October is here, and with the changing of the leaves comes pink extravaganza. The idea is well-meaning, but since its inception, in 1985, it has not been able to significantly affect change in the incidence of breast cancer.

According to the Maurer Foundation, breast cancer rates for women under 50 have remained stable since 1985 and breast cancer rates for women over 50 have remained stable since 2003.

During these 14-32 years – we have continued to pink-ify October and increase breast cancer awareness, and yet it seems to have had no impact.

Why do we continue this trend?

1-in-8-women-will-get-breast-cancer

Will it be you?

The statistic that 1 in 8 women will be diagnosed with breast cancer in their lifetime has remained stable, even with breast cancer awareness taking over our health care system. Today, the US Preventive Services Task Force recommends a mammogram every two years for women 50-74 years of age.

That is 13 mammograms for every woman with no symptoms, no preexisting breast cancer, no previous diagnosis of breast lesion, no known genetic mutation (such as BRCA1 or BRCA2), and no history of chest radiation at a young age.

Is it working? Is this the best course of action to prevent breast cancer? To prolong lives? To live happier, more fulfilling lives?

Is it worth it?

Is it worth a false-positive or an unnecessary biopsy? The paper, Benefits and harms of mammography screening, by Loberg et al. concludes

“Women should be correctly informed about the benefits and harms of mammography screening (Figures 1 and 2). A comprehensible way of communicating information on benefits and harms of mammography screening is presented in Figure 1: among 1,000 women who start screening at age 50 and are screened for 20 years, 2 to 3 will avoid dying from breast cancer and 200 women will have at least one false positive test, 30 will undergo a biopsy, 3 will be diagnosed with an interval cancer, and breast cancer will be overdiagnosed in 15.”

Loberg mammography_Fig1

Figure 1, Loberg et al., Breast Cancer Research (2015)

False positive – an identification of a breast tumor, when there is none. Data cited by Loberg indicate that over a 10 year period 30% of women in the US will have a false positive result, and 50% will experience a false positive in their lifetime! He also states that it takes up to 2 years for those false positives to be cleared and that women experience three years of psychological harm after screening.

False positive with biopsy –Women who undergo a biopsy, unnecessarily, due to a false positive.

Interval cancer – Cancers detected between mammogram screenings, that could have been overlooked or are rapidly growing tumors.

Overdiagnosis – In this case, the cancer is there, but is not relevant. This can apply to both in situ and invasive cancers. In other words, by the time the woman dies cancer would not have progressed to any stage that would have caused her health problems. So, while the cancer is actually there – the diagnosis causes stress during the remaining lifetime and doesn’t lead to a longer or more fulfilling life.

Loberg mammography_Fig2Figure 2, Loberg et al., Breast Cancer Research (2015)

Figure 2 from Loberg’s paper most adequately explains overdiagnosis and identifies four different possibilities, none of which prolongs life.

Do mammograms prevent death?

Loberg gets to the meat of the issue with the final figure of the paper:

Lobert mammography figure 6 (2015)

Figure 6, Loberg et al., Breast Cancer Research (2015)

If you examine where the dark green area (all death) meets the pale green area (alive) – it is in the same place. The only difference, Loberg concludes, is whether you died of breast cancer or other causes (as you see there is more light pink area along the top of the graph in the non-mammography chart).

At the end of the day, does it matter?

What is the financial impact of all this testing and overtreatment?

In Cost of Breast-Related Care in the Year Following False Positive Screening Mammograms by Chubak et al. (2010), they estimate an additional $503 in health care costs for the year following a false positive. That might not sound like much, but let’s do a quick and dirty analysis for the US…

308 millionpopulation of US in 2010
156,464,000Women in the US (50.8 % – source: Women’s Health USA)
54,136,544Women 50 or older – (34.6 %  source: Women’s Health USA)
27,068,272# Mammograms in the US a year. Assume every woman over 50 is following the suggested guideline of a mammogram every two years.
8,120,482False positives per year. (Loberg et al. – 30% false positives)
$ 4,084,602,245Cost per year of false positives. (Chubak et al. – $503 additional cost for a false positive)

 

A very rough estimate of… $ 4.1 TRILLION!

How do we truly affect change in women’s health?

Vitamin D has been associated with between 50-80% reduced risk of breast cancer incidence depending on the trial. GrassrootsHealth recommends getting your vitamin D level tested and maintaining 40-60 ng/ml (100-150 nmol/L) throughout your lifetime, to prevent many diseases, including cancer.

From the American Cancer Society’s Cancer Facts and Figures 2017 — 255,180 new cases of breast cancer will be diagnosed in the US this year.

What if we start now? Assuming a 70% reduced risk of incidence that would be 179,000 people who would be saved the trauma of breast cancer – both the disease itself and the horrific treatment.

Would it be worth implementing a new standard of care, which tested vitamin D levels twice a year until each person got their level over 40 ng/ml (100 nmol/L) and then once a year thereafter? GrassrootsHealth and 48 scientists say, “Yes!”

And yet we hear the following objections, again and again…

 

It is unsafe!It is costly!We need more research!
No, it is rare to find vitamin D toxicity.Joining D*action, this would be $65 per test, $130 per year.There are over 100 publications on the positive effects of vitamin D and cancer.
Toxicity may occur if you take over 30,000 IU/day for months at a time, or having a blood level at or above 200 ng/ml (500 nmol/L).

Toxicity occurs when a calcium test reveals a condition called hypercalemia (too much calcium in the blood).

While sunshine is free, if you need supplementation, it is approximately $25/year.GrassrootsHealth D*action has over 10,000 participants with an average vitamin D level of 44 ng/ml (110 nmol/L).

Join us today!

  1. Get your vitamin D level checked and maintain 40-60 ng/ml (100-150 nmol/L).
  2. Tell your friends, like our facebook page and share our information.
  3. Donate to GrassrootsHealth – as we enroll 1,000 more women in our Breast Cancer Prevention project.

References

Benefits and harms of mammography screening
Magnus Loberg et al.
Breast Cancer Research
May 2015
Read Paper

Cost of Breast-Related Care in the Year Following False Positive Screening Mammograms
Chubak et al.
Medical Care
September 2010
Read Paper

An Open Letter to the New York Times
Cedric Garland
December 2009
Read Letter (scroll down page)

The Problem with National Breast Cancer Awareness Month
Women’s Health
Robin Hilmantel
October 2015
Read Article

The Big Squeeze
A Social and Political History of the Controversial Mammogram
Handel Reynolds, MD
Cornell University Press
2012
Read Part of Book