Dr. Goldberg has been educating patients and students for over 35 years regarding the hazards associated with cancer screening and treatment methods. These often unnecessary, costly and sometimes harmful medical tests and treatments do not improve health outcomes as illustrated in article below. The following article is from the March 10th edition of Time Magazine. It was written by Dr. Marty Makary, a cancer surgeon at Jonh's Hopkins Hospital and an associate professor of health policy at the John's Hopkins Bloomberg School of Public Health.
Why Excessive Screening can Cause Unintended Harm, Stress and Waste
As a surgeon, I’m trained to crush cancer. For many years, every tumor I palpated and family I counseled drove me to hunt for cancer with a vengeance, using every tool modern medicine has to offer. But recently, one patient reminded me that the quest to seek and destroy cancer can produce collateral damage.
The patient’s story began with a full-body CT scan–a screening test used to detect tumors–that revealed a cyst on his pancreas. Some 3% of people have these cysts, and they are rarely problematic. Based on the cyst’s size and features, there was no clear answer as to what to do about it, but he was given options.
The patient tossed and turned at night, agonizing over stories of pancreatic cancer tragedies, consumed by the dilemma of whether to risk surgery to remove the cyst or leave it along. The conundrum strained his marriage and distracted him from his work.
Months before I met him, the patient underwent surgery, which revealed that the cyst was no threat to his health. The operation was supposed to cost $25,000 and require eight weeks off work. But the toll was much greater, including a debilitating surgical complication.
I thought, This is why he shouldn’t have had a CT scan in the first place. Screening made him sick.
New research finds that some Health-screening efforts have gone too far. A recent study found that yearly mammograms do not prolong the lives of low-risk women ages 40 to 59. Following more than 89,000 women for 25 years in a randomized controlled trial (the gold standard of science), the study is as methodologically impressive as they come. As hard as it is for our pro-screening culture to believe, the data are clear. We are taxing far too many women not only with needless and sometimes humiliating X-rays but also with unnecessary follow-up surgery.
The annual mammogram is not the only vintage medical recommendation under scrutiny. Another large study found that among low-risk adults, taking a daily aspirin–a recommendation hammered into me in medical school–can cause significant gastrointestinal or cerebral bleeding that offsets any cardiac benefits. Doctors are also re-evaluating calls for regular prostate-specific antigen tests and surgical colposcopies after “borderline” Pap smear results because of the risks of chasing false positives and indolent disease.
The problem of unintentional harm is far bigger than many suspect. The Office of the Inspector General for the Department of Health and Human Services reports that among Medicare patients alone, it contributes to 180,000 deaths annually. On a national level, if unintentionally harming patients in the process of trying to improve their health were a disease, it would rank as the No. 3 cause of death in the U.S., using Centers for Disease Control and Prevention stats.
In this era of rising medical prices, cutting waste should be the top priority, especially when that waste pulls doctors away from the important work of caring for sick patients. A 2012 Institute of Medicine report concludes that Americans spend as much as one-third of their health care dollars on tests, medicine, procedures and administrative burdens that do not improve health outcomes.
The patient I met also taught me about another negative outcome, one that does not show up in the national stats: emotional trauma from false alarms. The patient recounted feeling tormented by the idea that he might be harboring a precancerous time bomb. His distress arose not from cancer but from medicine’s limited ability to interpret a normal variation of anatomy discovered by new technology.
The good news is that a grassroots movement within medicine is identifying unnecessary tests and procedures to educate doctors and the public about them. The American Board of Internal Medicine Foundation has been asking medical-specialty associations to name the five most overdone tests and procedures within their specialty. The campaign so far includes more than 60 doctors’ societies.
Reducing overdiagnosis and overtreatment will require broadening medicine’s focus beyond hunting and killing disease to sound research and education on appropriate care. We all must come to grips with the public’s expectation for more medicine. New research is capturing what individual stories, like that of my patient, have been trying to teach us: we have a quiet epidemic of unnecessary, costly and sometimes harmful medical care.
Also see related articles by Dr. Tener:
Dr. H. Gilbert Welsch of the Dartmouth Institute for Health Policy and Clinical Practice explains why the American College of Radiology's two main arguments against the Canadian National Breast Screening Study are incorrect as he explains in the video below.
David Tener, DC
A study of mammograms spanning 25 years and thousands of patients has concluded that mammograms, largely considered the gold standard for breast cancer detection and “prevention”, appear to be useless, at best.1 The study, recently published in the British Medical Journey and widely reported by both CNN and The New York Times, has shaken the medical community because it’s one of the longest and most thorough studies to date and challenges one of the most profitable medical procedures with over 38.7 million performed each year according to the FDA.
Researchers tracked more than 89,000 women. Half were randomly assigned to mammogram screenings. The other half had no mammograms and performed breast exams on themselves. Twenty-five years later, researchers found an identical rate of breast cancer deaths in both groups. The researchers determined that overall, twenty two percent of the invasive cancers that were detected by mammograms were over diagnosed, meaning that they likely would not have presented a danger to the women over their lifetime had it been left alone. (Read the journal article in it's entirety)
CNN reports several professional associations including the The American Cancer Society, The American College of Radiology and the Society of Breast Imaging that have challenged the validity of the study and the authors’ conclusions. Interestingly, these very organizations are amongst those that stand to lose the most financially should mammography ultimately be discredited.
