Problems with Mammograms and MRIs

UPDATE 1: A study just published (February 2014, British Medical Journal) of 90,000 women, tracked for 25 years, shows mammogram screenings do not lower mortality rates compared to a similar population of women who did not have mammograms. Results also show 22% of women with breast cancer were over-diagnosed, meaning they received treatment they did not need, because the mammogram could not determine whether the cancer was aggressive or non-threatening. These results correspond with findings from a Swedish study published in 2012  in the Journal of the National Cancer Institute and a British study published in 2012 in the Journal of the Royal Society of Medicine.

UPDATE 2: Also see the Annotated Bibliography of Mammogram Research and Annotated Bibliography of Thermography Research to learn what researchers say about these technologies.

The following information is directly quoted from the American Cancer Society [with comments in brackets]. The overall message is that mammograms and MRIs are not effective in detecting cancer. Yet the American Cancer Society continues to push these ineffective diagnostic and screening tools as the only options for women. This is no longer true.

Limitations of Mammograms

A mass, which may occur with or without calcifications, is another important change seen on a mammogram. Masses can be many things, including cysts (non-cancerous, fluid-filled sacs) and non-cancerous solid tumors (such as fibroadenomas), but they could also be cancer. [The point is that an “abnormal” finding on mammograms is not a trustworthy indication of breast cancer.]

A mammogram cannot prove that an abnormal area is cancer.

Women can feel confident about the benefits associated with regular mammograms for finding cancer early. However, mammograms also have limitations. A mammogram will miss some cancers [Cancer is present, but the mammogram doesn’t find it, leading to a false belief that the patient is healthy, while the cancer continues to grow], and it sometimes leads to follow up of findings that are not cancer, including biopsies [not sometimes but most of the time–see the next paragraph].

Although the majority of women with an abnormal mammogram do not have cancer, all suspicious
lesions that cannot be resolved with additional imaging should be biopsied for a definitive diagnosis. [Question: How many women without cancer are “forced” to get unnecessary biopsies because the mammogram technology is incapable of detecting cancer accurately? Answer, according to this statement by the ACS: most. Mammograms only look at what is in the breast tissue, and they admittedly don’t do that very well.]

Difficulty with Dense Breast Tissue

Mammograms are not perfect at finding breast cancer. They do not work as well in women with dense breasts, since dense breasts can hide a tumor. Dense breasts are more common in younger women, pregnant women and women who are breastfeeding , but any woman can have dense breasts. [What this means: If a young woman has breast cancer, it may not be detected for years until she is older…and the cancer has grown significantly. Even then, the mammogram may miss it. Early detection is important, but a mammogram is least capable of finding breast cancer in younger women.]

Breasts are made up of fatty tissue, fibrous tissue, and glandular tissue. Someone is said to have dense breast tissue (as seen on a mammogram) when they have more glandular and fibrous tissue and less fatty tissue. Women with dense breasts have a higher risk of breast cancer than women with less dense breasts. Unfortunately, dense breast tissue can also make mammograms less accurate.

Women at moderately increased risk [for breast cancer] include those who . . . Have extremely dense breasts or unevenly dense breasts when viewed by mammograms [This statement, combined with the previous statement, means that mammograms have the least effectiveness in higher-risk cases. The greater the risk due to dense breast tissue, the less effective mammograms are.]

A number of factors can affect breast density, such as age, menopausal status, the use of drugs (such as menopausal hormone therapy), pregnancy, and genetics.

Dense breasts are not abnormal. Although dense breast tissue can make it harder to find cancers on a mammogram, at this time, experts do not agree what other tests, if any, should be done in addition to mammograms in women with dense breasts. [Notice “in addition to mammograms,” not “instead of mammograms,” even though mammograms are poor tools for detecting breast cancer in dense breasts. The ACS admits they don’t know what to do with younger women and other women with dense breasts–because their standard processes are not effective for this group of women.]

