Over-diagnosis & Mammography

Over-diagnosis & Mammography 


Radiology Today (click for magazine cover)

June 2012

Overdiagnosis & Mammography 
By Kathy Hardy
Radiology Today
Vol. 13 No. 6 P. 24

A study finds over-diagnosis with increased screening, but there’s no way to determine which tumors do not need to be treated.

As radiologists, oncologists, patients, and advocates continue to wrestle with when mammography screening should begin, a new study suggests that with more views of breast tissue comes more potential overdiagnosis of breast cancer. The study, published in the Annals of Internal Medicine, concludes that mammography screening entails a substantial amount of overdiagnosis, which could lead women to undergo unnecessary and potentially harmful treatments.

Some believe the research casts more doubt on screening mammography, a modality still dealing with an identity crisis in the wake of the US Preventive Services Task Force’s 2009 recommendations suggesting that women at normal risk of breast cancer can reasonably delay mammography screening until they reach the age of 50. However many people in the breast imaging field still recommend mammograms for women at normal risk begin at age 40. The split creates a decision for referring physicians and patients regarding when to start breast cancer screening. Many breast radiologists contend that the idea of overdiagnosis and potentially unnecessary treatment of nonfatal cancer adds to the dilemma for doctors.

“This new epidemiological study tries to show that if we weren’t screening so much, we wouldn’t find as many unimportant tumors,” says Robin B. Shermis, MD, MPH, medical director of Ohio’s Toledo Hospital Breast Care Center. “This study deals in a theoretical world. In practicality, we can’t always tell which tumors have a potential aggressive biology when they are first detected. At initial detection, there is no way to identify whether or not a tumor is life threatening or will become life threatening.”

In blunter words, if you can’t differentiate between the tumors that will progress and kill a woman and the ones that will never harm her, how do you decide which tumors to treat? Breast radiologists assert that it’s too early to discuss what to do when mammography uncovers a tumor that fulfills the laboratory criteria of cancer but, if left alone, would never cause the patient any harm. They contend that, since science cannot accurately predict which tumors are harmless and which are more aggressive, it’s necessary to treat any tumor that's found as if it's deadly. That means surgical removal and sometimes radiation or chemotherapy.

“That’s exactly the problem,” says Rulla M. Tamimi, ScD, an associate professor of medicine at Harvard Medical School and a coauthor of the study. “Through imaging and pathology, we’re unable to determine the difference between fatal and nonfatal cancers. It’s important to have studies like this to get the debate going. Women should know about overdiagnosis.”

Finding Too Much?
The objective of the report, “Overdiagnosis of Invasive Breast Cancer Due to Mammography Screening: Results From the Norwegian Screening Program,” was to estimate the percentage of overdiagnosis of breast cancer attributable to mammography screening. This was done with a comparison of invasive breast cancer incidence with and without screening.

Tamimi says the data from Norway provided a unique opportunity to review data collected during the county-by-county introduction of a breast cancer screening program for women aged 50 to 69 that took place from 1996 to 2005. Researchers analyzed approximately 40,000 breast cancers, comparing cases found in counties where screenings were offered against counties where screenings were not yet offered. The study’s authors found that instances of invasive breast cancer increased 18% to 25% among participants who received screening mammography. They also found that between 1,169 and 1,948 of those women were overdiagnosed and received unnecessary treatments.

“In any screening program, there will be risks and benefits,” Tamimi says. “One of those risks is detecting cancers that, if left alone, will not cause mortality in the population of people screened.”

Carol H. Lee, MD, FACR, attending radiologist at Memorial Sloan-Kettering Cancer Center in New York and chair of the ACR’s Breast Imaging Commission Communications Committee, notes that the Norwegian study findings agree with those of the US Preventive Services Task Force recommendations, which suggested that there is a risk of overdiagnosis based on the number of women screened. However, she’s not suggesting that this means cancers found in breast tissue should be left alone.

“Saying [there is overdiagnosis], I know that screening with mammography saves lives,” Lee says. “The emphasis on overdiagnosis is too great.”

Lee contends that screening mammography shouldn’t decrease just because it may find cancers that are not deadly. “Does it make sense to stop finding cancers because some of them will not go on to be fatal?” she asks. Lee also challenges the use of the term “overdiagnosis,” saying instead that nonlethal breast cancer may be overtreated, not overdiagnosed.

“If a tumor meets the histologic criteria for being malignant, we treat them all as if they’re life threatening,” Lee says. “That’s the trade-off. We can’t tell whether it is life threatening.”

Treat What You Find
Looking at the study’s parameters, radiologist Stamatia Destounis, MD, managing partner of Elizabeth Wende Breast Care in Rochester, New York, questions the validity of the data, noting that “if you want to prove something invalid you can look at the data any way you want.” In particular, she points to the time span used to gather data for this study.

