Do Screening Mammograms Save Lives?

Doctor, it's Dr. Jen Simmons. I'm so delighted to have Dr. Felice Gersh here with us today. She is a pioneer in the field of women's medicine. She is double board certified in ob, GYN and integrative medicine. She's the author of three bestselling books. She has an integrative medicine practice in Irvine, California. And she has really devoted, dedicated her life to doing the right thing and materially improving the health of women. Elise, welcome.

Well, I'm so thrilled to join you. And I would say ditto to everything you said about me. Back to you, except for the specialties.

Thank you. Thank you very much. So I first heard you speak about mammogram about a year ago. You were speaking to a group of health professionals, and you were really speaking about the issues that exist in the screening mammogram system. So the program, which was developed in 1970s with a certain intention, actually doesn't meet that intention. So why don't you start by telling us about what the intentions of the screening mammogram program were and where we are today.

Well, I absolutely believe that it was, as you said, well, intentioned. Breast cancer is definitely a cancer that kills women. In the United States, over 40,000 women die every year from breast cancer. So trying to prevent those deaths is, you know, it's a good mission. And they came up with doing this mammography screening. And it, it's gone through a few different iterations from, you know, having portable X rays to having digital to now having the, the, the tomo that they call the 3D. And now they're looking at, to growing it into CT scans with mammograms. And then there's, of course, MRIs have gotten into the, into the mix. And the problem is that the foundation upon which this whole industry was built is really a house of cards, unfortunately, because the premise was based on this theory that all breast cancer would grow in a linear fashion. It would start really little, and then it would grow at some predictable but unknown rate, and then it would hit some magical size, but no one knew what that was, and, and suddenly it would metastasize and then it would become the killer cancer. It was. Find it when it's really small, we'll just improve mammography screening, which unfortunately, as we all know, is radiation, which is a known carcinogen. So that is a problem in itself. We'll just evolve mammography to pick up smaller and smaller types of lesions. And by doing that, we'll find it before it hits that magical point when it will metastasize and kill. But that isn't really how breast cancer grows, and that's really not what causes metastasis. It's not size, it's the quality and type of cancer, the cohesiveness of the cells, whether they break apart or they stick together. The premise of this was just wrong, because breast cancer can metastasize very early, when it's tiny, or it can never metastas, because even if it's the size of a baseball, it could still be together, but just locally invasive. And nobody dies of breast cancer just growing in the breast. It has to move to another organ, like the brain, the liver, the lungs, such organs where it can kill. The fact that it can also regress, it could stop growing. It can go in a multitude of different directions. It turns out that that mammography has gotten more able to pick up. Well, I call them the incidentalomas that do, dad. So it picks up lots of little things that are nothing. It picks up cancers that we're never going to kill, but they really meet the definition of cancer, but they were never going to kill anyone. And in the process of doing all of this, you're irradiating the entire population of women, because this is selective, they're saying global. The entire population of women will be irradiated on a very regular basis, starting at a quite young age, where the tissues are actually even more sensitive to the harmful effects of radiation. So that it can potentially. The mammographies throughout the 40s, when it has the least ability to do anything useful whatsoever, can actually set the stage for the breast cancers of women in their 60s, as breast cancer does increase with age. And so many procedures are done, in fact, in the model for predicting risk factors for breast cancer, it includes how many biopsies you've had. If you've had more biopsies, they're invasive and harmful and create inflammation in the breast tissue that can actually increase the risk for breast cancer down the road as well.

I think that that's a really interesting point that I want to add on to something that you said before. First of all, we're using a test that causes cancer to screen for cancer, right?

I have a big problem with that.

It's illogical in itself. And someone actually asked me today about what should someone who is at high risk, like someone with a BRCA mutation, what should they do? Shouldn't they be screening? And again, it's based on that whole. The screening premise is based on a falsehood because it assumes that if we find something small, that it's more curable. But breast cancers are what they are from the beginning. And then we take someone who is a BRCA1 or a BRCA2 carrier, and these people are even more sensitive to the harms of radiation. And we screen them. So we're actually increasing the likelihood that they're going to get a breast cancer by increasing the screening that they get.

