Mammograms Linked To An Epidemic of Misdiagnosed Cancers

Mammograms Linked To An Epidemic of Misdiagnosed Cancers







Sayer Ji, Contributor
Activist Post

For most of the twentieth century, mastectomy was the first line treatment for Ductal Carcinoma In Situ (DCIS), and younger patients were more likely to undergo the procedure. Even after lumpectomy and radiotherapy
were shown to be at least as effective for invasive cancer as
mastectomy, still in 2002, 26% of DCIS patients were still receiving
mastectomy.1

The most common scenario today following diagnosis of DCIS is for the
oncologist to recommend lumpectomy, followed by radiation and hormone
suppressive therapies such as Arimidex and Tamoxifen.
The problem here is that women are not being educated about the nature
of DCIS or the concept of "non-progressive" breast cancers. There is
still the black and white perception out there that you either have
cancer, or do not have cancer.

In a poll on DCIS awareness published in 2000, 94% of women studied
doubted even the possibility of non-progressive breast cancers.2
In other words, these women had no understanding of the nature of
DCIS. And why would they? Major authorities frame DCIS as
"pre-cancerous," implying its inevitable transformation into cancer.
When the standard of care for DCIS is to suggest the same types of
treatment used to treat invasive cancer, very few women are provided
with the information needed to make an informed decision.

Early detection through x-ray mammography has been the clarion call of Breast Cancer Awareness campaigns
for a quarter of a century now. However, very little progress has been
made in making the public aware about the crucial differences between
non-malignant lesions/tumors and invasive or non-invasive cancers
detected through this technology. When all forms of breast pathology are
looked at in the aggregate, irrespective of their relative risk for
harm, disease of the breast takes on the appearance of a monolithic
entity that you either have, or don't have; they call it breast cancer.

The concept of a breast cancer that has no symptoms, which can not be
diagnosed through manual palpation of the breast and does not become
invasive in the vast majority of cases, might sound unbelievable to most
women. However, there does exist a rather mysterious clinical anomaly
known as Ductal Carcinoma In Situ (DCIS), which is, in fact, one of the
most commonly diagnosed and unnecessarily treated forms of "breast
cancer" today.

What women fail to understand—because their physicians do not know
better or have not taken care to explain to them—is that they have a
choice when diagnosed with DCIS. Rather than succumb to aggressive
treatment with surgery, radiation and chemo-drugs, women can choose
watchful waiting. Better yet, a radical lifestyle change can be focused
on eliminating exposure to chemicals and radiation, as well as improved
exercise and nutrition. This choice is not being made in most cases
because the medical community is not informing their patients that there
is such.

Ductal Carcinoma In Situ (DCIS): Cancer or Benign Lesion?

Between 30-50%
of new breast cancer diagnoses obtained through x-ray mammography
screenings are classified as Ductal Carcinoma In Situ (DCIS).3 DCIS
refers to the abnormal growth of cells within the milk ducts of the
breast forming a calcified lesion commonly between 1-1.5 cm in diameter,
and is considered non-invasive or "stage zero breast cancer," with some
experts arguing for its complete re-classification as a non-cancerous
condition.

Because DCIS is almost invariably asymptomatic and has no palpable
lesions, it would not be known as a clinically relevant entity were it
not for the use of x-ray diagnostic technology. Indeed, it was not until
the development and widespread application of mammography in the early
1980s as the central push behind National Breast Cancer Awareness
campaigns that rates of DCIS diagnosis began to expand to their present
day epidemic proportions.4,5
It is no wonder, therefore, that the United States, which has one of the
highest x-ray mammography rates, also has the highest level of DCIS in
the world. As of January 2005, an estimated one-half million U.S. women
were living with a diagnosis of DCIS.6

Proponents of breast screenings
claim they are saving lives through the early detection and treatment
of DCIS, regarding it as a potentially life-threatening condition,
indistinct from invasive cancers. They view DCIS a priori as
"pre-cancerous" and argue that, because it could cause harm if left
untreated it should be treated in the same aggressive manner as invasive
cancer. The problem with this approach is that while the rate at which
DCIS progresses to invasive cancer is still largely unknown, the weight
of evidence indicates that it is significantly less than 50%—perhaps as
low as 2-4%.

