Several things are missing such as number of cancer deaths after 10 years, total deaths all causes, that chemotherapy for
breast cancer doesn’t save lives. In clinical trials of terminal patients it extends life an average of 2 months.
For a discussion of the failure of 90% of chemotherapies read on “Hope’s Hypothesis” section
23. Second the common practice of blocking estrogen with a drug such as Tamoxifen promotes conditions such as cardiovascular
disease, dementia, and osteoporosis, weight gain, all of which on an average shortens life over 4 years. That is why pharma
is against HRT--for a discussion of HRT and its benefits. The correlation in the study at bottom and breast cancer is because
of indolent benign tumors be labeled as adenocarcinoma, which explains why early detect is a sham, and why so too is chemotherapy.
If the chemotherapy worked then there would be a major reduction in deaths through early detection. However since chemotherapy
doesn’t alter the progression of breast cancer it doesn’t reduce mortality. This is another product
of pharma’s KOL promoting sales, in this case through implying that the new guidelines supporting mammograms is
The issue with screening is that over 30% of women diagnosed using mammograms followed by biopsy would if not examined
had never progressed to an invasive cancer. Thus millions of women’s tumors are call cancer when in fact they are
benign. Subjecting them to treatment with chemo and blocking estrogen shortens their lives. Shortens more lives than the
gain from the number of women who have their breast cancer diagnosed earlier because of mammograms.
http://www.aei.org/publication/mammograms-are-a-mixed-bag/ Health Care, Health Economics
1. Joel M. Zinberg, American Enterprise Institute (Conservative think tank based in Washington). Dick Cheney was its
Vice President in 2005, and more than 20 staff members served in the Bush administration.
July 23, 2015 | US News and World Report
Mammograms are a mixed bag
Too much money is wasted on unnecessary breast cancer screenings.
It is always better to find cancer early by screening, right? Well actually, it depends. For some cancers (e.g. colon
cancer) the evidence is clear: screening saves lives. For other cancers like breast cancer, the answer is a contentious, mixed
This is not a purely academic question – U.S. mammogram screening for breast cancer costs $8 billion per year.
A new study in JAMA Internal Medicine suggests this is not money well spent. Current screening programs recommending annual
mammograms starting at age 40 may harm some of the women they are meant to help and waste billions of dollars.
If screening is effective, it should pick up cancers early to reduce the number of cancers diagnosed at an advanced stage
(i.e., those most likely to kill) and decrease breast cancer mortality. The study compared different rates of screening, breast
cancer incidence and breast cancer mortality in 16 million women 40 years old and older, residing in 547 U.S. counties. The
women were screened for breast cancer in 2000 and followed for 10 years.
The study found a positive correlation between the extent of screening and breast cancer incidence, i.e., more screening
finds more cancers. But there was no correlation between the extent of screening and 10-year breast cancer mortality. The
increased numbers of cancers discovered by screening were largely small cancers (less than 2 centimeters) and early stage
cancers. There was neither a reduction in the numbers of larger cancers, nor in the incidence of more dangerous cancers whether
locally advanced or that had already spread through distant metastases.
These new findings mirror a 2012 New England Journal of Medicine review of 30 years of mammography screening that showed
a 109 percent increase in the incidence of small, early-stage breast cancer but only an 8 percent decrease in the incidence
of advanced cancers with virtually no reduction in the most advanced, metastatic cases.
Why hasn’t screening delivered? A big part of the problem is overdiagnosis: finding early forms of cancer such
as non-invasive disease or very early invasive disease that would have never become clinically apparent or affected the woman’s
life expectancy. An estimated 19-31 percent of mammographically detected cancers are over-diagnosed. Once uncovered, these
cancers are treated with surgery (with young women increasingly selecting unilateral or even bilateral mastectomies rather
than lumpectomies), radiation (which can affect the heart and lungs), and toxic chemotherapy – all of which is unnecessary.
The women are left psychologically traumatized by the inaccurate diagnosis of a life threatening disease.
Overdiagnosis is not the only problem with screening. 20 percent of patients screened with mammography are told something
is wrong when in fact nothing is wrong. These “false positives” lead to additional testing, unneeded biopsies
and anxiety until the diagnostic uncertainty is resolved. A study in the health policy journal Health Affairs finds that overdiagnosis
and false positives in women 40-59 years old costs $4 billion per year – i.e., half of the annual expenditure on
mammography screening. There is also a 20 percent rate of mammograms missing cancers that are actually there. These “false
negatives” give women a false sense of reassurance and may lead them, and sometimes their physicians, to ignore
signs and symptoms of disease like a breast mass.
