Mammogram Recommendations: Why the Conflicting Guidelines?

Mammogram Recommendations: Why the Conflicting Guidelines?
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When women are fully informed about the risks and benefits of mammograms, 70% may choose not to get screened, but you may be in that 30%, and have a right to decide for yourself.

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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“For nearly a century, public health organizations, professional associations, patient advocacy groups, academics, and clinicians largely viewed cancer screening as a simple, safe way to save lives.” But these days, even though we’re all looking at the same body of evidence, “[d]iffering interpretations about [the] benefits and harms of [mammograms] has led to conflicting recommendations…that range from intensive [annual] screening starting at age 40 to no [routine] screening at all [ever].” Currently, the four main groups in the U.S. “charged with making [mammogram] recommendations” each set contradictory guidelines. So, what’s a woman to do?

Well, the guidelines are based on “systematic reviews” of the evidence. “In the last 15 years, 50 [such] reviews…have been published,” but they don’t all reach the same conclusions. The question is why? It turns out that the conclusions of systematic reviews may have been influenced by competing conflicts of “interests of the authors.”

“[O]nly in health care [does] the same group that provides a service also [tell] us how valuable that service is and how much of it we need… We must [sadly] acknowledge that just as in any other profession or industry, self-interest is unavoidably at work…” In an analysis of more than a hundred papers, the “imbalance” in those that tended “to emphasize the major benefits of mammography…over its major harms [was] related to the authors’ affiliation.”

It may be no coincidence that all the expert panels that have come out against routine mammograms excluded radiologists, figuring those who depend on mammograms for their paycheck might be more likely to recommend them—to which mammogram proponents respond: “if you don’t have a conflict of interest, you[’re] probably [not doing it right],” accusing the breast cancer-screening panels of “inject[ing] their own biases.” “In this debate, there are armies of the faithful, and only a disappointing scattering of moderators and peacemakers.”

Some have even suggested that we shouldn’t even be talking about this in public, but “[s]uch paternalism assumes that women cannot decide for themselves whether the available evidence supports or refutes the case for mammography. Discouraging a discussion with women about the evidence for and against…[could be considered] more harmful for women’s health, not less, if doctors truly believe that patients should be active partners in making decisions about their [own body].”

Yeah, if you read the actual studies, you can see if the investigators declare any conflicts of interest. But, if you just hear about the studies second-hand, you may have no idea. Until the developers of screening guidelines emphasize “evidence over commercial or financial interests,” we all have to take personal responsibility to become “informed consumers.”

It would be nice to be able to just trust like cancer charities, but “[i]t is virtually impossible” for such organizations to remain strictly “evidence-based” when they must rely on keeping donors happy “for their very existence.”

To his credit, the Chief Medical Officer of the American Cancer Society said that “we need to be true to the science.” But, note this was him talking about prostate cancer screening. See, the American Cancer Society just straight up tells women to get mammograms, but for men, it leaves them to decide for themselves. They’re open about the prostate cancer-screening harms, but “[v]ery little transparent information about the harms of [mammograms] is provided…”

So, there’s this “double standard”; “women are encouraged” to just do it, “while men are advised to” weigh the pros and cons, “although the fundamental issues to consider are [actually] very similar” between the two tests. “The dissimilarity in how [organizations like the American Cancer Society] view” the patients’ role in decision making “couldn’t be clearer. Do [they] believe that men can handle uncertainties regarding screening tests…,” but that women might just get all “confused”? Men get to “make informed decisions” about their bodies, but women are merely “summoned.”

The bottom line is that there is “more than one right answer” to the question: “Should I be screened for breast cancer?” My goal I have for this video series is to enable you to make the decision that is right for you or your loved ones. One survey suggested that if women were fully informed at how small the benefit actually was, 70% wouldn’t do it. But, you may be in that 30%, and have a right to decide for yourself.

Please consider volunteering to help out on the site.

Image credit: Rhoda Baer via Wikimedia. Image has been modified.

Motion graphics by Avocado Video

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

“For nearly a century, public health organizations, professional associations, patient advocacy groups, academics, and clinicians largely viewed cancer screening as a simple, safe way to save lives.” But these days, even though we’re all looking at the same body of evidence, “[d]iffering interpretations about [the] benefits and harms of [mammograms] has led to conflicting recommendations…that range from intensive [annual] screening starting at age 40 to no [routine] screening at all [ever].” Currently, the four main groups in the U.S. “charged with making [mammogram] recommendations” each set contradictory guidelines. So, what’s a woman to do?

Well, the guidelines are based on “systematic reviews” of the evidence. “In the last 15 years, 50 [such] reviews…have been published,” but they don’t all reach the same conclusions. The question is why? It turns out that the conclusions of systematic reviews may have been influenced by competing conflicts of “interests of the authors.”

“[O]nly in health care [does] the same group that provides a service also [tell] us how valuable that service is and how much of it we need… We must [sadly] acknowledge that just as in any other profession or industry, self-interest is unavoidably at work…” In an analysis of more than a hundred papers, the “imbalance” in those that tended “to emphasize the major benefits of mammography…over its major harms [was] related to the authors’ affiliation.”

