breast

by Sayer Ji
GreenMedInfo

Millions have marched for “cancer causes.” Millions more have been diagnosed “early” and now believe screening saved their lives. But a new study confirms something we have been reporting on since our inception: In most cases, screening not only has not “saved lives,” but actually increases your risk of dying.

An extremely important new study published in the British Medical Journal titled, “Why cancer screening has never been shown to “save lives”—and what we can do about it,” confirms something we have been reporting upon at GreenMedInfo.com since our inception, namely, cancer screening has not lived up to its long held promise of “saving lives” because disease-specific reductions in mortality do not equate to reductions in overall mortality. Worse, in some cases overall mortality actually increased because of screening. 

In the new study, Vinay Prasad and colleagues, argue that the real benchmark for the success of any cancer screening program is if the “early stage” cancers being diagnosed and treated actually result in a reduction in the overall mortality.

For instance, we have reported extensively on the widespread misclassification of ductal carcinoma in situ (DCIS) as a bono fidemalignant cancer, as well as its epidemic level overdiagnosis and overtreatment. Tens of fhousands of women are diagnosed each year with these so-called “early stage breast cancers,” even though the National Cancer Institute itself acknowledges it should be classified as a benign or indolent lesions of epithelial origin. The New England Journal of Medicine published a study in 2012 shows that approximately 1.3 million women were diagnosed with DCIS in the past 30 years, with most receiving either mastectomy, lumpectomy, radiation, chemotherapy, or some combination thereof. Ironically, many of these women ardently believe that their lives were “saved” by the screening and treatment, succumbing to the biomedical equivalent of Stockholm syndrome where identifying with the ‘aggressor’ becomes palliative. In reality, most suffered irreparable harm not from the “cancer,” but from both the psychological and physical effects of being wrongly diagnosed and treated. If the end point were not breast cancer specific mortality (‘invasive’ breast cancer has not declined but increased with screening, indicating overdiagnosis), but overall mortality, it is likely that these DCIS diagnosed women’s lives were significantly truncated because of screening programs; at the very least, the quality of their lives would have been significantly negatively impacted.

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Much of the damage, pain, and suffering associated with over-medicalization could have been avoided if public health advocates and private industry promoters of screening programs had realized that reducing the risk of cancer in one bodily location — the breast, the colon, the lung, the thyroid — does not necessarily translate into a reduction in mortality risk everywhere else. It is this meme-plex of medically-reinforced ignorance which drives the many disease-specific, multi-billion dollar, cause-marketing campaigns, like the heavily pinkwashed “Breast Cancer Awareness” campaign, which increasingly the public is acknowledging to be a highly unethical money-making scheme.

The article summarizes the problem associated with confusing disease specific with overall mortality reduction, succinctly:

Despite growing appreciation of the harms of cancer screening,1 2 3 advocates still claim that it “saves lives.”4 This assertion rests, however, on reductions in disease specific mortality rather than overall mortality.

Using disease specific mortality as a proxy for overall mortality deprives people of information about their chief concern: reducing their risk of dying.5 6 Although some people may have personal reasons for wanting to avoid a specific diagnosis, the burden falls on providers to provide clear information about both disease specific and overall mortality and to ensure that the overall goal of healthcare—to improve quantity and quality of life—is not undermined.7

In this article we argue that overall mortality should be the benchmark against which screening is judged and discuss how to improve the evidence upon which screening rests.”

And so, without the proper benchmark or end point, all the educational and fund-raising efforts going towards “reducing deaths” or “saving lives” from breast, prostate, lung, skin, brain, [insert body part], become misleading, if not overtly propagandist in nature.

