|Scrutinizing the evidence for breast
cancer procedures and treatments
How should I be screened for breast cancer?
In addition to physician exams and breast self-examination, there are
primarily three breast imaging techniques: mammograms (X-rays),
ultrasounds, and MRIs (with contrast dye). A newer technique,
thermography, is still being studied.
In his chapter, "The Danger and Unreliability of Mammography: Breast
Examination is a Safe, Effective, and Practical Alternative,"
(The International Journal of Health Services,Volume 31, Number 3  ),
Dr. Epstein states, "Mammography screening is a profit-driven technology
posing risks compounded by unreliability. In striking contrast, annual
clinical breast examination (CBE) by a trained health professional, together
with monthly breast self-examination (BSE), is safe, at least as effective,
and low in cost."
He goes on to say, "Mammography is not a technique for early diagnosis.
In fact, a breast cancer has usually been present for about eight years
before it can finally be detected. Furthermore, screening should be
recognized as damage control, rather than misleadingly as secondary protection."
(See Epstein, S., International Journal of Health Services 2001, in the
MEDICAL ARTICLES' IMAGING section, or go to: Dr. Epstein on Mammography.
Please consider the data in this section of the FAQ comparing
mammograms, ultrasounds, MRIs and thermograms before rushing into
any single diagnostic procedure. PRINT OUT THE ARTICLES FOR YOUR
Is there much radiation in mammograms?
UPDATE: In a March 2006 study, low energy X-rays used in mammograms were
found to cause approximately four times, but possibly as much as six times, more
mutation damage than higher energy X-rays. Since radiation risk estimates are
based on the effects of high energy radiation, this implies that the risks of
radiation- induced breast cancers for mammograms are underestimated by the
(See Heyes GH et al., Enhanced Biological Effectiveness of Low Energy X-rays
and Implications for the UK Breast Screening Programme, Br J Radio 2006.)
Mammography Consideration: For Women Between 40 and 49
A 2006 study suggests that surgical removal of breast tumors in young
women may instigate angiogenesis (new vessel growth) by possibly
removing inhibitors of angiogenesis or promoting growth factors in response
to wounding in dormant distant disease in approximately 20% of cases of
premenopausal node-positive women who have not had chemotherapy.
Women need to be advised of the risk of accelerated tumor growth and early
relapse before giving informed consent to mammography. (See Retsky M et
al., Does Surgery Induce Angiogenesis in Breast Cancer? Indirect Evidence from
Relapse Pattern and Mammography Paradox Int J Surg 2005. Plus,
see correspondence in New England Journal of Medicine, February 16, 2006.)
How reliable are mammograms in detecting breast cancer?
Although new mammography technology has increased the accuracy of detecting
breast cancer, it still remains more of a challenge to mammographically detect
breast cancer in women with non-fatty, dense breasts (common in women under
50). Has the advent of computer-aided mammograms helped to detect breast
cancer in women with dense breasts? A June 2006 retrospective study of
malignant tumors found better detection using computer-aided mammograms
dependent upon breast density types. For example, with lesser breast density,
type 1, there was an 84.85% accuracy rate in detecting malignancy, while for
dense type 4 breast tissue, there was a 69.70% accuracy rate. (See Obenauer S et
al., Impact of Breast Density on Computer-Aided Detection in Full-Field Digital
Mammography, J Digit Imaging 2006.).
If I have a lump in my breast and it turns out to be cancer, can the mammogram
spread it by compression ?
Dr. Robert Rosser, in his article, "Point of View: Trauma is The Cause Of Occult
Micrometastatic Breast Cancer in Sentinel Axillary Lymph Nodes," published in the
medical journal, The Breast (2000), cautions against compressing, squeezing, or
otherwise disrupting tumors that may result in trauma-induced micrometastases.
He calls these dislodged cancer cells "traumets."
Especially if a lump is known to be present at the time of the mammogram,
Dr. Rosser advises that the compression of the breast should be minimal to
prevent compression-induced traumets. While the risk of traumets may be small,
if a patient hasn't yet had a diagnostic mammogram, other non-compressing
imaging procedures may be considered.
