Dangers and Unreliability of Mammography: Breast Examination is a Safe, Effective, and Practical Alternative
Samuel S. Epstein, Rosalie Bertell, and Barbara Seaman
International Journal of Health Services, 31(3):605-615, 2001.
Mammography screening is a profit-driven technology posing risks compounded by unreliability. In striking contrast, annual clinical breast examination (CBE) by a trained health professional, together with monthly breast self-examination (BSE), is safe, at least as effective, and low in cost. International programs for training nurses how to perform CBE and teach BSE are critical and overdue.
Contrary to popular belief and assurances by the U. S. media and the cancer establishment- the National Cancer Institute (NCI) and American Cancer Society (ACS)- mammography is not a technique for early diagnosis. In fact, a breast cancer has usually been present for about eight years before it can finally be detected. Furthermore, screening should be recognized as damage control, rather than misleadingly as "secondary prevention."
Claims for the benefit of screening mammography in reducing breast cancer mortality are based on eight international controlled trials involving about 500,000 women (23). However, recent meta-analysis of these trials revealed that only two, based on 66,000 postmenopausal women, were adequately randomized to allow statistically valid conclusions (23). Based on these two trials, the authors concluded that "there is no reliable evidence that screening decreases breast cancer mortality- not even a tendency towards an effect." Accordingly, the authors concluded that there is no longer any justification for screening mammography; further evidence for this conclusion will be detailed at the May 6, 2001, annual meeting of the National Breast Cancer Coalition in Washington, D. C., and published in the July report of the Nordic Cochrane Centre.
Even assuming that high quality screening of a population of women between the ages of 50 and 69 would reduce breast cancer mortality by up to 25 percent, yielding a reduced relative risk of 0.75, the chances of any individual woman benefiting are remote (18). For women in this age group, about 4 percent are likely to develop breast cancer annually, about one in four of whom, or 1 percent overall, will die from this disease. Thus, the 0.75 relative risk applies to this 1 percent, so 99.75 percent of the women screened are unlikely to benefit.