Sunday, January 4, 2009

A Wellness Approach to Breast Cancer Screening

In this report, we will be discussing the very important topic of screening for breast cancer. My hope is that this information will facilitate your own investigations so that you will be able to make wise choices with confidence. I have included numerous quotations and citations from medical journal to facilitate your own investigations. DE



A Wellness Approach to Breast Cancer Screening


I am dividing this topic into two major sections:


Part A – the limitations of mammography

Part B – the benefits of thermal imaging (aka thermography or digital infrared thermal imaging -DITI)


Part A – the limitations of mammography


Summary: Recent studies have emerged which question both the effectiveness and safety of screening mammography


Screening mammography may not significantly reduce breast cancer death

Despite the fact that mammography can detect some breast cancers earlier, we have been surprised to learn that mammography is not very effective at reducing breast cancer deaths. I would like to take a look at the some recent studies that discuss this issue:

Articles 1-2 are against mammography
Article 3 recommends screening with mammography
Article 4 discusses the need for us to move forward

Please note that I have included a portion of direct quotes from these articles (emphasis and italics mine). Links to the actual articles are included to facilitate your own research.


Article #1 “Is screening for breast cancer with mammography justifiable?”

From The Lancet, January 8, 2000 Volume 355, Issue 9198, Pages 129 – 134
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(99)06065-1/abstract
Note: You can see the full text free as well; just sign up with a username and password

Their strongly-worded conclusion against mammography is as follows:

“Screening for breast cancer with mammography is unjustified. If the Swedish trials are judged to be unbiased, the data show that for every 1000 women screened biennially throughout 12 years, one breast-cancer death is avoided whereas the total number of deaths is increased by six. If the Swedish trials (apart from the Malmö trial) are judged to be biased, there is no reliable evidence that screening decreases breast-cancer mortality.”


Article #2 The 2001 Cochrane Review of Breast Mammography
http://www.cochrane.org/reviews/en/ab001877.html
The Cochrane Collaboration is an international, independent non-profit group which is often cited as one of the best medical reviewing organizations. They concluded the following:
“Based on all trials, the reduction in breast cancer mortality is 20%, but as the effect is lower in the highest quality trials, a more reasonable estimate is a 15% relative risk reduction. Based on the risk level of women in these trials, the absolute risk reduction was 0.05%. Screening also leads to overdiagnosis and overtreatment, with an estimated 30% increase, or an absolute risk increase of 0.5%. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.”

Comment: Again – a widely respected source doubts the benefits and raises concern of possible harm. This is in contrast with the next article which reflects the prevailing view in the US.

Article #3 Annals of Internal Medicine “Breast Cancer Screening: A Summary of the Evidence for the U.S. Preventive Services Task Force”

These are the recommendations which are most commonly followed in the US.
Annals of Internal Medicine 3 September 2002 Volume 137 Issue 5 Part 1 Pages 347-360
http://www.annals.org/cgi/reprint/137/5_Part_1/347.pdf

Their conclusions included
“In the randomized, controlled trials, mammography reduced breast cancer mortality rates among women 40 to 74 years of age. Greater absolute risk reduction was seen among older women. Because these results incorporate several rounds of screening, the actual number of mammograms needed to prevent one death from breast cancer is higher. In addition, each screening has associated risks and costs.”

Comment – Interestingly, the authors of this analysis were looking at basically the same overall data which was evaluated in articles 1 & 2. Why the difference in conclusions? Unfortunately, this analysis did not include the negative effect of false positives (i.e. – no cancer but study looks abnormal). The study leaves out the impact of unnecessary interventions such as surgery and this has a significant effect on making mammography look more attractive than it should. Additional issues with this article are cited below in article #4


Article #4 Annals of Internal Medicine – “The Mammography Dilemma: A Crisis for Evidence-Based Medicine?”

http://www.annals.org/cgi/reprint/137/5_Part_1/363.pdf
Annals of Internal Medicine 3 September 2002 Volume 137 Issue 5 Part 1

“If we take a step back, this controversy looks almost Swiftian when we consider that even under the most optimistic assumptions, mammography still cannot prevent the
vast majority of breast cancer deaths. Improving methods of risk prediction, communication, disease detection, and treatment will probably yield more public health benefit than continued debate about mammography. There will come a time when all the study patients have been followed up, all the analyses have been done, all the expert groups have met, and all the editorials have been written, and we still won’t be sure how much benefit and how much harm are caused by mammography. We must find good ways to help women deal with this uncertainty, for that time is imminent.”

Steven N. Goodman, MD, MHS, PhD

Comment: Dr. Goodman makes several excellent points. Basically he is saying that at best mammography has very limited benefit and cannot prevent most breast cancer deaths. I agree with his bottom line: we can go on arguing this issue forever but what women need is a better way.

The currently recommended series used for screening mammography exposes the breast tissue to potentially harmful radiation doses

You might take the position that perhaps these studies are somehow not recognizing the benefits of mammograms and choose to get a screening mammogram anyway. As you make your decision about having a screening mammogram, you should know that we now have evidence that the biologic effect of the radiation used in mammography is higher than previously believed.

Most quote the radiation dose from mammography as 0.7 mSv. A chest x-ray is about 1/7 of this i.e. 1 mammogram = 7 chest x-rays. Most would reassure you that the dose is negligible; however, one must factor in several additional issues:

Mammography is repeated frequently.