At this time, American Cancer Society guidelines do not contain recommendations for additional testing to screen women with dense breasts who aren’t at high risk of breast cancer. [The ACS said that women with dense tissue, such as younger women, have a greater risk of cancer than those without dense tissue. The ACS recognizes that that standard, “accepted” forms of screening are ineffective for women with dense breast tissue, particularly because mammograms cannot differentiate dense masses in the breasts from other breast tissue. Breast density has no effect on thermographs.

Limitations of MRIs

For most women at high risk, screening with MRI and mammograms should begin at age 30 years and continue for as long as a woman is in good health. There is no evidence right now that MRI is an effective screening tool for women at average risk.

For certain women at high risk for breast cancer, screening MRI is recommended along with a yearly mammogram. It is not generally recommended as a screening tool by itself, because although it is a sensitive test, it may still miss some cancers that mammograms would detect. [This is a troubling statement because mammograms also miss some cancers.

MRI is more sensitive than mammograms, but it also has a higher false-positive rate (it is more likely to find something that turns out not to be cancer). This would lead to unneeded biopsies and other tests in many of these women, which can lead to a lot of worry and anxiety. [This raises the question of why it is recommended.]

These false positive findings have to be checked out to know that cancer isn’t present, which means coming back for further tests and/or biopsies. [If MRIs have greater false positive rates than even mammograms, and are even less accurate than mammograms, why are they recommended?] This is why MRI is not recommended as a screening test for women at average risk of breast cancer, as it would result in unneeded biopsies and other tests in a large portion of these women.

Use of Breast Ultrasound

Usually, breast ultrasound is used to target a specific area of concern found on the mammogram. Ultrasound helps distinguish between cysts (fluid-filled sacs) and solid masses and sometimes can help tell the difference between benign and cancerous tumors. Ultrasound has become a valuable tool to use along with mammography because it is widely available and less expensive than other options, such as MRI. The use of ultrasound instead of mammograms for breast cancer screening is not recommended. [Ultrasounds are used to confirm mammogram findings, meaning they are more accurate, and they are less expensive than MRI. Because ultrasound imaging is broadly accepted by the medical community, ultrasound is commonly recommended to double check suspicious thermal imaging findings as a safe, lower-cost, more accurate diagnostic tool than mammograms.]

Additional Complications with Inflammatory Breast Cancer

Because of the way inflammatory breast cancer (IBC) grows and spreads, a distinct lump may not be noticeable during a clinical breast exam, breast self-exam, or even on a mammogram. [Mammograms may miss IBC because that technology is not effective for finding this type of cancer.] However, signs of IBC can be seen on the surface of the skin, and skin thickening often shows up on a mammogram and can be seen during a clinical breast exam or breast self-exam.

If inflammatory breast cancer (IBC) is suspected, a diagnostic mammogram is the first test ordered. Sometimes the swelling and tenderness can make it hard to do a good mammogram. The mammogram may show thickened skin, often without a visible mass (tumor). It can also show that the affected breast is larger and denser than the other breast.

Unfortunately, because IBC grows and spreads so fast, screening is not generally helpful for finding this disease early. [Mammograms specifically look for hardened masses in the breast, not inflammation. Indeed, the nature of inflammation makes mammograms particularly ineffective, as just noted. Note also that IBC creates swelling, which is caused by increased blood flow and which is easily detectable through thermal imaging.]

References

http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf

http://www.cancer.org/cancer/breastcancer/moreinformation/inflammatorybreastcancer/inflammatory-breast-cancer-inflammatory-br-ca-diagnosis

http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-diagnosis

http://www.cancer.org/cancer/breastcancer/moreinformation/inflammatorybreastcancer/inflammatory-breast-cancer-inflammatory-br-ca-detection

http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-risk-factors

http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-detection

http://www.cancer.org/cancer/breastcancer/moreinformation/breastcancerearlydetection/breast-cancer-early-detection-a-c-s-recs-m-r-i

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