“With mammography, you need to study a program for more than nine years,” she says. “Imaging to detect breast cancer involves identification of subtle findings on mammography over time and long-term follow-up after breast cancer diagnosis to identify long-term benefits. We need more information on the women within the study and the control group over longer periods of time to identify a benefit.”

In her work with the ACR, Lee spends a great deal of time discussing the benefits of breast cancer screening. With the publicity that surrounds studies like this and the task force recommendations, she says referring physicians and women are unsure of what steps they should take when it comes to mammography.

“Another benefit of screening mammography relates to treatment options,” Lee says. “If you have a mammogram, there’s a chance that it will pick up a cancer that will never be life threatening, but you’ll still undergo surgery and possibly chemotherapy and/or radiation. However, there is also a chance that your life will be saved and treatment for the cancer will be less invasive because it is caught sooner. Which would you prefer? Different women will have different reactions.”

One of Lee’s arguments against studies like this and the task force recommendations is that with an epidemiological study you’re dealing with mathematical modeling rather than with actual practice. Shermis agrees that epidemiology has its place when studying breast cancer from a public health perspective. However, while the studies may provide insight to cost factors associated with unnecessary medical procedures and the stress associated with screening mammography follow-ups, they don’t address the human aspect of detecting the disease in women.

“Yes, there’s anxiety associated with any follow-up related to screening mammography findings, but that’s minimal compared to knowing you have a tumor and not treating it,” Shermis says. “An option would never be to leave a cancer alone. In addition, there’s much less stress involved and it’s much less expensive to treat a cancer when it’s small than after it has grown large.”

Confusing Referrers and Patients
Shermis and others believe these study results simply add to the already confusing amount of information disseminated in the past several years regarding screening mammography guidelines.

“This is just more misleading info,” Shermis says. “Women and referring physicians are confused enough. We were just starting to see a bounce back in screening mammography from the backlash that resulted when the task force findings were issued. Now, this study compounds the confusion.”

Identifying cancer is not a perfect science, Shermis notes. However, it is the job of breast imagers, oncologists, and surgeons to follow the proper steps required to make the best educated decision possible when it comes to breast cancer detection and ultimately a course of treatment.

“Nothing’s perfect,” he says, “but when you have the right people involved, it’s a relatively smooth process. Until we can identify cancers, we need to treat tumors that we find. Breast cancer screening has been profoundly successful in saving lives. As long as you have good standards for how to work up cancers and you follow them, you will have success.”

Radiologists, surgeons, and oncologists “all recognize that this tumor may not do anything,” Shermis adds. “None of us could look at a cancer and say we didn’t have to treat it. However, we’ve seen tiny cancers metastasize and large cancers do nothing. We’re not in a position to guess whether or not a tumor could lead to cancer.”

“The continuing dilemma for breast imagers is that we try to be as evidence-based as possible,” Lee says. “We’re not resting on our laurels. Clinical trials done with a half-million women over more than 20 years show us that mammography is still the gold standard for breast cancer screening. We need to stop picking apart the basic finding that mammography saves lives.”

Identifying Dangerous Tumors
Rather than a continued focus on the ethicality of breast cancer screening, Lee suggests that researchers look to finding a way to sort out which cancers have the potential to be lethal and which are safe to leave alone. Tamimi believes that’s where data from the Norwegian study can actually be used to help the evolution of breast screening guidelines. Pointing out instances of overdiagnosis and overtreatment of tumors found in the breast can help researchers determine where to focus next in the process of developing accurate breast cancer detection methods. Advancements in imaging technology and the use of ultrasound and MRI in scanning breast tissue continue to help locate tumors but, in many cases, also increase the incidence of false-positives. But there are other areas where further research could help identify what the technology is finding.

“They need to look at tumor characteristics and tumor markers and learn more about which traits are less aggressive,” Tamimi says.

“Many women aren’t even aware that overdiagnosis exists in breast cancer screening,” she adds. “The discussion started with prostate cancer, but more should be said regarding overdiagnosis in breast cancer. Women are being told they have a cancer, which comes with its own stress, and then they have to deal with treatment. They should really have a clear picture of whether or not what was found in their breasts is good or bad before making those decisions.”

For the immediate future, however, Tamimi understands how these findings can create confusion for women over time. “It’s disappointing to people to hear that screening mammography isn’t the tool that it’s been presented as,” Tamimi says. “Dialogue about overdiagnosis is important to get out there so that research and developments don’t stay stagnant.”

Tamimi says the Norwegian study serves as a starting point for more effective communication between physicians and patients regarding over-diagnosis, which she contends goes hand in hand with misdiagnosis.

Lee points out that while this study brings up the issue of too much screening and the potential for overdiagnosis that might come with that, at the same time state and federal governments are debating the legislation of mandatory breast density notification. Texas, Connecticut, and Virginia passed laws within the last two years that require radiologists to notify patients if they have dense breast tissue following routine screening mammography; other states, as well as the federal government, are considering similar measures this year. There is the belief that legislating dense breast notification could lead to more screening with ultrasound, MRI, and other imaging modalities, which could lead to more false-positives.

