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Mammograms: What For, Exactly?

If you're still going for a mammogram screening once every year or two years, please consider the following:

  1. A routine mammogram screening typically involves four x-rays, two per breast. This amounts to more than 150 times the amount of radiation that is used for a single chest x-ray. Bottom line: screening mammograms send a strong dose of ionizing radiation through your tissues. Any dose of ionzing radiation is capable of contributing to cancer and heart disease.

  2. Screening mammograms increase the risk of developing cancer in premenopausal women.

  3. Screening mammograms require breast tissue to be squeezed firmly between two plates. This compressive force can damage small blood vessels which can result in existing cancerous cells spreading to other areas of the body.

  4. Cancers that exist in pre-menopausal women with dense breast tissue and in postmenopausal women on estrogen replacement therapy are commonly undetected by screening mammograms.

  5. For women who have a family history of breast cancer and early onset of menstruation, the risk of being diagnosed with breast cancer with screening mammograms when no cancer actually exists can be as high as 100 percent.

A large-scale screening study published in September of 2000 by epidemiologists at the University of Toronto revealed that monthly breast self-examination following brief training, coupled with an annual clinical breast examination by a trained health care professional, is at least as effective as mammography in detecting early tumors, and also safe.

Since we know that properly performed breast exams are just as effective at detecting early tumors as mammography, how can we justify the use of screening mammograms when we know that all forms of ionizing radiation increase the risk of developing cancer and heart disease?

With all of the controversy surrounding the usefulness of mammograms, it's easy to lose focus of what's really important: what are you going to do if you develop breast cancer?

If you rely on the recommendations of a conventional health care provider, you are likely to begin with surgery and follow it up with chemotherapy and/or radiation.

About three years ago, a family friend asked for my help after she was diagnosed with breast cancer. After reviewing her records and understanding her situation, I told her that I thought it was a good idea to go ahead and have her tumor surgically removed and then to make significant changes to her daily food choices to support her recovery. I also told her that in no circumstances would I recommend that she have chemotherapy or radiation after surgery.

Shortly after having surgery, she called to tell me that her family doctor was strongly recommending that she see a specialist for chemotherapy and radiation treatments.

I gave her doctor a call and asked him why he was recommending chemotherapy and radiation. His reply was that his recommendation was in line with the standards of practice outlined by the College (of Physicians and Surgeons of Ontario), and that if he didn't make this recommendation, he could be sued for malpractice.

Although I was a bit startled by his reasoning, I went on to ask him what sort of dietary recommendations he planned on giving his patient to help support her recovery. "Well, there's no evidence that diet has any effect on breast cancer, so she can eat anything she wants," he responded.

Although I was already well aware of some of the big problems in our health care system, talking with this doctor firmly convinced me that the average person with no medical background has a solid chance of being killed by medical treatments rather than passing on from natural, degenerative causes. Does this sound like an obvious statement to you? If not, please spend some time reading through our articles archive to learn how to best take care of your own health.

With screening mammograms and all other screening and diagnostic tests, you owe it to yourself to always ask: what will I do if this test comes back positive? Hopefully, your research will lead you to learning about how everyday food and lifestyle choices are the main determinants of your health. Why wait for a mammogram, x-ray, or blood test to bring bad news before you begin to take care of your health each day?

Perhaps you'll learn to experience the power and freedom that come with forgetting about many of the screening measures out there and instead, using your time and energy to prepare more nutritious meals, get more rest, work on worthwhile projects, and spend meaningful and fun times with family and friends.

Getting back to our family friend with breast cancer, she spent an entire year following her surgery eating a nutrient-dense, mainly raw, plant-based diet. She made and drank fresh vegetable juices every day. She took a high quality probiotic on a daily basis. I did acupuncture treatments for her on a regular basis to strengthen her immune system. About six months following her surgery, she added raw, organic eggs to her diet three times a week. One year following her surgery, she added wild fish and cod liver oil to her diet. She made sure that she got plenty of fresh air and sunshine whenever she could. She took time off of work and spent time every day praying and reading inspirational books. Through it all, we continuously worked at making sure that her tissues were not faced with excess estrogen and estrogen-like compounds.

It has been three years now since her initial diagnosis of breast cancer, and I'm grateful to report that even her medical doctor declares her to be free of cancer.

