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Should You Get a Mammogram?
Posted by Dr. Ben Kim on Apr 28, 2009
Q. I am scheduled for a mammogram in a few weeks. My GP and I are in disagreement over mammograms - she feels that I definitely need to have one whereas I try to avoid radiation as much as possible.
I know there are other methods of breast screening out there but none are available within this vicinity and come at a large cost when they are available.
I do self examinations regularly and my GP does an annual breast manipulation and has found nothing of alarm.
Am I being paranoid about radiation and are my fears of creating other issues (possibly caused by radiation) legitimate and/or well-founded?
Who knows - maybe it will 'surface' (sooner than later) that mammograms ARE one of the causes of breast cancer. Even my Naturopath feels I should have a mammogram.
Needless to say, Dr. Kim, at the moment I am feeling pressured into having one.
Any advice and/or thoughts on this subject would be greatly appreciated.
Susan S., Canada
A. It's been more than a couple of years since I last wrote about mammograms and the effects of ionizing radiation on human health, so while I empathize with Susan's angst, I welcome the opportunity to re-visit this topic and highlight the latest relevant findings that have been generated in peer-reviewed medical literature.
To me, Susan's question boils down to this: Do the benefits of mammograms outweigh their potential harmful effects?
Let's answer this systematically.
What are the benefits of having a mammogram?
Clearly, the chief benefit is potential detection of a malignant mass. I write potential detection because we know that in some cases, mammograms miss malignant masses. Some studies indicate that close to a third of malignant masses in women between the ages of 40 and 49 are missed with routine mammograms.
I'm also mindful in writing "detection" rather than "early detection" because it typically takes several years for a mass to become large enough to detect via a mammogram; finding cancer with a mammogram cannot be considered an effective screening measure to make an "early diagnosis."
What are the potential harmful effects of mammograms?
A routine mammogram screening typically involves shooting 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.
According to Dr. John Gofman, Professor Emeritus of Molecular and Cell Biology at the University of California in Berkeley, here's what we can clearly state about x-rays:
For decades, the scientific community has known that x-rays cause a variety of mutations.
X-rays are known to cause instability in our genetic material, which is usually the central characteristic of most aggressive cancers.
There is no risk-free dose of x-rays. Even the weakest doses of x-rays can cause cellular damage that cannot be repaired.
There is strong epidemiological evidence to support the contention that x-rays can contribute to the development of every type of human cancer.
There is strong evidence to support the contention that x-rays are a significant cause of ischemic heart disease.
This is not to say that you should never have an x-ray; this is to say that getting exposed to ionizing radiation comes with real risks, and these risks should be considered before consenting to any procedure that leads to exposure.
So in terms of ionizing radiation, what's the price that your body pays for a routine mammogram?
In the United States, the Food and Drug Administration mandates that no more than 300 millirems (a unit used to measure doses of radiation that are absorbed by the body) of radiation can be delivered per film during a mammogram.
Given that routine mammograms typically involve taking four films, two per breast, this amounts to up to 1200 millirems per mammogram.
According to the physics department at the University of Richmond in Virginia, the average American is exposed to approximately 360 millirems of radiation each year - this exposure comes from the sun and other natural elements, as well as from man-made devices.
To provide some perspective on everyday events that can add up to 360 millirems of radiation over the course of a year, here is more data from the University of Richmond:
Units of Radiation Absorbed (millirems)
|Plane trip from New York to Los Angeles||
|Series of x-rays for head and neck||
|CT scan (head and body)||
|Full body therapeutic thyroid treatment||
|Average annual dose per person per year||
So each time you receive a mammogram that involves four shots, you may be exposed to about the same amount of ionizing radiation that you're exposed to over the course of about three years and four months. This is assuming that the maximum allowable dosage is used, but even if less is used, it should be clear that the amount of ionizing radiation that is involved with mammograms is significant.
