Posted on: 10.04.2023 Posted by: Drlark Comments: 0

June 10, 2004


Breast Health

Mammography — Is


“Gold Standard” Fool’s Gold?

Fear of breast cancer is a very real issue for

many women. A 1995 Gallup poll found that 40 percent of women believe

they will die of breast cancer, even though the actual risk of death

from the disease is less than 4 percent. I can remember feeling

fearful about developing breast cancer myself when my beloved grandmother

died of the disease in 1969, one year before I entered medical school.

When mammography became more widely available during my years as

a doctor-in-training in the early 70s, I was hopeful that this screening

would fulfill its promise of saving the lives of many women.

Since that time, physicians have mandated that women need annual

mammograms in order to detect breast cancer at a much earlier stage,

thereby allowing for more effective treatment and life-saving intervention.

If you are like millions of other women, you have come to depend

on this “gold standard” for the early detection of breast


My early hopes and those of millions of others have been called

into question with the recent publication of two studies in the

Lancet. Danish researchers Ole Olsen and Peter Gotzsche reviewed

seven randomized, controlled mammogram trials which supported the

benefits of mammography in reducing the mortality from breast cancer.

They found that 5 of the 7 studies were so flawed they couldn’t

even be reviewed, and instead focused on the remaining two. They

found that even these studies had major evaluation biases and design

flaws. As a result, they determined that mammograms had no effect

on deaths attributed to breast cancer.

The studies also showed that, in many cases, mammograms led to needless

treatments, and were linked to a 20 percent increase in mastectomies,

many of which were unnecessary. Researchers speculate one reason

may be that the screening identified slow-growing lesions that would

never have become life-threatening had they been left alone.

A National Cancer Institute advisory panel has supported these findings.

In January 2002, they concluded that the benefits of mammography

are uncertain and the chance of receiving a false positive result

is substantial. Ironically, traditional medicine continues to support

the regular and continued use of mammography, despite the overwhelming

evidence to the contrary. In fact, 19 medical organizations, including

the American College of Obstetricians and Gynecologists, urge women

to continue receiving annual mammograms. The National Cancer Institute

even extended its recommendations to include annual screenings for

women age 40 and up, despite contrary advice from its own panel.

I feel strongly that you should be aware of this accumulated body

of negative studies regarding mammography, as well as the growing

controversy within the medical community regarding its use, when

you are making your own decisions about having annual mammograms.

Inherent Flaws with Mammography

These new studies are just the tip of the iceberg. A number of negative

studies regarding mammography have appeared in the medical literature

over the past decade, casting doubt as to its benefits and emphasizing

its many risks. As reported in the Journal of the National Cancer

Institute in 2000, the cumulative risk of having false positive

mammograms is quite significant in many women. While this can occur

with women of all ages, women in their 40s are at higher risk, since

they tend to have denser and more fibrous breasts, which can be

mistakenly read on a mammogram as suspicious for breast cancer.

Andrew Wolf, M.D., an associate professor at the University of Virginia

School of Medicine, supports these findings. In a May 2002 review

article on breast cancer screening in Consultant, Dr. Wolf

states, “If we start screening at age 40, there’s virtually

a 100 percent chance that some kind of abnormality will show up

that will warrant at least a follow-up mammogram, an ultrasound

scan, or a call from the doctor recommending a 6-month follow-up

examination. There is also a high likelihood that over the course

of a lifetime many women will undergo an unnecessary breast biopsy.”

Then there are those women who are given a false sense of security

when they are told that they have a negative mammogram. Based on

recent research, a June 27, 2002 article in The New York Times

reported that mammograms don’t detect breast cancer in 30 to 40

percent of the women who actually have the disease. Worse yet, mammograms

don’t appear to reduce the mortality from breast cancer any better

than a simple breast examination, as illustrated in a 2000 study

from the Journal of the National Cancer Institute. After

following nearly 40,000 women between the ages of 50 and 59, researchers

found that annual mammograms were no more effective than standard

breast exams in reducing breast cancer mortality. In other words,

mammography did not increase the survival rate of women with breast

cancer, even though they were diagnosed earlier. Another study published

in the Journal of the American Medical Association also found

that most women age 70 and older found little benefit from mammography.

Finally, some researchers even doubt the safety of mammography,

questioning whether regular exposure to ionizing radiation from

the screening itself may cause cancer. A 1994 study published in

Lancet addressed another concern — that the breast compression

which occurs during a mammogram may cause small, in-situ tumors

to rupture, thereby spreading cancer cells into surrounding tissues

and potentially leading to more invasive cancers and metastases.

My Recommendations

Given all of these negative studies and the evidence that detecting

breast cancer by mammography will have very little impact on reducing

a woman’s mortality from this disease, I do not believe that women

of any age should be told that they need to have routine, annual


Rather, I believe they should be offered the option after having

a frank discussion with their physician regarding the pros and cons

of the procedure. Additionally, I believe that mammography should

be offered to women who have strong risk factors, such as a significant

family history of breast cancer, where the benefits of early detection

may balance out the risks. Thankfully, there are alternative screening

techniques, such as thermography, currently under development that

may be more widely available in the near future. To see if this

type of testing is available near you, check with a complementary

physician or naturopathic doctor in your area.

I feel strongly that the best protection a woman has against breast

cancer is modifying her own lifestyle towards prevention of this

disease. This means engaging in regular, moderate aerobic exercise

for seven or more hours per week. As reported in the October 1999

Archives of Internal Medicine, this alone can reduce the

risk of breast cancer by nearly 20 percent. I also suggest that

you minimize your intake of alcohol, caffeine, and saturated fat.

Finally, I recommend that you perform monthly breast self-exams,

and be sure to have a thorough breast examination done by your physician

during your regular visits.

Read More on Breast Health:

Getting Started

Breast Cancer

Risk Factors for Breast Cancer

Fibrocystic Disease

Keep it SIMPLE tip — Exercise Lowers Breast Cancer


Nutritional Therapies

Change your Lifestyle

Caffeine: Friend or Foe

Soy Controversy

Complementary Therapies

Primavera Recipe

Oxygen Therapy and Oxidants



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