Please note: The information on mammograms at the top of this article is from an article written by Samuel Epstein, M.D.

Also, a good pictorial guide to performing a breast self-examination can be found here.

 
 

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cancer

Thank you for your comment on this issue. My mother was diagnosed with No-Hodgkins Lymphoma 22 years ago and as a result of the side effects of the chemo treatment she stopped. She opted for a completely natural solution and had been cancer free for over 20 years. She passed away at age 84 with colon cancer, which again she refused treatment. However, up to that time she took absolutely NO medication at all. The doctors were so insistent on her taking chemo and radiation treatments that they called and attempted to frighten her. She died very peacefully.

Cancer

thanks for sharing your mothers' success story. Truly an inspiration! x

Newsletter

Dr. Kim,
I only want to express my appreciation for your work. Thank you for sharing your knowledge and insights with us.

alternatives to mammograms

I read many years ago about digital infrared thermal imaging and was fortunate enough to get to go to a free talk about it recently. It appears to be a great alternative to mammograms and can detect changes in breast tissue much sooner than mammograms. It is one of the only ways to detect inflammatory breast cancer. If one just looks up thermography and breast cancer there are many informative websites. But like dr. kim said - it is only a screening process. The thing I liked about it was the people who did this were able to catch abmormalities long enough beforehand so that alternative therapies could be tried. And as far as I can tell, there are no side effect like radiation and all.

thermographic mammography

Thermography would be the new black...if insurance companies would pay for it. Last I checked (in 2008 or 2009, with Wellmark), the only way they'll cover a thermographic mammogram is if the doctor who gives you the more standard mammogram recommends thermography as a follow-up.... I'm 47 and have not had a baseline mammogram yet, in large part because the concept of compressing my breasts and zapping them with radiation seems inherently WRONG.

Natural Solutions to better health

Dr. Kim,
Your story about your family friend's doctor's response to you is so close to home for me. For my case, I had a severe case of leaky gut syndrome, which I found out through my own research. Both of my doctors were Stanford trained MDs. One said he could not help me since Nexium did not work for me, so he referred me to the other MD, a gastrointestinal specialist. After spending thousands of dollars with X-rays, endoscopy, etc., his diagnosis was that there was nothing wrong with me. I told him I could barely digest anything and I have been losing 10-12 pounds every 2 weeks. Since I was belching so much, my lungs felt like they were collapsing and my asthma attack was severe. His response was diet has nothing to do with my "condition" and that I can eat anything I want. His tests did not find any cancerous cells, so he then prescribed me with anti-depressants and wanted to do further analysis with more test of my stomach and esophagus. As a specialist, he did not even think about my other digestive organs that were problematic such as my liver and colon, which I later found out through an organ test via a homeopath that they were filled with toxins. You are right Dr. Kim, the average person with no medical background unfortunately will have a solid chance of being killed by medical treatments. I lost a total of 40 lbs. and if I have not been persistent and resourceful by seeking alternative treatments through diet, herbal and homeopathic solutions, I would have been dead 2 years ago. I am truly thankful for doctors like yourself and thank you for sharing valuable information through your newsletters.

Thermography

Great examples and personal reference - thanks very much for the article. Like the comment below, I also have opted for thermal imaging - Thermography. If what I've researched is accurate - this technologoy allows you to see changes in your breast 7 to 10 years before you would be able to feel or see anything in a traditional mammography. And there is no breast compression or radiation whatsoever. Would love to know others research findings there. Best to all.

Thermography

I do agree with Dr. Kim that alternative options may lead to better outcomes than chemotherapy etc. Thermography, however, can be misleading. I have had two friends with breast cancer misdiagnosed with Thermography. One and a large mass and it was not detected. The other had micro-calcifications. Thermography does not detect these calcifications well at all.
They can be highly cancerous and can be caught in early stages with conventional mammograms easily.

I truly believe in alternative medicine but some modalities can hurt the crediability of
complementary medicine.

Just a quick reply to Jo W. I

Just a quick reply to Jo W. I had a thermography test a couple of years ago which showed nothing. Last year, during a regular mammogram, a tumor was found. Sadly, I didn't make a practice of performing self exams, or I would have found it, because it was large enough to feel once I was aware it was there. It was also missed by my gynecologist during his manual exam :( so, don't just rely on them, take matters in your own hands (literally!)