Some highly respected physicians and scientists like Dr. Samuel Epstein have comprehensively analyzed this and other available data, and contend that every 1000 millirems of exposure increases a person's risk of developing some types of breast cancer by 1 percent.
I'm not sure how accurate anyone can be about these numbers, but there is credible evidence to suggest that going for a mammogram every year over decades can significantly increase your risk of developing breast cancer.
Even those who support going for annual mammograms acknowledge that the overall net benefit is itty bitty at best; the numbers indicate that two thousand women have to be screened for ten years for just one woman to experience benefit to her lifespan.
One of the most comprehensive studies of routine mammograms conducted on women aged 40 to 49 found that:
Women who went for annual mammograms developed breast cancer at a clip that was 22% higher than that of women who relied just on self breast exams.
Women who went for annual mammograms had twice as many cases of metastatic cancer compared to the group that did not receive mammograms.
But let's step back a bit from epidemiological data and put our focus on you.
We know that if you get a mammogram, you're not preventing anything. You're screening for abnormal masses.
If the medical professional who performs and interprets your mammogram deems you to have an abnormal mass, you're likely to receive a biopsy. And if your biopsy reveals a malignant mass, chances are good that your physician will refer you to an oncologist who will prescribe treatment, most likely a mix of surgical excision, chemotherapy, and perhaps a course of radiation.
The point is, when medical professionals and studies talk about mammograms saving lives, this has nothing to do with you preventing or overcoming cancer.
You are 100% unique in genetic composition, life history, and current life circumstances, and most importantly, your chances of developing and overcoming breast cancer have very little to do with survival rates that are calculated for entire populations.
All of the factors that determine your chances of developing and overcoming any type of cancer are not accounted for when a physician tells you that getting a mammogram can help save your life. These factors include what you eat, how you eat, your exposure to toxins, your living and work environments, the states of your closest relationships, and how fulfilled you feel.
With all of this in mind, it should be clear that experiencing significant stress over the decision to receive or decline a mammogram is in and of itself a contributing cause of every health challenge that we know of. Stress contributes to the development of disease, including all types of cancer; never forget that your body and health cannot be compartmentalized; every aspect of your life has some impact on the health of every cell in your body.
Having a physician whom you respect strongly recommend a mammogram doesn't make things easy, that's for sure. At the end of the day, I remind myself that no one carries more responsibility for my health than me.
I know my health and life better than anyone.
I know when I need more rest than I'm getting.
I know when I need to eat more of certain foods and less of others.
I know when there is friction in an important relationship in my life, and I know that transcending both pride and a desire for the other party to apologize is a good path to erasing friction that hurts my health.
I know when I have a guilty conscience and need to step up and do the right thing.
I know that I can use all of my awareness and autonomy to screen my health on my own with each passing day. Making the adjustments mentioned above as needed is the best program of disease prevention that I know of, and I put my confidence in this approach above all conventional measures that come with significant risk.
Put another way, the best line of screening for dis-ease is your own set of observations of how you feel physically and emotionally. And the best line of preventing dis-ease involves living in a way that optimally supports your innate self-healing mechanisms.
There's no question that some conventional medical tests provide immense value in assessing our health and helping us make decisions on how to approach various health challenges. The key is to make use of the least harmful tests available, and only when deemed truly necessary by our best instincts.
With regard to specific medical screening procedures for breast cancer, I feel that for the vast majority of women, regular self examinations coupled with a manual exam by one's physician on an annual basis is an effective approach that is virtually risk-free.
When a person's medical history and/or a finding with a manual examination indicate that it's prudent to investigate further, I feel that diagnostic ultrasound and even magnetic resonance imaging (MRI) should be used before mammograms, though the cost of magnetic resonance imaging is significant. Thermography is also a good option in some cases, though like all other screening measures, it cannot detect every type of growth.
But again, I feel that it's best to depend less on medical tests and more on how we feel day to day to stay on top of our health, and of course, to live as healthfully as possible. Why wait for a health crisis to prompt us into doing what we know we should every day?
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