My Personal Experience

I had a personal experience recently that I wanted to share before discussing some concerning information about mammograms. Full disclosure: I’ve never had a mammogram. That may surprise you since I am the co-founder of Root Cause Medical Clinic.

If you’re a patient here at the clinic and especially a woman for whom we prescribe bio-identical hormones, you know that we DO require a breast study and pap smear before we can prescribe hormones, and updated exams and blood tests are required to continue the prescription. That is just good healthcare practice.

About 5 years ago when I began taking bio-identical hormones myself, I too was required to have these tests. The regular paps I was already doing but I refused a mammogram and instead opted for a breast ultrasound.

When I arrived at the mammography center and insisted on ultrasound only, there was quite a flurry of activity. There was whispering behind the front desk, there was a discussion with the receptionist, there was further discussion with the nurse, and finally, I was permitted to get an ultrasound during which time I was further queried. I politely explained that as a clinical nutritionist I felt that radiating breast tissue was something we, as a society, would come to realize was a bad idea.

Plus, as someone with fibrocystic (dense) breasts, there was much evidence that mammograms were not the best testing procedure for identifying tumors. Ultimately, the nurse who performed the procedure agreed with me, in a hushed tone, and she admitted that she had some concerns about radiation herself.

Fast forward a few years to two weeks ago where I again was scheduled for another breast ultrasound. Again I was questioned. This time I had to sign a waiver stating my refusal and basically indemnifying the clinic if I was to have breast cancer. But again I had the ultrasound. This time was different as the doctor who was evaluating the ultrasound came into the room to examine the study in front of me. His viewpoints were these:

1. The ultrasound looked perfect,
2. The ultrasound was only 30% accurate in detecting breast cancer
3. A mammogram would be 80% accurate
4. The radiation of a mammogram was negligible and would not affect my tissues since I was in my 50s.
5. The odds of a woman in my age group getting breast cancer were 1 in 11.
6. Women who got breast cancer were “unlucky”. There were no particular measures one could take to avoid getting breast cancer; it was simply about being “unlucky”.
7. And lastly, I was making a very dangerous decision to NOT get a mammogram.

I Received a Very Scary Letter

I left and a few days later I received a letter that stated: “Your recent examination showed a finding that requires additional imaging studies for a complete evaluation. Most such findings are benign (not cancer). Please call for an appointment for these tests.” Certainly not the type of follow-up letter anyone wants to receive and of course it arrived Friday night so I had to wait until Monday morning to get some clarification. What puzzled me was that the doctor said my ultrasound was fine. How did that correlate to “showing a finding that requires additional imaging”?

It turns out that the letter was sent to me because I refused the mammogram. Does that make it okay to state categorically that something was found when nothing was? I don’t think so, but I wasn’t going to make a fuss about it. I then received an additional letter stating that I should return “immediately” for a mammogram so that the office could meet their “Medical Quality Standards Act” which requires them to follow-up with patients who have unresolved mammograms. If you’re thinking that about this time, a regular lay patient (meaning a non-doctor) would begin to feel like a common criminal for not partaking in a mammogram, I agree with you. It was almost intimidating for me… almost.

What You Should Know About Mammograms

So let’s look at the data behind mammograms so that we can make informed decisions for ourselves, our daughters, and our mothers.

Breast cancer is the leading cause of death among American women between the ages of 44 and 55. Mammography involves ionizing radiation (X-ray) of the breast. There are many in the medical community who speak out against the dangers of so much radiation, along with an error rate that many consider unacceptable. One particular example is Dr. Gofinan in his book “Preventing Breast Cancer”, which states that breast tissue is highly radiation-sensitive and that’s why mammograms can cause cancer. He goes on to say that such dangers are increased by genetic makeup, obesity, hormonal imbalance, and prior non-cancerous breast disease.

How Effective are Mammograms?

A Swedish study that evaluated 60,000 women discovered that 70% of the tumors ‘detected’ by mammograms, weren’t actually tumors at all. These are called “false positives” and if you’ve had many mammograms, you’ve perhaps experienced this frightening experience. You’ll receive a letter as I did and what is done is another mammogram, involving more radiation and typically a follow-up ultrasound to decide ultimately if the ‘tumor’ is really a problem.

A little more personal information: This is exactly what occurred to my mother every couple of years. She diligently had her annual mammogram, only to be told on most occasions that there was something ‘suspicious’. She would then have one or two more mammograms before finally having an ultrasound where it was determined she was fine. I finally encouraged her to spread out her mammograms and if ‘something’ came up to jump immediately to the ultrasound since that was where they ultimately made their decision that her ‘tumor’ wasn’t a tumor at all. She is now almost 91 and never had breast cancer, fortunately.