“On the one hand we’re saying there are too many false-positives and too much screening,” Lee says. “On the other hand, there is the breast density notification issue that will likely lead to more screening. As breast imagers we’re caught between two imperatives: screen less vs. screen more.”

While Lee recognizes that mammography is not perfect, it is the only screening tool that has been shown to decrease mortality from breast cancer. “The bottom line is that screening mammography saves lives,” she says.

— Kathy Hardy is a freelance writer based in Phoenixville, Pennsylvania. She is a frequent contributor to Radiology Today.

Preventing Thyroid Cancer / a useful warning

Thyroid Cancer

What's Thyroid? (Click Here)

On Wednesday, Dr Oz had a show on the fastest growing cancer in women, Thyroid Cancer.
It was a very interesting program and he mentioned that the increase could possibly be related to the use of dental X-rays and mammograms.

Dr.Oz demonstrated that on the apron which the dentist puts on you for your dental x-rays there is a little flap that can be lifted up and wrapped around your neck. Many dentists don't bother to use it. 

Also, there is something called a "thyroid shield/guard" for use during mammograms.

By coincidence, I had my yearly mammogram yesterday, I felt a little silly , but I asked about the guard for the thyroid shield/guard and sure enough, the technician had one in a drawer. I asked why it wasn't routinely used.

Answer : "I don't know. You have to ask for it."
Well, if I had not seen the Dr. Oz show, how would I have known to ask for the shield/guard.?

Dear reader, we need to pass and share this information on to our daughters, nieces, mothers and all our female friends and husbands please tell your wives.

Please remember to ask for the "Thyroid Shield/Guard" when you go for dental x-ray or mammogram.

Someone is kind and nice enough to forward this information to me. And I hope and wish you to pass it on to your friends and family members. 

June 2011

Dr. Oz, Thyroid Shields & Mammography — The Popular TV Host Sparks a Debate With Radiology
By Kathy Hardy
Radiology Today
Vol. 12 No. 6 P. 18

The latest controversy surrounding mammography comes from an unlikely source—a cardiovascular surgeon with his own syndicated television show. Mehmet Oz, MD, an Oprah Winfrey protégé and host of The Dr. Oz Show, started a debate over whether radiation exposure from mammography could be causing an increase in thyroid cancer when he recommended that women wear lead thyroid shields when getting their mammograms.

During a September 2010 segment of the popular medical advice program, Oz associated the findings from a study involving dental x-rays with the amount of potential radiation exposure stemming from screening mammograms, suggesting the two procedures may account for part of the increase in thyroid cancer among women and calling it “the fastest growing cancer in women.”

Recommendation Without Data

“There has not been any data on this, but personally, if I was getting a mammogram, I would use [a thyroid shield] too,” Oz said in the episode. “Because [of] the amount of radiation exposure, although it’s very small in mammography, it’s not that dissimilar from dental x-rays.”

The show was rebroadcast in December 2010 and apparently Oz’s recommendation went viral in the form of an e-mail with the subject line “Precautions re Mammograms and Dental XRays/A Useful Warning.” The e-mail message cites The Dr. Oz Show and retells the story of a woman who said she never would have known to ask for a thyroid shield when getting her mammogram if it hadn’t been for the show.

The topic also made its way onto blogs and social networking sites, sparking discussion about the topic. The issue of thyroid shields for mammograms even surfaced on the rumor-busting website Snopes.com, where the source of the rapidly spreading e-mail, tweet, and blog message is credited to The Dr. Oz Show. The site details statements on the topic made since the initial Dr. Oz Show, concluding that “in general, the soundest advice for those concerned about exposure during x-ray procedures is to discuss their concerns with their healthcare providers prior to such procedures and determine what level of protection the situation merits.”

The radiology community responded to the December rebroadcast with a joint statement from the ACR and the Society of Breast Imaging (SBI), referring to “an erroneous media report that the small amount of radiation a patient receives from a mammogram may significantly increase the likelihood of developing thyroid cancer. This concern simply is not supported in scientific literature.”

“Correlation is not causation,” says Constance Lehman, MD, PhD, director of imaging at the Seattle Cancer Care Alliance in Washington and a professor of radiology at the University of Washington. “Screening mammography is not an area where there should be a concern that this imaging exam causes significant harm to the patient. It’s not good science.”

For women who get mammograms every year, this debate may not sway them away from this routine. However, some in the radiology community believe the discussion surrounding the issue may keep some of the approximately 32% to 39% of women (mammography rates vary by race, according to the Centers for Disease Control and Prevention) from having a mammogram.

“This gives women another reason to question whether or not they need a mammogram,” said Phil Evans, MD, director of the University of Texas Southwestern Center for Breast Care, while a guest on a “rebuttal” episode of The Dr. Oz Show in April of this year.

