Tuesday, November 17, 2009

NYT reports "U.S. Guidelines Urge Mammograms at 50. not 40"

The New York Times' article "In Reversal, U.S. Guidlines Urge Mammograms at 50, not 40" explains how the new recommendations reverse long standing recommendation for routine, yearly mammograms at 40. If you read the complex Journal article "Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms" you will get idea of the intense number crunching that went into this decision. But, in the words of two painter friends I went to graduate school with: "Theory is one thing--reality is another." The reality is, if you talk to someone who was diagnosed with early breast cancer through a routine mammogram, these early screenings are lifesaving.

Once again, the discussion of well documented environmental causes of breast cancer are not part of the story. According to a 2009 press release by 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 there is "well documented evidence on a wide range of avoidable causes of breast cancer" including

• 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
• Occupational exposures in petrochemical plants.

The 2009 press release goes on to state:

"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...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."

I haven't had to deal with cancer in my immediate family (yet--knock on wood), so I am sure there are others, who are more informed on the subject. I am grateful for the routine mammograms that have saved the lives of several people I know, but I also believe there is evidence that there is overlooked risk of undergoing routine, yearly mammograms for premenopausal women--which is just beginning to be acknowledged by the mainstream medical community.

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