Sherri Tenpenny: The myth of the normal mammogram

by Dr Sherri Tenpenny

(NaturalNews) In my experience, it's not often that pro-mammogram literature or textbooks tell the truth about the limitations of mammography so imagine my surprise when I came across this section in the 1,100 page textbook I'm studying called Breast Imaging by Dr. Daniel B. Kopans.

"Because screening does not detect all cancers and does not detect all cancers sufficiently early to permit cure, screening should not be thought of as a method to reassure someone she does not have cancer. Emphasis was added by the book's author.

"Screening is purely a chance to detect some cancers early in their development, at a time when intervention may be able to alter the course of the disease. It should be understood that, given the present state of the art, screening does not detect all cancers or save all women, and there is still not a test or combination of tests that can guarantee a women does not have breast cancer. Screening is not the solution to the breast cancer problems, but until universal cure is developed or safe methods of prevention are discovered, screening with mammography can save many lives." (Kopans, pg. 146)

This is a revelation all women should understand: A normal mammogram does not mean a storm is not just over the horizon. Most women who receive a report that their mammogram is normal breathe a sigh of relief. For some, they have been lulled into a false sense of security. It can take up to nine years for the fastest growing cancers to be detected by mammography. What if your scan is normal and it's year eight?

I've heard women say, "I have to get my mammogram so I don't get cancer." They've said it with the same perky voice I've heard them announce, "I have to get my flu shot so I don't get sick!" Why is a flu shot viewed as something that provides health, like it's a shot of B12, instead of understanding a flu shot for what it is: an injection of a toxic substance? The same idea applies to a mammogram. It's not prevention. It's a dose of radiation, a toxic substance, promoted as something good for your health.

Dr. Kopans clearly states that a mammogram is "simply a measuring tool to assess if you have cancer" - yet. But women have a different perception of their annual exams. In fact, a 1999 study revealed that 44 percent of women believe screening mammography had a sensitivity of 100 percent, meaning, they believe that mammograms find every breast cancer (http://jech.bmj.com/content/53/11/7...). This is not only untrue, it is an unrealistic expectation of any medical test. In fact, the Breast Cancer Detection Demonstration Project, a large epidemiological study first done in the 1970s, found that a combination of mammography and clinical breast exam failed to detect at least 20 percent of cancers. (Kaplan, p148). This statistic has remained fairly constant to the present day.

False positive and false negative mammograms

While radiologists use a strict set of criteria for interpreting the films, the interpretation of a breast x-ray is challenging. A mammogram looks like white blobs and scratches across a black board. If you've never seen one, ask your doctor to see your films the next time you have a mammogram. It's an educational moment worth having and can explain why mammograms do not - and cannot - detect every cancer, especially at its smallest, earliest stage.

A false-positive mammogram means that something appears abnormal on the film, but then turns out to be a false alarm. Over a 10-year period, approximately 24 percent of women who have an annual mammogram will have at least one false-positive mammogram (http://qap.sdsu.edu/screening/breas...). Suspicious findings require a woman to be called back for "extra views" and more radiation exposure. An inconclusive mammogram can lead to an ultrasound, and most likely a biopsy, where eight of 10 are found to be normal.

In 2006, the Cochrane Review published a meta-analysis of mammograms performed on 500,000 women throughout the US, Canada, Scotland and Sweden. The review concluded that for every 2,000 women who received mammograms over a 10-year period, 10 women have extra, unnecessary and potentially harmful treatments and the number of mastectomies increased by 20 percent (http://www.ncbi.nlm.nih.gov/pubmed/...).

A false-negative x-ray, on the other hand, means cancer is present but not detected by the mammogram or is overlooked the radiologist who did the interpretation. In 1982, the false-negative rate for screening mammography was found to be eight to 10 percent (http://caonline.amcancersoc.org/cgi...). A decade later, some authors have suggested the false-negative rate was as high as 25 percent (http://radiology.rsna.org/content/1...). Dense breast tissue can compromise the ability of a mammogram to detect a mass, and lesions located near the sternum (breast bone) or near the chest wall can be difficult to visualize. A false-negative test can explain why one year the report is normal and the very next year, cancer is diagnosed.

