By Mindy Tyson McHorse, Contributing Editor
One of the biggest tragedies in the cancer epidemic is that science and technology gives a lot of people false hope. Especially women.
Today’s example: Too many women — and particularly those at high risk for breast cancer — don’t realize that mammograms are hardly effective. Yes, they detect some tumors, but more than a third of breast cancers are missed in women with dense breasts. And more than 40% of women in the U.S. have dense breasts.
That means mammography gives women false comfort that they’re free of disease, when in fact they have tumors getting bigger every day. They just don’t know it, because their dense tissue masks the appearance of tumors. Now technology has come up with a new solution — but you’ll have to overcome some foot-dragging by doctors if you want to benefit. Keep reading and I’ll explain…
Continued below. . .
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Several studies confirm that as tissue density increases, a mammogram’s ability to detect lesions plummets. A mammogram done on a woman with dense breast tissues will show white areas where dense tissue is found. But the problem is, cancers also show up as white areas.
Worse still, women with dense breast tissue are four to six times more likely to develop breast cancer. So you’ve got a huge group of women with the highest risk possible for this awful disease, who don’t know they’re at an elevated risk and have no way to reliably detect tumors.
But there may be a solution on the horizon, at least in terms of early detection. It’s called the Automated Breast Ultrasound (ABUS), and it appears to detect 30% more cancers in women with dense breasts who have normal mammograms. Better yet, it’s in the process of becoming a required part of the screening process.
A study in the September 2009 issue of European Radiology showed that automated, whole-breast ultrasound doubles the rate of cancer detection in women with high breast cancer risk and dense breasts. Even more incredible, it tripled the detection rate for cancers smaller than 10 mm. These findings provide plenty of justification for adding it to a widespread screening routine.
This is important, because early detection is still one of the best ways to beat existing cancer. In fact, according to the American Cancer Society, early detection means a survival rate of 96%.
How do you know if you have dense breasts?
Breast density has nothing to do with the way a woman’s breasts feel during an exam. It’s got more to do with having more gland tissue (which makes and drains milk), along with supportive tissue (called stroma) that surrounds the gland. Dense breast tissue is hereditary, though it can affect women of all races.
The simple answer to figuring out breast density is this: Take the volume of dense tissue in a woman and divide it by the volume of her breasts, then multiply by 100 for a percentage, and you have her tissue density. But what woman is able to figure out her own breast tissue volume?
Instead, we rely on our medical system, and therein lies the problem. Currently, radiologists and physicians have access to tissue density information, but often withhold that precious information from patients.
Just look at what’s happening in California. There’s a Senate Bill pending that would require mammogram providers to tell patients about their breast tissue density when their mammogram result letters are mailed out, since many doctors don’t share this information.
A similar bill was introduced last year and passed both the State Assembly and Senate, but was vetoed by Governor Jerry Brown, who echoed the concerns of the California Medical Association. They thought the required language — i.e., letting women know dense breast tissue puts them at higher risk and that they might benefit from additional screening — would cause women “unnecessary anxiety.”
Thank goodness at least for advocate and breast cancer survivor Amy Colton of California, who was diagnosed with advanced-stage breast cancer. She had three invasive tumors that her doctor said had probably been there for seven years. During those seven years she’d been getting “normal” mammogram results. Colton testified that both her physician and her radiologist knew she had dense breast tissue, but never told her that put her at higher risk, so she never knew to look into supplemental screening.
Colton since has undergone sixteen rounds of chemotherapy, five surgeries, and six weeks of daily radiation, all because her regular mammograms gave her a treacherously false sense of security.
Proof it works
That’s one of the reasons automated breast ultrasound is so important. Not only is it better at detecting malignancies in dense breast tissue, it’s also on the verge of being approved as a regular cancer screening tool. That way, women with dense breasts can be screened upfront instead of waiting to be informed they have dense tissue and then waiting for supplemental screenings.