False Positives Result in Needless Biopsies

Getting back to the Swedish study, the vast amount of false positives, similar to my mother’s experience, resulted in, not only emotional stress but costly follow-up testing and often unnecessary invasive procedures such as biopsies. The statistics are that 70 to 80 percent of all positive mammograms do not show any presence of cancer once a biopsy is performed. Unfortunately, the opposite is true as well. Mammograms also suffer from a high number of “false negatives”.

Dr. Epstein states that in women between the age of 40 and 49, 25% of the cancer is missed at each mammogram. And that’s a conservative estimate. The National Cancer Institute states the rate is 40% of missed cancer tumors amongst that age group. Part of the difficulty is that younger breast tissue tends to be denser and tumors are therefore tougher to identify. For this reason, the mammograms of pre-menopausal women suffer from false negatives at twice the rate of their post-menopausal counterparts.

Regular Mammograms INCREASE Your Risk of Breast Cancer

In the 1970s, radiation from mammograms was at a level of 5 to 10 rads (radiation-absorbed doses). Currently, it is closer to 1 rad, a definite improvement, but still, a dose of radiation 1,000x higher than a chest X-ray. According to Dr. Rauscher, former director of the National Cancer Institute, women between the ages of 35 to 50 will experience an increased risk of breast cancer of 1 percent, each and every time they are exposed to that 1 rad of radiation. Dr. Blaylock puts the estimate at double that – estimating that women suffer a 2 percent increased risk of breast cancer each year that they receive a mammogram. An authority on the effects of ionizing radiation on health, Dr. Gofman, feels that about 75 percent of breast cancer could be prevented by avoiding or minimizing exposure to ionizing radiation. This includes mammograms, x-rays, and other sources.

A chilling statistic is a correlation between a form of breast cancer called ductal carcinoma in situ (DCIS) and the introduction of mammograms as a screening tool. The incidence of DCIS has increased 328 percent since mammograms began. According to experts, 200 percent of that increase is due to mammography.

Harsh Compression of Breast Tissue is Dangerous

Having never experienced a mammogram myself I have only the opinions of others on this point, but many women have exclaimed that the procedure is extremely painful because the breast tissue has to be so harshly compressed for the procedure. I’ve had patients at our Root Cause Medical Clinic tell me that they would never do another mammogram simply due to the pain they experienced.

In the early 1920s physicians were cautioned to handle cancerous breasts with extreme care due to the potential of accidentally spreading cancer through any rough handling, poking, or prodding. The compression associated with mammograms exceeds this warning and has the potential of spreading cancerous cells through the rupturing of small blood vessels in or near undetected cancer cells. Pain aside for a moment, the extreme pressure may cause existing cancer cells to break loose and move out to other areas of the body. A healthy immune system will often wall off cancer cells and prevent them from spreading. It is thought that the severe compression of the breast could thwart such ‘protective walls’ and allow the cancer cells to migrate and multiply.

Some women carry a gene, called “oncogene AC” that makes them extremely sensitive to any dose of radiation. It estimated that 10,000 women who carry this gene will die of breast cancer this year due to receiving a mammogram.

Younger Women Should Avoid Mammograms

While those with the above gene are extremely sensitive, women under the age of 35 are also more at risk from radiation. The National Cancer Institute stated that for women under 35, mammograms could cause 75 cases of breast cancer for every 15 it identifies. A Canadian study backs this up, revealing a 52% increase in breast cancer deaths in young women receiving annual mammograms.

Understandably, children and pregnant women should also avoid radiation as much as possible.

Breast cancer incidence is increasing. Some say it’s due to better detection, but others claim it’s the fault of mammograms and radiation. A Canadian National Breast Cancer Study (1992) revealed that mammograms had no positive effect on mortality for women aged 40 to 50. Not only that, but the study felt that women of that age were more likely to die of breast cancer when screened regularly.

While the American Cancer Society recommends mammograms every two years between the ages of 40 and 49, the National Institute of Health stated that mammograms in the age group showed no evidence of savings lives. And in fact, could do more harm than good.

Bottom Line

If you are under 35, there is little evidence to support the use of mammograms and much more to vilify it. If you’re 40 to 55 years old, you might want to rethink exposing your breasts to radiation from mammograms (or any other source) based on the research findings stated above. If you’re over 55, the risk from radiation lessens and you need to decide what’s best for you based on your health status and risk profile. If there is a strong reason to suspect you have breast cancer, then mammography could be warranted. While no one argues that early detection of a tumor can save lives, do mammograms perform that function?