Indeed, the 10-year survival rates of patients with DCIS (96%-98%)
post-treatment speaks volumes to the relatively benign nature of the
condition.7,8 Another study found that at the 40-year follow-up period 40% of DCIS lesions still had no signs of invasiveness.9
Adding even more uncertainty, another study showed that coexisting
DCIS independently predicts lower tumor aggressiveness in node-positive
luminal breast cancer, indicating its possibly protective role. 10
Watchful Waiting (Around Doing Nothing of Use)

A solid argument can be made that watchful waiting is the most
appropriate response to the diagnosis of DCIS, and that in many cases
DCIS would be better left over-diagnosed and under-treated. As one paper
discusses:

"The central harm of screening is over-diagnosis—the detection of
abnormalities that meet the pathologic definition of cancer but will
never progress to cause symptoms." 11

A solid body of evidence has emerged suggesting that when DCIS is left
undiagnosed and untreated rarely will it become malignant. DCIS was in
fact poorly named from the outset, as it is does not behave like most
carcinomas (cancers). Cancer, like the constellation named after it,
derives from the Greek word for Crab, indicating the manner in which is
expands outward in uncontrolled growth. In situ means exactly the
opposite, "in place." An unmoving cancer is therefore a contradiction in
terms. These problems with classification have not gone unnoticed in
the medical journals:

"Despite the presence of the word carcinoma, ductal carcinoma in situ
(DCIS) is the poster child for this problem (a senior pathologist
involved in developing classification systems confided to one of us that
he regretted the use of the term carcinoma in DCIS). No one believes
that DCIS always progresses to invasive cancer, and no one believes it
never does. Although no one is sure what the probability of progression
is, studies of DCIS that were missed at biopsy (1,2) and the autopsy reservoir (3) suggest that the lifetime risk of progression must be considerably less than 50%." 12

The true irony here is that while participation in x-ray mammography
is considered by the public a form of breast cancer prevention and
"watchful waiting," it has become—whether by design or accident—a very
effective way of manufacturing breast cancer diagnoses and justifying
unnecessary treatment. This is not unlike what has been seen with
prostate cancer screenings that track Prostate Specific Antigen (PSA);
the aggressive treatment of lesions/tumors identified through PSA
markers may actually increase patient mortality relative to doing
nothing at all.

Women diagnosed with DCIS are simply not given the option to decline treatment. The problem is illustrated below:

"Because the 'best guess' is that most DCIS won't progress to invasive
cancer, the risk of over-diagnosis would be expected to be greater than
50%. The problem with over-diagnosis is that it leads to overtreatment.
Because it is impossible to determine which individuals are
over-diagnosed, almost everyone gets treated as if they had invasive
cancer." 13

Over-diagnosis is a huge problem, discussed in greater depth here:
<blockquote class="tr_bq">Over-diagnosis plays havoc with our
understanding of cancer statistics. Because over-diagnosis effectively
changes a healthy person into a diseased one, it causes overestimations
of the sensitivity, specificity, and positive predictive value of
screening tests and the incidence of disease (13). As the MLP and a recent analysis of Surveillance, Epidemiology, and End Results (SEER)1 data illustrate (14),
over-diagnosis also markedly increases the length of survival,
regardless of whether screening or associated treatments are actually
effective. However, over-diagnosis does not reduce disease-specific
mortality because treating subjects with pseudo-disease does not help
those who have real disease. Consequently, disease-specific mortality is
the most valid end point for the evaluation of screening effectiveness.14</blockquote>Ultimately
DCIS over-diagnoses contribute to the appearance that conventional
breast cancer screenings and treatments are more successful and less
harmful than they actually are, while at the same time making the
industry far more profitable than otherwise would be the case.

Source:-
http://www.activistpost.com/2012/10/mammograms-linked-to-epidemic-of.html