I am not a fan of screening your breasts to look for disease. But most women have been conditioned to look for what can go wrong with their health, and particularly their breasts after a certain age. If getting regular breast screenings helps to alleviate stress and fear, then these tests may be right for you.
That said, if you are going to engage in the practice of screening for disease, I would be sure to do everything in your power to create breast health and use the least invasive and least harmful tests available. I also encourage you to get familiar with your breasts, so you know what’s normal for you. And use your intuition to determine what any symptoms you may experience mean, and the underlying cause.
It’s also important to understand the limitation of mammograms and other screening tests and the risks they pose. For example, screening tests have led to a great deal of over diagnosis and over treatment—a view supported by breast cancer surgeon Dr. Laura Esserman.
The Trouble with Mammograms
Mammograms carry health risks both to body and mind, which may outweigh the benefits for many women. And increasingly due to high resolution mammograms, DCIS (Ductal Carcinoma In Situ) is being picked up on breast cancer screening tests.
In an article published in October, 2015 in JAMA Oncology, Dr. Esserman says that DCIS accounts for approximately 20-25% of screen-detected breast cancers. Yet, long-term epidemiology studies have demonstrated that the removal of 50,000 to 60,000 DCIS lesions annually has not been accompanied by a reduction in the incidence of invasive breast cancers.
The rate of DCIS detection in 1973 was 3.8%. In the United States alone, the increased rate of DCIS detection between 1983-1993 was 314%. And, among women ages 40-49 that rate was 339%, thanks mostly to widespread use of mammography.
To make matters worse, a large study of over 51,000 women found that the number of women who decided to have both breasts removed (double mastectomy) after being diagnosed with DCIS in one breast more than tripled between 1998 and 2005. In 1998, 4.1% of the women had prophylactic mastectomy in the non-DCIS breast. In 2005, 13.5% had prophylactic mastectomy.
I have friends who have had bilateral mastectomies for DCIS. This absolutely breaks my heart because DCIS is NOT cancer, though many doctors consider it to be “Stage 0 cancer.” And, depending upon what advice a woman is then given, she may well be advised to get treatment, which she rarely needs. This is a shame because 99.9% of the time DCIS is something a woman will die with but not die from!
The problem is that women have been trained to be so afraid of breast cancer that they’ll often willingly sacrifice their breasts just to relieve their anxiety—or what a doctor friend of mine calls “surveillance fatigue.” Plus, most doctors are trained to do something when they have a diagnosis. And, given the number of them who have been sued for “failure to diagnose,” it’s not surprising that so many women agree to sacrifice their breasts rather than live with what they are told is a huge risk, even when it isn’t.
For these reasons, it’s not surprising that the number of women having prophylactic mastectomies “just in case” has soared. The rates of contralateral prophylactic mastectomy more than tripled from 2002 to 2012 even though studies have shown that removing healthy breasts doesn’t improve survival. The celebrity trend of having double mastectomies preventively probably contributed to this rate as well.
As a caring physician, I’m certainly not going to be a Monday morning quarterback and ask a woman why she didn’t do more research about DCIS before having drastic and often unnecessary surgery. That would be pouring salt into her wound. On the other hand, this all too common situation makes me more determined than ever to help educate women about breast health, including the fact that far too many women are being over diagnosed and over treated for so called breast cancers that are not cancers. (By the way, the same thing happens with thyroid and prostate conditions!)
5 Reasons Not to Have a Mammogram
One of the goals of Breast Cancer Awareness Month when it was started in 1985 was to promote mammography. Of course, many of the sponsors of Breast Cancer Awareness Month stood to profit from the diagnosis and treatment of breast cancer (and still do). I have been warning women of this for over 20 years.
In November 2009, the United States Preventative Services Task Force said it recommended that women begin regular mammograms at 50 instead of 40, and that mammograms are needed only every 2 years instead of annually between the ages of 50 and 74. The Task Force concluded that the risk of additional and unnecessary testing far outweighed the benefits of annual mammograms—and I couldn’t agree more.
Even before the U.S. Preventative Task Force changed their recommendations, Danish researchers Ole Olsen and Peter Gotzsche concluded, after analyzing data from 7 studies, that mammograms often led to needless treatments and were linked to a 20% increase in mastectomies, many of which were unnecessary.
But as of today, most doctors still believe that mammograms are the best tests for detecting breast cancer early. This is simply not the case!
