Covering the Year
CIA & DynCorp
NUGGETS FROM THE NUTHOUSE
Terrorist as Militant
Newsweek X Bomb
Seattle to Pittsburgh
SF Labor Dispute
Israeli Youth Refuse
Underserved & Unprotected
Recession in Midwest
Obama & Immigration
HK Women Workers
New Latin America
Zaps - 12-09
NOTE: Z Magazine subscribers and sustainers have access to all Z Magazine articles here and in the archive. The latest Z Magazine articles available to everyone are listed in the Free Articles box at the top of the table of contents, and are starred in the list below. Questions? e-mail Z Magazine Online.
Mammography Revisited: Research and Rationalization
I'm 63 and have never had a mammogram. When I wrote about my reasons 17 years ago in Z Magazine, I got mixed and impassioned reactions: grateful, relieved support of my position that mammographies are neither safe nor effective and frightened or enraged opposition. How dare I, some demanded, discourage women from pursuing this life-saving, preventive measure?
Closer to home, my friends heard me out, then most succumbed to their doctors' insistence. But a growing number of doctors and researchers who have promoted and profited from this questionable procedure are calling for caution. Several recent studies speak directly to my 1992 argument that mechanically compressing and irradiating our breasts does not protect them—and may well do great harm.
In a meta-analysis of eight major studies to evaluate the effectiveness of mammographic screening that appeared in the prestigious British medical journal the Lancet in 2000, the researchers concluded: "Screening for breast cancer with mammography is unjustified...there is no reliable evidence that screening decreases breast-cancer mortality." A 2009 study in the open-access journal BMC Medical Informatics and Decision Making found that, "To save one life, 2,970 women have to be tested."
Moreover, their conclusions were based on studies in Europe, where, beginning at age 50, women get only one scan of each breast every two years. This is in dramatic contrast to the American Cancer Society's (ACS) recommended two scans per breast every year from age 40.
In October 2009, a front-page New York Times article told us that the very same ACS is "quietly working on its message" about mammography to emphasize the risks of overdiagnosis and overtreatment. Dr. Otis Brawley, ACS chief medical officer, admitted that, "American medicine has overpromised when it comes to screening." And Dr. Barnette Kramer, associate director for disease prevention, National Institutes of Health, said "overdiagnosis is pure unadulterated harm."
The British beat us to it. A 2008 letter by a group of physicians and researchers printed in the Times of London stated that the mammography handouts given to women do not "come close to telling the truth," but overstate benefits and minimize risks. In response, the British National Health Service has agreed to rewrite them. In a pamphlet, "Screening for Breast Cancer with Mammography," intended as a model for new leaflets, breast cancer researcher Peter Gotzsche wrote in 2008, "If 2,000 women are screened regularly for ten years, one...will avoid dying from breast cancer. At the same time, 10 healthy women…will [have] either a part of their breast or the whole breast removed and they will often receive radiotherapy and sometimes chemotherapy...[and] about 200 healthy women will experience a false alarm. The psychological strain until one knows whether or not it was cancer, and even afterwards, can be severe."
Over time the risks of false positives become even more striking. A 1998 study of 2,400 American women published in the New England Journal of Medicine estimated that after 10 screenings 49 percent of women will have at least one false positive test, resulting in repeated mammograms and possible biopsies. And a 2009 British Medical Journal article estimates that one in three breast cancers detected by mammography are "over-diagnoses," which are defined as detections of cancers that will never cause death or even symptoms.
It's becoming increasingly clear that what women get from mammography's marketing blitz is an almost-imperceptible clinical benefit and frequent diagnostic errors. The urgent message of this new research is that mammograms are, at best, questionably effective. But a separate and more far-reaching question remains—are they safe?
A 2008 study in the American Medical Association's Archives of Internal Medicine came to some shocking conclusions: invasive breast cancer rates went up in four Norwegian counties after mammograms were performed every two years for six years. A large control group of women who received only one mammogram at the end of 6 years was found to have 22 percent fewer cases of invasive breast cancer than the screened group. That is, over the course of 6 years, 1,909 out of 100,000 screened women had developed breast cancer, but only 1,564 out of 100,000 unscreened women had done so.
These figures become even more disturbing in light of the authors' convoluted reasoning: "...the natural course of some screen-detected invasive breast cancers is to spontaneously regress." They conclude that there is a much higher rate of spontaneous remission of invasive breast cancers than was ever before suspected, that 22 percent of undetected and untreated invasive breast cancers will spontaneously disappear. The disparity between the two groups continued after the six years. The women who got fewer mammograms got fewer cancers, both during the period of screening and after. This large-scale, well-designed study means either that some combination of the radiation, compression, and stress of waiting for bad news caused these excess cancers or that many more cancers would have spontaneously healed if left to their "natural course."