What to say to the doctor who insists on a screening mammogram?

I so appreciate hearing an alternative viewpoint. At age 52 I succumbed to the urging of my physician and friends and very reluctantly had my first mammogram, including a repeat for "more images" along with a sonogram (because there was "something suspicious" and there was no baseline with which to compare the images). Nothing was found.

Each medical professional assured me that digital images involve very little radiation, but I didn't believe it and I also felt that the compression just could not be a good thing to do to your body. When the imaging center told me "next year won't be so bad", I responded that I would not be back "next year". They looked at me with horror and disdain. My soon-to-be ex-physician was equally non-supportive in my desire to forego additional screening mammograms. I presented the referring physician with a copy of an Australian report that basically concluded that there was no benefit to annual mammograms and should someone decide to go this route that there was no need to start at age 40 nor was there any real benefit to an annual image. She did not take this information well and accused me of trying to "play doctor".

I think a lot of women are intimidated into following the conventional "wisdom" - they fear that the physicians will refuse to keep them as a patient or that later they'll get an "I told you so" if cancer should present.

Does anyone have any recommendation as to what to say in this situation?

What to say to a Dr. or nurse who insists on a mammogram

I have told everyone at Kaiser that as soon as they get thermography I will come be screened. This is safer with no radiation and if you have someone good to read them it has been very successful in not only checking for breast cancer, but full body thermography can screen for lots of other health issues.

Kaiser called me weekly heckling me to get my free preventative mammogram, but I decline every time. I really don't believe in them they can cause what they supposedly are trying to prevent.

Mammograms

I have always thought the same thing about mammograms - that they can cause cancer. I had one done in my life and it left me bruise and sore for 2 yrs. I decided, that wasn't for me again. I had to have open heart surgery to repair my mitral valve (due to heart infection caused by strep throat that wasn't treated quickly when I was 20 yrs.) and also a double bypass which was totally unexpected. I have changed my diet since surgery at age 65, gone off all meds - atenolol and lipitor and have gone to natural supplements - red yeast rice, fish oil, niacin, CoQ10, etc. My BP is 101/62 with no meds. I went off the lipitor because I discovered that the drug can deplete CoQ10, etc. and can cause irregular heartbeats. Since going off it, I have less and less irregular heartbeats. My cardioligist said some people have them the rest of their life and occasional ones were not to worry about. I also find that if I do not drink enough liquids, it will trigger them also! In addition, I also take Immunextra - pine cone extract to enhance my immune system. I am friends with the doctor who patents this at Tampa Bay Research Institute and know how well it work - it help my husband recover from plasmacytoma to years ago - protein markers are gone from his blood now - his oncologist said keep taking it because something has to be working to do that. If anyone wants more info, look at www.immunextra or www.tbri.org. It enhances anything that someone takes and won't interfere with any drugs, supplement, etc. - only enhances its outcome. Taken with chemo, it help a person get rid of toxins.

Mammograms

Thank you Dr.Kim for a great article. Since I first read it, a while back now, I've referred to it many times and the one thing that's stuck with me is the question you pose to the reader--basically, have we asked ourselves what course of action we would take if we did receive a diagnosis of breast cancer. I think the question is very powerful and one most people do not ask themselves. There are no guarantees with mammography or thermography or any other test we may undergo. We'll hear pros and cons for any screening device because we are each uniquely different in our thoughts and experiences.
Perhaps I am naive and many people would find concern with my next statement. I don't believe in mammography. It is a form of screening based on fear and although many women have been 'saved' by the procedure, others have been equally tormented by it. I think you are absolutely right when you question why it would take a diagnosis in order for us to lead the kind of lifestyle that fosters health and well being. And some would say, "Yes, but I may not be here today if I hadn't gone in for a mammogram." But I ask, "Now that the tumor has been removed, has it caused us to make some important lifestyle changes and all that entails? Has it caused us to question. . ." To be honest, I think many people confuse 'detection' with 'prevention.' Mammography has nothing whatsoever to do with prevention or health building. Women think that because they don't receive a diagnosis, that renders them healthy and they hope for the best until next year comes around. That idea alone creates more fear and a false sense of security. In essence, we've given all our power away to an 'other' while at the same time telling ourselves, there is no connection between the lives we lead and the effects or outcomes they create. In other words, you can't rely on mammography to be your lifeline. We must dig deeper.
I am that person, and it has taken me awhile to understand this, who believes in that sense of freedom you speak of in not feeling the 'need' to rely on tests. I don't get caught up in statistics either because these too are fear promoters and crush the spirit. I know I don't want what conventional medicine has to offer where breast cancer is concerned--ectomies, radiaton, chemotherapy. I know my focus is good food, whole food supplements, sunshine, sleep, reducing stress, education, self-reflection, laughter, family and friends, passion and compassion. I believe our focus should be on breast HEALTH and not breast cancer.

