New Federal Guidelines Ignore Dangers of Mammography
By Dr. Samuel Epstein
The updated Federal guidelines, announced by Health and Human Services Secretary Tommy Thompson on February 21, strongly recommending annual mammography for women over the age of 40, are unlikely to resolve the current headline debate.
The guidelines, surprisingly based on an
unpublished analysis by an independent advisory board, ignore evidence on the
risks of breast cancer from mammography. Furthermore, they dismiss evidence
on the effectiveness of breast self examination (BSE) combined with annual
clinical breast examination (CBE).
This is about 1,000 times greater than exposure from a chest x-ray which is broadly focused on the entire chest rather than narrowly on the breast. The premenopausal breast is highly sensitive to radiation, each 1 rad exposure increasing breast cancer risk by about 1 percent, with a cumulative 10 percent increased risk for each breast over a decade's screening.
Radiation risks are further increased, by
some four-fold, for the 1 to 2 percent of women who are unknowing silent
carriers of the A-T (ataxia-telangiectasia) gene. By some estimates, this
accounts for up to 20 percent of all breast cancers diagnosed annually. All
these risks are greater for women in their thirties who are being encouraged
to undergo "baseline screening," for which there is no evidence of
any future relevance.
Based on a unique individually randomized control trial on breast cancer mortality in some 40,000 women, it was concluded that monthly BSE following brief training coupled with annual CBE by a trained health care professional is a least as effective as screening mammography in detecting small tumors.
National networks of BSE and CBE clinics
staffed by trained nurses should be established to replace screening mammography.
Apart from their minimal costs, such clinics would empower women and free
them from increasing dependence on industrialized medicine and complicit
These costs would be increased some
four-fold if the highly profitable machine and film industries succeed in
replacing film machines, costing about $100,000 each, with the latest
high-tech digital machines costing about $400,000 each. These have been
recently approved by the FDA although there is no evidence of improved
Samuel S. Epstein, M.D.
Professor Emeritus Environmental Medicine
Published in the LA Times February 25, 2002