The current gold standard for breast cancer screening is mammography and clinical breast exam by a physician. The United States is the only country where mammography has been promoted to pre-menopausal women and aggressively to most women on an annual basis. In November 2009 The United Sates Preventive Taskforce, an independent panel of experts in prevention and primary care appointed by the federal Department of Health and Human Services, changed the recommendations for women receiving screening mammograms. They advised women to start at age 50 (not 40) and to undergo mammography every 2 years (not annually). Dr. Diana Petitti, vice chairwoman of the task force and professor of Biomedical Informatics at Arizona State University, said the guidelines were based on new data and analyses and were aimed at reducing the potential harm for over-screening. She was quoted in an N.Y. Times article, “While many women do not think a screening test can be harmful, medical experts say the risks are real. A test can trigger unnecessary further tests, like biopsies, that can create extreme anxiety. And mammograms can find cancers that grow so slowly that grow so slowly that they never would be noticed in a woman’s lifetime, resulting in unnecessary treatment.”

The European’s take a much more conservative approach with mammograms being performed in post menopausal women every 2-3 years instead. Agencies such as the American Cancer Society and the National Cancer Institute have assured the American population that this procedure is both safe and effective in reducing breast cancer deaths through earlier detection. Contrary to these assurances and popular belief, there is a growing body of evidence that screening for breast cancer with mammography is unjustified. This topic is controversial for a variety of reasons and the reader is reminded that the purpose of this web site is educational and to provide information. 

• A January 2000 article in Lancet, one of the most prestigious and conservative medical journals in the world, analyzed eight breast cancer mammography trials. Because there was conflicting conclusions in the earlier studies regarding the benefit of mammography, the investigators from the different studies were asked for further details. Baseline imbalances were shown for 6 of the 8 trials, and inconsistencies in the number of women randomized were found in 4. The 2 adequately randomized trials found no effect of screening on breast-cancer mortality. The Lancet study concluded, after the inconsistencies were corrected and the data reanalyzed, that “there is no reliable evidence that `{`mammography`}` screening decreases breast-cancer mortality.”

• It may come as a surprise that over 90 percent of the women who develop breast cancer discover the tumor themselves. A recent study in Canada (Canadian National Breast Cancer Screening Study) involved 40,000 women, aged 50 to 59 on entry. Half the women performed monthly BSE (breast self exam) following the instruction of trained nurses, had annual CBEs (clinical breast exams) by trained nurses, and had annual mammography. The other half practiced monthly BSE and had annual CBE but no mammograms. This study found that the addition of annual mammography screening to the physical exam had no impact on breast cancer mortality. A Japanese mass screening study further demonstrated the effectiveness of CBE. In spite of this evidence, the American Cancer Society and radiologists just dismissed the studies as not being a substitute for mammography.

• John W. Gofman, M.D., Ph.D. is a Professor Emeritus of Molecular and Cell Biology at the University of California, Berkley, and an expert on biocellular effects of radiation and chromosome damage. In his book Preventing Breast Cancer: The Story Of A Major, Proven, Preventable Cause Of This Disease, Dr. Gofman points out that if a woman, starting at age 50, accumulates 15 mammograms over her lifetime and assuming that the mean glandular dose to the breast per 2 view exam is 0.2 rads, the likelihood of a fatal mammogram-induced breast cancer is roughly 1 in 500. If a woman receives more than 15 mammograms or starts at an earlier age, the risk of developing a breast cancer from this X-ray procedure goes up. The bottom line of his book is the recent increase in breast-cancer incidence is not a mystery. He documents how 75% of the annual incidence is caused by earlier exposure to ionizing radiation from X-rays.

• G. J. Heyes and A. J. Mill of the Radiation Biophysics Group at the University of Birmingham, UK, compared mammography X-rays and atomic bomb spectrum radiation for neoplastic potential. The full study was published in Radiation Research 162, 120-127 December 2004. Mammography radiation delivers a “low-energy” 29 kVp X-ray that has a much more destructive effect on cells than higher energy types of X-ray. The researchers used a standard mammography unit identical to those used in breast cancer screening and a high energy X-ray source that matched the spectrum of radiation the Nagasaki atomic bomb survivors were exposed to. In this study, even though the per unit dose from both sources was the same, they found the risks associated with mammography screening to be up to 5 times higher than previously assumed and that the low-energy mammography X-rays were more hazardous than previously assumed. The researchers stated that the risk-benefit relationship of mammography exposure needs to be re-examined.

For more on radiation related issues you may wish to log on to