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Safe Breast Self Examination by Young Women vs. Risky Mammography

Cancer Prevention Coalition CHICAGO, IL, July 22, 2009 --/WORLD-WIRE/-- Critics of EARLY, a bill promoting routine breast self examination by secondary school students to detect cancer, are ignoring the risks of premenopausal mammography, warns the Cancer Prevention Coalition.

On March 26 this year, Representatives Debbie Wasserman-Schultz (D-FL) and Amy Klobuchar (D-MN), supported by Representatives Christensen, Schakowsky, and Waxman, introduced the Breast Cancer Education and Awareness Requires Learning Young, EARLY, Act of 2009. The objective of this Act is “to increase awareness of the risks of breast cancer in young women, and also to provide support for young women diagnosed with breast cancer.” The bill has 260 co-sponsors, enough to guarantee passage by the House.

However, as reported in the April 10 issue of "The Cancer Letter," the Bill met with a storm of protests by “experts in breast cancer prevention.” These include Dr. Donald Berry, chairman of the Department of Biostatistics at the M.D. Anderson Cancer Center, who warned that the bill is misguided. “I leave politics to the politicians, why can’t they leave science to the scientists? - Except for family history, there are no important risk factors ... for women younger than 40.”

Nevertheless, as reported in the April 2002 issue of “Radiology Today,” Dr. Berry admitted that “The Board has concluded that the evidence is weak for the benefits of screening mammography.”

Dr. Leslie Bernstein, director of the City of Hope Comprehensive Cancer Center, warned that, “This proposed Bill does too much harm.” He also claimed that “We have no known environmental causes of breast cancer other than radiation ... except when you are having a mammogram,” a surprising and damaging admission.

Drs. Bernstein and Berry, besides other critics of EARLY, are strangely unaware of well documented evidence on a wide range of avoidable causes of breast cancer, warns Dr. Samuel Epstein, professor emeritus Environmental & Occupational Medicine at the University of Illinois at Chicago School of Public Health, and Chairman of the Cancer Prevention Coalition.

"These include the Pill, estrogen replacement therapy, eating meat contaminated with sex hormones following their implantation in cattle prior to entry to feedlots, drinking genetically engineered (rBGH) milk, proximity of residence to hazardous waste sites and nuclear plants, exposure to chlorinated organic pesticides, and occupational exposures in petrochemical plants."

Not surprisingly, the American Cancer Society, a strong proponent of routine premenopausal mammography, failed to comment on EARLY. In 1984, with its October 17 flagship National Mammography Day, the American Cancer Society inaugurated the National Breast Cancer Awareness Month (NBCAM). This was conceived and funded by the Imperial Chemical Industries, a leading international manufacturer of petrochemicals, and its U.S. subsidiary Zeneca Pharmaceuticals. Dr. Epstein points out that, "Zeneca is the sole manufacturer of Tamoxifen, claimed to reduce risks of breast cancer, even though it is toxic and carcinogenic."

The NBCAM assured women that annual mammography starting at the age of 40 “results in a cure nearly 100 percent of the time.” However, and still unrecognized by the American Cancer Society and the National Cancer Institute, screening mammography poses significant and cumulative dangers of radiation, particularly for premenopausal women.

The routine practice of taking two films of each breast annually results in approximately 0.5 rad (radiation absorbed dose) exposure. This is about 500 times greater than the exposure from a single chest X-ray, which is broadly focused on the entire chest rather than narrowly on the breast.

The premenopausal breast is highly sensitive to radiation, Drs. Epstein and Bertell warn. Each rad exposure increases cancer risk by about 1%, with a cumulative 5% increased risk for each breast over a decade’s screening.

A premenopausal woman having annual mammograms over a 10 year period is exposed to roughly 5 rads, the approximate level of radiation received by a Japanese woman a mile or so away from the Hiroshima or Nagasaki atomic bombs, says Dr. Epstein.

Not surprisingly, he says, premenopausal mammography screening is practiced by no nation other than the United States.

Radiation risks are further increased by fourfold for the 1% to 2% of women who may be unknowing and silent carriers of the A-T (ataxia-telangiectasia) gene, and thus highly sensitive to the carcinogenic effects of radiation. By some estimates, this accounts for up to 20% of all breast cancers diagnosed annually.

Compounding these concerns, missed cancers are common in premenopausal women due to the density of their breasts. Additionally, mammography entails tight and often painful breast compression, particularly in premenopausal women. Dr. Epstein warns that, "This may lead to the rupture of small blood vessels in or around small undetected breast cancers, and the lethal distant spread of malignant cells."

That most breast cancers are first recognized by women themselves was admitted as early as 1985 by the American Cancer Society. “We must keep in mind that at least 90 percent of women who develop breast cancer discover the tumors themselves.”

Furthermore, as reported by Drs. Epstein and Bertell, an analysis of several 1993 studies showed that women who regularly performed monthly breast self-examination detected their cancers much earlier than those who failed to do so.

In spite of such evidence, the American Cancer Society and radiologists still dismiss breast self-examination (BSE), and claim that “no studies have clearly shown the benefit of BSE.”

Apart from the importance of self-empowering women, the costs of breast self-examination and clinical breast exams are trivial compared to the inflationary impact of mammography. The estimated annual costs for screening pre- and post-menopausal women are in excess of $10 billion, or about 14 percent of Medicare spending on prescription drugs. Costs of digital mammography, enthusiastically supported by radiologists linked directly or indirectly to the radiology industry, are approximately four-fold greater, even in the absence of any evidence for any improved effectiveness.

The scientific evidence on the “Dangers and Unreliability of Mammography: Breast Examination Is A Safe, Effective, and Practical Alternative,” supported by 47 scientific references, was published in 2001 by the prestigious "International Journal of Health Services" (volume 31, p. 605-615). This article was authored by Dr. Epstein, Dr. Bertell, and the late Barbara Seaman, the founder and leader of the breast cancer activist movement, who warned of cancer risks of the birth control pill over two decades before it was admitted by the American Cancer Society.

Finally, as reported by Liz Savage, “Invitation or Summons? UK Debate Surrounds Messages About Mammography,” (Journal of the National Cancer Institute volume 101, 13:912-913, July 1, 2009), “Earlier this year, The Times of London published a letter reprimanding the UK’s National Health Service for not providing women with adequate information about the risks of screening mammography. Signed by nearly two dozen physicians, researchers, and patient advocates, the letter described ‘the harms associated with early detection of breast cancer by screening that are not widely acknowledged.’ The most important of these harms are over-diagnosis — detecting cancers that would not have been diagnosed during the patient’s lifetime without screening — and its frequent consequence, over-treatment.”

Samuel S. Epstein, MD
Professor emeritus Environmental & Occupational Medicine
University of Illinois at Chicago School of Public Health
Chairman, Cancer Prevention Coalition
Chicago, Illinois

Rosalie Bertell, PhD
Founding Member
European Committee on Radiation Risk
International Association for Humanitarian Medicine
Founder and President emeritus
International Institute of Concern for Public Health