It may be no coincidence that all the expert panels that have come out against routine mammograms excluded radiologists, figuring those who depend on mammograms for their paycheck might be more likely to recommend them—to which mammogram proponents respond: “if you don’t have a conflict of interest, you[’re] probably [not doing it right],” accusing the breast cancer-screening panels of “inject[ing] their own biases.” “In this debate, there are armies of the faithful, and only a disappointing scattering of moderators and peacemakers.”

Some have even suggested that we shouldn’t even be talking about this in public, but “[s]uch paternalism assumes that women cannot decide for themselves whether the available evidence supports or refutes the case for mammography. Discouraging a discussion with women about the evidence for and against…[could be considered] more harmful for women’s health, not less, if doctors truly believe that patients should be active partners in making decisions about their [own body].”

Yeah, if you read the actual studies, you can see if the investigators declare any conflicts of interest. But, if you just hear about the studies second-hand, you may have no idea. Until the developers of screening guidelines emphasize “evidence over commercial or financial interests,” we all have to take personal responsibility to become “informed consumers.”

It would be nice to be able to just trust like cancer charities, but “[i]t is virtually impossible” for such organizations to remain strictly “evidence-based” when they must rely on keeping donors happy “for their very existence.”

To his credit, the Chief Medical Officer of the American Cancer Society said that “we need to be true to the science.” But, note this was him talking about prostate cancer screening. See, the American Cancer Society just straight up tells women to get mammograms, but for men, it leaves them to decide for themselves. They’re open about the prostate cancer-screening harms, but “[v]ery little transparent information about the harms of [mammograms] is provided…”

So, there’s this “double standard”; “women are encouraged” to just do it, “while men are advised to” weigh the pros and cons, “although the fundamental issues to consider are [actually] very similar” between the two tests. “The dissimilarity in how [organizations like the American Cancer Society] view” the patients’ role in decision making “couldn’t be clearer. Do [they] believe that men can handle uncertainties regarding screening tests…,” but that women might just get all “confused”? Men get to “make informed decisions” about their bodies, but women are merely “summoned.”

The bottom line is that there is “more than one right answer” to the question: “Should I be screened for breast cancer?” My goal I have for this video series is to enable you to make the decision that is right for you or your loved ones. One survey suggested that if women were fully informed at how small the benefit actually was, 70% wouldn’t do it. But, you may be in that 30%, and have a right to decide for yourself.

Please consider volunteering to help out on the site.

Image credit: Rhoda Baer via Wikimedia. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

You can check out my Doc Note under the first video in this series to get a sense why I chose to spend so much time on this topic. This is the second video in a 14-part series. If you missed the first one, check it out here: 9 out of 10 Women Misinformed about Mammograms. Stay tuned for:

If this is not a topic that interests you, don’t worry. We’re going to be interspersing new content on other topics throughout this extended series. If, on the other hand, you’re extremely interested and don’t want to wait all the weeks this plays out, you can get all the mammogram videos streaming right now for a donation to NutritionFacts.org. Click here.

If you haven’t yet, you can subscribe to my videos for free by clicking here.

71 responses to “Mammogram Recommendations: Why the Conflicting Guidelines?

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  1. The fundamental premise is Science doesn’t care about our opinions. . .

    But yet we have to use our opinion to make an informed decision.




    12
    1. Should we be using our opinions to make screening and treatment choice decisions? Shouldn’t we be presented the accurate statistics on the positive outcomes for a screening or treatment and the statistics around doing nothing and make a choice based on what gamble we are willing to live with?

      With bc the worst thing I saw them doing in cases where they present statistics to help patient make a choice is they present the statistics in a way that leads a person to the wrong conclusions. For example at test that is 80% accurate for determinging if you have a disease or not that comes back positive does not mean there is an 80% chance that you do in fact have the disease. Instead that statistic has to be merged with the % of population that actually gets the disease to arrive at what a positive test result actually says about your likelihood of having the disease. For ones where only say 5% of population get the disease and 80% accurate test result coming back positive means you have something <50% chance of actually having the disease based on posterior probability math that i was recently educated on. That figure certainly helps one make a more informed decision about which gamble they want to take when treatment has side effects that one might consider worse than the disease itself.

      A more straight forward example of how the statistics are falsely presented to patients in the bc space is brca1/2 risks. The brca1 case is presented as increasing ones chance of getting breast cancer 50=85% by age 70 and ovarian by 40-60% by age 85. That's misleading given how I understand those statistics is you look at them in the context of what is the percentage chance of anyone getting the disease, e.g. bc 15% under age 45. So given that is increased by 50-85% if you have brca1 this gets you to .15 * 1.5 and .15 * 1.85 = 22.5-27.75% percentage chance of getting disease if you have brca1. That much lower statistic reads a whole lot different than the discussed 50-85% increased chance and I expect makes a big difference in a women deciding whether or not she'd want to first try a whole food plant based [wfpb] diet and active life style as a means of mitigating her risks vs racing to an operating room and allowing them to start removing parts that will affect the quality of your life.