“All these little controversies are dissuading women from having mammograms,” added Daniel B. Kopans, MD, a professor of radiology at Harvard Medical School and director of breast imaging at Massachusetts General Hospital, another guest on the April episode.

In both episodes, Dr. Oz made a point of saying that women should get mammograms, noting that they save lives but adding that “we have a suspect history of exposing people to radiation.”

“If you want women to get mammography, do everything you can to make it safe,” he said during the April show.

He went on to implore women to speak up for their right to ask for a thyroid shield when getting a mammogram, saying, “It’s about your right to control your care.”

Kopans says it is too early to determine the large-scale effect of Dr.Oz’s statements regarding thyroid radiation from mammography. At the breast imaging center at Massachusetts General, a few women coming in for mammograms are asking for thyroid shields each day; however, he has not seen any detectable decrease in patient volume.

“I do not have any data from any of the centers, but here and around the county, some women are asking for the shields,” Kopans says. “Here we are explaining that they are not necessary and could compromise the mammogram, but we have them if the patient insists.”

On the show, Kopans differentiated mammography from dental x-rays by explaining that x-rays are like a spotlight. In a darkened room, a spotlight would illuminate only the area at which it was directed. Similarly, x-rays are confined to a specific area.

“The thyroid may be ‘illuminated’ during dental x-rays, but there is no radiation to the thyroid during a mammogram,” he says.

Minute Risk

Kopans explains the only radiation that reaches the thyroid during a mammogram is scatter and that studies show this scatter radiation amount is equivalent to 30 minutes of background radiation that people receive every day from the environment.

“During [Oz’s] one-hour show, we were all receiving twice the dose, from background radiation, that the thyroid might receive from a mammogram,” he says. “This means that a woman could have a mammogram every year for 40 years and her thyroid would receive less total radiation than it receives from one day of background radiation.”

Statistics cited in the ACR/SBI press release show that for annual screening mammography for women aged 40 through 80, the cancer risk from the amount of radiation scattered to the thyroid during a mammogram is “incredibly small,” measured at less than one in 17.1 million women screened. They stress that this “minute” risk of thyroid cancer be balanced with the fact that using a thyroid shield could impact the quality of the mammography image, interfere with the diagnosis, and ultimately result in the need for a second mammogram.

“As we told Dr. Oz, it was not just the fact that a thyroid guard was unnecessary and could compromise the mammogram, the concern is that misinformation over inconsequential issues will discourage women from participating in screening and its potential to save lives,” Kopans says.

While on the show, Evans showed a mammogram image where the patient was wearing a thyroid shield. In the image, viewers could see where the shield slipped down into the field of view, blocking some of the breast and necessitating a repeat mammogram, exposing the patient to more radiation. Another doctor on the April show, Jocelyn Rapelyea, MD, associate director of breast imaging at the Breast Imaging and Intervention Center of George Washington University, explained that since the initial Dr. Oz Show episode, many patients visiting her practice for mammograms had asked for shields, necessitating repeat views 20% of the time.

Although Oz said thyroid cancer is the fastest-growing cancer in women, Kopans noted that cancer of the thyroid is increasing with the same rapidity among men. As the radiologist noted during the program, “Unless men are sneaking in at night to have mammograms, mammography had nothing to do with the increasing incidence of thyroid cancer.”

Imaging’s Message

“The bottom line was that there was no risk to the thyroid with mammography, so a shield was not needed and that it could compromise optimal imaging,” Kopans says. “Dr. Oz dismissed the compromised imaging, suggesting that we often didn’t understand risk until many years later and that he was going to stick with his recommendation.

“Our recommendation is that we will provide a thyroid shield if a patient asks,” he continues, “but it is totally unnecessary and could compromise optimal positioning and lead to the need for repeat exposures.”

This isn’t the first time radiologists and women’s health professionals felt the need to defend and promote the benefits of mammography as a screening tool for breast cancer. Since the 1970s, when mammography became the standard screening method for breast cancer, the practice has come under attack, says Carol H. Lee, MD, a diagnostic radiologist at Memorial Sloan-Kettering Cancer Center in New York and chair of the ACR’s Breast Imaging Commission. During the 1990s, the American Cancer Society, with support from the ACR, aggressively promoted the benefits of screening mammography, running advertisements on television and in magazines informing the public of the importance of this method of breast cancer screening. At that time, there was some feedback stating that mammography was being “oversold,” she says, “although how can you oversell something that’s proven beneficial?”

Defending Mammography

“I don’t understand what the motivation is [for arguing against mammography],” Lee adds. “We have a test that has been studied and proven to detect breast cancer and reduce mortality, yet it continues to face challenges.”

In 2009, recommendations regarding breast cancer screening from the U.S. Preventive Services Task Force (USPSTF) stirred controversy by withdrawing its recommendation for routine screening mammography for women aged 40 to 49. This recommendation reversed the task force’s 2002 recommendations for breast cancer screening beginning at age 40. The task force also concluded in the 2009 recommendations that the decision to start regular biennial screening mammography before the age of 50 should be an individual choice between a woman and her doctor, taking into consideration specific benefits and harms. The benefits of early breast cancer detection should be weighed against the potential harm of a false-positive finding or the increased exposure to radiation, according to the task force.