I think that that is so important as a takeaway and to understand, like, why do women even get breast cancer? And it's due to harm that happens to the DNA and it comes from some kind of inflammatory source. Anything that is going to create inflammation in the breast, of course, that includes poor diets, obesity, aging, loss of our hormones, not having hormones, but loss of our hormones, and of course, radiation and other carcinogens that unfortunately, we live in chemical soup in our lives and so on. And when we add to that we're increasing the risk of breast cancer, not decreasing it, we can then change how genes are manifesting, the expression of genes to actually promote breast cancer. And then we have what we talked about in the past, that's called the paradox of the whole thing. That because there are so many people that have some kind of callback, they're told they have a positive finding and so on, that then every woman knows, some woman, either by first or second degree, we'll say, that has had something found. So every woman now feels she's like the proverbial sitting duck, that she is going to have something found and then runs back, and then they're told to keep coming and having more views. And the callback numbers to have additional views is an enormously high percentage, which leads to even more radiation exposure and anxiety. And then the expectation in women's minds that they're all going to get breast cancer and they're waiting for the shoe to drop, so to speak. So that paradox of the more you have breast cancer screening, the more things are found of all sorts, you know, completely incidental lomas. Breast cancers that we're not going to kill, breast cancers that were already destined to kill. I mean, that finding a breast cancer doesn't mean you've changed the outcome. That is like such, you know, thing. And. And so women then are brainwashed. I can't. I hate to use that word, into feeling that mammography is essential to save their lives. And the emphasis is in place on all the things that women can actually do that are really foundationally useful to lower their risk of breast cancer. They keep talking about early Detection, mammography, that mantra, mammography saves lives. It may reduce by a small number, and it is a small number breast cancer deaths. In some cases, it's a very small number, but it increases other causes, like we call all cause mortality because women die from other things at a higher rate. When you look at go out 10, 20, 30 years, the death rate is actually in no way lower in mammography screened women, the overall death rate than in unscreened women. Because you're the treatments for women that never would have died from their breast cancer or their destiny was already set. But then you accelerate their poor health status by doing all the treatments that we do for breast cancer on women that really weren't. They're not getting any benefit from it. So no.

So I want to dig into that a little bit. I want to dig into that because I think that that's a really important point that people don't understand. So when people hear that mammogram saves lives, it's not true. And in fact, when we look at the mammogram program and what it actually does, it accelerates all cause mortality. The biggest threat to a woman's life is cardiovascular disease. It dwarfs, it dwarfs the number of people that die of breast cancer. Cardiovascular disease kills exponentially more women than breast cancer does. We are taking these women, we are screening them with mammography, we are finding these lesions that would have never become clinically meaningful or relevant. And we are treating these women for an invasive breast cancer. Even when they have non invasive breast cancer, even when they have dcis, they are treated the same way as if they have an invasive breast cancer. Now you're taking people that would have never died of breast cancer, and you are accelerating heart disease, accelerating bone loss, accelerating dementia, causing anxiety and depression. And we know that all of these things translate into decreased longevity and decreased survival. And not only are they not living as long, they are living far worse. Because you take a woman with DCIS and she undergoes mastectomy, which many of them do out of fear, bilateral, often, often bilateral mastectomy. And now they're living the rest of their life as an amputee, questioning their sexuality, having a completely different fear infused into their life, and living a far lesser quality of life, all for a disease that would have never, ever affected their longevity. This is a huge problem. It is.