mammograms

Hi Dr. Kim,
I read with interest your article on mammograms. My mom had breast cancer at age 38 and passed away at age 49. I had my first mammogram at age 29 when I had a benign mass {hamaratoma} removed from one breast. I have had mammograms annually ever since, I am almost 42. The new digital mammograms are much quicker and seem easier than the older machines. I also have started to get annual MRI's. I am grateful for all this screening, but now feel a bit concerned. Can you direct me to literature that supports the correlation between mammography and causation of breast cancer? Thank you so much. I enjoy your newsletter and recipes! Deb

Hi Deb, You may find the

Hi Deb,

You may find the following article to be helpful:

http://drbenkim.com/mammogram-radiation-dangers.htm

With best wishes,

Ben Kim

breast health article

Dear Dr. Ben, excellent article, you discussed many good points... mammograms make no sense with how they abuse the breast tissue...it would be great to share thermograms as an alternative if there is pressure or a need to assess the breasts for unhappy cells :)
Thanks for all your insights into health and well being!
Tammy

New research about mammograms

Many of you might care to look at recently released research by the Nordic Cochrane Institute and published in the BMJ.
An analysis of data over 10 years of 2 groups of Danish women - one group having regular mammograms, the other group are un-screened.
The mortality from breast cancer in the screened group drops by 1% over that period.
The mortality from breast cancer in the un-screened groups drops 2% over that period.
##More women died from breast cancer in the SCREENED group.
The NCI have been very critical of the information released to women - (we get half the story with cervical screening as well) they called for an urgent redraft of the BreastScreen brochures in several countries.
They decided the only way to inform women was to draft their own brochure - it's at their website, "The risks and benefits of mammograms" - essential reading for any woman thinking of having a mammogram.
Clinical breast exams - no evidence they bring down the death rate, but they cause biopsies. Some believe biopsies are a risk factor for cancer.
I've adopted the "breast awareness" program devised by the late Dr Joan Austoker from Oxford University. I take note of the look and shape of my breasts after I shower every day (no touching) and if anything changes, I'll see a Dr.
If the only screening tests are harmful and/or unreliable, I'll pass. I'm not prepared to gamble with my healthy body.
http://www.nlm.nih.gov/medlineplus/news/fullstory_96794.html

I Say "No" -- My Sister, the Doctor, Says "Yes"

I am so happy to have found this article, which states so clearly many of the points that I have been trying to get across to family and friends on the issue of mammograms (as well as health/medical issues in general). Also, I find many of the readers' comments just as valuable. I will be passing along the article and comments to many -- including my sister, who is an OB/GYN doctor and needs to hear this.

Hopefully, more and more women are questioning the risks/benefits of mammograms, especially in light of the new guidelines presented by the United States Preventive Services Task Force last year. Interestingly for me, "my time" to start yearly mammograms at age 40 came a few years ago, before the new guidelines. Being the type of person that I am -- doing research for myself, rather than trusting someone else's position, regardless of that person's title -- I started reading up on mammograms. Even without the data, as another reader commented, the process (compression of the breasts, radiation exposure, etc.) seems inherently wrong. Still, I was surprised at how clearly the data supported my suspicion that mammograms would be more harmful than beneficial to me (especially in the 40 to 50 age range). It didn't take much research for me to decide for myself; but knowing so many women in this 40 to 50 age group, I was disturbed that they were being told, in accordance with the recommendations at the time, to get yearly mammograms. I passed along the information that I had gathered, hoping that they would make their own informed decisions, rather than letting someone else "decide"/tell them what to do.

