Last week, as part of Women’s Month, we looked at breastfeeding and post-partum nutritional care.
This week, we touch on a sensitive topic: Mammograms.
From the mainstream medical perspective, mammograms are like vaccines: always safe and effective. Questioning this narrative marks you as a flat-earther conspiracy theorist. We hope to present a more nuanced view so you can make up your own mind, based on facts.
For the sake of clarity, we will investigate various aspects one by one.
The Incidence Of Breast Cancer
Breast cancer statistics are shrouded in vague figures. According to the American Cancer Association, a US woman has a 13% risk of developing breast cancer during her lifetime. (Link)
- 21 – 30: 4 per 100,000
- 31 – 40: 30 – 35 per 100,000
- 41 – 50: 125 – 130 per 100,000
- 51 – 60: 200 – 210 per 100,000
- 61 – 70: 280 – 290 per 100,000
- 71 – 80: 340 – 360 per 100,000
Note: It was not easy to gather these numbers from study reports, and if you add them together, you get a lifetime incidence of ~1%. One would have hoped for more accurate source data, but that was not available at the time of writing.
So, is the lifetime risk 13% or 1%? We will probably never know for certain. Those who promote the higher incidence often have conflicts of interest.
The Actual Experience
No woman enjoys having a mammogram done. In fact, so dehumanising is the experience that many women default on them, either altogether or only having one done ever so often. Depending on what study you read, ~20 – 60% of American women opt out of the recommended schedule. Many reasons are given, but everyone skirts around the emotional trauma of the mammogram process. The skimpy gown, the ice-cold metal plates, the squeeze that brings tears to your eyes… And then the anxious wait to hear the results.
Surely the indignity and trauma would be worth it if it prevented you from dying of cancer? Science doesn’t reckon with the power of social connections: Women talk to each other and share their experiences – they’re not isolated data points. Watching your best friend suffer and die from chemotherapy-inflicted side effects when she had a tiny “early” cancer leaves an indelible impression that ripples through the grapevine. The message seems unambiguous: the cure is worse than the disease; the harshness of the mammogram experience is simply the ante-room of something much worse.
In short: mammograms have an image problem, and it’s not getting better over time.
Age of First Mammogram
Women with an average risk for breast cancer (= basically everyone) are asked to have their first mammogram at age 40. They are expected to repeat this annually or every second year. This means the average woman is expected to have 15-40 mammograms during her lifetime.
Here’s the thing: Between the ages of 40 and 50, a woman’s breast cancer risk is ~1 in 1,000 (0.1%), yet she is expected to have 10 mammograms in that decade. In order to find 1 cancer, ~10,000 mammograms have to be performed. Is the cost of annual mammograms worth the potential benefit?
Radiation Exposure
Everybody knows that radiation exposure increases the risk of developing cancer. Mammograms rely on radiation to produce the images. The logical question is: Doesn’t the radiation exposure during a mammogram increase breast cancer risk? Especially if the exposure is repeated annually?
That is a good question. Let us look at the facts. Any online search will tell you that the radiation exposure during a standard (2D) mammogram is ~0.5 millisieverts (mSv). The next thing the internet will tell you is that this is about as much as is used for a standard chest X-ray. Nothing to see here – keep moving.
Digging a little deeper reveals a more complicated picture. That radiation used in the chest X-ray was over a wide area (shoulder to shoulder and neck to umbilicus). During a mammogram, the same amount of radiation is focused on a much smaller area. Instead of looking at the total amount of radiation given, it makes more sense to look at the amount of absorbed radiation, measured in milliGray (mGy).
During a standard chest X-ray, the amount of radiation absorbed by the breasts hovers around 0.02 and 0.2 mGy per breast. During a mammogram, the amount hovers between 3-4 mGy per breast. So, the actual absorbed radiation exposure during a single standard mammogram is at least 10x that delivered to the breasts by a standard chest X-ray. It may even be as high as 30x or 40x.
Who wants to have that many X-rays in a year? Year after year?
