Mammography is ineffective and even dangerous! Stop it immediately! is that so?

A huge study was published in the british medical journal about the value of mammography. His results are unequivocal - mammography does not improve the prognosis of breast cancer patients. From this it follows that one should not do a mammogram like this, in any case, everyone presents it, except for those who actually read the article and saw that his conclusion was completely different.

A huge study was published in the british medical journal about the value of mammography. His results are unequivocal - mammography does not improve the prognosis of breast cancer patients. From this it follows that there is no need to do a mammogram.

That's how everyone presents it anyway, except for those who actually read the article and saw that his conclusion was completely different.

What does "early detection" mean?

In one sentence - finding cancerous tumors when they are too small to be felt. This is important because the smaller the tumor when it is found - the better the chances of recovery from the disease.

A cancerous tumor starts from a few cells that divide quickly and form a lump. As soon as the lump is big enough - it penetrates the lymphatic system and sends metastases to distant places. At first to the lymph nodes, a kind of "central station" of the fluids in the body, and then on.

If the tumor is under 2 cm in size and there are no cancerous lymph nodes at all - the chances of recovery are close to 100%. If the tumor is between 2-5 cm and there are no infected nodules or there are up to 3 infected nodules - the chances are close to 93%. It's not 100% survival, but it's still cool.

If the tumor is larger, breaks through the skin, spreads to more lymph nodes or both - the chances of surviving the cancer drop to 72%. This means that out of every 100 women who get sick, 28 will die from breast cancer.

If the tumor has spread to distant organs (bone, liver, lungs, brain) - the cancer cannot be cured. With the help of the new drugs and targeted chemotherapies that exist today, a woman can live with metastatic breast cancer for even ten years, but it is usually a fatal disease and the woman will die from breast cancer.

From this it is clear why it is important to discover the tumor early, right? And preferably below the size of 2 cm, without any infected lymph nodes.

There are several ways to detect breast tumors. I have reviewed before on this very blog, but we will return briefly (for those who want to read more about the topic of early detection of breast cancer, you can enter the entry on cEarly detection of breast cancer, Or on Hereditary breast cancer):

Touch - the simplest, cheapest and most convenient way. A woman goes to the doctor, the doctor palpates the breast, discovers a lump, and refers the woman for further investigation.

The problem with this method is that the detection in this situation is of tumors of a size that can be felt, and these tumors are usually over 2 cm. why? Because that is what we are able to touch. The human hand is unable to detect breast tumors half a centimeter in size.

In addition, the breasts of women, especially young women, tend to grow many benign tumors as well. Doctors often identify these benign nodules as malignant nodules and therefore refer the woman for unnecessary investigation.

Ultrasound - a test based on sound waves. A woman goes to the technician. A technician checks the breast with an ultrasound, the technician discovers a lump, and refers the woman for clarification. This is a very, very sensitive test that is able to detect very small tumors.

The problem with this method is that it detects too many nodules, and does not differentiate between malignant and benign nodules. The result is, once again, an unnecessary inquiry that women go through.

MRI - super-expensive and super-excellent test. It detects malignant nodules, detects benign nodules, good for any type of breast, does not cause radiation. Great test in the world. But it is also very expensive, very long (each test takes close to half an hour), there are too few MRI machines in Israel, so it cannot be used as a good screening test for the general population.

Which brings us to…

Mammography - X-ray of the breast. A woman goes to a mammography clinic, a woman undergoes a mammogram, a mammography specialist deciphers the photo, if a suspicious lump is discovered - the woman is referred for investigation. If not - come home and see you at the next test. Mammography is better than ultrasound in distinguishing between a benign mass and a malignant mass.

There are some problems with mammography. It is, for example, ineffective for early detection in a compressed breast or in the breast of young women. MRI must be used in these women. It is based on X-ray radiation, and is therefore less recommended in general (although it has already been shown that it does not increase the risk of breast cancer among women who undergo mammography).

But the main problem with mammography is not with mammography at all but with the person who decodes it. Following the development of "defensive medicine" and the fear of lawsuits, mammography examinations began to be deciphered for seriousness. Even women with lumps that are maybe-but-not-certainly cancerous are already being sent for further investigation. Because mammography can detect tumors as small as half a centimeter, it also detects many benign lumps, which may never develop into cancer.

As soon as a lump in the breast is discovered, the investigation consists of a biopsy, and if it is in a pre-cancerous state - excision of the lump and sometimes the addition of radiation, chemotherapy or hormonal therapy - depends on the discretion of the attending physician. If the biopsy shows a cancerous lump, the next step is resection of the lump, of the lymph nodes, radiation to the area (if it is a partial mastectomy rather than a complete one), chemotherapy, and sometimes hormonal therapy in addition, depending on the receptors on the tumor.

A precancerous tumor will not necessarily develop into cancer in the future. Sometimes these lumps recede and absorb without causing damage. It is clear that from a moral point of view it is impossible to tell a woman "live with a lump that may or may not develop into cancer", so they prefer to take the stricter approach, if a pre-cancerous lump has been discovered.