Dr. Rosser suggests that the time between the mammogram and the surgical
excision of the traumet may determine whether an insignficant traumet will divide,
grow and progress to a real metastasis that may spread from the lymph nodes and
elsewhere if not removed.
(See Rosser, RJ, The Breast, The Breast 2000, in the MEDICAL ARTICLES'
Other Imaging Procedures to investigate: Ultasound and MRI
How does an ultrasound compare to a mammogram and an MRI ?
Ultrasound (also called a sonogram), which does not use compression,
radiation, or dye, is generally useful for screening women with dense breasts. The
MRI, which uses a contrast dye, is similarly useful in women with dense breasts.
In a study assessing the accuracy of mammography, clinical examination,
ultrasonography, and magnetic resonance (MRI) imaging in the preoperative
assessment of the local extent of the breast cancer, ultrasound showed higher
sensitivity than mammograms for invasive ductal carcinoma in nonfatty breasts.
(See Berg WA et al., Diagnostic Accuracy of Mammography, Clinical Examination,
US, and MR Imaging in Preoperative Assessment of Breast Cancer, Radiology
What is a Breast MRI?
Please go to this link for a full explanation.
What is a Breast MRI?
What if I feel a lump?
Update: In a May-June 2006 study, ultrasounds were found to be more accurate in
measuring palpable tumors (tumors that can be felt) than clinical exams or
mammograms. As determined by pathological exam, the maximal tumor diameter
was within 2mm of the pathologic tumor size in 45.2% of ultrasounds, 28.2% of
mammograms, and 14.5% of clinical measurements. (See Shoma A et al.,
Ultrasounds for Accurate Measurements of Invasive Breast Cancer Tumor Size,
Breast J 2006.)
In addition, in another 2006 study, axillary ultrasonography was found to be
helpful in differentiating metastatic lymph nodes from normal lymph nodes. (See
Wang YB et al., Evaluation of the Ultrasonographic Features of Axillary Lymph
Node Metastasis in Breast Cancer, Clinical Oncology Institute, 2006.)
In the case of a palpable tumor, a mammogram is given in tandem with an
ultrasound, and many doctors and breast centers in the US resist doing an
ultrasound (no compression and no radiation) alone. Often, only persistence on
the patient's part will allow the patient to undergo an ultrasound alone.
A recent German study, cited below, suggests that ultrasound may be the
"preferred imaging procedure" for a palpable tumor ( a tumor which can be felt.)
During an ultrasound, the breast isn't compressed or exposed to radiation.
Usually, a mammogram is given in tandem with an ultrasound, and many doctors
and breast centers in the US resist doing an ultrasound alone. Often, only
persistence on the patient's part will allow the patient to undergo an ultrasound
Re-evaluating the role of breast ultrasound in current diagnostics of
malignant breast lesions
Hille H, Vetter M, Hackeloer BJ. Praxis fur Gynakologie und Geburtshilfe,
CONCLUSIONS: Breast ultrasound should be the preferred imaging
procedure in the case of a palpable lump, leading to a definitive
diagnosis itself or with an additional consecutive core needle biopsy.
For women without symptoms, breast sonography should be mandatory
and complementary to mammography in the case of breast density
grade II (BI-RADS) or more.
(See more literature on mammograms, ultrasound and MRI in the MEDICAL
ARTICLES' IMAGING section.)
Take home questions
to ask yourself:
1. If other reliable
are available, do you
risk having a
mammogram if the
compression during the
more than minimal?
2. If you've already
had a mammogram,
can you shorten the
surgery date to
minimize the chance of
traumets before they
can become real
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1. If other reliable imaging procedures are available, should do you
want to risk having a mammogram if the compression during the
mammogram is more than minimal?
2. If you've already had a mammogram, can you shorten the time
between the mammogram and surgery date to minimize the chance of
traumets before they can become real "mets" (metastases)?
When weighing the safety of all three mainstream procedures
(mammography, MRI and ultrasound), we must consider the
radiation toxicity of the mammogram and the chemical toxicity of
the contrast dye in the MRI procedure. Of the three mainstream
procedures, only ultrasound is non-toxic. Thermograms are being
used more widely but are still being evaluated for reliability. Each
patient needs to study each method before making an informed
|Read The Lancet
Oncology on screening
Do 35% of invasive
regress once they
reach 1 cm?