We’ve been waiting on this for a while. The technology for automated breast ultrasound was first cleared for diagnostic use in 2005. In October of 2008, the U.S. Food and Drug Administration approved its use to help diagnose women with abnormalities suspected to be breast cancer. But it still didn’t become part of the routine screening process.
Fortunately, in April of this year an expert panel for the FDA recommended that automated ultrasound be approved for regular breast cancer screening in women with dense breasts. And moving the process forward one more step, last month the FDA said the ABUS system was “approvable” pending audits of the manufacturing processes. (The ABUS was created by U-Systems, Inc. and is distributed by Siemens.)
According to the study in the September 2009 European Radiology mentioned earlier, whole-breast ultrasound (ABUS) found 32 out of 49 cancers in women with dense breasts, whereas mammography by itself found only 19 of the 49.
You can’t know “too much” about your own health
Seems to me it’s a woman’s right to know whether she has dense tissue and needs additional screening. It doesn’t make sense for doctors not to tell women about elevated risk. And if money is their big concern (isn’t that always the case?), they should consider that early detection and treatment saves tens of thousands of dollars over treating advanced-stage cancer — not to mention saving lives.
So on one hand, it’s great to know technology is advancing and improving. But fancy technology is pointless unless it gets integrated into routine diagnostic tests so real people can reap real advantages.
In the meantime, any woman with dense breast tissue is advised to make sensible lifestyle choices to keep cancer risk at a minimum — like eating healthy food, limiting alcohol, staying at a healthy weight, exercising on a regular basis, and not smoking.
And if you’re a woman and don’t know whether your tissue is dense, keep asking till you find someone willing to tell you the truth about your risk.
Last month, the California bill passed unanimously in the Senate. Next step is the Assembly. And while California awaits the verdict, Texas and Virginia have also enacted breast density inform bills. Several other states are working on similar legislation, and Connecticut has already passed a law.
And, in the fall of 2011 a federal bill was introduced that would require radiologists to inform mammogram recipients of dense tissue.
I hate to say we’ll have to wait and see, so if you’re a woman, make sure you ask your doctor about your tissue density level. Unlike the Governor of California and his doctor friends, I don’t think there’s such a thing as “too much information” when it comes to your health.
And if you’ve been told you have breast cancer, what then? Cancer Defeated publishes a guide on what to do called Breast Cancer Cover-Up. It reviews the best options for treatment, as we see them. The Special Report also covers thermography, a screening test for breast cancer that we think is far superior to mammography. (Mammography — in addition to being inaccurate — actually CAUSES cancer with its massive annual doses of radiation). Click here to learn more about this Special Report.
And men have problems of their own when it comes to screening and early detection for cancer. It seems there’s new evidence that the PSA test is nearly useless. If you missed this important news, please scroll down and read it now.
Government Experts Throw in the Towel
on the PSA Test
After at least two decades of touting it as the gold standard for prostate screening, the medical establishment appears to be turning its back on the popular PSA test.
In a May 2012 statement from the U.S. Preventive Services Task Force (USPSTF), co-chair Michael LeFevre, M.D., said that “men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms.”
This pretty much has been my stance all along! Keep reading and see why the PSA test has been such a disaster…
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The government group is now saying that the ‘cons’ of having the test generally outweigh the ‘pros’ for most men under age 75.
The ‘cons’ are nasty indeed: If this unreliable test indicates a man may have prostate cancer, the next step is a biopsy. This is a highly invasive test in which small samples of tissue are cut out of the organ to be examined for cancer cells.
A biopsy can result in pain, fever, bleeding, infections and problems urinating. Worst of all, if cancer cells are actually present, it can spread them.
After all this risk and discomfort, the biopsy will often show no cancer is present — because the PSA test that prompted the biopsy in the first place is so often wrong.
And what if you DO have cancer?
Let’s suppose the biopsy does find cancer. What then? The most likely next steps are surgery or radiation. You might think, “Wonderful, the PSA test led to early detection and treatment!”