Within a matter of days, imaging and women’s health organizations spoke out against the 2009 USPSTF recommendations and to date, gynecologists and radiologists continue to recommend that women begin screening mammography at age 40.

“The ACR and the SBI reviewed the USPSTF analysis and found that this group of individuals lacked expertise in breast cancer care and failed to understand the fundamental scientific evidence and that these guidelines would result in numerous lives being lost that could be saved by annual mammography,” Kopans says. “A recent review concluded that, among women now in their 30s, as many as 100,000 lives would be lost unnecessarily to breast cancer by following the USPSTF guidelines.” Concerns continue regarding the impact of this latest mammography controversy and the potential setbacks in early breast cancer detection it could cause.

“My greatest concern is the large number of women who are not undergoing regular mammograms because of issues like this, leaving them at risk for a delayed diagnosis of breast cancer,” says Lehman. “We are working hard to make sure all women age 40 and older are undergoing mammography so that if they have breast cancer, we can find it early when they can still be cured.”

— Kathy Hardy is a freelance writer based in Phoenixville, Pa. She is a frequent contributor to Radiology Today.

** Dr. Oz discusses his controversial advice about requesting thyroid guards during mammograms and dental x-rays. Here, his critics weigh in. Your health is on the line. What would you do?

Click here to watch Part 1

Click here to watch Part 2

Click here to watch Part 3

United States of America Breast Cancer Foundation MIsleading in Screening Campaign

MNN.COM›Health›

Fitness & Well-Being

Komen cancer foundation 'oversells mammograms'

Experts accused the breast cancer foundation of overselling pre-emptive mammography and understating the risks.

By Agence France-PresseFri, Aug 03 2012 at 5:48 AM EST

BREAST CANCER: The Susan G. Komen for the Cure foundation uses misleading statistics in its pro-screening campaigns, two doctors from The Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire said. (Photo: Joel Saget/AFP)

Medical experts on Friday accused a major U.S. breast cancer foundation known for its high-profile "pink ribbon" campaign of overselling pre-emptive mammography and understating the risks.

The Susan G. Komen for the Cure foundation uses misleading statistics in its pro-screening campaigns, two doctors from The Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire wrote in the BMJ medical journal.

"Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen's advocacy for it," professors Steven Woloshin and Lisa Schwartz wrote.

They take issue with a Komen poster comparing the 98-percent five-year survival rate for breast cancer when caught early, with a 23-percent rate for later diagnosis.

Comparing the two figures did not say anything about the benefits of screening, they argued, and in reality a mammogram only narrowly decreases the chances that a 50-year-old woman will die from breast cancer within 10 years from 0.53 percent to 0.46 percent.

Breast cancer treatments are more effective today, and some question whether screening mammography has any benefit whatsoever, wrote the pair.

They accused Komen of overlooking the potential harms, with up to half of women screened annually over 10 years experiencing at least one false alarm that requires a biopsy.

Screening also results in overdiagnosis — detecting cancers that would never have killed or even caused symptoms in a person's lifetime, and unnecessary treatment.

"The Komen advertisement campaign failed to provide the facts," said the piece. "Worse, it undermined decision making by misusing statistics to generate false hope about the benefit of mammography screening."

In 2010, a report in the New England Journal of Medicine said mammograms have only a "modest" impact on reducing breast cancer deaths.

Komen, in a response to the BMJ comment, insisted that early detection enables early treatment, which gives the best shot at survival.

"Everyone agrees that mammography isn't perfect, but it's the best widely available detection tool that we have today," said Chandini Portteus, the foundation's vice president of research, evaluation and scientific programmes.

"We've said for years that science has to do better, which is why Komen is putting millions of dollars into research to detect breast cancer before symptoms start, through biomarkers, for example."

In February, Komen was embroiled in a controversy over its decision to stop funding for an abortion clinic group in the United States.

Mammograms Expose Women to Serious Cancer-Causing Radiation

By Dr. Mercola

Mammograms are widely promoted as a "life-saving" tool for helping women detect breast cancer in its earliest stages. 
The message has so thoroughly saturated the public mind that nearly 68 percent of women over the age of 40 have had a mammogram in the past two years -- and most of these women believe doing so will help them avoid dying from breast cancer.
Unfortunately, women have largely been sold a false bill of goods, as the science tells a very different story about the ability of mammograms to save lives.