When I heard about the new guidelines, I was thrilled, thinking that, now, women would stop subjecting themselves to this routine harm, since the "experts" would now be telling them something different. I didn't realize that the American College of Obstetricians and Gynecologists had not accepted the new recommendations -- I found this out after a recent conversation with my sister who is an OB/GYN doctor. In response to my questions and arguments, she tried to justify her/their position with emotionally-based arguments, such as "It saves lives", rather than actual facts/data/research. This did not surprise me -- and brings me to a major point worth making...

Your body and your health is ultimately in your own hands. You can read the research on this and other topics yourself. You do not have to rely on someone else's interpretation of the facts. It would be great to have a doctor like Dr. Kim. But what is more likely is that you will have doctors who have shortcomings and biases that prevent them from acting FULLY in your best interests. I did not need a sister who became a doctor for me to understand this; but it does make it easier for me to illustrate my point. After our conversation on this topic, I did even more research -- I couldn't believe that my sister was so defiant about their recommendations. I found that the INFORMATION is overwhelmingly in favor of not having mammograms in the 40 to 50 age range.(And after that, it remains a question to be answered by the individual.) It is obvious to me that I have read more/know more about this topic than her. Or, maybe she does read the data but is not looking squarely at the information -- for any number of reasons: because she believes that she has to defend her organization's position; because the other doctors in her practice expect them all to be "on the same page"; because they lose credibility by changing a past recommendation, even if it is to the patient's benefit; because there's no nice way of saying that they've been telling women the "wrong" thing for seven years; because billions of dollars are being spent on mammograms each year in America, and maybe this affects their bottom line. For any or all of these reasons, she and other doctors may not be reading the information with an open mind; rather, they may be on the defensive, or reacting more emotionally than logically. Doctors are people; they, like everyone else, are flawed.

By the way, as the article states and readers have commented, the focus should be on prevention, not detection. I, too, believe that focusing on tests and screenings makes people less likely to focus on prevention -- I have found a lot more evidence supporting the significance of diet, lifestyle, etc., as opposed to evidence of the successes of treatments and cures. In other words, I find the statistics for how successful you can be at preventing breast cancer (and other cancers and diseases) much more definitive than the statistics for the successes of detecting and treating these diseases. Back to my sister, the doctor, again -- It seems that when topics of prevention come up, she tends to roll her eyes and bring up the tests and screenings, as if THAT should be our defense against the diseases. Once again, doctor or not, she's wrong.

I am 48 and have refused to

I am 48 and have refused to have a mammogram because I have read about the effects and dangers of mammography (through Dr. Joseph Fuhrmann's website.)This article does a great job summarizing those dangers and the confusion between "diagnosis" and "prevention."

I did not realize that women with dense breast tissue and early-onset menstruation had such high false-positive rates. I fit both those categories; thank goodness I did not have one. What disruption to my life, financial stress, and needless pain I might have suffered if I had. What needless worry such a false diagnosis might have caused my family and friends as well.

When mammography comes up in conversation with friends or family, or at the MD's office, and I say that I will not have one, and never have, they often stare at me in horror or suggest that I am stupid, neurotic, or naive. I will print out this article so I can hand it to them next time this comes up. I refuse to go to an MD who treats me as if I am an imbecile or neurotic for refusing mammograms and for believing, for very good reason, that nutrition and cancer are linked.

Mammography is a very lucrative business. Who supports the research that promotes mammograms, chemotherapy, and radiation? Who funds the writing and publishing of many medical textbooks? I think the answers to these questions would shock many people who trust these "treatments."

Mammograms

I am 54 and did not have a mammogram for 4 years. Last week I found a lump in my armpit and was diagnosed with breast cancer; Invasive Ductal Carcinoma. If it had been caught earlier with a mammogram, I may not be going through what I am going through today. It is a good idea to keep up with your mammograms, in my opinion.

Mammogram

In response to the 54 year old woman who didn't have a mammo for 4 years and found a lump: I faithfully started having mammos at age 40 and every year after that. At age 52 I found a lump. I did not report it to my doctor because I two mammos with the lump and they found nothing.( I went for 2 years with the lump). The lump started to increase in size, which prompted me to tell my doctor. I went for another mammo and that one came up negative, also. So, they sent me for an ultrasound and an MRI. Both tests showed the tumor. I then had a biopsy and it came back positive.I was diagnosed with stage 2 estrogen positive ductal/ invasive. I am telling you this, because I believe that mammos are a waste of time. If I dependend on the mammos, I probably would still be walking around with a much larger tumor.( By then, it would've been too late) Even after having my surgury and 2 rounds of chemo(which, by the way, I had to stop because of a severe allergic reaction), the oncologist and breast srugeon still try to get me to have a mammo. I have opted for a yearly MRI and ultrasound. They also recommended radiation, which I did not do. I see them every 6 months and get bloodwork done to "check for markers". It's been 2 years and 2 months since my diagnosis. I also have issues with their recommendation to take Tamoxifin or Arimidex. But, that's a different article....

mammography

On the other hand - who benefits really - who benefits economically from women not getting mammograms - - the pharmaceutical industry who sells excessively expensive cures.