Not so fast. Most prostate tumors are pretty harmless. Surgery and radiation are NOT needed. The best option is to do nothing. So, in reality, the PSA test has led to overtreatment. And the treatments can lead to lifelong incontinence or impotence, not to mention a lot of pain, expense, lost work days and who knows what else.
Well, actually, we do know what else: the fear, stress and anxiety of worrying about a cancer that didn’t pose a threat.
Each year about 1,000 to 1,300 men die from complications connected to treatments that took place because the victims had a high PSA score.
As I’ve written in this space before, only about one prostate cancer out of ten is aggressive and therefore life-threatening. In a large study called the Prostate Cancer Prevention Trial, only 28% of men in their 60s who had a high PSA score turned out to have cancer as shown by a biopsy — slightly more than one man out of four.
The rest — 72 out of a hundred — had a high PSA score, but NO CANCER.
And of those who had cancer, only about one out of ten died of it. To be exact, 3 died out of every 28 men whose biopsies showed cancer. And don’t forget, that’s 3 out of the 100 who had a high PSA score at the beginning of this whole mess.
I want to underscore this: Out of a hundred men with a high PSA score only 28 had cancer and only three died of it.
This test is all but worthless, and that’s what the U.S. Preventive Services Task Force now confirms. The USPSTF reviewed previous research on this subject, including two large studies in the U.S. and Europe. When they compared men who were routinely screened with the PSA test and those who were not, there was no difference in death rates over a ten-year follow-up.
Again, I want to underscore this: Men who were tested like the dickens for prostate cancer were just as likely to be six feet under a decade later as those who weren’t tested at all.
Now, there’s a curious twist to this story. Most studies have focused on five-year survival rates, and found that PSA-screened men ARE more likely to survive more than five years. Why doesn’t that hold up when you look at a ten-year time frame?
All you get is more years of worry
It’s actually simple, when you think about: Finding cancer earlier means you live longer knowing you have it.
Consider an example: If John Smith died of cancer in 2010 and it was first diagnosed in 2006, he’s not a five-year survivor. But say he had a PSA test in 2003 and a biopsy then detected cancer. He still dies in 2010 — but, bingo! Now he’s a seven-year survivor!
And that’s exactly why the PSA test, biopsies and aggressive treatment are trumpeted as increasing five-year survival rates. The men do NOT live longer. They die at the same time they would have anyway. But the cancer is detected earlier and in the official records those men beat the five-year mark.
When the USPFTF focused on ten-year survival rates, they exposed this bogus claim of success, and the PSA test was revealed to be almost worthless.
The group advocates putting a halt to PSA screening tests unless a person “makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”
The panel said the best option would be to pursue better testing and treatment options. Clearly, what’s needed most is a test to identify aggressive cancers and distinguish them from slow-growing cancers that — in men over 60 — could be left untreated. There’s some action on this front, but no reliable test yet, as far as I know.
Watch the trend, some doctors say
Supposedly there IS a way to get some good out of the PSA test — observe the trend over a series of tests. If you’re tested every six months and the PSA score is trending up, some doctors say it indicates an aggressive cancer may be present. Biopsies and more aggressive treatment may be warranted.
Quite a few urologists and oncologists are now working on this assumption, but I don’t know how much evidence there is to support it. For what it’s worth, I have a dog in this fight. My PSA number is slightly elevated and increased very slightly over the past year. I’m not alarmed, but I’ll get tested again in six months and see if there’s an uptrend.
It’s called “watchful waiting” — and it’s by far the most sensible strategy for most men who have a high PSA score and even for those who are told they have a tumor.
Urologists and even general practitioners are reluctant to give up on the PSA test. They continue to use as if it means something. My guess is that most men middle-aged and up are still being regularly tested. “Do nothing” is not an appealing strategy to most people — and that includes patients, who are easily panicked into biopsies, and then into radiation or surgery, when a doctor starts throwing around the “C” word.
Lee Euler Publisher