      7
      1. Not to mention that probably 99.9% of doctors, oncologists, radiologists, etc. NEVER mention how you can affect gene behavior and/or cancer possibility or progression to your benefit by eating WFPB.




        19
        1. Exactly so if you new your chances of having the disease were increased by the presence of a gene or positive test result, but that gene or test result isn’t 100% guarantee things will get worse then with those facts in hand you can at least decide if you want to first try wfpb nutrition and active lifestyle to mitigate your risk of things evolving. That is provided you are not someone who was already doing those things and have what is considered an early stage and/or questionable finding.




          4
      2. details on what I was taught about calculating the actual % chance you have a disease given a non-perfect test result comes back positive

        P(D) = 15% and P(D’) = 85% where P = probability, D = disease and D’ = don’t have disease
        P(T+|D) = 80% and P(T+|D’) = 10% where T+ = test result returned positive and | = given

        posterior probability math P(D|T+) = P(D)*P(T+|D) / ( P(D)*P(T+|D) + P(D’)*P(T+|D’) )
        for example case P(D|T+) = 0.15*0.8 / (0.15*0.8 + 0.85*0.10) = 0.5854

        so a 59% chance you have disease given a non-perfect test result comes back positive even though the test can be touted as being 80% accurate




        5
        1. myusrn,

          This looks like an appropriate use of Bayes Theorem from Mathematical Statistics! Unfortunately, many people I have met in the medical field have never heard of this theorem, much less how to use it properly. Thanks for your explanation. For anyone interested in learning more, here’s a little more detailed explanation:

          https://en.wikipedia.org/wiki/Bayes%27_theorem




          4
      3. Can you please provide references to how you arrived at your calculation regarding BRCA statistics?

        And a note to the commenters, it’s easy to get righteous and cynical when you’re dealing in hypothetical terms…

        I’ve been following a WFPB diet for 7 years and before that I was a vegetarian for 13 years. I have BRCA 1 and was diagnosed last year with metastatic breast cancer at the age of 39.




        2
        1. Inbar, so sorry you are having to deal with this illness. Your post is a necessary, sensitive, reminder that behind all these statistics there are real people who are suffering.




          7
          1. Thanks, Marilyn. And for the record, I still believe that a WFPB diet is the best first line of defense. Though I was initially averse to pursuing conventional treatment, and very skeptical given the inherent conflicts of interest, I think the best decision I made on my road to recovery was eventually learning to be open to learning about all the options presented and then incorporating the ones that suit me best. To that end, Dr. Greger’s insights have been an invaluable source of information and I’m looking forward to this full series on mammograms, though I’m an outlier case and much of it may not be relevant for me.




            5
            1. It really makes us pause when we are the ones affected. Very true that we need to be offered all the choices and explained properly – and so wonderful that you were open and still trust that wfpb is beneficial!

              What I have found in my own life / experience and as I do lifestyle coaching is that Stress is actually the underlying cause of disease and it manifests itself in different areas of the body for different people. It is important to follow wfpb, but when we still have issues that cannot be explained – stress has always sufaced as the underlying cause.

              A helpful series in this line is The Law of Life by Dr Horst Muller
              https://www.youtube.com/watch?v=VyVzV263eDE




              1
        2. Inbar,
          I am glad you mention this. I am always hesitant to mention on these forums because ‘something’ must’ve caused the disease. My daughter was diagnosed with a Wilm’s tumor at age 3. It was the size of a grapefruit when we found it. We are whole foods, plant based. I had a healthy, easy pregnancy with a normal vaginal delivery. I breastfed her three years and was still breastfeeding when she was diagnosed. Everything I fed her was organic. We took GBOMBS serious and even our soaps, lotions, were organic. She had so much sunshine, love, and a healthy environment…
          The point is that we aren’t bullet proof and sometimes shit still happens. For the record, my daughter is 5 now and is thriving. We treated with surgery, chemo, and radiation because it had metastasized. Her main chemotherapy was Vincristine, a vinca alkaloid made from the periwinkle flower.




          5
          1. Hi Ruby,

            I am sorry to hear about what you went through with your daughter. I hope she is recovering well and thriving.

            You completely got the gist of what I was saying. Yes, we should all be taking responsibility and making informed choices about what we consume.
            But no, that doesn’t make us invincible. It’s scary to admit that we have less control in this life then we set ourselves up to believe.




            3
      4. Drug companies use the same ‘math’. For example say the heart attack rate in the placebo group is 3 out of 100. They will advertise that the rate using their drug is 33% less if only 2 in the drug group have an attack.
        The actual number less is 1 out of 100.