Here are 5 reasons why I avoid mammography:
- Leads to overdiagnosis and overtreatment. A systematic review reveals that mammography screening leads to overdiagnosis and overtreatment at a rate of 48.3 percent. This is particularly true for women under 40, and possibly for all premenopausal women for whom mammograms are not very accurate due to denser breast tissue. In late 2012, the New England Journal of Medicine reported that 1.3 million US women have been over diagnosed and over treated over the past 30 years. I’m certain that number has increased since the article was written.
- Does not reduce mortality rate. Studies show that for every 2,000 women screened over 10 years, only one will avoid dying of breast cancer! And, 10 healthy women, who would not have been diagnosed if they had not been screened, will be treated unnecessarily.
- Exposes you to high levels of radiation. Radiation from a mammogram can be up to 1,000 times greater than a chest X-ray. In addition, some experts believe that ionizing radiation used in mammograms mutates breast cells. Plus, tight compression of the breasts can facilitate the spreading of already malignant cells (as can a biopsy). Premenopausal and pregnant women have breast tissue that is more sensitive to radiation. And it’s possible that these high levels of radiation could potentially cause an epidemic of radiation-induced breast cancers.
- Can cause increased anxiety. Your beliefs about your health can determine how healthy or sick you become. In our culture, we are led to believe that cancer cells are abnormal. This is not true, and it can cause many women to feel undue stress about their breasts. The truth is most of us have cancerous cells in our body that our immune systems are able to keep in check. But thinking you have breast cancer when you really don’t, can create a cascade of fear and anger, which has a chemical effect in your body. In fact, studies have shown the connection between stress, anxiety and cancer progression. And one study shows that false positive screenings can have negative, long-term psycho-social effects for up to 3 years after a false positive finding.
- Mammograms are not prevention. Our culture uses mammograms as a fix but doesn’t encourage women to change their diets, exercise, stop smoking, and learn how to be in relationships that nurture them. These are the preventive changes that favor healthy breasts. The United States Preventive Services Task Force (USPSTF) released a revised recommendation in 2009 stating that women in their 40s should NOT necessarily have yearly mammograms and need to carefully weigh the risks considering their personal situation.
A Better Screening Alternative to Mammography
There are other methods used for breast cancer screening including ultrasound and clinical breast examination. Additional modalities exist, but can be too expensive (MRIs), too invasive (biopsy), or not quite there yet, such as diffuse optical tomography (DOT), which shows promise and is still being studied.
A better screening test and one that I recommend is thermography. Studies show that thermography identifies precancerous or cancerous cells earlier, produces unambiguous results (which cuts down on additional testing), and doesn’t hurt the body. I am saddened and surprised that thermography hasn’t become more popular.
Thermography uses digital infrared thermal imaging to map heat emissions and patterns in the breasts (or other areas of the body) that are specific to the individual. Heat is an indication that inflammation exists. Typically inflammation is present in precancerous and cancerous cells. When differences in temperature and heat patterns are noticed, thermograms can help detect cancer more accurately.
(Note: Inflammation is also present in torn muscles and ligaments as well as arthritic joints, which thermography can also detect)!
My colleague, Philip Getson, D.O. has been a medical thermographer since 1982.
Dr. Getson explains how thermography works this way:
It is widely acknowledged that cancers, even in their earliest stages, need nutrients to maintain or accelerate their growth. In order to facilitate this process, blood vessels are caused to remain open, inactive blood vessels are activated, and new ones are formed through a process known as neoangiogenesis. This vascular process causes an increase in surface temperature in the affected regions, which can be viewed with infrared imaging cameras. Additionally, the newly formed or activated blood vessels have a distinct appearance, which thermography can detect.
Earlier Detection and Better Accuracy
The most promising aspect of thermography is its ability to spot anomalies years before mammography ever could. A 10-year study showed that thermal imaging can detect changes at the cellular level (before a tumor forms) 8-10 years before any other test.
Tumors typically grow for about 7 years before they can be detected by physical examination or mammography. This means that with thermography as your regular screening tool, it’s likely that you would have the opportunity to adjust your diet, beliefs, and lifestyle to transform your cells before they became cancerous. Talk about true prevention!
It’s also likely you could avoid an unnecessary biopsy—a 50% likelihood for women who have regular mammograms for 10 years or more—or being scared by a false positive result on a mammogram.
