Reporting the Risk of Mammography: A Bias in the Literature

For 13 years I have been providing infrared breast thermography as a screening tool used as an alternative, or in addition to mammography. Breast thermography does not rely on radiation and has been shown in many studies to identify breast cancer earlier than mammography. Since I have been providing this unique service, I have answered many questions and provided a great deal of information relating to breast health. However, I continue to be amazed at how many women do not know that mammography contributes to breast cancer. I am even more concerned at how many doctors are recommending this potentially harmful screening procedure to unsuspecting women without giving proper informed consent regarding its risk. Once again, for the record, mammography causes breast cancer. This is a fact. Any health care provider who claims otherwise is either a liar, or simply stupid.

Some of the best literature to support what may seem to be an extreme statement on my part comes in the form of "risk versus benefit" studies that have been conducted with regard to screening mammography. These studies have all been published in medical journals that can be found on the medical research database www.pubmed.gov. This database is a service provided by the National Institutes for Health and the US National Library of Medicine. All of these studies have examined the risk of causing breast cancer with mammography, versus the benefit of finding cancer early. And what these studies have proved is that screening mammography increases the likelihood that a woman will get breast cancer. The younger you are when receiving mammography the greater your risk. Older women are not at as high of a risk, because as women age, breast tissue becomes less sensitive to radiation, and the DNA damage caused by radiation has less time to ultimately result in a malignancy. Most of the studies of this nature have found that mammography will cause more cancer than it finds in women under the age of 40. From 40 to 50 a few more cancers will be found than caused; and after age 50 still fewer cancers will be caused by radiation. There are a plethora of additional types of research that have shown that radiation causes cancer, but such an excessive demonstration is beyond my intent of this discussion. If any readers are still dubious, recall the last time you had dental x-rays and the technician draped you with a heavy lead apron!

Now to the main point of this discussion. There is a reason many health care providers are insistent that their patients receive mammography and also have a strong tendency to minimize its potential hazards: There is an underreporting of the potential harm associated with screening mammograms in the medical literature. A research article published in May, 2007 of BioMed Central entitled "Are Benefits and Harms in Mammography Screening Given Equal Attention in Scientific Articles? A Cross-sectional Study". The authors concluded what most of us probably would imagine: "Scientific articles tend to emphasize the major benefits of mammographic screening over its major harms. This imbalance is related to the authors' affiliations". In other words, the authors of this study found that research related to the risk of mammography is biased. Surprised?

I am not suggesting that mammography is not useful. It is extremely useful when attempting to get more information about a suspicious breast finding--such as after an abnormal breast thermogram or upon discovering a lump. However, any rational person must question when, and how often to get a mammogram. I would have to say, based on research, screening mammograms before the age of 40 are probably not wise; from 40-50 questionable; and after 50 probably not a bad idea--on occasion. There are European studies showing that getting mammograms every 2-3 years is just as effective at detecting breast cancer as getting them every year.

My recommendation is that if you are concerned about the risk of radiation, discuss your concern with your doctor and consider getting a thermogram. If you are using thermograms instead of mammograms, make certain you are getting your screening thermogram regularly. I have had numerous instances where I haven't seen a patient in several years or more, where upon finally getting a thermogram, had an abnormal finding that resulted in a cancer diagnosis. If these patients had been getting regular screening, the cancer would likely have been identified earlier resulting in earlier treatment and a better prognosis. Additional information regarding thermography can be found on my website.

Dr. Nick LeRoy, DC