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Should You Get a Mammogram?

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
Chest x-ray
Dental x-ray
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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Thank you for a wonderful article. I truly believe that if you take care of yourself each and every day by making healthy food choices, reducing and dealing with stress, embarking on tasks that bring you joy and fulfillment, why would we need somebody else to give us a potential diagnosis in order to make these kind of positive changes that promote health and well being? Why not just start living a healthy lifestyle? Too often, women go for mammograms, get a clean bill of health, so to speak, and then continue living their, let's say, less than desirable, unhealthy lifestyle, and hope for the best until next year. I think there is a sense of great freedom from living 'outside' of the FEAR that's induced through the medical establishment, a sense of strength that is enhanced when you develop a sense of who you are and how you feel. Again, many thanks for shedding light on a very important topic.

I found your comments very interesting if not a little naive. In a perfect world wouldn't that be wonderful if all you had to do was eat healthily, exercise, do what makes you happy and stressfree.

I felt that I lived a healthy, stressfree life but a mammogram showed a form of breast cancer. If I had done what you suggest I may not be here to tell the tale today.

Mammogram may not be the whole answer but I believe it is the best we have at the moment and women should not be discouraged from taking advantage of it.

I agree the mammograms expose women to far too much radiation. Breast MRIs are far more accurate but it's difficult to find an insurance company that will cover it over the mammogram.

I started having my mammograms like a good girl at 40. Not every year but I did do my self-exams. Six months after my mammogram (which detected nothing) at age 42 I found a mass in my right breast. After all the chemo, rads and surgeries I'm just plain wore out.

I took good care of myself and got cancer anyway. Does this mean I'm going to take up smoking and drinking and grabbing that extra slice of pizza? Of course not. But I do appreciate life a lot more and know that there are people out there who love me and want me to stick around for a while.

Thank you for the great article. I hope it makes both men and women ask their doctors more questions about x-rays and radiation.

I had my first mammogram at age 40. Since it was an uncomfortable experience and I did not have any cancer in my family other than my mother who was a heavy smoker, I did not get another mammogram until 14 years later. As a result of my previous experience I was a big baby about this one, and the technician let me determine the amount of pressure. Nothing suspicious was identified.

The next year, my mammogram showed a mass that turned out to be cancer. Even knowing exactly where the 1.2cm lump was, it could not be felt. I shudder to think what my situation would have been if my cancer had remained undiscovered until it was large enough to have been felt during a self exam. (And I have wondered if it would have been found the previous year if I had not been such a baby.)

While I feel it is a good idea to limit radiation, I am also a big believer in mammograms.

The point that is being made is that the mammo's contribute to breast cancer...a better question would be if you would have skipped the mammo at 54, might you have avoided breast cancer at 55? Thermography is worth investigating--radiation is dangerous and very unnatural/harmful to our cells--the risk is too great.

Hello, just wanted to say I LOVE your news letter, always so full of super interesting things..
This article was very exact in my eyes, I really do believe WE are the ones who know ourselves the best:::
Anyway, I share all you share... thanks
Bye for now

Thermography detects potential problems far earlier than a mammogram and in such a way you can do something about it. It is non invasive, non painful and does not involve radiation. Please check this out as a method of screening and thus prevention.

Say, a person has yearly checkup for both dentist and mammogram? What if it's even in the same month? Isn't there a more prescribed method of combining thermography and mammography within a 5 year period instead of every year for mammograms? If insurance companies want to be proactive instead of reactive, I would think they would welcome this plan and help pay for it as well. Just my thoughts and opinion.

I came across a video of Jennifer Harvey, M.D., Director of Breast Imaging and Co-Director of a Breast Program at the University of Virginia. She stated that mammography radiation is lower than you'd receive from a round-trip flight from NY to LA, and only slightly higher than the radiation we are exposed to each day. I wonder how she measures ionizing radiation?

I do not see how radiation and compression zapping directly into your breast tissue year after year can possibly be safe. I don't care if it is low dosage or not. I think Its barbaric and unsafe. Not to mention all the false alarms leading to more scans. It may be a way to detect early but how the heck can we be sure it is not causing all this breast cancer? That is the part that I find extremely disturbing!

My best friend's mom, who was 70, was to leave on a BIKE ride around New England with her daughter a few years ago. This was biking, not ride a little, drive, ride a little more. She was in that good of health. The day before she was to leave she had a mammogram scheduled. The doctor called her that night in alarm. The results were not good and she needed surgery that week. Bike ride cancelled and surgery scheduled a few days later. After opening her up they saw a "spider-web" of cancer. She was dead six months later after multiple surgeries, radiation, chemo. This woman had no idea she had cancer. She was feeling great. She was terrified by what they told her and did it all only to die after experiencing all that pain, puking, and misery. Thanks, but I would rather die riding my bike than the way she did. It was horrible. And most likely cutting into that cancer helped to spread it and death faster.

I have never been happy about mammograms! Having had two over the years and scared to have any more I read your article and feel I did the right thing after all . As far as one can tell its best to try to avoid X rays but
dental ones seem the most common. I wish there was another way as I am sure I have had far too many over the years including two CT scans. Its all very difficult. Your advice seems very sensible on all aspects of healthy living. Many thanks!