Thermography’s accuracy and reliability is remarkable too. In the 1970’s and 1980’s, a great deal of research was conducted on thermography. In 1981, Michel Gautherie, Ph.D. and his colleagues reported that an abnormal thermogram was 10 times more significant as a future risk indicator for breast cancer than having a history of breast cancer in your family.
10 Reasons Why I Recommend Breast Thermography
As I have discussed, thermography allows malignancies to be detected early—before signs even become evident.
In addition to early detection and accurate test results, here are some other reasons I like thermography:
- It’s a simple test. Thermography is as simple as taking a picture.
- Better for dense breasts. Women with dense breast tissue (such as younger women in their 20s and 30s), women with fibrocystic cystic breast tissue, and pregnant and breastfeeding females can use thermography. Thermography doesn’t identify fibrocystic tissue, breast implants, or scars as needing further investigation.
- Detects cell changes in armpit. The armpit is an area that mammography isn’t always good at screening.
- It’s painless. The pressure of a mammogram machine is equivalent to putting a 50-pound weight on your breast, which can be quite painful for most women. Women of all shapes and sizes can be screened without pain or discomfort using thermography.
- There is no radiation. It’s well known that excessive doses of radiation can increase your risk of cancer. It’s ironic that the test women are using for prevention may be causing the very problem they’re trying to avoid in the first place! And this doesn’t even touch on the harm done to the body from unnecessary biopsies, lumpectomies, mastectomies, chemotherapy, radiation treatment, and so forth.
- It’s safe for all women. As I mentioned, thermography does not use radiation. There is nothing injected into the body. And there is no compression of sensitive breast tissue. So there is a low risk of damaging fragile cellular structures. It’s merely an image of the heat of your body. So, it can be effectively used by women of all ages, from pre-adolescence to postmenopausal women. Thermography is even safe for pregnant and nursing women!
- Can help with decision-making. Thermography can be used as an additional test to help women, and their care teams, make more informed treatment decisions.
- It’s cost-effective. Compared with other techniques for diagnostic imaging, thermography is relatively inexpensive. Plus, it is an effective diagnostic tool for men, women, and children.
- It’s fast. Thermography is a quick procedure ad provides real-time assessment and detection.
- It’s unique to you! The best part about thermography is that the results are unique to you. So, your imaging tests are being compared to your own previous tests.
Choosing a Thermography Center
Dr. Getson says there are some things you need to know when choosing a thermography center. For one, it’s important to note that not all thermographic equipment is the same. Be sure to ask what the “drift factor” is for their machines. Anything over 0.2 degrees centigrade leads to poor reproducibility. Also, the room in which the study is performed should be free of outside light and the temperature should always be at 68-72 degrees Fahrenheit with a proper cooling system in place.
Be sure that your thermography center of choice is backed by qualified, board-certified physicians who are specifically trained to interpret of these images. And be sure that the physician is available to explain and discuss all findings. Finally, make sure the images are “stat”-ed—or marked up—for future comparison.
One More Reason to Avoid Mammography
On Mar. 9, 2023, the U.S. Food and Drug Administration (FDA) issued an update requiring all mammography facilities to comply with their rule that all women undergoing mammography screening for breast cancer be informed on the density of their breasts. I want you to understand what this means and not let it scare you.
The term “breast density” is a radiologic term. It does not indicate disease. Most women over the age of 40 have dense breasts. This is because they have more connective tissue. Less dense breasts typically have more fat. As I have stated above, mammography is not great at distinguishing between cancer and other breast tissues such as fibrocystic tissue or scars, which appear white on a mammogram, as does cancer. (Fat appears black).
This is why mammography is not a great test for women with dense breast tissue And a 2022 study showed that women with dense breasts have a higher chance of false positives with mammograms, which can cause undue stress and potentially unnecessary and harmful treatments.
The Best Breast Test for You
As with anything, I suggest you let your inner guidance help you in all decisions about your health. If you feel it’s best to get a bi-annual or annual mammogram, then by all means continue with them. Just be aware of the drawbacks and risks associated with the test.
And don’t be intimidated or feel guilty if you prefer to forgo mammography completely. A thermogram can tell you how healthy your breasts are rather than just screening them for cancer. When done properly, it also has the potential to truly detect breast cell anomalies long before mammography can detect cancer. This allows you to implement lifestyle changes that can improve the health of your breasts proactively.
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