In short - every discovery of a lump, even if it is not cancerous, puts the woman through a long and tiring round of treatments, and let's not forget the mental stress that accompanies all of this.

And is it not possible to reduce the chance of discovering benign or pre-cancerous lumps?

it is possible But it is impossible to reach zero. For starters - only women are surveyed at an age when breast cancer is very common. That is, between the ages of 50 and 75. Under the age of 50, it has already been proven that mammography causes more harm than good, because many benign tumors are discovered and not enough cancerous tumors are discovered to justify the unnecessary surgeries. In addition, the incidence of breast cancer increases with age, so the effectiveness of the detection also increases with the age of the woman.

In addition, they are surveyed only once every two years and not every year. This is to reduce the chance that we will "catch" a benign mass. After all, if it is benign, it can be reabsorbed within a year, or at least reduce in size. Sometimes pre-malignant tumors do this too.

Let's not forget, the purpose of a mammogram is to detect cancerous tumors. Not to locate a tumor that may-one-day-be cancerous.

Now that we have all that knowledge, let's take a look at the new study from the BMJ.

The study population

Women aged 40-59, who were divided into two groups - those who underwent mammography and manual examination every year and those who remained as "controls" who were asked to fill out health questionnaires every year.

Wait, didn't you say that a mammogram is done once every two years and only from the age of fifty to the age of seventy-five because then it is more effective and finds fewer pre-cancerous and benign tumors?

Yes.

The study began in 1980, mammograms were performed until 1988, and it followed the women in the program until 2005 with the aim of discovering all the women who died of breast cancer over the years, even after regular mammograms were completed.

Wait, so the results of the discovery are correct for the technology of mammography that existed almost 30 years ago?

Yes.

And the results of the survival of the patients that were discovered during the study are correct for the treatments that were almost 30 years ago?

Yes. can i continue Thanks.

Results of the study

During 25 years, 666 cancer cases were discovered among the group that underwent mammography during the review period (about 73.3% of these cases were discovered thanks to mammography). In the same group, after the review was stopped as part of the study, another 2,584 cancer cases were discovered after the end of the review period.

In the group that did not undergo a review, 524 cancer cases were discovered during the study period, and 2,609 cancer cases after the study.

The tumors detected in the mammography group were on average 0.3 cm smaller than the tumors detected in the non-mammography group. It doesn't sound like much, but the tumors in the mammogram group were detected on average at stage 1, which is the stage where there is almost 100% cure, and the tumors in the non-mammography group were detected on average at stage 2, which is the stage where there is 93% cure.

One third of the tumors in the mammography group were detected in the pre-palpable stage, without infected nodes. The meaning is - 100% healing. In this group, of detection at a pre-palpable stage, 20% of women died of breast cancer, probably due to unavailability of treatment, outdated treatments or lack of response to treatments. In the group without mammography, all the tumors were detected at a palpable stage, a third of them had infected lymph nodes (which lowers the chances of cure), and a third of the women who got breast cancer in this group died as a result of breast cancer.

Let's go back to the numbers for a moment - a third of the women in the mammography group who had cancer were found to be in the stage of complete healing. One third of the women who developed breast cancer in the group without mammography died of breast cancer.

During the period of the screening tests, between the years 1980-1988, 171 women died of breast cancer in the control group, and 180 women in the mammography group. About 30% of the women who died of breast cancer in the control group died in the first two years of the study. About 65% of the women who died of breast cancer in the mammography group died in the first two years of the study.

This is because during the first two years those who had cancer were detected more quickly in the mammography group, and her death was "attributed" to cancer. Because they discovered him.

After five years there is a fascinating finding - in the mammography group, 19 women died in the fifth year of the screening, which is 10% of the women who died of breast cancer in this group. This means that during these five years, all breast cancer cases in the mammography group were detected, so those whose cancer was advanced were operated on or died, and those whose cancer was early (ie, a small lump) had their lives saved. That is why after five years almost no women died in the mammography group.

In contrast, in the control group, who did not have a mammogram, 72 women died of breast cancer, more than 40% of the deaths from breast cancer in this group. This is because their cancer was not detected early enough. If they had discovered him - most of them would not have died.

In total, in both groups, 1005 women died of breast cancer, most of them in the years after the end of the study period and the regular mammograms. In the years after the end of the study, it is not clear how often a mammogram was performed, if a mammogram was performed at all, what the women in both groups chose to do after the end of the study, and if there was a national program for the early detection of breast cancer in their country in those years (there was not. It was closed in 1988, as written in the article ). In addition, in the group that underwent regular mammography examinations, many tumors were discovered in a pre-cancerous stage, therefore many women underwent unwarranted examinations and surgeries. As I said at the beginning of the record, this is one of the problems with mammography.

So this study proves what everyone has known for many years, that mammography is only effective over the age of 50, only if it is performed once every two years regularly, and that its main disadvantage is the detection of benign tumors that do not develop into cancer?

Yes.