A decade later, some authors have suggested the false-negative rate was as high as 25 percent (http://radiology.rsna.org/content/1...). Dense breast tissue can compromise the ability of a mammogram to detect a mass, and lesions located near the sternum (breast bone) or near the chest wall can be difficult to visualize. A false-negative test can explain why one year the report is normal and the very next year, cancer is diagnosed.

Interpretations and Interpreters

Radiologists vary in their ability to accurately interpret mammograms and the overall range of accuracy is troublesome. In 2005, a disturbing study published by U.S. Army Medical Research for its "Era of Hope Project," radiologists (on average) accurately identified only 77 percent of cancers. For individual radiologists, the detection rate ranged from 29 percent to 97 percent, meaning that some physicians only found about 30 percent of tumors on sample mammograms, an extraordinarily high false negative rate. Interestingly, this reference seems to be no longer available for review.

At the other end of the scale, a meta-analysis of 117 studies published in Annals of Internal Medicine (2007) reported that false-positive results on mammograms range from 20 percent to 56 percent in women 40 to 49 years of age (http://www.annals.org/content/146/7...). In a new study to be released in the April issue of Radiology, researchers found that radiologists who interpret fewer scans generate more false positive reports. The minimum number of mammograms required of radiologists practicing in the U.S. is currently 960 mammograms every two years - or about 10 per week. The researchers estimate that increasing the number of required scan interpretations to 1,000 per year, or about 20 per week, would result in 43,629 fewer women being recalled for extra studies, reducing the cost of false-positive tests by $21.8 million per year. On average, for every cancer detected, 22.3 women were called back for more testing (http://www.emaxhealth.com/1024/radi...).

Adding a safe test

Infrared Breast Imaging, we call IRBI for short, has been in used since the 1960s. The technology was originally designed for the U.S. military to use for night vision exercises but was found to have many medical applications. In 1982, the FDA approved infrared imaging to be used as an adjunctive tool for the diagnosis of breast cancer. The designation was granted due to the difference in biology between a cluster of inflamed cells and a cluster of normal cells without inflammation. The increased heat, indentifying a problem, could be easily and non-invasively identified with an infrared scan.

Infrared breast scans have been dismissed by conventional physicians as unreliable, claiming that the tool produces "too many false positives". But a false-positive infrared scan means the image was abnormal, but did not have a corresponding abnormality found on a mammogram. However, unlike a false-positive mammogram, a positive-infrared image is the single most important marker and risk factor for a developing cancer. It is a warning sign of an abnormality requiring action to normalize and resolve the inflammation. It is a call to action that conventional doctors have ignored because most have little understanding of how apply dietary changes, lifestyle changes and supplements to heal the breast.

Accuracy of IRBI scanning

The bulk of the research involving breast thermography was conducted in the 1980s. State-of-the-art, ultra-sensitive infrared cameras and sophisticated computer software have evolved to detect, analyze, and produce high-resolution images. The problems encountered with early generation infrared camera systems, such as improper detector sensitivity, excessive thermal drift, calibration problems, analog interface, first generation software, etc. have been solved for almost two decades.

Think about the difference between black and white televisions and new plasma screen TVs. Consider the evolution from the first computers which were housed in rooms, to the handheld gigabyte gadgets in common use today. Technology progresses in every area; tools used today for breast thermography are vastly improved over equipment used twenty years ago. The results proved its usefulness in the 1980s; the new tools make it even more valuable and effective today.

Many studies over the last 25 years have shown the value of adding infrared imaging to an abnormal mammogram. One example, done study done in 2008 and published by the American Society of Breast Surgeons, was a prospective clinical trial of 92 women who had an infrared scan added to a suspicious lesion identified by mammography. The scan correctly identified cancer with a sensitivity of up to 97 percent and a negative predictive value of 82 percent (http://www.ajsfulltextonline.com/ar...)00475-3/abstract). For infrared nay-sayers, the facts speak for themselves. Infrared Breast Imaging, an IRBI scan, can provide important information as a stand-alone test and as a value-added to a suspicious mammogram. As an additional benefit, an infrared scan is painless and uses no radiation.

Dr. Kaplan's textbook assessment is correct: Screening is not the solution to breast cancer. Redefining the meaning of "early detection" as a step to restore unhealthy breasts back to wellness and vigor. It's a step in the right direction. It's time to put this technology in its rightful place as an adjunctive screening tool for women and for breast health.