Indeed, the extant scientific evidence itself reveals that at best the present disease specific agenda for “cancer prevention” is pseudo-scientific. In the section of the study subtitled, “Why cancer screening might not reduce overall mortality,” the authors summarize what the literature reveals on the topic:

Discrepancies between disease specific and overall mortality were found in direction or magnitude in seven of 12 randomised trials of cancer screening.8 Despite reductions in disease specific mortality in the majority of studies, overall mortality was unchanged or increased. In cases where both mortality rates were reduced the improvement was larger in overall mortality than in disease specific mortality. This suggests an imbalance in non-disease specific deaths, which warrants examination and explanation. A systematic review of meta-analyses of cancer screening trials found that three of 10 (33%) showed reductions in disease specific mortality and that none showed reductions in overall mortality.9

The implications of this are profound.

As we reported previously with Anjelina Jolie’s decision to have her breasts and ovaries prophylactically removed, ostensibly to “reduce her risk of dying,” removing healthy body parts to prevent disease-specific mortality is unlikely to reduce the overall risk of dying. And yet, the “Jolie effect” is a well established phenomena. Her decision was lauded the world over as courageous and  an “evidence-based” precautionary step, with tens of thousands of women (and some men) following suit. We hope the new BMJstudy raises a flag of true caution for those who may habitually and uncritically follow the celebrity-centric herd mentality.

The significant harms of screening overdiagnosis and overtreatment extend to men as well. For instance, aggressive prostate screening programs over the past few decades have resulted in the removal and/or irradiation of millions of men’s prostates. A 2004 study found that an astounding 200,000 men are being diagnosed annually with prostate cancer.1 Tragically, the 2013 National Cancer Institute report referenced above also found that so-called “early stage prostate cancer,” high grade intraepithelial prostatic neoplasia (HGPIN), is also essentially a benign lesion within prostatic epithelial tissue, not unlike DCIS in women’s breasts. In other words, millions of men were diagnosed with a potentially lethal “pre-cancer” or “early stage cancer” they never had.

As an aside, it should be noted that even in the case of lesions of true concern for malignancy, there is always hope. Cancer is not an inexorably lethal, genetic mutation-driven process that happens in an environmental, nutritional, and psycho-spiritual/emotional vacuum. Instead of viewing it as the biological equivalent of a terrorist, and cutting, burning, and poisoning the target tissue (and, collaterally, the entire body of the host), we need to abandon the warfare model of allopathic medicine and adopt one that focuses on targeting cancer stem cells in non-toxic ways, looking at carcinogenesis through the lens of the informational dysregulation of genetic and epigenetic pathways in the cell; informational “disease” in contradistinction to physiochemically-based disease is, of course, more prone to being reversed. Cancer, in this view, can be halted in its tracks, and even regressed, assuming that, along with informational corrections (e.g. “nanopharmacological” approaches like homeopathy, “energy healing,” high quality food (which is also information-containing)), the tumor microenvironment can be adjusted back to healthier conditions through detoxification, lifestyle modifications, mind-body interventions, and targeted, “high dose” nutritional support.

The new study explained how prostate screening programs have created “off target” deaths, primarily through the high rate of false positives, overdiagnosis of non-harmful cancers (e.g. HGPIN), and detection of incidental findings (i.e. unintentionally discovered conditions):

For example, prostate specific antigen (PSA) testing yields numerous false positive results, which contribute to over one million prostate biopsies a year.12Prostate biopsies are associated with serious harms, including admission to hospital and death.12 13 Moreover, men diagnosed with prostate cancer are more likely to have a heart attack or commit suicide in the year after diagnosis or to die of complications of treatment for cancers that may never have caused symptoms.12 13

Shockingly, PSA-based prostate screening has been found to have a false positive rate of about 75%.2 Obviously, given this finding, there is nothing specific at all about the prostate “specific” antigen test, which is why the United States Preventive Services Task Force now strongly recommends against it.

How the Public Is Misled Into Believing “Screening Saves Lives”

As we have explored in previous writings, such as “The Dark Side of Breast Cancer Awareness Month” and “A DIRE WARNING: The Cancer Industry Owns The Media And Your Mind,” the public is intentionally misled into believing a priori cancer screening saves lives even when no real, independent scientific evidence exists to support it.