        3
    2. I agree with your overkill opinion on diagnostics. And with all the harassment from entertainment and medical types in the news I never say, Yes Mam” anymore. But what about this Dr. Gundry, formerly of Loma Linda University, and his anti-lectin blah blah? I’m curous as to your respected opinion, plusw you’ll always need more material. Happy Nerw Year! I’m paying off two knee surgeries in Bangkok.




      0
    3. Hemo, wondering if you have any science or opinions on merits and or necessity of
      supplementing with probiotics during (or maybe after) a course of antibiotics (ten days
      of amoxicillin). Thanks for any feedback.




      0
    4. Hemo, wondering if you have any science or opinions on merits and or necessity of
      supplementing with probiotics during (or maybe after) a course of antibiotics (ten days
      of amoxicillin). Thanks for any feedback.




      1
  2. Every year my doctor tells me to get a mammogram. Every year I tell him no, except in those years when my self exam has brought up some uneasiness. Seems a rational way to handle it. Plus I eat a WFPB diet and know that I am doing more for my breast health than any doctor with his stupid test has ever done.




    29
  3. Thank you Dr. Greger for doing videos like this. The fact that all your articles and videos reference studies, where you have reviewed them to determine the good vs bad study protocols and interpretation of results, makes them invaluable compared to all the other material out there on nutrition, tests & treatments that w/o the level of due diligence you do makes them essentially subjective opinion.

    I don’t understand why doctors don’t provide the option for a much less invasive, and seemingly just as telling, ultrasound for cases where a person wants to do a an early detection test or someone is concerned about some new palpable matter that has shown up.

    What I experienced in the case of someone close who did end up having bc was that the quick/simple/painless ultrasound and person interpreting the result pegged what was going on right away long before the litany of tests they put you through afterwards such as bone scan, pet/ct scan, and the worst the needle biopsy. Why even do the latter, and risk disrupting the bc cells, if everyone at that point has already committed to going in and doing resection of what was found in tests and determined not to be measurably present anywhere else in the body.




    5
    1. Good point. And did any oncologist ever tell an actual cancer patient that even PET scans don’t always show cancer when it is present? I had four PET scans over several years and none showed actual cancer until the fourth. By then I’d undergone two needle biopsies and chemo twice. By the time I had a mastectomy, after all that, there was STILL live cancer in the main tumor.

      No more radiation for me. I’m relying on my WFPB diet, good habits, and intuition from here on out.




      11
      1. After all the posturing i saw them do on how pet/ct scan was the ultimate test for determining state of cancer throughout ones body I later found how through constant q&a with radiologist doing the test and processing results that pet/ct scan can only measure things that are 5mm/0.5inch or larger.

        So when they say the pet/ct scan only found cancer in one, and focus on that, its could be misleading treatment effort if it exists elsewhere at 4,3,2,1mm in size.

        Point being if they were honest about what these test conclusions actually tell us, and what they don’t, then patients can make a more fact based decision about what steps they want to take next to mitigate risk, progression, etc. taking into account a desire for quality of life. Based on the studies reviewed and discussed on this site a wfpb nutrition game plan seems to be a no side effects way of improving ones statistical chance for desirable outcomes regardless of what standard medical care options they might choose to do next.




        3
        1. How very interesting. They make PET scans sound like they are the ultimate in cancer diagnostic tools.

          I just looked up my pathology report. The main tumor was .7 centimeters, so that would be 7 millimeters, wouldn’t it? Sorry to be ignorant of metrics, but I think that’s right. Anyway, it didn’t show on four PET scans and I could easily feel it. It felt huge – like almost the size of a bantam egg.

          When I asked my oncologist why it didn’t show on the scan he said he didn’t know, that sometimes they just don’t, so from then on he’d only use MRI. I could have saved myself a LOT of radiation.

          By the way, I did work with one alternative MD who had me do an infusion of 25 grams of vitamin C following each scan. He said that would help mitigate the effects of the radiation. I hope he was right.




          3
        1. Jennifer,

          Yes, I’m very familiar with the Gerson therapy. I have books by two women who both were near death with melanoma and who cured themselves with it. It was my first choice when I learned I had cancer.

          But, not only is it a full time job for the patient and another person and probably yet a third person because of all the fresh juices to be consumed and coffee enemas to be performed, shopping for it all, the cleanup, etc. etc. Oh, and I was supposed to be RESTING? Anyway, I went to California to learn about it at a clinic a doctor has in Redlands. Even with them making all the juices and doing all the cooking and shopping, I never could fit in five coffee enemas a day, nor could I hold them, as is supposed to be done. What a mess! But I was willing to do it because I knew it worked for some pretty hopeless cases.

          Unfortunately, it didn’t work for me. During the two months I followed it, my tumor doubled in size. That’s when I started researching other possibilities. I did a lot of things, mostly alternatives and dietary, including low dose Insulin Potentiated Chemotherapy (IPT) along with a raw vegan diet and other therapies. That shrunk the tumor tremendously, but as soon as I got home and the weather turned cool I couldn’t keep warm. I started eating cheese and the tumor grew back very quickly. Eventually I had to do treatments that my insurance would pay for, which was the second round of chemo. I’ll never do chemo again, though, since it didn’t kill the cancer and has a very poor track record for most common cancers.