In Most Cases, Mammograms Don't Save Lives

Considering that mammograms are regarded as the "gold standard" for breast cancer prevention in the conventional medical establishment, you may have assumed they save lives.
Well, researchers from Dartmouth College had a novel idea -- they decided to determine how often lives were actually saved by mammography screening vs. breast cancer industry generated statistics and their marketing propaganda.
And what they found should make even the staunchest mammography proponent give pause.
Using breast cancer data from The National Cancer Institute and The Centers for Disease Control and Prevention, researchers calculated a 50-year-old woman's likelihood of developing breast cancer in the next 10 years, the odds the cancer would be detected by mammography, and her risk of dying from the cancer over 20 years.
They found that a mammogram has, at best, only a 13 percent probability of saving her life, and that the probability may actually be as low as 3 percent. No matter what analyses they used, including considering women of different ages, the probability of a mammogram saving a life remained below 25 percent.
Researchers concluded:

"Most women with screen-detected breast cancer have not had their life saved by screening. They are instead either diagnosed early (with no effect on their mortality) or overdiagnosed."

This bears repeating:
Mammograms often diagnose tumors that may never threaten a woman's life. They also often result in false positives that lead to over-treatment, i.e. misdiagnosed women often undergo unnecessary mastectomies, lumpectomies, radiation treatments and chemotherapy, which can have a devastating effect on both the quality and length of their lives.

Up to 50 Percent of Breast Cancer "Diagnoses" are Not Actually Cancer

As Sayer Ji, founder of GreenMedInfo.com, explained in a recent article, between 30-50% of new breast cancer diagnoses obtained through mammography screenings are classified as Ductal Carcinoma In Situ (DCIS), which may not be cancer at all.
DCIS refers to the abnormal growth of cells within the milk ducts of the breast forming a calcified lesion commonly between 1-1.5 cm in diameter, and is considered non-invasive or "stage zero breast cancer" -- with some experts arguing for its complete re-classification as a non-cancerous condition.
Many conventional physicians view DCIS as "pre-cancerous" and argue that, because it could cause harm if left untreated it should be treated in the same aggressive manner as invasive cancer; however the rate at which DCIS progresses to invasive cancer is still largely unknown, with the weight of evidence suggesting it is significantly less than 50% -- perhaps as low as 2-4%. 
Amazingly, there are no diagnostic standards for DCIS, and there are no requirements that the pathologists doing the readings have specialized expertise.
Dr. Shahla Masood, the head of pathology at The University of Florida College of Medicine in Jacksonville, told the New York Times:

"There are studies that show that diagnosing these borderline breast lesions occasionally comes down to the flip of a coin."

The New York Times also reported on several other concerning findings about the frequency of misdiagnosis of DCIS:

• A 2006 study funded by Susan G. Komen for the Cure estimated that in 90,000 cases where women were diagnosed with DCIS or invasive breast cancer, they either did not have the disease or they received an unnecessary treatment due to a pathologist's error.
• A 2002 study at Northwestern University Medical Center found that nearly 8 percent of 340 breast cancer cases "had errors serious enough to change plans for surgery."
• Dr. Lagios, a pathologist at St. Mary's Medical Center in San Francisco, reviewed nearly 600 breast cases in 2007 and 2008 and found discrepancies in 141 of them.

The Times stated, "Dr. Lagios says that based on his experience, microscopic core needle biopsies of low-grade D.C.I.S. and benign lesions, called atypical ductal hyperplasia, or A.D.H., may be misread 20 percent of the time."
So, if you are a woman considering going in for a mammogram, you need to be aware of the fact that mammograms often detect breast abnormalities (lesions) that -- while being diagnosed as "early cancer" and treated as if aggressive, invasive cancers -- will often never progress to actual cancer if left to run their natural course.
In fact, groundbreaking new research published in The Lancet Oncology shows that many actually invasive breast cancers spontaneously regress when left underdiagnosed and untreated. The authors of the study concluded:

We believe that many invasive breast cancers detected by repeated mammography screening do not persist to be detected by screening at the end of 6 years, suggesting that the natural course of many of the screen-detected invasive breast cancers is to spontaneously regress.

When you consider that mammography screenings often result in the diagnosis of what may be an inherently benign breast lesion, DCIS, and that the diagnosis itself may come down to a "coin's flip" worth of certainty – and then, you add in the fact that even so-called 'invasive breast cancer' may "spontaneously regress," the entire justification for mammography screening seems to fall apart. 
After all, is exposing the breast to carcinogenic radiation once a year really a wise decision, given that the screening process itself is so obviously inaccurate and misleading? Also, considering that self-examination, examination by a trained professional and screening with radiation-free thermography provide sound alternatives, it is important that women at least be provided with an informed choice.

