Baum gave an informative lecture at UCL recently, “Breast cancer screening: the inconvenient truths” – at his website and on Utube. Dr Raffle has written some great articles on the rareness of cervical cancer and the unreliability of the test.
“1000 women need regular smears for 35 years to save one woman from cervical cancer”. (BMJ 2004)
Check out her articles and research.
The cervical screening program needs urgent review, but I fear vested interests will hold up change for as long as possible. No one here is pressuring them or warning women of the risks.
We should not be testing women under 25 (I’d say 30) – testing does not change the tiny death rate, but these women produce the most false positives AND we should not test more often than 3 or 5 yearly. Our false positives rates are sky high, thanks to over-screening. The lifetime risk of cc is 0.65% – it’s rare and was in natural decline before screening started – take out false negatives and fewer than 0.45% can possibly be helped by pap testing – yet the lifetime risk of referral for colposcopy and usually some sort of biopsy – a whopping 77% – of course, this means big money for doctors. (Dr Laura Koutsky, “Cervical cancer and HPV” Cancer Prevention, Fall 2004, Issue 4)
We also pay our doctors to reach pap testing targets which creates a potential conflict of interest – most women are unaware of these payments.(Financial Incentives Legislation and PIP scheme)
It also seems many women could simply have the HPV test ay age 30 and if negative for high risk HPV and in a monogamous relationship or no longer sexually active, could forget pap testing. A HPV blood test is also available.
Yet this information is not released to women, these women are tested “in case” their risk profile should change….
When screening carries risk, it should be the woman’s decision to test, not the govt or a doctor. The woman herself is the best judge of her risk profile.
(Ref: “Cervical cancer screening” in Australian Doctor, July 2006 by Assoc Prof Margaret Davy and Dr Shorne – a handout for doctors, not women!)
Only 5% of women have HPV at age 40 – yet our program has no regard for the healthy population of women, the more than 99% who’ll never have an issue with this cancer. It shows a blatant disregard for our health, right and bodily autonomy and privacy.
I’d urge all women to demand complete and honest information, screening options and some respect for informed consent, which may be a decision to screen, not to screen at all or to adopt your own schedule.
The worry and harm caused by these programs GREATLY exceeds any benefits.