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MAMMOGRAMS

MAMMOGRAMS -  AN X-RAY OF THE BREAST DESIGNED TO PICK UP EARLY MALIGNANCES - IS THE OTHER SCREENING TEST BEING STEPPED UP SHARPLY.
 
AS THE COMMONEST FEMALE CANCER AND THE MAIN CAUSE OF DEATH IN WOMEN UNDER 55, BREAST CANCER HAS BECOME A POLITICAL FOOTBALL, WITH BREAST CANCER ACTIVISTS ON BOTH SIDES OF ATLANTIC DEMANDING GOVERNMENT ACTION.
 
IN THE US, CONGRESS RESPONDED TO PRESSURE FROM BREAST CANCER ACTIVISTS BY ORDERING THAT NATIONAL INSTITUTE OF HEALTH INCREASE SPENDING ON BREAST CANCER RESEARCH AND TREATMENT BY NEARLY 50 PER CENT - TO SOME $132.7 MILLION.
 
IN THE UK, THE GOVERNMENT LAUNCHED IT'S NATIONAL BREAST SCREENING PROGRAMME IN 1990, OFFERING MAMMOGRAPHY TO WOMEN AGGED 50-64, AND IN IT'S FIRST YEAR EXCEEDED ITS TARGET OF SCREENING 70 PER CENT OF THE MILLION WOMEN INVITED TO PARTICIPATE EVERY THREE YEARS.
 
NEVERTHELESS, IN SOME QUARTERS THIS ISN'T GOOD ENOUGH. ALL THIS ACTIVITY MAY COMFORT THOSE WHO WISH TO SEE MEDICINE DOING SOMETHING ABOUT BREAST CANCER.
 
HOWEVER, NOBODY CAN AGREE ON WHOM SHOULD BE SCREENED AND HOW OFTEN. WIDE VARIATIONS EXIST BETWEEN COUNTRIES (AND EVEN BETWEEN DIFFERENT GOVERNMENTAL BODIES) AS TO WHICH GROUPS OF WOMEN WOULD BENEFIT THE MOST.
 
AND THE BOTTOM LINE IS THAT THE LEVEL OF BREAST CANCER MORTALITY REMAINS CONSTANT, DESPITE HUGE EFFORTS TO IMPROVE EARLY DETECTION AND LOCAL TREATMENT.
 
FURTHERMORE, THE FALL IN MORTALITY BEGAN IN 1985, BUT THE FIRST NHS SCREENING UNITS WERE NOT WORKING UNTIL THREE YEARS LATER, AND GREAT BRITAIN AS A WHOLE WASN'T SUFFICIENTLY COVERED UNTIL 1990.
 
AS ROYAL MARSDEN HOSPITAL BREAST CANCER SPECIALIST MICHAEL BAUM WRITES, CLAIMING THAT ANY PART OF THE DROP IN MORTALITY IS DUE TO THE SCREENING PROGRAMME IS 'INTELLECTUALLY DISHONEST.'
 
 
BAUM ESTIMATED THAT, BASED ON CURRENT STATISTICS, THE HEALTH SERVICES WOULD HAVE TO SPEND £2 MILLION ON UNIVERSAL MAMMOGRAM SCREENING TO BENEFIT ONE WOMAN OUT OF 10,000 AMOUNG THE UNDER FIFTIES.
 
 
MICHAEL BAUM AND ISMAIL JATOI, ANOTHER TOP BREAST CANCER SPECIALIST, WROTE A SPECIAL FEATURE LABELLING AMERICAN DOCTORS 'NEGLIGENT' FOR GIVING MAMMOGRAMS TO WOMEN UNDER 50, BECAUSE IT CAN OFTEN DO MORE TO THE CONTRARY, THE AMERICAN CANCER SOCIETY AND THE AMERICAN COLLEGE OF RADIOLOGY HAVE CARRIED ON URGING ALL WOMEN OVER 40 - WHICH OF COURSE INCLUDES THIS LIMBO GROUP BETWEEN THE AGES OF 40 AND 49 - TO HAVE ANNUAL MAMMOGRAMS.
 
