Thursday, January 30, 2014

BOOK REVIEW: Mammography Screening: Truth, Lies and Controversy



Dr. Peter Gotzsche is an M.D., but first and foremost he is a researcher.  His method is to evaluate the scientific research that has been completed by others and subject it to tough scrutiny, analyzing the scientific approach and methods used in that research.  One often wonders why the "latest scientific studies" can both prove and disprove the same hypothesis.  If we are to believe Dr. Gotzsche, it is due to the fact that faulty scientific methods, personal bias, political interference, financial gain, and notoriety all have the potential to influence the outcomes of those studies.  Known as a statistics "Ninja", Dr. Gotzsche brings all the facts down to one criterion:  did the researchers use the proper scientific method?

Dr. Gotzsche analyzed the research that was done on the efficacy of mammography.  Does mammography indeed save lives?  If so, then to what extent?  He examined the top studies done worldwide and found that all the major studies which "prove" mammography is beneficial have failed miserably in their application of the scientific method.  Those studies which used the scientific method appropriately all showed that mammography is harmful to the majority of women.  That's an over-simplification of many chapters of explanation in his book, but unless you have a medical or scientific background (and statistics would help, too), you may struggle to keep awake for long sections of the book.

Mammography is harmful? How can that be so?  Why have we been led to believe that we women are all going to die if we don't get our annual screening?  The answer, which is complex, is also addressed in the pages of this lengthy tome.  Many doctors and practitioners truly believe they are being helpful -- after all, they are just prescribing what they have been taught.  Once the word went out that mammography would save lives, they began recommending it to their patients without question.  We, the patients, "took our medicine" and had our annual mammograms (also without question).

This brings me to my biggest concern:  informed consent.  We have, at least in the United States, gotten to the point in which patients are made to fear the dreaded consequences of refusing any treatment, but they are not also informed of the risks of the treatment and the possibility that they may not even need that treatment.  Let me use my example.  I began getting mammograms when I was about 35 years old.  Due to my lumpiness, I got a mammogram almost every year since then, and many times I had to get two complete sets.  By the time I was fifty, I had had about 20 mammograms.  NO practitioner ever suggested that mammography radiation may be harmful.  Then one year I had calcifications show up on mammography.  That led to a second set of films (again). That led to ultrasound, which led to a needle punch biopsy, which led to surgery, which led to me being told I had cancer and needed radiation and drug therapy.  Okay, let's back up a bit.  At first glance, one would think that I am a poster child for how mammography saves lives.  After all, I'm going to show up on the statistics as a patient who was saved thanks to the screening process.  This is because the studies on the efficacy of the screening process look at the ten-year survival rate.  Will I still be alive in ten years?  Yes.  That sounds wonderful, but the studies which are used to promote the efficacy of mammography are neither looking at the overall mortality rate for breast cancer patients, nor the number of women who die from the treatment of breast cancer.

What Dr. Gotzsche concludes is that I was over-diagnosed and over-treated.  My diagnosis of Ductal Carcinoma In-Situ (DCIS) is a "cancer" that rarely becomes malignant and rarely causes death.  So I would have been alive in ten years whether or not this "cancer" had been found.   Yet in this time of "crisis", I was led through one procedure after another, with the urgency of compliance drilled into me.  When I received this diagnosis, I began my research and was prepared for my appointments with the specialists.  I asked the breast cancer specialist if it was true that this "cancer" is rarely invasive.  She agreed that it was true.  So why, I wonder, did all of the "specialists" keep that bit of information quiet during my procedures?  Why hadn’t I been informed?  Then, when I saw the radiation oncologist, I dared to ask if it's possible that the twenty mammograms I had already had could have caused my cancer, and he agreed that it was highly probable.  Again, why hadn’t I been informed of that risk?  Another tightly kept secret is that there has been no overall decrease in the number of advanced breast cancers since the widespread use of mammography.  If mammography catches cancers in the early stages, then there should be a significant drop in late stage cancer diagnosis, but there isn’t. There is much that we are not being told.   I am finding that the medical profession is very tight-lipped when it comes to informed consent.  It is possible that the fear of litigation for under-treatment has caused a shift toward over-treatment.

This is a highly emotional topic for thousands.  Every one of us knows a woman who has had malignant breast cancer.  It is a tragic diagnosis.  We need to keep our wits about us, though, and look at pure, unbiased science as to whether or not mammography is as widely beneficial for all women as we have been taught.

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