And when you take even very tiny, what they would call locally invasive, so it's very tiny, and they say it's invasive and then they do a lumpectomy, but then they're at the radiation. And like you said, radiation not only is a carcinogen, but it's also a tissue destructor. How you're irradiated, this has been shown, whether it's the left breast or the right breast, they're both tremendously harming when you do the radiation, the cardiovascular system, because you're irradiating the muscle of the heart, the myocardial cells, so they are more prone to dysfunction, have heart failure and the arteries that feed the heart become totally altered, like little hard tubes instead of flexible dynamic vessels. And so you're accelerating heart failure, heart attacks. And no one dies, like we mentioned, from locally invasive breast cancer. And no one is saying that radiation is saving lives. They're talking about it reducing local recurrence by a small percentage, which when you look at absolute numbers, is really small. And it's. So the radiation that is being done in older women as well, they're talking about maybe reducing it, but it's still incredibly prevalent. And they're much more likely to cause an earlier death from these women like you touched from a cardiovascular event, from a horrible death from like heart failure and having heart attacks and becoming a cardiac cripple. And, you know, these terrible things that happen. And, you know, so the treatments are being used very aggressively on women who have risk factors for having heart disease and heart, you know, bad heart outcomes, Very, very aggressively. And, you know, there's been so much more in the news about some of the potential harms from breast implants as well. And, you know, now you're taking so many women and putting, you know, implants in them that have to be replaced on a regular basis, which means they have to go through anesthesia, which has risk, risk of infection, hospital acquired infections. So, you know, there's a multitude of risk factors that are now coming into play. And once again, nobody dies of ductal carcinoma in situ. And it's often multifocal. That means it's in multiple places, often in both breasts. And that isn't even how breast cancer presents. It's not multifocal simultaneously in both breasts. It's like a different entity. And it's treated so aggressively and creates so much fear. And you can't underestimate what happens emotionally and the impact on all organ systems. And of course, taking away women's hormones. I'm a big hormone advocate. Is going to accelerate everything that you mentioned, like dementia and fractures and fractures cause many deaths in women. You can't underestimate the critical importance of the musculoskeletal system and then accelerate other metabolic diseases like diabetes, which has such an array of horrible life altering side effects and so on. So you got to look at the global picture. That's what you and I are doing. You can't just look at one thing. And there's been some studies. It's not impossible to do large scale prospective studies anymore. But in some data that has been collected over 10 years of doing a mammogram every year on 1,000 women, maybe, maybe you'll reduce one breast cancer death. Maybe. But look at the harm that you've created in a global population by screening 100% of women with this. And every time they create a new iteration of mammography, guess what? It has more radiation involved.

Exactly, exactly. This 3D mammograms that everyone is so excited about is three times the radiation of a 2D mammogram. And this radiation, this adds up. It's not going anywhere.

Oh, it is cumulative. Absolutely.

And cumulative.

They talk about, oh, you have far. When you do the 3D, you have fewer recalls come back. Callbacks, callbacks. But the thing is that when you look at the difference between the film screen, that's the one that antedated the, the 3D, the callbacks for the film, the digital was over the course of say 10 years, 60% of women had callbacks. 60% of women, there's something wrong. We have to do more views and get more radiation. And then often, let's repeat it in six months more and so on they get. And then they all psychologically are harmed. So what's the difference with the 3D? 50% callback, 60%. You think it goes down to 2% callback? No, it's from 60 to 50. And actually in my own practice, I haven't actually seen that. I don't know who collected that data. But I have patients that, you know, they have other doctors too, and they're. And they decide they want to do it. And I see really high callbacks, you know, on my patients. I can't. I mean, it's just, I really should keep some data here. But I would say in some cases, because they're trying to do them on younger, younger women so they can't see it's dense tissue. So it seems like it's like 70% callbacks. It's like, come back, we need to get more views. And it's like, and the anxiety that this creates. And of course, when you have them come back, then you're creating even more radiation exposure. Of course. So it's Just amazing what has been created from trying to save lives into creating a morass of fear and radiation exposure that is really highly potentially creating breast cancers. It can take from the time of the initiation of the breast cancer in older women until it's clinically manifested, can take 20 years. Okay, so, for example, if someone did something and then a year later they find breast cancer, that breast cancer didn't start from scratch and then be found in a year. I mean, people need to know that that's how sometimes they do a study and they say they gave this and then a year later they found breast cancer.

Yeah. In fact, that was part of the Women's Health Initiative. Right, Exactly.

That could not be the cause because that's not the way breast cancer develops and grows. So if you do, and this is what is being proposed by many medical societies, you start with annual mammograms at age 40. I've seen younger than 40 that they proposed. If you do that, and you're going to have a lot of callbacks in the 40s because those women are still having hormones in the 98% of cases are still making hormones. So they're going to have dense breasts, they're going to say, come back, we need more views. And all this. And so all those mammographies with three times, every time they do this series, it's three times the radiation dose of the previous iteration. What is that meaning for their risk for breast cancer in their 60s, like I said. And that's like, not being even talked about.

No, no, it's not. It's not because. Because we, we are being bombarded with that message, mammogram saves lives. And no one wants to talk about if it's true or how it's true, because it's simply not true. But this is a big machine. And the screening program leads to diagnostic studies, leads to additional studies like MRIs and ultrasounds, leads to biopsies, leads to cancer treatment. And this earns a lot of money for the system.