Most physicians recommend yearly mammograms as the go to method of breast cancer screening, yet the benefits of mammography are controversial. The health hazards of routine mammography are well established:
- The routine practice of taking 4 films of each breast annually results in approximately 1 rad (radiation absorbed dose) exposure, which is about 1,000x greater than what you’d get from a chest x ray. Radiation from routine mammography poses significant cumulative risk of initiating and promoting breast cancer.2-4
- Mammography entails tight and often painful compression of the breast, particularly in premenopausal women. This may lead to distant and lethal spread of malignant cells by rupturing small blood vessels in or around small, as yet undetected breast cancers. 5
- False positive diagnoses are very common, leading many women to be treated unnecessarily with mastectomy, chemotherapy, and yes, more radiation! For women with multiple risk factors including a strong family history, prolonged use of birth control, early menarche etc., the cumulative risk of false positives increases to as high as 100% over a decade’s worth of screening.6
- Contrary to popular belief and assurances by the National Cancer Institute and the American Cancer Society, mammography is not a reliable technique for early diagnosis. In fact, breast cancer has usually been present for 8 years before it can finally be detected.7
For women who are concerned about the hazards associated with routine mammography, safe alternatives for measuring breast cancer risk do exist and should be considered.
Self Breast Exam
Annual clinical breast exams together with at home monthly self breast exams is safe, effective and low cost. Most breast cancers are discovered by women themselves and proper training in self-breast examination has been shown to increase the frequency and number of small tumors found. 8
Thermography looks at vascular changes in the breast. Thermal imagining detects the subtle physiologic changes that accompany breast pathology, whether it is cancer, fibrocystic disease, or a vascular condition. Unlike mammography, thermal imaging is not painful and emits no radiation. Studies suggest that thermography is a safe, practical and effective means of detecting breast abnormalities. 9,10
At The Goldberg Clinic, Estronex Testing is recommended for women over 35 and for those at elevated risk of breast, ovarian and cervical cancer. The Estronex Profile measures six important estrogen metabolites and their ratios to help women (and men as well) assess whether they are at risk for the development of an estrogen sensitive cancer. Approximately 90% of breast cancer is estrogen dependent, making the Estronex Test an important screening tool to assess relative risk. Based on the data collected, patients can be guided into the right health promoting behaviors to balance their ratios and thereby reduce their risk. All that’s required is a urine sample.
Optimize Your Health
Mammography is not preventive. It is diagnostic. It does nothing to improve health and the risks/hazards associated with the procedure have been well established. When addressing chronic health issues (cancer or otherwise) a concerted effort should always be made to understand each patient’s genetic predispositions/weaknesses and determine how to best improve upon them by changing nutritional and other environmental factors on an individualized basis. Criteria reviewed and considered for all patients at The Goldberg Clinic include but are not limited to:
- Individualized Dietary Reform
- Sleep and Rest Patterns
- Sunlight Exposure/Vitamin D Production
- Pure Water Intake
- Allergens (Dietary and Environmental)
- Digestive Function and Gut Microflora Involvement
- Emotional Stress
- Earth Connections
It is by working to create the best conditions for health to occur that the function of all the body’s systems are optimized, genetic weaknesses are minimized and chronic health issues can be and addressed. This is in contrast to “preventive” procedures and imaging studies which neither addresses the cause(s) of disease nor prevents its development.
See previous articles by Dr. Tener:
1. Miller A, Wall C, Baines C. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial, BMJ 2014;348:g366
2. Bertell, R. Breast cancer and mammography. Mothering, Summer 1992, pp. 49- 52.
3. National Academy of Sciences- National Research Council, Advisory Committee. Biological Effects of Ionizing Radiation (BEIR). Washington, D. C., 1972.
4. Swift, M. Ionizing radiation, breast cancer, and ataxia-telangiectasia. J. Natl. Cancer Inst. 86( 21): 1571- 1572, 1994.
5. Watmough, D. J., and Quan, K. M. X-ray mammography and breast compression. Lancet 340: 122, 1992.
6. Christiansen, C. L., et al. Predicting the cumulative risk of false-positive mammograms. J. Natl. Cancer Inst. 92( 20): 1657- 1666, 2000.
7. Epstein S, Bertell R, Seamen B. Dangers and unreliability of mammography: Breast examination is a safe, effective, and practical alternative, International Journal of Health Services 2001; 31(3):605-615.
8. Hall, D. C., et al. Improved detection of human breast lesions following experimental training. Cancer 46( 2): 408- 414, 1980.
9. Arora N, Martins D, Ruggerio D. Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer. Am J Surg 2008; 196(4):523-6.
10. Keyserlingk JR, Ahlgren PD, Yu E. Infrared Imaging of the Breast: Initial Reappraisal Using High-Resolution Digital Technology in 100 Succesive Cases of Stage I and II Breast Cancer, The Breast Journal 1998; 4(4)