It is the expected norm within the medical community that women -- especially those over 40 or with a family history of breast cancer -- should get their annual mammography without fail. But how effective of a tool is it in actually saving lives?
According to a recent study by an international team of researchers at various European institutions, the answer is that it's not especially effective. Breast cancer screening was not shown to have a major impact on the reduction of breast cancer mortality in the recent past.1 While the mortality rates from breast cancer have certainly gone down in most developed countries in the last two decades, it would seem that the lower numbers might not be attributable to mammography.
The researchers examined breast cancer mortality rates by pairing up European nations. In each pair were countries with comparable healthcare systems and comparable breast cancer risk factors; but in each case, the country listed first made mammography screening a standard of care roughly 10 to 15 years earlier than the nation listed second in the pair. The countries that were analyzed for this study were Northern Ireland compared to the Republic of Ireland, the Netherlands compared to both Belgium and Flanders, and Sweden compared to Norway.
The expectation, obviously, was that the rates of death due to breast cancer would drop much more quickly in those nations that began the screening process sooner. However, the reality was that those rates fell consistently across the board between 1989 and 2006 -- in fact, sometimes even more quickly in the countries that incorporated mammography as a health care standard later. Northern Ireland experienced a 29 percent drop versus 26 percent for the Republic of Ireland, the Netherlands had a 25 percent reduction versus 20 percent for Belgium and 25 percent for Flanders, and Sweden underwent a 16 percent decrease versus 24 percent for Norway, which started regular screening much later. This was not the way it was supposed to be!
The extra decade or more of mammography screening did not make a difference in mortality rates. The largest drop in breast cancer mortality was found to be in women between the ages of 40 and 49, whether they were receiving mammograms or not. While the authors appear ready to give the medical establishment a hearty pat on the back for these better numbers, even though they did not result from more mammograms, they may very well have resulted from something other than improved health care and "superior" treatment.
Another "possibility" could just be that breast cancer mortality rates have been reduced because hormone replacement therapy (HRT) finally stopped being widely prescribed by doctors everywhere. For many years, the medical community prescribed synthetic estrogen and progestin pills for postmenopausal women as a matter of course to supposedly relieve the symptoms of menopause. Eventually, though, numerous studies found the risks wildly outweighed any benefits HRT conferred. Some of the horrifying discoveries made in the research were that HRT leads to a 62 percent increase in risk of stroke, up to a 35 percent increased risk of heart disease, and a 66 percent increased risk of getting breast cancer.
Because of the profound health risks discovered, the first Women's Health Initiative study was stopped three years before scheduled completion. Within a year of discontinuing HRT, the number of new breast cancers among the subjects declined by 28 percent. In the second (voluntary) study, 50 percent of the subjects stopped HRT, and that was reflected in a 43 percent drop in new breast cancers. Plus, when news got out to the public, women stopped taking HRT in huge numbers and again, breast cancer rates plummeted. Overall, HRT prescription rates are down about 50% from their peak. That means about 3,000,000 women in the US alone are no longer facing a 66% increased risk of breast cancer. I'm not sure that doctors can ethically give themselves a pat on the back for no longer "prescribing" breast cancer for their patients. But back to mammograms.
The current study clearly calls into question the medical establishment's pet theory that the reduction in breast cancer rates has more to do with the fact that the subjects in the study got more frequent mammograms than women in the general public, and that fewer mammograms leads to fewer detected cancers. It would appear that conclusion, to put it kindly, is subject to debate. Another consideration that Jon Barron discussed two years ago is that because of the high doses of radiation involved, each mammogram increases your risk of getting breast cancer by two percent. Two percent may not seem like a lot until you add up ten to fifteen years worth of annual two percent increases that you get with regular mammograms. It pretty much nullifies any advantage early detection gives you, which would help explain why increased mammogram screening does not improve mortality statistics. While it is wonderful that breast cancer mortality rates are down, it is unfortunate that they rose in the first place because of the very "therapies" and "diagnostic tools" the medical community created for women. Sometimes, it seems, we are our own worst enemy.
1 Autler, Phillippe; Boniol, Mathieu; Gavin, Anna; and Vatten, Lars J. "Breast Cancer Mortality in Neighbouring European Countries With Different Levles of Screening but Similar Access to Treatment: Trend Analysis of WHO Mortality Database." British Medical Journal. 28 July 2011. BMJ Publishing Group Ltd. 30 August 2011. <http://www.bmj.com/content/343/bmj.d4411.abstract>.