I tried to get a thermography exam and my doctor tried to block me.

At my last visit to my

At my last visit to my physician for general exam including breast exam she too questioned when the last time I had a mammogram. I told her that I have not had one. I'm not even 50 yet, but she has been giving me the slip for having a mammogram for the last 5-6 years. I informed her that I know my body and that I perform my breast exam-manual monthly and go in for one by the physician yearly. I also informed her that there is much controversy on the subject of mammograms and about the new information that exists on the subject.(I have some medicial backgroud myself.) She too looked at me like something was wrong with me, and said, "what controversy?" "Mammograms are 100% safe and they give you no radiation whatsoever." They won't hurt you at all." She also stated that the digital mammograms were even safer. In my belief, that information is malpractice. I'm not pleased with my doctor giving me such information and treating me like I don't know anything. I plan on finding a better physician and continuing taking my health in my own hands as I have done most of my life.

Mammograms

I would like to say that I agree with Dr Kims position. I however think that this is more a situation of how things ought to be rather than how they are in reality. If you are a woman that is already practicing a healthy lifestyle, as outlined in the article, then I agree that educating yourself on how to perform a proper breast self exam and having your self screened by a professional through an exam would be a better choice. I dont think that the women who are not already taking care of there health will benefit from the article simply because they likely wont make any change other than ceasing mammograms. The reality is they are ignoring all the information about preventative measures already and they will likely adhere to the idea of not getting a mammogram but make to effort to change their current habits. I think these women should get a mammogram screening. It may save their life.

mammograms

My wife was diagnosed at 46 years old with breast cancer via a routine mammogram. She was treated with lumpectomy and 30 radiation treatments and is currently taking Tamoxifen. She was lucky that the tumor was hormone sensitive and that she was negative for the BRCA1 and BRCA2 genes. If not for that mammogram it would have been a very long time before it was discovered.
I wholeheartedly disagree with Dr. Kim and as a physician myself would not recommend skipping mammograms to anyone.

mammograms

I hate the way mammograms feel and fear the radiation but I will continue to get them. I have two sisters who have had breast cancer and mastectomies. There are other things to look at besides mammograms. One sister, the nurse, noticed grapefruit like puckered skin on her breast. The mammogram and ultrasound were clear, but her gut told her to check things out and an MRI showed a large lobular tumor against her chest wall. My other sister, the doctor, noticed changes in the shape of her nipple and the suspicious area in her mammogram was indeed cancer. A little paper insert I got from the American Cancer Society 40 years ago listed many things to look for to help detect breast cancer, including changes in shape, skin texture and nipple appearance. My sister learned about the grapefruit skin sign from that slip of paper I pasted to our bathroom mirror 40 years ago. Women need to again be informed about these signs in addition to just going for mammograms.

Women are being misled about mammography

Any screening test of early detection of breast cancer is risky because of overdiagnosis. And it isn't just radiation and chemotherapy that are dangerous but also surgery to remove a breast cancer, as it frequently leads to secondary cancer, in a number of cases it is going to be metastatic (read "The Mammogram Myth: The Independent Investigation Of Mammography The Medical Profession Doesn't Want You To Know About" by Rolf Hefti. Also see Mammograms: Dangerous! Mammography Risks, Myths & Breast Cancer Facts ). If women knew the real facts about breast cancer, mammography, and screening, many would hesitate to blindly believe what their doctors tell them.

mammagrams

thank you so much for posting this article and sharing this most valuable information. I feel pretty good that my diet is more plant-based these days. I feel so much better from it. I intend to share this article with others. oddly enough, my chiropractor friend told me about a safer mammogram, unfortunately the procedure name escapes me at this time. thanks again. take care. - rahmah

 

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