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The new study reveals just how truly inflated the public’s expectations have become:

A systematic review has shown that the public has an inflated sense of the benefits and discounted sense of the harms of mammography screening, the cervical smear test, and PSA screening.  In one study 68% of women thought that mammography would lower their risk of getting breast cancer, 62% thought that screening at least halved the rate of breast cancer, and 75% thought that 10 years of screening would prevent 10 breast cancer deaths per 1000 women. Even the most optimistic estimates of screening do not approach these numbers. The most recent Cochrane review of randomised controlled trials of PSA screening failed to show a reduction in disease specific death. The Cochrane review of mammography did not show reduced breast cancer deaths when adequately randomised trials were analysed.

Advocates of screening have emphasised its benefits, sometimes verging on fear mongering.  Others, including us, think that shared decision making should be the focus. But as long as we are unsure of the mortality benefits of screening we cannot provide people with the information they need to make an informed choice. We must be honest about this uncertainty.

A summary of the Swiss medical board’s decision not to recommend mammography shows that for every 1000 women who undergo screening one breast cancer death is averted (from five to four), while non-breast cancer deaths either remain at 39 or may increase to 40.  If non-breast cancer deaths remain the same, a woman must weigh net benefit against harms. If screening increases non-breast cancer deaths to 40, women would simply be trading one type of death for another, at the cost of serious morbidity, anxiety, and expense. Women should be told that to date, with over 600 000 women studied, there is no clear evidence of a reduction in overall mortality with mammography screening.”

The public’s uncritical trust in screening programs help keep hidden the significant harm they produce; harms that are further obfuscated by industry-sponsored research. The study cites the fact that, “of 57 studies [reviewed] only 7% quantified overdiagnosis and just 4% reported the rate of false positive results.” They also found that, “When researchers do examine the harms of screening the results are typically sobering”:

False positive results on breast cancer screening have been associated with psychosocial distress as great as a breast cancer diagnosis 6 months after the event. False positive results affect over 60% of women undergoing screening mammography for a decade or more, and 12-13% of all men who have undergone three or four screening rounds with PSA. In the NLST [National Lung Screening Trial] 39.1% of people had at least one positive test result, of which 96.4% were false positives.

Overdiagnosis affected 18% of people diagnosed with lung cancer on low dose CT in the NLST, and researchers have found that as many as one in three diagnoses of invasive breast cancer (or one in two for invasive cancer and carcinoma in situ) by mammography constitute overdiagnosis. These numbers are broadly equivalent to those found with most major screening tests.”

There are also well-known, though rarely acknowledged, harms associated with the screening technologies themselves. For instance, x-ray mammography uses a particular type of gamma radiation that has been found to have as much as a six fold increased carcinogenicity. Another example is CT scans. It has been estimated that .4% of all cancers in the U.S. are caused by them. Clearly cancer screening programs that rely on intrinsically carcinogenic diagnostic technologies (as well as carcinogenic treatments like chemotherapy and radiotherapy) must be halted if they can not actually be proven to “save lives,” which, I believe, the study clearly demonstrates.

The study concludes, powerfully:

We encourage healthcare providers to be frank about the limitations of screening—the harms of screening are certain, but the benefits in overall mortality are not. Declining screening may be a reasonable and prudent choice for many people. Providers should also encourage participation in open studies.

We call for higher standards of evidence, not to satisfy an esoteric standard, but to enable rational, shared decision making between doctors and patients. As Otis Brawley, chief scientific and medical officer of the American Cancer Society, often states: “We must be honest about what we know, what we don’t know, and what we simply believe.”

For additional learning listen to the lead author Vinay Prasad’s interview from the British Medical Journal’s website below: 

Read more on this topic below:

References

1 Review Cancer statistics, 2004. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E, Feuer EJ, Thun MJ, American Cancer Society CA Cancer J Clin. 2004 Jan-Feb; 54(1):8-29.

2 http://www.thennt.com/nnt/psa-test-to-screen-for-prostate-cancer/

Read the full article on GreenMedInfo.com.

Published on January 15, 2016