          If I got cancer again I would go to TrueNorth Health Center and fast. If that didn’t work, I’d say I’ve lived a good life and it must be my time to go. I’m almost 75, and I don’t consider myself old at all.

          I will add that I’ve only known three other women who had the same type of aggressive breast cancer I did (triple negative, which is unrelated to female hormones), all of them younger than me, one only in her 30s. Two of them were convinced by their alternative doctors to go on ketogenic diets. Sadly, I’m the only one still alive.




          6
  4. My own personal experience regarding mammograms my first & last mammograms go back to the mid-80s when I was 24 years old and found what seemed to be a lump in my breast. I was living in France at the time & was told I had to have a mammogram. I was frightened, & they kept bringing up the ‘c’ word, so I just did what they told me. The whole process was a horror show, & by the time they were on the 9th or 10th picture (I am not exaggerating), I realized they had no idea what they were doing. They couldn’t seem to get any good shots & said they had to squeeze my breast harder between the plates to get something that was readable. I told them we were done.

    I went back to the US & was told the same thing – I needed to have a mammogram. And I went through the same hell. To give you an idea, the technician told me that the doctor told him that they had to mash my breast between the plates until I couldn’t stand it anymore. My response was, “I thought we already did that.” And I left.

    I was poked and prodded by other doctors, one of whom tried to aspirate it. Then I finally called an old high school friend who had completed medical school & was doing an internship or residency, & he gave me the name & number of one of the top specialists in the country, who just happened to be in Philadelphia. This specialist told me that the reason why they couldn’t get any decent pictures is because young breast tissue is too dense to show anything. He explained that mammography is only useful for older women, aged 40 on up. So, I never should have had them in the first place. An ultrasound, which was a much more pleasant experience, revealed that it was absolutely nothing.

    You can imagine how relieved, yet angry I was. I’ve never had a mammogram since, & I never will. That whole experience marked the beginning of my distrust of the medical profession in general.

    Thank you sooooo much Dr. Greger & NF Staff for doing a series on this important topic. Women need to be able to make informed decisions about mammograms & not just blindly follow whatever the healthcare providers tell them.




    29
    1. The question is that your risk will increase at certain age and so screening may be necessary (30 percentile). But then up to a certain age (70, 80 or 90) then it may be that your body cannot withstand chemo or surgery and so what’s good does screening do if it only adds to your worry? And we don’t want to hear this but we will all die after a certain age.




      2
      1. I agree that one should first ask and understand what would be the next step(s) if any given screening came back positive. If you know that you wouldn’t [ for quality vs quantity reasons ] or couldn’t [ because body couldn’t tolerate the surgery or treatment ] do the next step(s) in the event a screening test came back positive then don’t do the test to begin with.

        I have a neighbor who has a myrid of cardiac issues going on. He has already asserted that at his age he is not willing to signup for any of the surgeries and/or pharmaceutical options they would use to treat something if they found it. Yet he keeps going in for echocardiograms, wearing holter monitor to produce multiday heart activity reports and other tests. Every test increases his level of stress before and after the test and that is time he could have spent living quality moments and days especially if he’s already decided he wouldn’t do any of the followup a positive test finding might suggest as a next step.




        3
        1. My 96 year old dad (97 this year) has said over and over in his will and verbally that he wants no tube, no surgery nothing to prolong his life. If it is time to go then he goes. He is not the kind of person who wants to die because he has no visible disease and he enjoys his kids and grandkids, and he does things like eating properly and take supplements to live long, but he is not afraid to die either. I have been to hospitals to see my relatives who had cancer and I saw people moaning in pain. Why prolong this kind of life?




          8
    2. Rita, this is only the beginning of the series. There may be some information specific to your age group coming up, so stay tuned.

      Also, Dr. G doesn’t recommend so much as inform, so that we can make decisions on our own, based on the actual science.




      4
  5. You do the most amazing work and I want to tell you every day, with every video. I do hope there is info at the end of this series regarding thermograms. Thanks again.




    6
  6. I appreciate your videos and information! I am wondering if perhaps women are just “told” to do the screening and men are encouraged to weigh the pros and cons because breast cancer is more fatal then prostate cancer? Also hoping you will be sharing what the risks are with mammograms-never knew there were any (other then discomfort). Thanks!




    2
  7. Rita, this is just the 2nd of a 14 video series. Your concerns may be addressed in later videos. And having been diagnosed with breast cancer myself, I read summaries of recent research, and I find that treatment guidelines for women over 70 are being revised, based on newer evidence and type and stage of cancer (among other factors). So this group is under consideration.