The other claim you will find online is that the radiation exposure during a mammogram is equivalent to about six to eight weeks of environmental radiation. This makes it sound safe, since we don’t all run around wearing tinfoil hats. However, consider the importance of time in this equation. Dealing with low levels of radiation over time requires little effort by the body. Dealing with 2 months’ worth of radiation in a couple of seconds is impossible. There will be damage.
Overdiagnosis
Let’s take a look at how accurate mammograms are in detecting breast cancer. One aspect of this accuracy is overdiagnosis. There is a form of early breast cancer known as DCIS (ductal carcinoma in situ). It is also sometimes referred to as stage 0 breast cancer. The thing is, many women have DCIS, but it never progresses to stage 1 cancer. It just sits there. Mammograms do not differentiate between DCIS and proper cancer and will flag these women as having breast cancer. This is mainly what is referred to as over-diagnosis.
A major US study published in The BMJ in 2023 (Link) estimated that breast cancer over-diagnosis from screening mammograms rose sharply with age, ranging from 31% for women aged 70–74, up to 47% for ages 75–84, and over 54% for women aged 85 and older. In other words, roughly half of mammograms in elderly women falsely claim they are suffering from breast cancer.
For broader age groups (women 40-50), a systematic meta-analysis in PMC (Link) estimated an overall average over-diagnosis rate of 12.6% (1 in 8 women), while studies focusing on women aged 50–74 placed the figure around 15% (about 1 in 7 screen-detected cancers).
The problem with over-diagnosis is that the entire medical industrial complex swings into full action when a mammogram detects cancer. The fact that it is DCIS does not stop the protocol. Chemotherapy, surgery and radiation are pushed on the hapless woman. It isn’t easy to resist this pressure, especially not if you are advanced in age.
Under-diagnosis
Mammograms miss about 10% to 20% of breast cancers, commonly referred to as a false-negative rate. This means screening mammograms have an overall sensitivity of roughly 80% to 90%. Under-diagnosis rates vary based on tissue density, tumour characteristics and age. (Link)
Do Mammograms Save Lives?
When it comes to medical science, Cochrane reviews are regarded as the pinnacle of best evidence.
In the context of mammogram breast cancer screening, the “Nordic Trials” refer to a series of large, randomised controlled trials conducted in several Nordic countries (most notably Sweden), which studied the effectiveness of routine mammogram screening in reducing breast cancer mortality among women.
The Cochrane review, published in 2013 (Link), included seven trials that involved 600,000 women aged 39 to 74. 300,000 women were randomised to receive annual screening mammograms; the other 300,000 were not. The result? There was ABSOLUTELY NO mortality benefit in the mammogram group. None whatsoever. The same number of women died from breast cancer whether they had annual screening or not.
The Canadian National Breast Screening Study, published in 1992, was the largest study of its kind up to that point. This randomised control trial followed close to 90,000 women aged 40 to 59 for almost 25 years. The authors randomly selected ~45,000 women to receive annual breast cancer screening with mammograms. The other ~45,000 women did not receive mammograms. Some of these women did self-breast exams, some had clinical exams done by their doctors, and some of them did nothing.
What do you think happened over a quarter century?
In comparing women who did to those who did not have annual mammograms, the authors found NO statistical difference in breast cancer mortality.
To recap: mammogram or not, the same number of women in both groups died from breast cancer.
However, there was a statistically significant finding of a difference between the two groups of women. Women in the annual mammogram group had a 20-30% higher rate of breast cancer diagnosis, compared to the control group. Obviously, these extra cancers were detected much earlier than could be detected by manual examination. This is the chief rationale for mammography: Catch ’em early and save lives!
Do the maths: 30% more cancers diagnosed (and earlier), yet ZERO breast cancer mortality benefit.
Does early detection really make a difference in the final outcome?
The Psychological Cost
The Nordic Trials Cochrane review stated, “Furthermore, more than 200 women [per 100,000] will experience important psychological distress, including anxiety and uncertainty, for years because of false positive findings.”
The lingering emotional toll of a false cancer diagnosis is not just something women have to “get over”. IT is real. It steals their joy. An invisible stalker shadows their every move. Remember, up to 30% of women can be the victim of a false cancer diagnosis. That is one third of our female population subjected to unnecessary emotional violence.