In the US – radiologists typically perform 2 views per breast – doubling the dose.

The current guidelines for screening mammograms were based on the assumption that the biologic effect of the radiation was the same as the higher energy x-rays like those used in chest x-rays. Recent articles demonstrate the biologic effect of mammographic x-rays is actually 2-5 times greater (see Radiation Research 162, 120–127 (2004) and International. Journal Radiation Biology (2002, vol. 78, no. 12, 1065-1067). This would make each mammogram more comparable to 14-35 chest x-rays

Implications of this new understand on mammography screening

When we look at the current protocols in light of this higher biologic effect, we realize the need to significantly reduce mammography exposure. The International Journal of Radiation Biology calculated the risk to benefit ratio using this new understanding of the radiation used in mammography. This new calculation results in changing the mammographic recommendations to a later age: starting screens at age 47 instead of 40 and starting annual mammograms at around age 60 instead of 50. These ages would be much higher if, instead of 2x, the upper end of the estimate is used (5x).

You may not realize that the United States is the only country that routinely screens premenopausal women. The U.S. also extends its screening practice by taking two or more mammograms per breast.


Younger women desperately need more than the status quo

In his article Beyond Mammography, Len Saputo, MD points out that the most devastating loss of life from breast cancer occurs between the ages of 30-50. The breast is not only more sensitive to radiation during this period but the mammograms are less useful due to the increased breast density. The minimal effectiveness of screening mammography as well as the complications of false positives and radiation exposure requires us to develop a better approach. A new tool is needed to help women, especially young women, and this is where thermal imaging comes in.

Part B – the benefits of thermal imaging

What is thermal imaging?

Thermal imaging (aka Thermography or Digital Infrared Thermal Imaging - DITI) is a powerful tool which enhances the ability to detect breast changes and can enable earlier cancer detection

Digital Infrared Thermal Imaging ‘DITI’ is a 15 minute non invasive test of physiology
Non invasive
No radiation
Painless
No contact with the body
F.D.A approved

This quick and easy test starts with your medical history being taken before you partially disrobe for the scanning to be performed. This first session provides the baseline of your “thermal signature”. A subsequent session assures that the patterns remain unchanged.
All of your thermograms (breast images) are kept on record and once your stable thermal pattern has been established any changes can be detected during your routine annual studies.


Clinical studies have shown Breast Thermal Imaging to be a powerful tool to detect breast cancer

Oncology News International (September 1997 Volume 6 Number 9) reported the results of a detailed study 100 women with non-invasive stage I and II breast cancer. In this study, the 84% sensitivity rate of mammography alone was increased to 95% when infrared imaging was added.

All patients had undergone preoperative clinical examination, mammography, and infrared imaging:

Clinical examination alone was positive in 61% of the study patients
Mammography was highly suspicious in 65% of patients, with an additional 19% having contributory but nonspecific (intermediate) mammography findings
Infrared imaging was considered abnormal in 83% of patients


Thermal imaging also had 1/3 less false alarms (in the medical jargon it had the highest specificity)


Conclusion: Breast screening using breast thermography is able to safely and effectively detect changes which can lead to an earlier diagnosis of breast cancer


A Suggested Wellness Oriented Recommendations for Breast Imaging

Wellness Recommendation: Use breast thermal imaging to safely identify those at the highest risk.

Rational mammography: Mammography should be used selectively to follow up abnormal exams rather than as a routine screen.

Mammograms will continue to have a role in evaluating breast health; however, this role may best reserved to complement thermal images that suggest changes and warrant further evaluation.


Wellness Recommendations

Starting around age 30 - a baseline “thermal fingerprint” should be done by having 2 breast thermal imaging studies 3 months apart and then yearly.

Have a clinical breast exam done annually.

Follow up abnormal thermography with diagnostic mammography, ultrasound, breast MRI and biopsy if needed.

If you choose to have screening mammography done, remember that you adding annual thermal imaging improves detection.


Prevention of Breast Cancer
Obviously, the most important aspect is to do everything possible to decrease breast cancer. I am not going to cover all of this big topic, but I would point out 4 important areas:

Progesterone
We have multiple studies which lead us to conclude that Progesterone plays a powerful role in preventing cancer:

The higher the level of progesterone, the lower the rate of breast cancer in premenopausal women High progesterone levels were associated with 1/8 risk of breast cancer.

Women with normal progesterone levels had 1/5 the rate of cancer deaths seen in progesterone-deficient anovulatory women.

Progesterone has been documented to activate the p53 gene which is involved in preventing cell division.

Progesterone has been documented to kill breast cancer cells in the lab.

For more on the importance on hormones, please see my July 20, 2008 posting.

Vitamin D at optimal levels is associated with a 50% lower all-cause death rate.

Avoid Sugar – Sugar and simple carbohydrates weaken the immune system and feed cancer cells. Avoid sugar and high-fructose corn syrup completely. Keep simple carbohydrates like bread, pasta, pizza, cereal, cakes, cookies, crackers, milk, honey & fruit juice to a minimum.

Fruit & Vegetables - Eat 5-9+ servings of fruit & vegetables daily. If you are not consistently getting this I would highly recommend taking fruit/vegetable caps – 2 fruit caps in am; 2 vegetable caps in pm. You can order at: www.naturalwellnesschoices.com