The National Cancer Institute estimates there will be more than 194,000 new breast cancer cases and almost 41,000 deaths this year, but very little is known about remission or regression. In a 1999 Danish international survey, researchers Larsen and Rose concluded that spontaneous remission of breast cancer is "very rare and the natural course is very variable."
The notion that nearly a quarter of serious breast cancers might just evaporate on their own allows researchers to ignore the obvious, because it's also the unthinkable: that mammography promotes breast cancer. There's no reason to believe the unscreened group ever developed those 345 cancers that inexplicably healed. To suggest that they did without even considering the more alternative of iatrogenesis, the medical origin of these cancers, demonstrates psychological denial, not scientific method. Both interpretations of the data call into serious question our highly profitable, but apparently neither effective nor safe, mammography screening program.
Too many researchers and physicians have bet their reputations and income on mammography and have pushed, threatened, and scared patients into getting scans early and often "for their own good." So when these turn out to be neither safe nor effective, researchers engage in guilt-driven rationalizations to conceal the truth from themselves as much as from others.
Marilyn Kaggen is a writer, photographer, and teacher living in Brooklyn, New York. For a list of resources used in this article, contact M. Kaggen, c/o Z.
Z Magazine Archive
CUBAN 5 - From May 30 to June 5, supporters of the Cuban 5 will gather in Washington DC to raise awareness about the case and to demand a humanitarian solution that will allow the return of these men to their homeland.
Contact: email@example.com; firstname.lastname@example.org.
BIKES - Bikes Not Bombs is holding its 24th annual Bike- A-Thon and Green Roots Festival in Boston, MA on June 3, with several bike rides, music, exhibitors, and more.
Contact: Bikes Not Bombs, 284 Amory St., Jamaica Plain, MA 02130; 617-522-0222; mailbikesnotbombs.org; www.bikesnotbombs.org.
LEFT FORUM - The 2013 Left Forum will be held June 7-9, at Pace University in NYC.
Contact: 365 Fifth Avenue, CUNY Graduate Center, Sociology Dept., New York, NY 10016; http://www.leftforum.org/.
VEGAN FEST - Mad City Vegan Fest will be held in Madison, WI, June 8. The annual event features food, speakers, and exhibitors.
Contact: 122 State Street, Suite 405 B, Madison, WI 53701; email@example.com; http://veganfest.org/.
ADC CONFERENCE - The American-Arab Anti-Discrimination Committee (ADC) holds its annual conference June 13-16 in Washington, DC, with panel discussions and workshops.
Contact: 1990 M Street, Suite 610, Washington, DC, 20036; 202-244-2990; convention @adc. org http://convention.adc.org/.
CUBA/SOCIALISM - A Cuban-North American Dialog on Socialist Renewal and Global Capitalist Crisis will be held in Havana, Cuba, June 16-30. There will be a 5-day Seminar at the University of Havana, plus visits to a co-op and educational and medical institutions.
Contact: firstname.lastname@example.org; http://www.globaljustice center.org/.
NETROOTS - The 8th Annual Netroots Nation conference will take place June 20-23 in San Jose, CA. The event features panels, trainings, networking, screenings, and keynotes.
Contact: 164 Robles Way, #276, Vallejo, CA 94591; email@example.com; http://www.netrootsnation.org/.
MEDIA - The 15th annual Allied Media Conference will be held June 20-23, in Detroit.
Contact: 4126 Third Street, Detroit, MI 48201; http://alliedmedia.org/.
GRASSROOTS - The United We Stand Festival will be hosted by Free & Equal, June 22 in Little Rock, Arkansas. The festival aims to reform the electoral process in the U.S.
LITERACY - The National Association for Media Literacy Education (NAMLE) will hold its conference July 12-13 in Los Angeles.
Contact: 10 Laurel Hill Drive, Cherry Hill, NJ 08003; http://namle.net/conference/.
IWW - The North American Work People’s College will take place July 12-16 at Mesaba Co-op Park in northern Minnesota. The event will bring together Wobblies from across the continent to learn skills and build one big union.
PEACESTOCK - On July 13, the 11th Annual Peacestock will take place at Windbeam Farm in Hager City, WI. The event is a mixture of music, speakers, and community for peace. Sponsored by Veterans for Peace.
Contact: Bill Habedank, 1913 Grandview Ave., Red Wing, MN 55066; 651-388-7733; firstname.lastname@example.org; http://www. peacestockvfp.org.
LA RAZA - The annual National Council of La Raza (NCLR) Conference is scheduled for July 18-19 in New Orleans, with workshops, presentations, and panel discussions.
Contact: NCLR Headquarters Office, Raul Yzaguirre Building, 1126 16th Street, NW, Washington, DC 20036; 202-785-1670; www.nclr.org.
ACTIVIST CAMP - Youth Empowered Action (YEA) Camp will have sessions in July and August in Ben Lomond, CA; Portland, OR; Charlton, MA. YEA Camp is designed for activists 12-17 years old who want to make a difference.
Contact: email@example.com; http://yeacamp.org/.