Are There Alternatives To Mammograms?
We’re glad you asked. It so happens that there are many alternatives to mammograms. Some of them are much more accurate; others are more or less as accurate as mammograms. Some are expensive; others are free. Here is a list of options for those who want to do screening but don’t want to go for mammograms. Please note: We’re simply listing alternatives, since we believe you should have a choice. We’re not recommending any of these as “better” or “the best”. You need to do your own research and make your own choice.
Thermography
Thermography is a non-invasive technique that uses infrared imaging to detect changes in temperature and patterns of blood flow seen in the very early stages of cancer development. Infrared imaging is an FDA-approved adjunct to mammography. One of the primary benefits of thermography is its lack of radiation exposure to the patient. This makes it similar to ultrasound and contrary to conventional mammography. Additionally, it is non-invasive, meaning there is no contact with the breast during imaging.
Ultrasound
Ultrasound is another non-invasive technique for cancer screening which doesn’t utilise ionising radiation or breast compression. Typically used as an adjuvant to other screening modalities, studies suggest that ultrasound has greater sensitivity and accuracy for detecting breast cancer than mammograms in certain populations of women. Sound waves create the images seen by ultrasound, which can guide further diagnostics or biopsy. Unfortunately, most hospitals and clinics will not perform breast ultrasound in the absence of a concurrent mammogram, regardless of a woman’s choice to omit the radiation.
Magnetic Resonance Imaging (MRI)
MRI uses powerful magnets, radio waves and a high-speed computer to produce extremely high-resolution images of soft tissues in the body, without any ionising radiation. Despite their obvious advantages, breast MRIs unfortunately have some concerning risks of their own – specifically their requirement for contrast dye.
In order to capitalise on the full advantages MRI has to offer, gadolinium-containing contrast medium is routinely given prior to the procedure. Gadolinium is a heavy metal which has well-documented ties to severe kidney damage in certain patient populations and long-term tissue deposition in the brain and other soft tissues. In 2007, the FDA issued its infamous Black Box Warning on the use of gadolinium. A Black Box Warning is the most serious type of warning issued by the FDA, alerting users to be extremely cautious in weighing the potential risks versus benefits before use.
Breast MRI is also extremely expensive and typically not covered by medical insurance companies.
Self-Breast Exams (SBEs)
Women aren’t typically fans of examining their own breasts, but they should be! 60% of breast cancers are found by the women who own them. Those of us who have them should really get to know them. You can set a reminder on your calendar or phone. Check in with your breasties on a monthly basis – preferably the week after your period (if you’re still having those). If you’re not, feel them on the first day of each month.
Liquid Biopsy
This involves blood testing for cancer cells. No boob smashing required. This is a Rolls Royce of cancer screening options, but it is not easily available in South Africa. This is an annual blood test to check for the presence of basically any type of cancer. No radiation, no colon prepping, no invasive physical exam. Sweet!
Quantitative Transmission (QT) Imaging
So, this is new. You lie on your stomach on a special table and your boob goes in a bowl of nice warm water. It just sits there while the imaging takes place. QT imaging is a type of ultrasound imaging, specifically utilising “quantitative transmission ultrasound” technology to create true 3D images of the breast. It’s safe, it’s fast and it’s painless. Because QT imaging uses ultrasound, it does not involve ionising radiation. The high image resolution allows for visualisation of even significantly dense breast tissue. These images have incredibly high resolution and can be repeated in close sequence to follow suspicious lesions over time, potentially reducing the need for additional imaging or biopsy in some patients.
Sadly, like conventional ultrasound, QT imaging is not recognised as a standalone screening tool for breast cancer.
An Ounce Of Prevention
In a previous post, we outlined some tips on how to reduce your risk for breast cancer to almost zero:
11 Steps To Prevent Breast Cancer
No matter what your genetic make-up, the right lifestyle choices play a significant role in lowering your risk for breast cancer. Take these to heart and rid yourself of the fear of getting cancer!
To your (untouchable) health,
The Team at Integrow Health