Oh, it's a multi, multi billion dollar system. And then put out data. Oh, the survival rate has increased so much. But they talk about survival as five years. So if you're finding cancers that were never destined to kill, or if they were destined to kill, they're still going to kill, but they're going to kill more than five years out. And all the ductal carcinoma in situ and all the false positives, then you can say, well, look, the, the survival rate is so much better. They're only talking about Five years. And you're really not changing when you go out 30 years. I mean, they're not talking about, well, when you look at global mortality 30 years down the road, like from the women in their 40s to women in their 70s, they're not talking about that when they say better survival. They're talking about five years. And those women were going to die in five years whether they had a mammogram or not. They were not going to die in five years. So what are you even talking about? This is where they play with statistics, you know, to make it sound like, oh, we have changed the paradigm.

Yeah, they manipulate the data to prove their point, but it's not truth and it's not fair and balanced information. And I want to make sure that we cover the March 8th FDA guidelines that everyone is so excited about, because we are empowering women. And the FDA instructed all mammographic centers that they have to inform women of their breast density by 2025. They think in doing this, they will improve the quality of the centers and improve the quality of reporting. And I actually have grave concerns, and I was quoted in a Fox News article about my concerns in the way that if we are going to tell women about their breast density and create fear and anxiety in this population, we are not offering them any solution. We are not even telling them what it means to have dense breasts and what, if anything, that they can do about it. So I believe that this is just going to drive more imaging, drive more anxiety, and I don't think it serves any positive purpose at all. So I'm not excited about these guidelines any more than I'm excited about the mammographic screening program, because I know that it doesn't have any benefits and it is all downside. So let me hear what you think about these new FDA guidelines and what meaning or significance that they have.

Right. So I faced it, because 38 states already had this in place, including mine, California, and that's been for about a decade. So what it does is it does drive up more imaging because. And then that drives up more radiation exposure, more interventions like biopsies, because many of the mammograms that are ordered are ordered by primary care doctors, like internists and family doctors and also ob gyns. And they all have this liability fear. You know, like, I don't want to miss it. I don't want to miss it. I don't want someone to sue me because I didn't, you know, aggressively pursue this. So now they're going to say, okay, well, let's send you back for more views. And then the people at the breast centers or all these breast centers now, they are going to say, okay, well let's get you in to get more views. We'll, you know, repeat it in six months. So they get more imaging, of course, creating tremendous anxiety. And if you get enough images, you're going to find these incidental doodads, okay. That are going to drive more biopsies, invasive procedures, and finding things that once again, we're never going to, you know, kill. Or if they were going to kill, they're still going to kill. I mean, they doesn't.

I also do think that just the anxiety, knowing that, that we know that anxiety has chemical repercussions in our body. Our, our chemical state changes when we are anxious. We can prove it with inflammatory markers. It does change our internal chemistry.

Absolutely.

And it is going to have physical manifestations. So I worry that we're even going to create some disease out of this because I don't think that radiologists are talking to people, to women, about what it means to have dense breasts.

You know what they're not? They're simply using this global. It's a risk factor. That's all they know. It's a risk factor for breast cancer. So it drives more fear, anxiety, more recalls, more additional imaging. And they don't know what any of that means. And understanding that virtually 100% of women in their 40s are going to have dense breasts, because dense breasts is what if you did a mammogram on 25 year old women, they have what I always call whiteout. I mean, you can't see a darn thing on a mammogram because the breasts are so dense. So why is that? Because they have functional breasts. They have estrogen, which causes the growth of the tissues of the breast, like the ductal cells.

And a breast is made up of glandular tissue, of connective tissue and a fat. And young women who are in a position to have children and breastfeed are going to have mostly glandular tissue by design.