THIS '30 PER CENT RISK REDUCTION' HAS BEEN ADOPTED AS A MANTRA BY THE MEDICAL PROFESSION. IT HAS PROVIDED A JUSTIFICATION OF SORTS TO SCREEN MANY GROUPS, SUCH AS WOMEN UNDER 50, WHERE BENEFITS OF SCREENING HAVE NEVER BEEN SHOWN.
 
DESPITE THE NEW RECOMMENDATIONS FROM US NATIONAL CANCER INSTITUTE, A RESEARCHER FROM THE UNIVERSITY OF NORTH CAROLINA DISCOVERED THAT 89 PER CENT OF DOCTORS IN HER REGION WERE STILL SCREENING EVEN MORE THOUGH THEY WERE AWARE OF THE CHANGE IN RECOMMENDED PROCEDURE.
 
AS A PEFECT EXAMPLE OF JUST HOW INGRAINED ROUTINE SCREENING IS, MINERVA, THE PEN NAME OF COLUMIST IN THE BRITISH MEDICAL JOURNAL, CHEERILY ADMITTED THAT THERE IS 'LITTLE HARD EVIDENCE' BUT 'PLENTY OF SOUND REASONS' FOR BELIEVING THAT SCREENING FOR THOSE OVER 65 IS JUST AS IMPORTANT RISK FACTOR FOR THE DISEASE, AND 65 YEAR OLDS MAY GO ON TO LIVE ANOTHER 12 YEARS, SHE ADDED, 'IT'S GOT TO BE GOOD FOR THEM.'
 
BUT EVEN AMONG THE OVER FIFTIES, THERE IS NO CONCLUSIVE EVIDENCE THAT MAMMOGRAPHIC SCREENING IS DOING ANY GOOD. IN THE MUCH QUOTED SWEDISH STUDY, THE RESEARCHERS CAME UP WITH THEIR FIGURE BY POOLING ALL RESULTS OF THREE BANDS OF AGE GROUPS - THE 40-49 YEAR OLDS, 50-69 YEAR OLDS AND 70-74 YEAR OLDS - INTO AN OVERVIEW.
 
 
THE STUDY SHOWED A POSITIVE BENEFIT (29 PER CENT REDUCTION IN MORTALITY) AMONG THE WOMEN IN THEIR FIFTIES, BUT NONE AMONG THE WOMEN IN THEIR FORTIES OR THOSE IN THEIR SEVENTIES.
 
HOWEVER, WHEN YOU ACUTALLY EXAMINE THE SCIENCE BEHIND THESE STATISTICS, THIS IS THE ONLY STUDY TO SHOW CLEAR BENEFIT, EVEN AMONG THE 50 YEAR OLDS.
 
THE 30 PER CENT IMPROVED SURVIVAL FIGURE BEING BANDIED ABOUT DERIVES FROM SEVERAL ARTICLES WHICH EXAMINED ALL OF THE STUDIES OF SCREENING AND ATTEMPTED TO POOL THE RESULTS.
 
ALTHOUGH MOST STUDIES DIDN'T SHOW A CLEAR BENEFIT, THE ARTICLE CONCLUDED THAT THOSE THAT WERE MOST SCIENTIFIC, OR 'RANDOMISED' (THAT IS, WOMEN ASSIGNED RANDOMLY TO EITHER SCREENING  GROUPS OF CONTROLS) ALL PROVED TO BE OF BENEFIT.
 
IT'S ALSO WISE TO KEEP IN MIND WHAT THIS 30 PER CENT SUPPOSED REDUCTION IN MORTALITY ACTUALLY TRANSLATES INTO. AT BEST, IT MAY PREVENT OR POSTPONE ONE CANCER DEATH FOR BETWEEN 7,000 AND 63,000 WOMEN INVITED FOR SCREENING EVERY YEAR.
 
 
THERE HAS BEEN FAR LESS PUBLICITY, THE CANADIAN RESEARCHERS POINT OUT, ABOUT ALL THE STUDIES THAT BEEN DONE SINCE THOSE EARLY DAYS, SHOWING THAT MAMMOGRAPHY DOES NO GOOD FOR ANYONE IN ANY AGE GROUP, BUT DOES GREAT HARM THOUGH FALSE-POSITIVES AND GET-IN-THERE-EARLY INTERVENTION.
 