Annual Mammograms Increase Your Risk of False Positives, Unnecessary Biopsies

Research funded by the National Cancer Institute and published in the Annals of Internal Medicine revealed that getting an annual mammogram leads to an increased risk of false-positive results and unnecessary biopsies compared to getting a mammogram every other year.
After analyzing more than 386,000 mammograms from close to 170,000 women over a 10-year period, the study found 61 percent of those who received annual mammograms would be called back in for a follow-up, at least once, when in fact they did not have cancer. An additional 7-9 percent would receive an unnecessary biopsy. This is compared to 42 percent and 5-6 percent of the women, respectively, who had a mammogram every other year.
Furthermore, the research showed that annual mammograms were not more effective at identifying late-stage cancers compared to the every-other-year group. The overall results led lead researcher Rebecca Hubbard to say that false positives are simply "part of the process of screening mammography."
Unfortunately, this also means many women are exposed to increased stress as well as potentially invasive and potentially harmful treatments for absolutely no reason.
Even still, The American Cancer Society (ACS) advises women age 40 and older to undergo a mammogram screening every year, and continue to do so for as long as they are in good health, despite updated guidelines set forth by The U.S. Preventive Services Task Force, which state that women in their 40s should NOT get routine mammograms for early detection of breast cancer.
ACS' role in the promotion of mammography is far from altruistic, of course, as they have numerous ties to the mammography industry itself.

Mammograms Expose You to Serious Cancer-Causing Radiation

False positives, lack of life-saving results and overdiagnosis aside, there's yet another reason why you may want to carefully analyze your decision to receive a mammogram, and that is the serious health risks associated with diagnostic radiation exposure.
A mammogram uses ionizing radiation which, in and of itself, can contribute to the development of breast cancer. In fact, mammograms expose your body to doses of radiation that can be 1,000 times greater than that from a chest x-ray, which we know poses a cancer risk.
What is so confusing is that the type of X-rays used in mammography are called "low-energy," radiating at around 30 Peak kilovoltage (kVp) vs. 200 kVp and above for "high-energy" radiation. 
Commonsense would seem to dictate that "low-energy" means lower harm. Indeed, It has become conventional wisdom within radiobiology and radiology that the "lower energy" rays used in x-ray mammography are far less dangerous to DNA than those associated with the spectrum of radiation released by atomic bombs at Hiroshima and Nagasaki – so-called "high energy" X-rays.  Unfortunately, nothing could be further from the truth.
An accumulating body of clinical evidence indicates that the 30 kVp range of "low-energy" radiation used in breast screenings is up to 400% more damaging to the DNA – and therefore 400% more carcinogenic – than the "high energy" radiation it is often compared to.

Making Sense of All the Radiation Numbers

What this means is a potential sea change for the breast screening industry, which will no longer be able to justify its already horrible track record of "early detection" and "saving lives," nor its industry-friendly and highly skewed risk-benefit analyses -- based as they are on a completely inaccurate radiation risk model which minimizes the risk at the expense of women's health.
Keep in mind that The Cochrane Database Review determined in 2009 that for every woman whose life is prolonged through mammography screening diagnosis 10 women are "unnecessarily treated," i.e. their life is shortened.
What is so tragic is that this does not take into account the fact that the "low-energy" radiation being used in x-ray mammography, is planting the genetic seed for invasive breast cancer in countless women who would not have otherwise developed cancer, had they not been exposed to the radiation through screening in the first place. 
It is already commonly accepted by the medical establishment that x-ray mammography screenings do cause breast cancer – they just do not realize, or are not willing to admit, how severe the problem is.
For example, research published in The Journal Radiology showed that annual mammography screening of 100,000 women from age 40-55, and biennial screening after that to age 74, would cause 86 radiation-induced cancers, including 11 fatalities and 136 life years lost.  If we adjust for the new radiation risk model, required by acknowledging the difference between "low" and "high" energy radiation, we must multiply the harms caused by a factor of four to get a more realistic estimate of the iatrogenic damage: namely, 344 radiation-induced cancers, including 44 fatalities and 544 life years lost.
And remember, research has already been performed clearly showing that adding an annual mammogram to a careful physical examination of the breasts does not improve breast cancer survival rates over getting the examination alone.
So it comes down to an assessment of risk versus benefit, and even the mainstream press is beginning to report researchers' sentiments that:

"It's generally a really close call."

As Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, told TIME:

"Women need to understand their trade-offs here. The reason to be screened isn't because you've heard a lot of survivor stories. Some of those women have not benefited [from screening]."

And, as was revealed by a study in the Cochrane Database of Systemic Reviews, breast cancer screening using x-ray mammography led to 30 percent overdiagnosis and overtreatment, or an absolute risk increase of 0.5 percent!

What Really Will Reduce Your Risk of Dying from Breast Cancer?