    6
      1. Lida, no, the treatment guidelines are being revised towards less treatment, depending upon the type and stage of cancer, the age and health of the patient and perhaps other factors I don’t recall. It’s a question of balancing risk of harm (treatment comes with serious adverse effects, up to and including death in some cases) with the benefits (which are often experienced several years later). It’s no longer one size fits every patient. My mother was diagnosed with a second breast cancer in her late 70s; she discovered the lumps herself, and she had surgery because the lumps “bothered” her. But when she declined radiation “therapy,” the radiology oncologist stomped or stormed out of the room (her words); she said he later came back to apologize. But she lived another 15 years, dying at age 93 of other causes. And some of the treatment revisions include no chemotherapy and no radiation, depending upon those factors, just surgery and maybe endocrine therapy, for women age 70+. These revisions are based upon research studies. Too late for my mother, who was wise anyway.




        4
        1. Dr J, Your story is somewhat similar to my mother’s. Her first breast cancer came at age 84 and she declined anything other than surgery. At 91 they found it had returned and was in her shoulder at the back as well as a breast. She had already had a stroke and was in a full time care home.
          Instead of further treatment she was put on Hospice, but she lived another three and a half years and died of a series of strokes.




          1
  8. Thank you, thank you, thank you for pointing out the double standard for men and prostate screening vs. women and mammograms. I’ve been noticing it for years and will be speaking up about it at my doctor’s office the next time I am pressured to have a mammogram.




    6
    1. Not an expert…but I think most men have prostate cancer by the time they die (usually before) and typically die of something else. Breast cancer is probably different? Though maybe not to that great of an extent.

      Breasts are the canary in the coal mine…an indication of the consequences of living in a toxic world?




      0
  9. The subject of engineering opinions is deep. Companies use psychological techniques to manipulate opinions in order to obtain the most clients and thus compete and bring profits. It is a marketing science with a goal. Their goal is always growth but in sheep clothing. This video helps to identify the clothing.




    5
  10. As far as the guidelines about elderly, my grandmother’s doctor was still recommending mammograms when she was in her late 80’s, but by then, she had lost her timid, do anything people told her personality and had a “Hell, no, I won’t go” sense of humor and laughed when she said it, but fully meant it.




    8
    1. Deb, I LOVE your grandmother!

      My mom’s dentist wanted her to have a root canal on a tooth that wasn’t bothering her at 90, and couldn’t understand why we didn’t see that as a normal thing to do.




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      1. A root canal for a tooth, which didn’t bother her?!?!

        I have never heard of such a thing, even for a younger person.

        My grandmother was allergic to things like Novocaine and ended up having two root canals with no pain meds at all.

        The dentist said it was so painful for him watching this brave 80-something year old grasping onto the chair without uttering a sound.

        Though my friend, who was in his twenties, did end up having one of those, because he got a root canal at a school and the person kept trying to give him Novocaine, but kept messing up and it was a final exam and my friend ended up trying to fake not being in pain and said it was horrible.

        (My grandmother was less of a complainer about it than my twenty year old friend.)

        She died in her early nineties of pneumonia.




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  11. As long as you are investigating breast screening and have noted the risks of mammograms, why don’t you continue the study and compare risks and benefits of thermogram and ultrasound screening to mammograms. The AMA and the affliated benefactors push mammograms for their self interests and the insurance industry falls in line and provides insurance coverage for mammograms, but not the other methods of breast screening. It is my understanding that thermograms are more effective in detecting breast cancer without the risks, but I would sure like you to “put it to the test.”




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    1. I think that the long-standing and still current view is that mammography is more accurate. For example, this below was an Iranian study (published 2016) so I am pretty sure that neither the AMA nor any of its sponsors could have manipulated the results:

      “132 patients were included. The median age of all patients was 49.5 ± 10.3 years (range 24-75 years). The sensitivity, specificity, PPV, NPV, and accuracy for mammography were 80.5%, 73.3%, 85.4%, 66.0%, and 76.9%, respectively, whereas for thermography the figures were 81.6%, 57.8%, 78.9%, 61.9%, and 69.7%, respectively.

      Conclusion
      Our study confirms that, at the present time, thermography cannot substitute for mammography for the early diagnosis of breast cancer.”
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040931/

      This discussion of the issues is also worth reading. It appears that there are no easy answers

      https://www.medicalnewstoday.com/articles/316632.php




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    1. Is mammogram recommended for women over 70 (73) with no family history of breast cancer ?

      Is crestor recommended for women over 70 (73) with normal to low hdl and ldl cholesterol and low tryglycerides ?




      1
      1. Rita, there was an interesting article addressing this issue in ‘The New York Times’, May 5, 2014 issue.
        Article title ‘A New Women’s Issue: Statins’.
        It’s still available online, you can google it.
        Basically it says expert opinion and studies show a decrease of symptoms in some women, but no difference in outcome.




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  12. ““[O]nly in health care [does] the same group that provides a service also [tell] us how valuable that service is and how much of it we need… We must [sadly] acknowledge that just as in any other profession or industry, self-interest is unavoidably at work…” In an analysis of more than a hundred papers, the “imbalance” in those that tended “to emphasize the major benefits of mammography…over its major harms [was] related to the authors’ affiliation.”

    This does not seem a new problem, as this excerpt from George Bernard Shaw’s “Preface on Doctors” written in 1909(!) for his play, The Doctor’s Dilemma shows. In my opinion no one has written a more devastating, accurate – and funny! – critique of this problem in health care before or since. Shaw’s preface begins:

    “It is not the fault of our doctors that the medical service of the community, as at present provided for, is a murderous absurdity. That any sane nation, having observed that you could provide for the supply of bread by giving baker’s a pecuniary interest in baking for you, should go on to give a surgeon a pecuniary interest in cutting off your leg, is enough to make one despair of political humanity. But that is precisely what we have done. And the more appalling the mutilation, the more the mutilator is paid. He who corrects the ingrowing toe-nail receives a few shillings: he who cuts your inside out receives hundreds of guineas, except when he does it to a poor person for practice. …”

    And as far as medical diagnostics goes:

    : “As to the humor and conscience of doctors, they have as much as any other class of men, no more and no less. And what other men dare pretend to be impartial where they have a strong pecuniary interest on one side? Nobody supposes that doctors are less virtuous than judges; but a judge whose salary and reputation depended on whether the verdict was for plaintiff or defendant, prosecutor or prisoner, would be as little trusted as a general in the pay of the enemy. To offer me a doctor as my judge, and then weight his decision with a bribe of a large sum of money and a virtual guarantee that if he makes a mistake it can never be proved against him, is to go wildly beyond the ascertained strain which human nature will bear. It is simply unscientific to allege or believe that doctors do not under existing circumstances perform unnecessary operations and manufacture and prolong lucrative illnesses. . . . ”

    http://www.gutenberg.org/files/5069/5069-h/5069-h.htm




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    1. Alef1, love the GBS quotes from the play. Thanks for sharing them.

      It’s hubris that bothers me most about some doctors, male or female. Up until I saw the specialist, when I was going through the whole mammography ordeal at age 24 that I described above, every doctor I saw told me it was imperative that I go through it. Both times every one of them came across as all-powerful and all-knowing and treated me like I was crazy & stupid for not completing the mammogram. They were so sure of themselves, yet every single one of them got it wrong.

      Of course, not all doctors are like that. My GP isn’t like that at all. But there are still far too many who are. I think the profession attracts too many greedy people for reasons illustrated in GBS’s play. And I think it’s likely that hubris is encouraged throughout the whole medical school, internship, & residency process. It’s yet another dysfunctional system in our society.




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  13. Do some videos on birth control pills!! I won’t touch the stuff- I have two planned kids through fertility awareness- SAFE, effective- did I mention SAFE?? As in like no scary cancer causing, blood clot inducing scary chemicals? This is another one of those pharmaceuticals that doctors push on girls and women to “fix” period problems or not get pregnant- or more like ensure that they have a customer for twenty years. Get informed. You don’t need birth control pills to fix period problems or avoid pregnancy- my husband and I have never used a condom or birth control and have putting off a third baby for over two years now for medical reasons. A woman’s body is not broken- fertility is not a disease- please do some videos on the dangers if artificial birth control!!




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    1. Yes, Dr. G, please do some videos on the safety of birth control as Millenial Marie suggested! Please, please, please!

      Back in the 90s a gyno put me on low dose birth control pills in order to fix a problem with my periods. Soon after I started the treatment, I began feeling pain in my legs & noticed the appearance of some spidery, varicose veins. When I complained to the doctor about it, she said, “Yes, but who cares.” And I said, “Me. I care.” I stopped the treatment immediately, & either the problem went away all on its own, or the Chinese herbs I started taking did the trick. I really don’t know which.

      I’ve had way too many bad experiences with doctors. That’s why I come here – to learn as much as I can so I can avoid them as much as possible.




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      1. I’ve heard so many stories about bad effects of birth control- from depression and weight gain to landing women in the hospital for months- not to mention no libido. Not worth it. There has to be a better way. But in the name of women being in control (or under the control of doctors and pills) no one can say anything bad about birth control….. We know better these days- there are more and better options and they don’t involve scary devices, scary pills, or health risks. I’m more pro woman than most people because I believe that a woman’s body is amazing and that my reproductive system with proper nutrition can work the way it’s supposed to (and have cycles of fertility and non-fertility). I have a friend who is a PA who had a patient (an adult) that thought she was sick because she had cervical mucus- I have a friend who teaches sex Ed that thought you can get pregnant on your period….. We can do better guys……




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      2. WFPB Nancy, you were blessed. I was also put on low dose bc pills and within two weeks because I felt terrible on them. My health deteriorated and I was diagnosed with unexplained deteriorating asthma (I AM a mild asthmatic.) I had blood clots in my ankle that went undiagnosed for three months and was throwing clots to my lungs. 1986. My leg swells every day.




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  14. Maybe it would be best to leave the question of mammography frequency to female doctors…I suspect they would be able to provide more accurate information to their patients than the typical male doctor.




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  15. When discussing the effect of blood from a plant based diet on cancer you pointed out that in the case of prostate cancer the study lasted a year because prostate cancer is slow growing but that the women’s study of breast cancer was two weeks because breast cancer can progress rapidly. This is the prime difference on whether women should be routinely screened while the question for men is less critical and left up to their judgment.




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  16. Has anybody on this forum ever thought about storing Whole PLANT food for the possibility of a global disaster, a regional disaster, or a local disaster. The earth’s history of global disasters are asteroid collisions with the earth, volcanic eruptions the size of yellow stone national park, Solar flares so powerful that they are called Carrington Effect flares which could destroy the electrical grid around the entire planet, pan endemics that lead to specie extinction. Regional disasters would be floods, droughts, earthquakes, fires, prolonged icy conditions, wars, economic depression, political collapse and chaos. Local disasters are weather related, fires, floods, crime, unemployment, pollution, and so on. There is no denying that these things have happened in the past and they will happen again and again and again. So, how does a Whole Plant Food Based person store food for emergencies? The best food to store are all of the hundreds of types of grains and beans because they have a really long shelf life. You need to store seeds also, because you can sprout them and have instant greens in three to five days with seeds like alfalfa seeds. The seeds would be necessary to start your GARDENS: outdoor garden, container gardens, and indoor gardens. Having a source of water would be critical to the success of survival.




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    1. I have a bucket of freeze-dried food that in a pinch might last 1 month….supposed to be backpacking grade….in other words half decent. In case of a disaster…I pretty sure you will be interested in eating anything that is edible and keeps you going.

      Now of you had several million at least…and a place with lots of security…your plan might work. Don’t have the link…but there is an article on life in what I believe was the Balkans….things got down to the nitty-gritty rather quickly…and life was very basic for most people.

      I’ve lived on pasta-rice and canned soup for extended periods of time…it’s doable but not likely pleasant for most people….and not really healthy. Main thing was to fill up and get the basic calories. I was living on a beach at the time and I remember when I found a partial head of cabbage washed up…it was still good and I thought I was in seventh heaven.

      Most people including myself do not realize how dependent they are on social support systems…I don’t mean people to talk to…I mean availability of food..shelter…water…security. It could all fall apart fairly quickly.




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  17. I’m in the group who has chosen to buck the system and not get the recommended mammogram, but not without reason. I got my first prescription for a mammogram 13 years ago at 35 when that was the recommended age for beginning such a procedure. My reasoning follows:
    Low body weight
    Life long endurance athlete
    Late menarche
    5 babies and 5 years breast feeding
    Plant based diet
    No family members with breast cancer

    So the risk of breast cancer is low.




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    1. Laura,

      Can’t argue with your excellent health history and lifestyle leading to a reduced risk. Different consistencies of breast tissue can lead to a poor diagnostic potential, even with mammography or manual breast examination.

      Given the new evaluation methods both on the market now and increasing in new offerings shortly for a screening of cancer proteins and antibodies in the blood stream I’m going to suggest some surveillance.
      What are your thoughts on a genetic screening panel to also get a read on your risk. When I’m referring to the genetic screening I’m not just talking about the BRACA1/BRAC2 exclusively. An expanded genetic panel would give you more confidence in your knowing that your risk is indeed low.

      I encourage you to do a regular breast self-exam as a good form of a non-invasive cost-free checkup.

      Keep up the laudable life style and stay healthy !

      Dr. Alan Kadish moderator for Dr. Greger http://www.Centerofhealth.com




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  18. ELI5

    Okay, it is time to seriously dumb these things down people. In the comments I still see a lot of confused and misguided thoughts about this subject despite the two videos. So please allow me to do the dirty work and give you the ELI5 version. I will give you the exact questions you should ask yourself to make a good decision. Here it goes.

    Are you eating a whole food plant-based diet and are you getting the recommended daily physical activity? YES or NO.

    If YES you are, congratulations, you are getting the best preventative medicine in the world, the gold standard that money can not buy. Your odds of developing whatever form of cancer is utterly destroyed! Stay away from doctors and medical screenings they can only make you worse. Limit yourself to some routine blood work.

    If NO you are not, we are sorry to tell you that your body does not guarantee sustained health because it is not generating the biochemical ideal conditions. You have a risk of cancer developement that is comparable or greater than the averages that one sees in the developed world. Because you are having average risk you should follow the average people’s recommendations; so get your cancer screenings and your doctor visits and inspect your body for signs of cancer. You are not getting the gold standard of preventative medicine but it is better than nothing.

    CONCLUSION
    For someone eating and moving average one can expect average cancer risk, this makes medical screenings “preventative medicine”, check your cancer, I mean body.

    For someone doing wfpb+exercise, all bets are off, you are getting the best of the best regarding prevention from disease; for you medical screenings are mere diagnostic tools (that also happen to be a bit radioactive) in hospitals far far away. Don’t bother, if it ain’t broke, don’t fix it.




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