So if you have what I'll call functional breasts, breasts that were designed to breastfeed, okay, those breasts are going to always be dense, and that is normal. That's because they have the glandular tissue that does its job, the lobules, the ducts and so on. And it's only when you get old, like say 60 plus, and you've been away, and if you're not on hormones, not on hormones, then if you have a breast that doesn't get exposed to estrogen like everything else in the body. As you get old, the glandular tissue that is involved in milk production and distribution, that all shrivels. So the breasts become more predominantly fat and so on a mammogram, they are less dense. But dense is not abnormal in women who have estrogen in their bodies, whether exogenous, like we're giving it to them, or endogenous, their bodies are making it. So that's normal. And what does it mean if you're an older woman not on hormones and you have dense breasts? It means that there's inflammation going on in those breasts and, and breasts, like many other tissues in the body, have an enzyme, aromatase, that can convert androgens, the male type hormones, into estrogens. And that happens, that enzyme is upregulated or becomes more active in an inflammatory environment. So you have more local production of a type of estrogen that comes from adrenal androgens. That's called estrone, which is not the same estrogen that the ovaries make, because estrogen is not a hormone, It's a family of hormones. And different types of estrogens have different effects. And the estrogen made by the ovary is very different in its effect than the estrogen that's made in fat tissue and other connective tissue in the breast in an inflamed environment. And the way that that is behaving, it's a very different scenario. So any woman who has naturally produced estrogen is going to have some degree of breast density. And they're telling women in their 40s who have regular menstrual periods that, oh, you have dense breasts, that's a risk factor. So if you actually look at women globally, 50% or more have dense breasts and that's including even the, you know, the older women. So when you talk about younger women, it's like going to be like 100% if they're having hormones and periods. So you're scaring all these women who have normal breasts and they're not distinguishing between a 75 year old woman who happens to have extreme breast density, and that's a sign of extreme inflammation in the breast. And then they never talk about, well, why is that happening? Well, most of those women have nutritional deficiencies, obesity and other risk factors that can be modified even, but that's not even talked about. So this global breast density thing, without actually explaining it, without recognizing that it only is actually a risk factor when it's extreme and it's in much older Women. That's not what's being dealt with now. It's like every woman who has dense breasts is suddenly put into this high risk category. And that is not true because there's no differentiation. There's no explanation for what causes breast density and how normal it is in a very significant population. Women who are undergoing screening.

Yeah. So let's sum up what we talked about today, because I know that you're a busy lady and you need to get back to your life. So we talked about. The screening program is based on a false premise. It is based on an assumption that breast cancer is predictable, that it has some predictable growth pattern and that it starts really small, gets to some critical size, at which time, if you find it before then, you'll prevent metastasis and you'll prevent deaths from breast cancer. But that's not true. Breast cancers are what they are from the beginning. And there are very small breast cancers that no matter what you do, people will not survive, and very large breast cancers that it doesn't matter what you do, because this cancer is not going to threaten someone's life. In screening the entire population, we are finding and treating lesions that do not need treatment. We are also not preventing the presentation of advanced cancers. When we screen people, we do not decrease the number of people who present with advanced cancers. That's because of that unpredictable pattern. And, and when we find these lesions that don't need treatment, but we treat them, we are causing and accelerating other disease states. There are psychological ramifications that are very real and change the course and the trajectory of people's lives. But we also accelerate cardiovascular disease, the number one threat to a woman's life. We are accelerating bone loss and fractures are a considerable reason for death and disability. We are also accelerating dementia, Alzheimer's, neurologic diseases in treating these breast cancers that really did not need treatment. The entire screening program, while it claims to save lives from breast cancer, they are really only talking about a five year survival. When we look at the long term data, there is no long term benefit to screening. In fact, I think, as we have proven today, there is a tremendous cost to the system, to lives, and to quality of life.

Absolutely.

Dr. Gersh, thank you so much for being here with me today and for helping to make this issue that is very hard for people to understand and accept because they have heard repeatedly for the last 50 years that mammograms save lives. So thank you for making this, presenting this information in a way that is understandable for people. I don't want people to feel badly that they're not getting a mammogram. You should not feel badly. You should not feel like you're not doing the right thing, that you're being irresponsible. I know that the messaging makes people feel that way, but the truth is that there are so many things that you can do to drive health, and getting a mammogram is not one of them.

Well, I love your message about. Yes. Why don't we focus on the things that actually change outcome, like the choices we make in so many ways, and not do things that harm us? I love it. Quality of life is what life is about. And, and, and this is everything. This is both longevity and quality of life we're talking about. And thank you for inviting me on.

Absolutely. Thank you for being here today. And I will see you real soon.