Breast cancer is the most common cancer among U.S. women, and one in eight will be diagnosed with it during their lifetime. Unfortunately, the aggressive push for mammography has many women equating actual preventive measures (e.g.  lifestyle, diet and nutrition changes, as well as avoiding chemical exposures) with annual breast screenings, which do nothing to prevent cancer, and may actually contribute to it.
Unfortunately, medical organizations like The American Cancer Society do very little to spread the word about the many ways women can help prevent breast cancer in the first place.
A healthy diet, regular physical exercise, and an effective way to manage your emotional health are the cornerstones of just about any cancer prevention program, including breast cancer.
The following lifestyle strategies will also help to further lower your risk:

• Radically reduce your sugar/fructose intake. Normalizing your insulin levels by avoiding sugar and fructose is one of the most powerful physical actions you can take to lower your risk of cancer. Unfortunately, very few oncologists appreciate or apply this knowledge today. The Cancer Centers of America is one of the few exceptions, where strict dietary measures are included in their cancer treatment program. Fructose is especially dangerous, as research shows it actually speeds up cancer growth.
• Optimize your vitamin D level. Ideally it should be over 50 ng/ml, but levels from 60-80 ng/ml will radically reduce your cancer risk. Safe sun exposure is the most effective way to increase your levels, followed by safe tanning beds and then oral vitamin D3 supplementation as a last resort if no other option is available.
• Maintain a healthy body weight. This will come naturally when you begin eating right for your nutritional type and exercising using high-intensity burst-type activities like Peak Fitness. It’s important to lose excess weight because estrogen, a hormone produced excessively in fat tissue, may trigger and/or feed breast cancer.
• Get plenty of high quality animal-based omega-3 fats, such as those from krill oil. Omega-3 deficiency is a common underlying factor for cancer.
• Avoid drinking alcohol, or limit your drinks to one a day for women.
• Breastfeed exclusively for at least six months. Research shows this will reduce your breast cancer risk.
• Watch out for excessive iron levels. This is actually very common once women stop menstruating. The extra iron actually works as a powerful oxidant, increasing free radicals and raising your risk of cancer. So if you are a post-menopausal woman or have breast cancer you will certainly want to have your Ferritin levels drawn. Ferritin is the iron transport protein and should not be above 80. If it is elevated you can simply donate your blood to reduce it.
• Avoid charring your meats. Charcoal or flame broiled meat is linked with increased breast cancer risk. Acrylamide—a carcinogen created when starchy foods are baked, roasted or fried—has been found to increase breast cancer risk as well.
• Avoid unfermented soy products. Unfermented soy is high in plant estrogens, or phytoestrogens, also known as isoflavones. In some studies, soy appears to work in concert with human estrogen to increase breast cell proliferation.

Dogma vs. Fact . . . . .

There is no credible scientific data to demonstrate that the injection of multiple antigens into a baby, particular a baby under the age of one year, is safe and effective. There is no credible scientific evidence to negate the hypothesis that vaccines cause immediate or delayed damage to the immune system a well as neurological disorders ... - Stephen Marini, PhD

Doctors' dogma vs. Fact ...

Mainstream doctors regard vaccinations as dogma, never to be questioned or refused for any reason. This traditional dogma is enforced by various government agencies that blindly follow the dictates of the medical and pharmaceutical lobbies. Many are awaking to the fact the our medical communities have be hijacked by the pharmaceutical industries for more than decade already. Like antibiotics, cancer chemotherapy, the annual physical, mammograms and Pap smear tests, the validity of vaccinations is on the same emotional footing as motherhood and apple pie.

Vaccines are the only product sold for profit in North America that carry the risk of injury or death and yet are practically forced upon every healthy citizen. Until the late 1980s, few questioned the wisdom of this lucrative pharmaceutical enterprise. Regardless of the scare tactics and rhetoric, the fact is that parents in both Canada and the United States have the legal right to refuse vaccinations for themselves and their children.

To my Canadians and Americans friends in every province in Canada and every state in the US , you are allowed exemptions to compulsory vaccinations for religious, personal or philosophical beliefs. Anyone , including any health-care professionals, telling you otherwise is misinformed or, whether they mean to or not, are promoting a particular belief system.

Note: It is your constitutional right to educate yourself in health and medical knowledge, to seek helpful information and make use of it for your own benefit, and for that of your family. You are the one responsible for your health. In order to make decisions in all health matters, you must educate yourself. With this blog http://theinnozablog.blogspot.com and the guidance of a sincere and honest doctor, you will learn what is needed to achieve optimal health.

Those individuals currently taking pharmaceutical prescription drugs will want to talk to their respective health care professional about the negative effects that the drugs can have on herbal remedies and nutritional supplements, before combining them.

Today, there are many natural alternatives to vaccination. be informed about the side effects and danger of vaccinations, immune-boosting strategies and your right to decide wisely with latest updates.

The US and Canadian and many nations governments, supported by questionable studies and with the financial assistance of vaccine manufacturers, promote compulsory vaccination of healthy children. According to those who have analyzed the studies, pro-vaccination papers are statistically flawed and illogical. Moreover, studies designed to look at the long-term safety of vaccines are virtually non-existent.

The fact is that vaccines can be dangerous. Informations regarding the safety and efficacy of immunization is not readily available to the general public. The powers that be are not likely to freely admit to the negative aspects of vaccines for the simple reason that there are millions of dollars and great political power tied up in the promotion of immunizations. So, it is up to the individual to question the dogma and probe for the truth.