THE STUDY ATTACKED MAMMOGRAPHY AFTER DISCOVERING THAT ONLY ONE IN 14 WOMEN WITH A POSITIVE MAMMOGRAM RESULT INDICATING BREAST CANCER WILL ACTUALLY HAVE THE CONDITION.
 
'SINCE THE BENEFIT ACHIEVED IS MARGINAL, THE HARM CAUSED IS SUBSTANTIAL, AND THE COSTS INCURRED ARE ENORMOUS, WE SUGGEST THAT PUBLIC FUNDING FOR BREAST CANCER SCREENING IN ANY AGE GROUP IS NOT JUSTIFIABLE,' THESE EPIDEMIOLOGISTS CONCLUDED.
 
BREAST CANCER ISN'T A TIDY DISEASE THAT PROGRESSES IN THE SAME WAY FOR EVERY WOMAN, SOMETIMES IT SPREADS THROUGH OUT THE BODY, OTHER TIMES IT ADVANCES IN THE BREAST ALONE. MUCH OF OUR TREATMENT DOESN'T INFLUENCE THE OUTCOME IN ANY CASE.
 
ONE REASON MAY BE THAT MAMMOGRAMS ACTUALLY INCREASE THE MORTALITY RATES. AMONG THE UNDER-FIFTIES, MORE WOMEN DIE FROM BREAST CANCER AMONG SCREENED GROUPS THAN AMONG THOSE GIVEN MAMMOGRAMS.
 
THAT MORE YOUNGER SCREENED WOMEN DIE MAY REFLECT THE FACT THAT MAMMOGRAPHY IS INDISCRIMINANT, PICKING UP MANY CANCERS WHICH WOULD DO NO HARM IF LEFT ALONE. THE SCATTERGUN NATURE OF THE TECHNOLOGY HAS SEVERAL IMPLICATIONS.
 
THIS ABILITY TO PICK UP ANY SORT OF TUMOUR FALSELY INCREASES THE INCIDENCE OF BREAST CANCER BY A QUARTER TO A HALF. ADDING ALL THESE BENIGN TUMOURS WHICH OF COURSE DON'T LEAD TO DEATH, INTO THE CANCER DATA ALSO HAS THE EFFECT OF MAKING IT LOOK LIKE MORE PEOPLE IN THE SCREENED POPULATION SURVIVE BECAUSE OF EARLY DETECTION.
 
 
THE THIRD EFFECT OF REGULAR AMMOGRAMS IS THAT THEY LEAD TO MASSIVE, UNNECESSARY TREATMENT BECAUSE BENIGN TUMOURS ARE MISTAKEN FOR MALIGNANT ONES.
 
AND OF COURSE AN INAPPROPRIATELY STRONG MAMMOGRAPHY REPORT, WHICH MIGHT INCLUDE STATEMENTS SUCH AS 'MALIGNANCY CANNOT BE EXCLUDED', RAISES THE ANXIETY LEVEL OF THE PATIENT AND REFERRING PHYSICIAN AND OFTEN ENDS UP WITH THE WOMAN ON THE OPERATING TABLE.
 
UP UNTIL NOW, ONLY RELATIVELY HIGH DOSES OF RADiATION HAVE BEEN ASSOCIATED WITH INCREASED RISK OF BREAST CANCER. HOWEVER, NEW EVIDENCE DEMONSTRATES THAT EVEN MODERATE STRENGTHS OF STRONG X-RAYS RAISE THE RISK OF BREAST CANCER FIVE OR SIX TIMES IN WOMEN WHO CARRY A CERTAIN GENE, OCCURING IN ABOUT 1 PER CENT OF THE POPULATION - OR AT LEAST ONE MILLION AMERICAN WOMEN.
 
BESIDES A GENETIC SUSCEPTIBILTY, THE PHYSICAL TRAUMA CAUSED BY THE FORCE OF MAMMOGRAMS USE 200 NEWTONS OF COMPRESSION, THE EQUIVALENT OF 20 1-KG BAGS OF SUGAR PER BREAST.
 
TO BE CONTINED...MORE EXCERPTS FROM LYNNE MCTAGGART'S GREAT BOOK ; 'WHAT DOCTORS DON'T TELL YOU.'
 
 
 
 
 

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