None of the above is meant to suggest that screening should never be done, only that it should be directed at the people
most likely to benefit. The ability of mammography to uncover dangerous breast cancers rises as women age because the incidence
of breast cancer rises and the breasts become less dense, making mammograms easier to interpret. The number of screening harms
declines as women age for the same reasons.
The U.S. Preventive Services Task Force recently released updated recommendations for breast cancer screening and found
that for women under age 50 who have an average risk of cancer, the harms outweigh the benefits of screening. It recommends
that women between the ages of 50-74 should be screened only every other year, and suggests that women below 50 consult with
their physicians to discuss if their history and individual risk factors warrant screening before age 50. The American College
of Physicians High Value Care Task Force recently made identical recommendations. These recommendations mirror guidelines
used around the world. The U.S. has been unique in initiating annual screening at age 40 and continuing indefinitely (50 percent
of women over 80 are screened despite the Preventive Services Task Force’s recommendation to stop at 74). Other
countries start at 50 and then test every two to three years up to 70-74 years old.
Raising the starting age and decreasing the frequency of screening programs has been loudly criticized by a variety of
patient and cancer advocacy groups. Politicians have also chimed in. Rep. Debbie Wasserman Schultz, D-Fla., who was diagnosed
with breast cancer at age 41, warned in the Washington Post that, “deferring them [mammograms] until after age 50
is dangerous” and will result in “needless deaths.” But her criticism fails to take into account
the documented limitations and pitfalls of mammography. Ironically, Wasserman Schultz discovered the lump in her breast herself,
two months after a negative screening. Thankfully, she was aware of the signs of breast cancer and was not falsely reassured
by the false negative mammogram..
Screening early and often, no matter how well intentioned, is costly and counterproductive. Finding every last cancer,
no matter how small or innocuous, does not save lives and subjects many women to unnecessary treatment. If we are serious
about evidence-based medicine and greater value in healthcare, mammogram screening should be limited to those populations
most likely to benefit. The money saved would be better spent on breast cancer research and treatment and on providing women
with the information they need to make informed decisions about cancer screening.
• Breast cancer
The study calls cancer benign indolent tumors. “25% increase in the incidence of small breast cancers, and a 7%
incidence of larger breast cancer.” Yet cancer deaths are the same. This means that since early chemotherapy makes
no difference, the treatment does not save lives—the endpoint. That a chemotherapy extends life a couple of months
would not justify the horrific side effect so common with the treatment. Note they didn’t use total deaths, because
the treated group dies years earlier. The longer out the greater the difference because most of the women will have their
estrogen blocked—a bad thing for pharma since estradiol extends life at least 4 years if a women is on the natural
Original Investigation | July 06, 2015 LESS IS MORE
Breast Cancer Screening, Incidence, and Mortality Across US Counties
Main Outcomes and Measures Breast cancer incidence in 2000 and incidence-based breast cancer mortality during the 10-year
follow-up. Incidence and mortality were calculated for each county and age adjusted to the US population.
Results Across US counties, there was a positive correlation between the extent of screening and breast cancer incidence
(weighted r = 0.54; P < .001) but not with breast cancer mortality (weightedr = 0.00;
P = .98).
An absolute increase of 10 percentage points in the extent of screening was accompanied by 16% more breast cancer diagnoses
(relative rate [RR], 1.16; 95% CI, 1.13-1.19) but no significant change in breast cancer deaths (RR, 1.01;
95% CI, 0.96-1.06). In an analysis stratified by tumor size, we found that more screening was strongly associated with an
increased incidence of small breast cancers (≤2 cm) but not with a decreased incidence of larger breast cancers
(>2 cm). An increase of 10 percentage points in screening was associated with a 25% increase in the incidence of small
breast cancers (RR, 1.25; 95% CI, 1.18-1.32) and a 7% increase in the incidence of larger breast cancers (RR, 1.07;
95% CI, 1.02-1.12).
Conclusions and Relevance When analyzed at the county level, the clearest result of mammography screening is the diagnosis
of additional small cancers. Furthermore, there is no concomitant decline in the detection of larger cancers, which might
explain the absence of any significant difference in the overall rate of death from the disease. Together, these findings
suggest widespread over-diagnosis.
Enter supporting content here
Health is essential for quality of life. Given the proclivity for injurious behavior (the prime examples being obesity, tobacco,
soldiering, and recreational drugs) I can only conclude that the rational function of the brain is primarily social,
including the generation of reasons for what is inexcusable; and the rest of what we do is quite similar to
the actions of our cats and dogs. I wish that all people would develop a love of philosophy (the term in Greek
means love of wisdom). With such love there would be a commitment to hold beliefs in proportion to the evidence
in support there of, and there would be a drive for to live a truly moral life.
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