by Dr. Scott Saunders, M.D.
Cancer testing is a large part of a doctor’s business. We have been told that if we find cancer early, and cut it out, burn it with radiation, or poison it with chemotherapy, we can make a bigger difference.
While there is a lot of debate over this issue, we still continue to try to detect cancer early – or before it even starts. I’m going to focus on the most common cancer screening tools, the ones you’ve all heard about, and that you were told you should do – or else! These include:
- PSA testing
- PAP smears
I started studying cancer screening over ten years ago when I had a patient with an inexplicable case of cancer. Because there were many cases in her family, Cecilia was always afraid of getting cancer and did all she could to prevent it by eating all organic and exercising regularly. She even got all her cancer screening tests, PAP smears, annual mammograms and a colonoscopy at age 50.
One day, she came in to see me with a lump in her left breast. It was large, a couple of centimeters, and not tender. I looked at the mammogram report done only a few months before and it was negative for any signs of malignancy. I reassured her that it was probably a cyst, but we would send her for an ultrasound to be sure. A biopsy was done, it was cancer and, in spite of all the treatments, she died just over a year later.
Since I had known Cecilia for years and knew she was diligent in her health care, I was shaken by her death. I wondered how we could have missed such a large tumor. How could the mammogram have missed it only months before? I asked the radiologist to review it, and he found no evidence of any mass in that exact location at that time. So, I started doing some real research on the test itself, and was shocked by what I found! Not only were mammograms questionable, but most of the cancer screening tests did more harm than good!
A mammogram is an x-ray, and x-rays don’t distinguish the difference between normal tissue and cancer. Instead, the radiologist looks for tiny calcium deposits that indicate there is some inflammation in the tissue. The problem is that calcium deposits happen with any kind of inflammation, and are not specific to cancer. Thus, many women who don’t have cancer are told they do, and the aggressive real cancers are missed; like in Cecilia, because they don’t form calcium deposits.[i] The newer mammograms are better able to distinguish tissues with less radiation, however the problems with screening persist.
The primary problem with mammograms is that they don’t decrease mortality, at all. In the long-term studies, including the Canadian study[ii] and the Oslo study (noted above) after 25 years and 14 years, respectively, the incidence of mortality from breast cancer remained the same – in spite of finding more cancer.
The Canadian Study showed that 22% of the women who were treated for cancer didn’t even have cancer! Or, they would not have died from it if they did.
The eight major long-term studies have been reviewed extensively. The most detailed study of all of them, the 2011 Cochrane Review[iii], said:
“Screening is likely to reduce breast cancer mortality. As the effect was lowest in the adequately randomized trials, a reasonable estimate is a 15% reduction corresponding to an absolute risk reduction of 0.05%. Screening led to 30% over-diagnosis and overtreatment, or an absolute risk increase of 0.5%. It is thus not clear whether screening [mammography] does more good than harm.”
In short: The risk (0.5%) is greater than the benefit (0.05%) by TEN TIMES! In other words, you are ten times more likely to end up with treatment for a cancer you didn’t have, than to prolong your life span by finding and treating a tumor earlier.
What do I do to screen for breast cancer?
Other screening tests for breast cancer have similar problems… and that is finding something that gets treatment, but would not have become life-threatening if left alone. One of my patients wanted MRI screening tests because she was afraid of the radiation (there is about a 1/5000 risk) from a mammogram, and didn’t want her breasts pinched in the machine. A mass was found, and biopsy showed it was an Interductal Carcinoma In-Situ, and she was told she needed surgical removal, radiation, and chemotherapy. She opted-out of treatment, and she is still fine – with her mass that continues to grow – twelve years later. She would have been considered a “cure” if she had been treated.
Whether you use MRI, ultrasound, mammogram, or thermogram, you must consider what you will do once you find a bump! Do you wait? Do you treat aggressively? Unfortunately, we have more questions than answers. Judging by the numbers in the Cochrane study above, I might opt out of screening for this one. Instead, I would do my best to prevent breast cancer from forming in the first place: