The Pros & Cons of Mammograms

The Pros & Cons of Mammograms
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Fact Boxes can quantify benefits and harms in a clear and accessible format.

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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.

When it comes to cancer screening, doctors have too often ignored the fact that women may place different weights on various pros and cons, and just “focused on persuading rather than educating” to let people make up their own mind. To do that, though, “they need some quantification of its benefits and harms” in a clear and accessible format. Enter: fact boxes.

For example, “[i]n 2014, German physicians recommended transvaginal [ultrasounds]” to millions of women to screen for ovarian cancer, in which a probe like this is inserted to look around. Okay, but what does the science say? Based on a study of hundreds of thousands of women, if you randomize a thousand women to get vaginal ultrasounds, and a thousand women to skip them, and then follow them out for a decade or so, three of the women who skipped the screening will die from ovarian cancer, but the same number died with the screening. So, there was no benefit at all. Instead, 32 of them went into surgery to have their ovaries removed, because something looked suspicious on the ultrasound. But, it turned out to be totally unnecessary, and one of those women suffered surgical complications—all for naught. Just harms, no benefits, yet millions of women were subjected to the probing, “probably resulting in more than 10 000 women having healthy ovaries removed in just one year.” A boon for the hospitals and the surgeons and their local BMW dealers, but just pain and suffering for the women.

What would a fact box for mammograms look like? Each of these gray circles represents one woman. A thousand randomized to skip mammograms, and a thousand randomized to get mammograms. After a decade, in the no-screening group, about five out of the thousand women will die from breast cancer. So, even without screening, the chances of dying from breast cancer in one’s 50s is less than one percent. But, by getting regular mammograms, instead of five out of a thousand women dying from breast cancer, only four in a thousand will die from breast cancer—though the number of women dying overall appears to be the same, either way. So, no lives are necessarily saved overall. But maybe the studies just haven’t had the statistical power to pick up on an overall survival benefit.

In terms of harms, 100 of the women getting mammograms will be called back in for false alarms, and maybe even biopsied, and five will have unnecessary lumpectomies or mastectomies. “A third potential harm, getting radiation-induced breast cancer from the [mammograms themselves], is not included because only rough indirect estimates exist”—and it may only be like one in 10,000 women.

Here’s a graphical representation. This is over a 20-year period, so women following the current USPSTF recommendations to get screened every other year starting at age 50. One would expect 200 false alarms over those two decades, but only about 30 would end up being biopsied. It would miss a few cancers, but in 15 cases, find too many: women diagnosed with and treated for breast cancer unnecessarily. But, on the other hand, two breast cancer deaths would be averted thanks to mammograms—though no overall lives would apparently have been saved.

Not everyone agrees with these numbers, though. Here’s the most optimistic numbers I could find, per thousand women screened. Up to 10 times the benefit, getting mammograms every year for 25 years starting at age 40, at the cost of an average of three false alarms each, a one in three chance of getting a biopsy, and about a 1% chance of being diagnosed and treated for breast cancer unnecessarily.

Now, this is assuming asymptomatic women at average risk. Women at higher risk, like those who’ve already had breast cancer or have BRCA gene mutations, would be expected to benefit much more. But, for the average woman, “there is simply no ‘right’ answer to whether a woman should undergo mammographic screening.” It should be left up to each woman to make up their own mind.

We hope that the data presented will help with that decision. “Some may choose to pursue screening, valuing any potential for benefit as warranting the accompanying harms. Others may choose not to…,” feeling the potential harms may be just “too great to justify…the…benefit.”

Regardless, how about trying to not get breast cancer in the first place? “[I]ndividuals [may] rather be told to get a quick test every few years than be told to eat well and exercise to prevent cancer” before it starts. “Screening has become an easy way for both doctor and patient to think they are doing something good for their health.” But getting screened for cancer doesn’t change their risk of getting cancer in the first place.

And, not just cancer. The same diet and lifestyle that can protect against cancer can also protect against the leading killer of women. Here’s the number of women dying from breast cancer versus the number of women dying from heart disease. And, while mammograms may not save lives, we know that lifestyle modifications to prevent heart disease can. So, maybe some of those billions spent every year on mammogram programs could be better spent saving the lives of women.

Please consider volunteering to help out on the site.

Image credit: Steel Wool via flickr. 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.

When it comes to cancer screening, doctors have too often ignored the fact that women may place different weights on various pros and cons, and just “focused on persuading rather than educating” to let people make up their own mind. To do that, though, “they need some quantification of its benefits and harms” in a clear and accessible format. Enter: fact boxes.

For example, “[i]n 2014, German physicians recommended transvaginal [ultrasounds]” to millions of women to screen for ovarian cancer, in which a probe like this is inserted to look around. Okay, but what does the science say? Based on a study of hundreds of thousands of women, if you randomize a thousand women to get vaginal ultrasounds, and a thousand women to skip them, and then follow them out for a decade or so, three of the women who skipped the screening will die from ovarian cancer, but the same number died with the screening. So, there was no benefit at all. Instead, 32 of them went into surgery to have their ovaries removed, because something looked suspicious on the ultrasound. But, it turned out to be totally unnecessary, and one of those women suffered surgical complications—all for naught. Just harms, no benefits, yet millions of women were subjected to the probing, “probably resulting in more than 10 000 women having healthy ovaries removed in just one year.” A boon for the hospitals and the surgeons and their local BMW dealers, but just pain and suffering for the women.

What would a fact box for mammograms look like? Each of these gray circles represents one woman. A thousand randomized to skip mammograms, and a thousand randomized to get mammograms. After a decade, in the no-screening group, about five out of the thousand women will die from breast cancer. So, even without screening, the chances of dying from breast cancer in one’s 50s is less than one percent. But, by getting regular mammograms, instead of five out of a thousand women dying from breast cancer, only four in a thousand will die from breast cancer—though the number of women dying overall appears to be the same, either way. So, no lives are necessarily saved overall. But maybe the studies just haven’t had the statistical power to pick up on an overall survival benefit.

In terms of harms, 100 of the women getting mammograms will be called back in for false alarms, and maybe even biopsied, and five will have unnecessary lumpectomies or mastectomies. “A third potential harm, getting radiation-induced breast cancer from the [mammograms themselves], is not included because only rough indirect estimates exist”—and it may only be like one in 10,000 women.

Here’s a graphical representation. This is over a 20-year period, so women following the current USPSTF recommendations to get screened every other year starting at age 50. One would expect 200 false alarms over those two decades, but only about 30 would end up being biopsied. It would miss a few cancers, but in 15 cases, find too many: women diagnosed with and treated for breast cancer unnecessarily. But, on the other hand, two breast cancer deaths would be averted thanks to mammograms—though no overall lives would apparently have been saved.

Not everyone agrees with these numbers, though. Here’s the most optimistic numbers I could find, per thousand women screened. Up to 10 times the benefit, getting mammograms every year for 25 years starting at age 40, at the cost of an average of three false alarms each, a one in three chance of getting a biopsy, and about a 1% chance of being diagnosed and treated for breast cancer unnecessarily.

Now, this is assuming asymptomatic women at average risk. Women at higher risk, like those who’ve already had breast cancer or have BRCA gene mutations, would be expected to benefit much more. But, for the average woman, “there is simply no ‘right’ answer to whether a woman should undergo mammographic screening.” It should be left up to each woman to make up their own mind.

We hope that the data presented will help with that decision. “Some may choose to pursue screening, valuing any potential for benefit as warranting the accompanying harms. Others may choose not to…,” feeling the potential harms may be just “too great to justify…the…benefit.”

Regardless, how about trying to not get breast cancer in the first place? “[I]ndividuals [may] rather be told to get a quick test every few years than be told to eat well and exercise to prevent cancer” before it starts. “Screening has become an easy way for both doctor and patient to think they are doing something good for their health.” But getting screened for cancer doesn’t change their risk of getting cancer in the first place.

And, not just cancer. The same diet and lifestyle that can protect against cancer can also protect against the leading killer of women. Here’s the number of women dying from breast cancer versus the number of women dying from heart disease. And, while mammograms may not save lives, we know that lifestyle modifications to prevent heart disease can. So, maybe some of those billions spent every year on mammogram programs could be better spent saving the lives of women.

Please consider volunteering to help out on the site.

Image credit: Steel Wool via flickr. Image has been modified.

Motion graphics by Avocado Video

Doctor's Note

This wraps up my series on mammograms; the rest is up to you. How important are false-positives or overdiagnosis to you? That’s something you have to answer for yourself. To review any of my in-depth mammogram series, here they all are:

I’ve got tons of videos on diet and lifestyle approaches to preventing and treating breast cancer. Just stick it in the search bar up top, and all will be revealed. 

And if you want this whole series in one place, you can get it on DVD or streaming for a donation to NutritionFacts.org by going here.

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

41 responses to “The Pros & Cons of Mammograms

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  1. Thank you so much for this series! My own decisions were reinforced. My husband has over and over exclaimed how glad he is that I stood my ground with a surgeon who admitted the lumps were not cancer but I needed to get a mammogram – with lumps that hurt badly without squishing. It is nice to be on the same page!!!

  2. Dr. Greger stated: “Women at higher risk, like those who’ve already had breast cancer or have BRCA gene mutations, would be expected to benefit much more.” But why? And where’s the evidence? I’ve actually asked this question of my doctors after my own treatment for breast cancer (detected by a lump, not mammography), and the answers were basically: “Since mammography saves lives of women before a diagnosis of breast cancer, we believe that it saves lives of women afterward.” Well, the first part of that statement does not appear to be correct; what does that mean for the second part? Is there any evidence that mammography is effective for women at high risk of breast cancer?

    1. “Is there any evidence that mammography is effective for women at high risk of breast cancer?”

      I’d ask a slightly different question, “Is there any evidence that mammography is effective for actually INCREASING SURVIVAL in women at high risk of breast cancer?”

      While I expect that it might seem true that mammography would prove effective for detecting breast cancer for women at high risk, this can increase survival if and only if the treatment that follows detection increases survival.

      Do we have any evidence that conventional treatment for women who actually have cancer increases survival? Not really, as the survival data for the studies I’ve seen includes ALL women diagnosed with breast cancer and who undergo conventional treatment, and over 90 % of those women don’t have breast cancer at all. Which means, that when one looks at the survival data, that it seems far more likely that the surviving population seems heavily weighted with the 90% “false positive” women who never really had breast cancer in the first place.

      To quote the transcript from the “Mammogram Paradox” video:

      “This raises questions about doing routine mammograms, period, as it “converts thousands of healthy women into cancer patients unnecessarily”—some of whom may not make it out alive. Ironically, though, those who do become mammography’s biggest cheerleaders, thinking mammograms saved their life. The mammogram found a cancer you didn’t even know you had, and yeah, the treatment was rough—surgery, radiation, drugs, but it worked; life was saved. Thank God she got that mammogram; you should, too.

      Whereas actually, the more likely scenario—in fact, maybe the 10 times more likely scenario, is that the treatment didn’t do anything, since the cancer wouldn’t have hurt you anyway. So, you went through all that pain and suffering for nothing. That’s the crazy thing about mammograms; the people who are harmed the most are the ones who claim the greatest benefit.”

      As medicine can not as this time distinguish between those women who really have breast cancer from those who don’t, the evidence that conventional therapy increases survival for those who actually have breast cancer seems at best extremely weak. While it does make sense that careful surgery would help women who have localized breast cancer that has not spread by removing it, the usual follow-ups of radiation and chemotherapy not only severely negatively impact the bodies immune system, but other systems as well, and in themselves cause mutations that can give rise to cancer down the road.

      How long would women untreated for breast cancer live, as a control, compared to women who undergo conventional cancer treatments? We don’t know, because doctors see it as unethical not to treat such patients. Instead, they compare how long a patient lives undergoing one kind of conventional treatment versus another, where increased survival might simply mean that one kind of chemotherapy seems less toxic – rather than more beneficial – than the one the study compared it to.

      How long would women who actually have breast cancer live if left untreated? I don’t know, and although doctors pretend they know when they give the “six months to live speech if you don’t do what I say”, they don’t really know either. No data.

      But we do have a good idea of how long women the 9 out of 10 diagnosed with breast cancer who don’t really have it will live if left untreated. On average, as long any other woman their age, and a LOT longer than if they’d undergone surgery, radiation, and chemotherapy.

      1. alef1, you wrote: “As medicine can not as this time distinguish between those women who really have breast cancer from those who don’t.” Actually, I think you meant “As medicine can’t distinguish between an indolent cancer (so slow growing or non-aggressive that the patient will die of something else) and aggressive cancer (one that is likely to kill you if left untreated — and even so still might).” Because a biopsy makes it pretty clear whether a woman has cancer (invasive) or “pre-cancer” (in situ) or not, but not what kind.

        I’ve also read that the mortality from breast cancer has been going down, maybe as much as by 30%, and that it appears to be due to improved treatment, not to “early detection” with mammography. My rough rule of thumb is that cancer treatments (after surgery) maybe help 1 out of 10 people with invasive breast cancer who undergo them: about 60% of patients would die of other causes without treatment, and about 30% would die despite treatment, and about 10% would be helped by treatment to live to die of other causes. And medicine can’t distinguish between these patients, either. So all invasive breast cancer patients were treated after surgery, to help the 1 out of 10. However, research is helping to parse out who can relatively safely forgo chemotherapy, and perhaps radiation “therapy” as well (based on gene expression profiles, biochemical markers, and other factors). However, even here, there are no guarantees; some patients who undergo treatment die of breast cancer, as do some deemed safe to avoid it. I think of it as a slightly informed crap shoot.

        1. “As medicine can not as this time distinguish between those women who really have breast cancer from those who don’t.” Actually, I think you meant “As medicine can’t distinguish between an indolent cancer (so slow growing or non-aggressive that the patient will die of something else) and aggressive cancer (one that is likely to kill you if left untreated — and even so still might).”

          Agreed.

          Except that I don’t know if an aggressive tumor seems more likely to kill you if left untreated, as compared to treated, by which I mean surgery, followed by radiation and chemotherapy. As I wrote above for a tumor that has not yet spread, removal of the entire tumor through careful surgery – that does not inadvertently spread formerly localized cancer cells throughout the body, should work. And while as Deb points out a mastectomy or even a lumpectomy will still seem a big deal to the woman, for the woman with still localized aggressive breast cancer it can save her life. If the cancer has already spread though before surgery, it might not help at all, or even make it worse, if the surgeon seems at all sloppy, by spreading the cancer. further. And for women in this category, I have seen no evidence that radiation and chemotherapy would improve their survival.

          And as we can’t at present distinguish what kind of cancer a woman has – even if they opt for surgery alone, this still means that 9 out of 10 women diagnosed with breast cancer will end up mutilated unnecessarily. And if doctors fully informed their patients of the odds – some – perhaps many – women, might decide that it seem worth it. Others, considering the odds heavily in their favor that they most likely do not have something that would develop, could quite rationally choose not to. And that should seem their decision, not the doctors.

      2. This is difficult to judge since much depends on the type of breast cancer and the stage. However, I think it is incorrect to assume there is no real data on survival of treated versus untreated women. I’ve seen a number of such studies eg

        “This study included all 5339 patients aged < 80 years with nonmetastatic breast cancer recorded at the Geneva Cancer Registry between 1975 and 2000. We consulted the clinical files of all nonoperated women to identify those who refused surgery. Patients who refused surgery were compared with those accepting surgery using logistic regression. The effect of refusal of surgery on breast cancer mortality was evaluated by Cox proportional hazards analysis.

        Results:
        Seventy patients (1.3%) refused surgery. These women were older, more frequently single, and had larger tumors. Overall, 37 (53%) women had no treatment, 25 (36%) hormone-therapy alone, and 8 (11%) other adjuvant treatments alone or in combination. Five-year specific breast cancer survival of women who refused surgery was lower than that of those who accepted (72%, 95% confidence interval, 60%–84% versus 87%, 95% confidence interval, 86%–88%, respectively). After accounting for other prognostic factors including tumor characteristics and stage, women who refused surgery had a 2.1-fold (95% confidence interval, 1.5–3.1) increased risk to die of breast cancer compared with operated women."
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357734/

        1. Hi TG –

          Thanks for the link. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357734/

          The premise makes some sense – as assuming that most of these patients still had localized tumors that had not yet spread, removal should help.

          However, as the women who refused surgery had larger tumors than those who did not, and as it seems likely a priori that the larger and more developed the tumor the more likely the tumor may have already spread, even if tests did not detect this, the conclusions of the authors already have become compromised. To compare two groups, you need to match them as best you can in all characteristics except the one you want to look at, and not only did the group that opted out of surgery have larger tumors, they also averaged a full 10 years older! (See Table 1)

          If you looked at the survival of any two groups of people, in which one group had an average age of 58 while the other had an average age of 68, whether they had cancer or not, one would naturally expect to see decreased survival in the older group. Which they did.

          Furthermore, many of those who had opted out of surgery still underwent some for of conventional therapy – 36% had hormone therapy, 2.8% had chemotherapy, and 5.7%) received combinations of chemotherapy, radiotherapy, and tamoxifen. researchers should also have matched these variables when comparing the two groups.

          If they actually wanted to make a fair comparison of survival, given those who did have surgery comprised a much larger group 5,268 compared to only 70 who opted out, they could have easily randomly sorted out a subgroup from the surgically treated group that matched the opted out of surgery group with respect to age, tumor size, % that had hormone therapy, etc.

          They did not. I would not give this study a passing grade. Thumbs down.

          The more I look at the details of this research, and the way they set it up, the more this study looks like one contrived to arrive at a specific result. I hope that the other studies you’ve seen do a lot better than this!

          1. Some of these are fair points but some such effect is expected given that the patients weren’t selected or randomised. They self-selected.

            Also, you may have missed the part of the article where the authors state:

            “The age-adjusted risk to die of breast cancer for women who refused surgery compared with women who accepted surgery was 3-fold increased (hazard ratio, 3.0; 95% CI, 2.1–4.2). After adjusting for period of diagnosis, social class, method of discovery, sector of care, clinical tumor size, clinical lymph node status, and use of nonsurgical therapy (tamoxifen, radiotherapy, chemotherapy alone or in combination), the risk to die of breast cancer was still 2-fold increased (hazard ratio, 2.1; 95% CI, 1.5–3.1) among women who refused surgery.”
            https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357734/

            I think that this is a better study than your post gives it credit for. To be frank, and echoing your previous post’s last sentence, your remarks seem contrived to arrive at a particular result! I would encourage people to read the entire article for themselves.

            1. “I think that this is a better study than your post gives it credit for. To be frank, and echoing your previous post’s last sentence, your remarks seem contrived to arrive at a particular result! I would encourage people to read the entire article for themselves.”

              Hi TG –

              Good luck with that. Getting even scientists to read more than the title and the abstract has almost become a lost cause these days.

              As for the result I arrived at, I felt fully prepared to accept their conclusions about the value of surgery – at least for women with localized tumors, but as I pointed out, this study had a number of serious flaws. They could have done a direct comparison between two matched groups – they either did not do this, or did, and decided not to share the results.

              As far as the paragraph you mentioned, when they bring in a whole set of fudge-factors to age adjust etc. the data, all of these adjustments – and the assumptions they made in creating the algorithms – basically seem a black box, that no one other than a statistician can access or understand, that one has to take on trust. And when I see a paper promoting surgery published in a journal for surgeons, the Annals of Surgery, for me at least, trust becomes in short supply.

              1. I am not sure that I follow your points.

                For example, you criticise the study for lack of matching. In fact, it was a case control study in which cases were compared with controls and matched for eg age, tumours size, lymph node status etc …… and then you describe these matched qualities as “fudge factors”!

                1. Incorrect.

                  They did not do a “a case control study in which cases were compared with controls and matched for age, tumor size, lymph node status etc “. They compared two very different groups – a much larger group 5,268 of those who had surgery, compared to a very small group of only 70 who opted out. These groups differed significantly in many respects. They did not look at a randomly selected matched subgroup that matched the characteristics of those who opted out, who had on average larger tumors, 10 years older, etc. Instead they “adjusted” the statistical results that they obtained by comparing the very small group of people who opted out versus the very large and in many significant ways very different group who had the surgery, using “fudge factors” to adjust the data, based on assumptions that one may or may not agree with, that no one other than statisticians have access to.

      3. “How long would women untreated for breast cancer live, as a control, compared to women who undergo conventional cancer treatments?”

        I can give you a sample of two. My sister died of breast cancer after refusing any medical intervention until the bitter end; suffering a slow, painful decline over 3-4 years. I was DX with stage IV breast cancer 6.5 years ago and underwent “conventional” treatment (lumpectomy & radiation followed by estrogen receptor antagonist medication) and I’m still here with no reduction in quality of life. The 5-year survival rate for stage IV is currently around 25%.

        Improvements in care ARE being made. After a biopsy, cells are given a grade according to how different they are from normal breast cells and predictions can be made as to how fast-growing they will be. Hormone receptor +/- results can indicate which therapies will be the most effective. I spent 9 months on anti-estrogen medication before a lumpectomy reducing my tumor to the point that only a small area of tissue was removed. Chemotherapy was not needed or recommended.

        1. As far as improving ones odds not just for survival but for a healthy outcome, I’d recommend that anyone diagnosed with cancer check out Dr. Kelly Turner’s Radical Remission: Surviving Cancer Against All Odds, book, ( https://radicalremission.com/about/the-book/), and read it cover to cover, the sooner after diagnosis the better, although anytime seems good. Hope and inspiration can become in very short supply for people diagnosed with cancer once the cancer industry has gotten hold of them, where forcing patient compliance through fear, intimidation, and misinformation seems the rule. This book can provide a much needed infusion of hope and inspiration to those who have desperate need for them, and includes inspirational accounts both from those who chose alternative treatments alone and survived, and those who chose conventional treatments in combination with alternative modalities and survived.

          Building on previous work and going a few steps farther, Dr. Turner collected additional validated accounts of extraordinary healings from cancer, and then analyzed these accounts by actually asking the individuals involved what they had done. In her work she makes no apologies for focusing on individuals with extraordinary healing outcomes, and on the strategies they used to achieve such outcomes. These stories do not just seem anecdotal, which to doctors sometimes seems a synonym for unreliable or possibly invented accounts, but factual reports of extraordinary outcomes supported by full medical documentation.

          Regardless of whether patients chose conventional or alternative modalities, Dr. Turner found that almost all patients who experienced extraordinary outcomes made use of these nine key factors:

          1. They radically changed their diets; 2. Took control of their health; 3. Followed their intuition; 4. Used herbs and supplements; 5. Released suppressed emotions; 6. Increased positive emotions; 7. Embraced social support; 8. Deepened their spiritual connection, and 9. Had strong reasons for living.

          1. I watched a few interviews with her on YouTube about a year ago.

            I remember her talking about how doctors weren’t interested in what caused spontaneous remissions, and when she talked to the patients, they had worked very hard to have the spontaneous remission happen.

            She was part of my process of choosing to just do alternative treatments.

            I was too old for Tamoxifen, and I am not sure what the rates are for the other drugs and I wasn’t going to do surgery or radiation.

            I read all of the natural product studies and just jumped in and felt so confident.

            I bear witness to radically change their diet most of all, because if diet is such a big cause, I am not sure you could succeed without changing it.

            Though, I will say that I added in as many superfoods as possible and as many glasses of alkaline water and tea as possible long before I got rid of cheese, milk or eggs and there was a change in symptoms even just by flooding my system with the superfoods and I took hundreds of systemic enzymes and digestive enzymes and every kind of probably worthless supplement as possible. Something worked.

            Whether getting rid of soda and not drinking as much coffee – would be the acid theory.

            Or whether it was green tea, cancer interrupted or the antioxidant power of dandelion tea or broccoli sprouts or pomegranate seeds or if it is one of “Is there anything kale can’t do?’

            Getting enough herbs and broccoli sprouts and green tea and dandelion tea and pomegranate and kale and other cruciferous vegetables and Brussel Sprouts and garlic and onions and figuring out how to use essential oils and how to make my drinks alkaline enough was where I started.

            Now, I am also eating walnuts and pecans every day and I have been trying to find ways to incorporate lemon and lemon peel more often and cloves.

            I have not figured out turmeric and amla yet, but I am still working on it.

            This has been a non-stop adventure. I have been at it long enough that I watched my horizontal nail ridges grow out and watched my lump and eczema on my nipple go away and I feel like this has increased my intuition and increased my positivity and increased my love of food and increased my passion for colors and for the simple things in life,

            I didn’t get a diagnosis and I have to say that, because I was post-menopausal, never really ate well and had spent my whole life filling my body with every processed food and preservative and chemical and never ate organic and always ate junk food and drank soda and coffee and ate so much cheese and artificial GMO everything and fast food and restaurant food and white breads and white pastas and I never ate fruit and rarely, rarely ate vegetables and when I did, it would be an iceberg lettuce salad at a restaurant, so just hearing that I had to turn the Titanic around or go through medical care wasn’t something I was sure that I would even be capable of.

            This site is helping me refine all of it.

            1. I am laughing, because I was candy bars every day and double gulp soda for breakfast for years.

              Adding in the 7 servings of fruits that I eat every day, got rid of the room for candy bars and water and tea made the soda taste toxic.

              1. I had the symptoms start going away before I could even finish figuring out how to change the diet.

                Not sure which thing was working, but it didn’t matter.

                I said earlier that Dr. Greger’s 12 foods and the cancer fighting foods from his videos are things you add in.

                Focusing on adding in hyper-nutrition was so much more fun than trying to figure out how to treat all of the diseases that I probably had.

            2. I found Dr. Budwig’s essential oil for Cancer recommendation on Dr. Axe’s site.

              Rub frankincense essential oil on your neck three times daily. Also, drink three drops in 8 ounces of water three times daily.

              Cool, I have something to try.

  3. I totally agree with the concept of trying prevention through lifestyle changes; so many potential benefits, no harms that I know of. But I think it’s an uphill battle. I remember chatting once with a customer in a grocery store, who was buying lots of kale — for smoothies, she told me. She then proceeded to tell me that she had been diagnosed with breast cancer, and after treatment decided to lose weight. She then talked about how she’d learned that excess weight was a factor for increased risk of breast cancer, and practically hissed at me: “Don’t you think if I’d been told to lose weight to avoid breast cancer, I would have?” And I thought to myself: “No, I don’t think you would have, because there is no way you could have not known about the health risks of poor diet and excess weight, even if not specifically for breast cancer.” The message is out there; people don’t want to hear it.

    And my doctors even claim that they counsel their cancer patients about lifestyle — but I doubt it. First, because they never counseled me or my husband (also diagnosed with cancer) about it at all, and second, judging by the looks of their patients in the waiting room.

    1. As this video seems the last in the mammography and breast cancer series, and perhaps the main one that many future viewers may see, I think it seems worthwhile to repost these NFO video links that I compiled awhile for those who might find them useful:

      BREAKTHROUGH CANCER AND DIET RESEARCH
      http://nutritionfacts.org/video/is-it-the-diet-the-exercise-or-both/
      http://nutritionfacts.org/video/how-plant-based-to-lower-igf-1/

      STARVING CANCER WITH METHIONINE RESTRICTION
      http://nutritionfacts.org/video/starving-cancer-with-methionine-restriction/

      METHIONINE RESTRICTION AS A LIFE EXTENSION THERAPY
      http://nutritionfacts.org/video/methionine-restriction-as-a-life-extension-strategy/

      THE BEST (ANTI-CANCER) SALAD GREENS
      http://nutritionfacts.org/video/1-anticancer-vegetable/
      The top 10 against prostate cancer: Garlic, Brussels sprouts, Green Onions, Leek, Broccoli, Cauliflower, Kale, Yellow Onion, Cabbage, Beets.
      The top 10 against breast cancer: Garlic, Leek, Green Onions, Brussels sprouts, Cauliflower, Cabbage, Broccoli, Radish, Kale, Yellow Onion, and at # 11, Rutabaga!

      THE BEST (ANTI-CANCER) FRUITS
      http://nutritionfacts.org/video/which-fruit-fights-cancer-better/
      The top 2 against cancer growth – cranberries >> lemons >> apples or strawberries > red grapes > bananas or grapefruits > peaches > the last and least, pineapples, pears, and oranges, which had negligible effect.

      BOOSTING NATURAL KILLER CELL ACTIVITY
      Blueberry consumption may double the population of our cancer fighting immune cells, and the spices cardamom and black pepper may boost their activity.
      http://nutritionfacts.org/video/boosting-natural-killer-cell-activity/

      BERRIES VS. CANCER
      http://nutritionfacts.org/video/black-raspberries-versus-oral-cancer/
      http://nutritionfacts.org/video/strawberries-versus-esophageal-cancer/
      http://nutritionfacts.org/video/cranberries-versus-cancer/Vegan

      FLAX VS. CANCER
      http://nutritionfacts.org/video/just-the-flax-maam/

      Note On Flaxseed: (similar effects reported for other cancers, including breast and colon)
      A paper on the benefits of eating flax that came out in the in the December, 2008 issue of Cancer Epidemiology, Biomarkers & Prevention (http://cebp.aacrjournals.org/cgi/content/abstract/17/12/3577 )

      Men in groups eating a diet supplemented with 30g (about 3 TBS) of flaxseed a day had less than half the rate of tumor cell proliferation compared to those who did not. This inhibitory effect applies to other kinds of cancers as well.

      If a pharmaceutical company had a drug that did even half as well, even if only for prostate cancer, its stock price would surge.

  4. This was a powerful series.

    Hoping that the statisticians and researchers who are focused on mammograms start to dial in on differences in things like pre and post-menopausal, genetic risk factors, and whatever other factors they can find.

    Each piece of information helps women who fall into those categories.

  5. How is it possible, on the chart at 3:00 minutes, for there to be 2 breast cancer deaths prevented (out of 1000 women) but no overall deaths prevented? Also there are a few typos on the chart heading.

    1. Steve, the source for the breast cancer deaths vs. overall deaths was in one of the previous videos. I don’t remember which, but it was a striking piece of information.

    2. Not a typo.

      To summarize, for the majority of women, getting a routine mammograms seems a gamble with the odds stacked against them at over 10 to 1. For every woman “saved,” apparently at least one other dies, from over-diagnosis and over-treatment, with 10 healthy women having the quality of their lives severely impacted and shortened by years through undergoing a nightmare of unnecessary and grossly harmful treatments – having their breasts removed, their bodies damaged by radiation and poisoned by chemotherapy, and their bank accounts emptied.

      And as I understand it, for the woman “saved” who actually had breast cancer this does not mean that she goes on afterwards to live a long and healthy life – only that she survives at least 5 years from when she received her diagnosis.

      1. Yes, Alef, those are the thoughts I was pondering.

        Death in 5 years is only one factor.

        Women are getting their breasts cut off is a big deal.

        The financial ruin is a big deal.

        People lose their houses over medical care.

        I have so many friends who are so close to the edge, because of high deductibles and expensive care, that I probably am doing whole foods plant based to avoid doctors and med costs.

        I laugh, because Dr. Ornish said that “You might die” isn’t a good motivator and he is right, in my case.

        You might die is the type of thought “sometime in the great unknown” and it is balanced by all the elderly relatives who ate poorly and lived into their 90’s.

        It is going to cost me a fortune on meds turned out to be the thought that helped me to succeed.

        Immediate pay back.

        Also the images.

        The hardening of artery images and the after a year on Keto images were particularly effective.

        1. They don’t give enough of a graph of disfigurement – one out of three women having biopsy is a big disfigurement issue and that effect on mental health and relationships isn’t factored in.

          They also needed to actually put a box for the “might get Cancer from the procedure” group, even if it was a small box with a dotted line around it.

          If doctors can’t figure out the statistics accurately, they can’t expect the women to know what to mentally do with “might get Cancer from the procedure” and some women might say, “Okay, I will go once every 5 years” based on that factor. Or they might have to convince their doctor to let them have an ultrasound or something and doctors will fight them without having it represented in a proper way.

          Even if was an analogy. The movie, “Sleepless in Seattle” used the women over 40 have more chance of being struck by lightning than getting married….” or some line like that. Is it more chance of getting struck by lightning than getting Cancer from getting a mammogram every year? Does that vary based on body weight or something?

          And how much does the whole mastectomy and chemo and radiation cost nowadays?

          When I checked into the whole Mexico clinic thing, there were clinics you could go to where the cost of treatment was something like $20,000.
          My friend who owns a business in Paris had an American worker get Cancer who hadn’t gotten on France’s insurance and his cost for treating the cancer was something like $3000 for the whole treatment. (Made me think that some of my friends who don’t have insurance could combine a trip to Paris and still end up in less debt at the end.)

          I have friends who went homeless from trying to pay off medical care and it took them almost two years to get back into an apartment, because the medical care was also ruining their credit rating and they didn’t have cancer. They had spent a few nights in the hospital at $10,000 per night.

          My friend who had a heart attack and who has Diabetes and other problems has had her power shut off a few times.

          Last year, my brother’s wife had the worst type of meniscus tear and her ER visit, plus surgery, plus PT brought them up to their $12,000 deductible, then, she broke her front tooth and neither of those things are anywhere near the cost of cancer.

          I have a lot of people around me who have $12,000-ish deductibles and a few people around me who can’t afford insurance and the concept of having a useless surgery is the straw, which broke the camels back for many people.

  6. Thank you for the detective work. I’ve noticed that in previous videos, some people result to attack the detective (messenger?) instead of talking about the findings or provide evidence against. As they see people showing gratitude for the findings, they re trying to make good news sound bad. It is a 7 billion pot.

  7. Dr G,

    BMW dealers benefiting from my totally unnecessary breast surgeries for a cancer diagnosis that turned about to be false – all started with a suspicious looking mammogram. Ha ha! That’s almost funny.

    1. Mimi, I’m so sorry for your story. I have a friend at end stage leukemia, probably caused by chemotherapy for breast cancer almost 20 years ago — which was almost certainly over diagnosis from a mammogram and further imaging. She also had a double mastectomy. It all seems so terribly unnecessary. Black humor; very necessary at times.

  8. As profit clearly seems the motivating factor, to me this looks like a good situation for a class action lawsuit.

    Case 1. Suppose a patient could prove that Doctor X had intentionally diagnosed breast cancer, followed by a mastectomy on her, radiation and chemotherapy, when Doctor X knew that the woman did not have breast cancer at all. Aside from Dr. X losing his or her license, the liability judgement would run into the millions, even tens of millions. The result as far as the medical industry goes – a very large net loss.

    And yet it looks like the actual situation for over 90% patients treated for breast cancer after mammography screening looks pretty much the same.

    Case 2. Research indicates that when doctors diagnose breast cancer for a patient, followed by a mastectomy, radiation and chemotherapy, that they do so knowing that the woman has an over 90% probability that she does not have breast cancer at all. Now if they did this without properly informing the woman of these odds, and in fact intentionally misleading the woman in this regard, and even abusing their position by using fear and intimidation to get her to do undergo conventional treatment, to my mind on average this makes them just as guilty as Doctor X in Case 1, and just as liable for unprofessional conduct and to punitive damages.

    Of course, lawyers could argue that in any specific case, that doctors may have acted appropriately with regard to the diagnose, given that they have about a 10% chance of doing so. But for a class action lawsuits, for a large group of patients, this argument no longer applies, as on average, it seems clear that a large percentage of those in that group have suffered unnecessary harm. To me class action lawsuits brought against pharmaceutical companies who have marketed dangerous drugs should serve as a model useful model for a class action lawsuit against the mammography industry.

    From: https://www.druglawsuitsource.com/news/top-class-action-pharmaceutical-drug-lawsuits-2

    “Class action lawsuits are frequently filed against pharmaceutical companies for serious complications and harm caused by prescription medications.

    These lawsuits can involve thousands of victims who were injured or died from using a medicine prescribed by a physician. Many times, the risk of harm is not disclosed to the public or the medical community by the drug maker.

    A “class action drug lawsuit” is one in which a group of people with the same or similar injuries caused by the same drug sue the pharmaceutical company as a group. This is done so that the courts do not have to litigate thousands of similar cases and it creates a formidable team of lawyers for the victims to battle the large drug makers.”

    A successful class action suit of this kind would change the behavior of doctors with respect to accurately informing their patients of the actual benefits and risks of mammograms with regard to false positives and of the odds of unnecessary treatments, not because doctors would suddenly become more ethical, but because they would become personally and financially liable if they did not do so.

    At this point, given the amount of money made by the medical industry through routine mammogram screenings, and the false positives and unnecessary treatments that follow in their wake, I don’t see any other way of stopping this juggernaut of profits except by making dishonesty and intentionally misleading potential patients not only risky but extremely unprofitable.

    1. alef1, the problem is that it’s difficult to tell which cancers will be aggressive, certainly true for DCIS (Ductal Carcinoma In Situ — Stage 0, maybe a pre-cancer).

      And patients are stampeded by fear into treatment — after all, fear is the basis of the marketing to sell screening tests in the first place. My husband was diagnosed with prostate cancer before we met, and treated just before we started dating (he took two years to research treatments, since it was early stage), and so I did a lot of reading, and learned early on the harms of PSA screening and over diagnosis. But I recall chatting with a woman after a meeting who was distraught because her husband had just been diagnosed with prostate cancer, possibly very early stage; I asked about treatment options, and she literally screamed: “I JUST WANT IT OUT!! I WANT IT OUT!” I have always wondered if she was aware of the likely harms of surgery: impotence, incontinence, anal leakage. Now I wonder what her husband knew.

  9. Bravo! Great series, Dr. G & staff. Thank you for all the hard you put into this, digging through all the studies on this important topic. I, for one, will be sharing this series with every woman I know.

  10. Thank you so very much for this series. While it can be seen as deviating from your core focus of nutrition, it shares a common thread–we are not typically given neutral, scientific based findings on what the most current and sound research says is optimal for personal decision making on our own well being. Please keep providing us this vital “outside the nutrition box” information. Vicki

  11. Thanks, Dr. Greger, for another thought-provoking analysis of the use of mammography for early detection of breast cancer in the United States. It seems important to mention that the pathologist is the individual responsible for accurately diagnosing the kind of breast cancer a woman has, its stage, and other characteristics. When I was examined by a general surgeon prior to my biopsy, he could detect the lump manually. Based on the mammogram and ultrasound images, he suspected it was cancerous. But it was the pathology report that clarified the diagnosis: invasive ductal carcinoma. In all fairness to my surgeon, he provided encouragement by sharing that his mother was a 21-year survivor of breast cancer. I was fortunate to have a surgeon who had genuine compassion for me as a patient. Sometimes the power of a story can resonate with a patient in a way that statistics cannot.

    Based on this series, I’ve asked my medical oncologist if I can have an ultrasound rather than a mammogram for my six month check up. With Dr. Greger’s inspiration I am very careful about the food selections I’m making in accordance with the whole food, plant-based diet. Change is possible!

  12. Forgive me for communicating too much when I am learning things.

    I am talking it through, because it helps me to learn and helps build the logic.

    I am barely a vegan, but I don’t have to review that choice over and over again.

    Reversing diseases is wiser than monitoring blood sugar.

  13. Despite what some may say, there is evidence that breast cancer treatment saves lives. Decisions on whether to have a screening mammogram should be seen differently from decisions on whether to receive treatment once a diagnosis has been made. And diagnoses are usually made following multiple tests not just mammograms. I

    t is important not to just uncritically accept claims made by alternative health websites, medical conspiracy theorists or people who have very decided opinions about these matters – but no evidence – and just expect others to take their word for it. Do the research and demand evidence before taking decisions:

    “A total of 185 (1.2%) patients refused standard treatment. Eighty-seven (47%) were below the age of 75 at diagnosis. The majority of those who refused standard treatments were married (50.6%), 50 years or older (60.9%), and from the urban area (65.5%). The 5-year overall survival rates were 43.2% (95% CI: 32.0 to 54.4%) for those who refused standard treatments and 81.9% (95% CI: 76.9 to 86.9%) for those who received them. The corresponding values for the disease-specific survival were 46.2% (95% CI: 34.9 to 57.6%) vs. 84.7% (95% CI: 80.0 to 89.4%).

    Conclusions
    Women who declined primary standard treatment had significantly worse survival than those who received standard treatments. There is no evidence to support using Complementary and Alternative Medicine (CAM) as primary cancer treatment.”
    https://wjso.biomedcentral.com/articles/10.1186/1477-7819-10-118

  14. So…I guess my question is: would Dr Greger recommend routine mammography screenings for his wife and or daughters??

  15. I really appreciate all the information provided in this series. It’s good to get the perspective of caution about mammograms to counteract the chorus telling us to get them, get them, get them.

  16. One constantly hears that if a family member has had breast cancer, than your odds of getting breast cancer increase. But, how do you know if that family member really had breast cancer, or was misdiagnosed? It seems to be a a downward spiral. Then the relatives of these women who were misdiagnosed keep getting more mammograms because they are told they now have an increased chance of getting breast cancer, and this idea perpetuates to all female family members, and their off-spring! One false positive could have a negative impact for several generations of female family members!

  17. This is a very poor Pros and Cons, missing too many details and leading to false conclusions. Do learn the facts. Real facts. Cancer kills. Some are slow and some are fast. All are cruel to the body.

    Learn what tools and testing are available. For BC the best tool to date is MRI but very costly, takes time, and one has to be in a machine. Digital breast tomosynthesis (tomo), also known as 3D mammography, is a screening and diagnostic breast imaging tool to improve the early detection of breast cancer. Which is a better tool than standard mams. During the 3D part of the exam, an x-ray arm sweeps over the breast, taking multiple images in seconds. Same experience to the woman as a regular mam and is a little more in cost than a mam for most.
    There are more tools that have improved over the years too with ultrasounds and other devices that do not harm the body.

    Cancer can occur in anyone. It does not discriminate. Any race, sex, age, extremely active and healthy, etc.

    The only known causes for some BC types are the female hormones and HER2.

    Know you family history for all health issues.

    BC can occur with no history, good health, fit body, and great eating habits.

    Know that with any cancer, the earlier you find it, the easier it is to treat to live longer and not have to take drastic measures that can have other lasting impact on your body.

    If you do not want to treat then don’t screen.

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