Many argue that they do not and their liability outweighs their benefit. The good statistic is that the number of deaths caused by breast cancer has decreased. The bad news is that the incidence has been and continues to rise each and every year.

Is There Any New/Better Technology on the Horizon?

Thermography is a non-invasive, non-radiation technology that has been on the market for a while – 40 plus years. It uses the light emitted from human skin to map the temperature of the breast. Abnormal tissue growth can raise the temperature of the tissue and this shows up as a hot spot on a thermogram. It is estimated that thermography can often detect cancer up to 10 years prior to a mammogram or of a standard breast exam. How?

Thermal imaging detects changes at the level of the cell itself. In this way, changes can be revealed prior to the formation of a tumor. Studies show that by the time a tumor has grown to the size to be detectable, it’s been growing for almost 7 years. A tumor 90 days old has two cells, at one year there are 16, at five years there are over a million – yet those million cells are still undetectable by a mammogram. At 8 years, a time when a mammogram or physical exam would be able to detect them, there are about 4 billion cells. When it comes to ‘early detection’ thermography truly fits the bill. Detecting early changes in cells would allow a woman to make the dietary and lifestyle changes necessary to truly prevent cancerous change. And that’s true ‘prevention’ – much better than ‘detection’ in my opinion.

A 4-year clinical trial published in the American Journal of Roentgenology gave thermograms to 769 patients who had just received suspicious findings on their mammograms. Of all those women that thermograms identified as cancer-free, only 3% turned out to have cancer. This is a vast improvement over the 10 to 30% rate for mammograms. In 1981 Dr. Gautherie and the team reported on a 10-year study that revealed an abnormal thermogram as being 10 times more accurate as a future predictor for breast cancer than having a family history of the disease.

Thermograms are pricey and not covered by insurance at this time. But there is no radiation, no compression of the breast (meaning no pain) and even dense breasts are not a problem for this technology. The biggest plus point is that thermography can detect cancers at a very early stage of development, something we all want. Additionally, it is believed that thermograms would reduce the rate of costly, stressful biopsies.

Each year in the US more than a million biopsies are performed – 75 to 80% of them are benign – therefore was no reason for the procedure to be done. A thermogram would prevent such unnecessary invasive procedures. With its many plus points, if you can swing it financially, it’s definitely worth considering.

Interested in Thermography? Keep These Points in Mind

1. Before you go to a thermographer, ensure that if anything suspicious is found on the thermograph that he or she has a way for you to get a follow-up ultrasound and not a mammogram. This is important as some thermographers can provide this service and others cannot. The last thing you want to do is pay for a thermogram only to end up with a mammogram as a mandatory follow-up.
2. Ask what the ‘drift factor’ is of the apparatus. Anything over 0.2 degrees centigrade leads to poor reproducibility and should be avoided.
3. What is the credential of the interpreting physician? They should be board-certified and specifically trained in the interpretation of thermograms.
4. The room where the image is performed should be free from outside light and at a temperature of 68-72 degrees F with proper cooling available.
5. The images should be marked up for future comparison. Doctors call this “stat” ed.
6. Find out if the images are read on site – this is preferred.
7. Ensure that the doctor is available to explain and discuss all findings.

Why isn’t thermography more popular? That’s a good question. There are the cost and lack of insurance coverage. Plus some say that mammograms have become such big business in this country that any competition is frowned upon. Case in point – when I asked the doctor who evaluated my ultrasound about thermography, he told me it was “worthless”. Keep in mind he runs a mammography center so his opinion is a highly biased one.

Another option is a digital mammogram. Radiation is still used, but a much smaller dose is required. Another benefit is that the image produced can be manipulated by the doctor to zoom in on any questionable areas of the breast without the need for additional imaging and therefore radiation. This ability to navigate around the image is probably why digital mammograms are more accurate for women with dense breasts.

Unfortunately, to date, the studies that have been done show no evidence that digital helps to reduce a woman’s risk of dying from breast cancer. An analysis of women aged 40 through 79 found that digital mammography had similar accuracy to its film version. The breasts still require compression, unfortunately, but the radiation exposure is diminished. The upshot here is that if you decide to go forward with a mammogram because you or your doctor found a lump, do make the effort to find a center that uses digital imaging as it will at least cut your radiation risk.

I hope this information was informative. Personally, I am planning to pursue thermography to get a baseline for my breast tissue. I will ensure that any ‘findings’ can be followed up by ultrasound and I’ll let you know how the experience goes. Despite the assurances that radiation is less risky once over the age of 55, radiation is still radiation and digital or not, mammograms still involve harsh compression that, to me, seems dangerous.

I hope this was helpful so that you can form your own opinion and strategy for future breast evaluation and health.