A short YouTube talk by Dr. Jenn (Jenn Simmons, MD) arguing that population mammographic screening (introduced in the 1970s) does not save lives, causes overdiagnosis and overtreatment, and exposes breast tissue to repeated ionizing radiation. She contends breast cancer biology is often non-linear (aggressive tumors are aggressive from the start; many detected lesions would never become clinically relevant). Alternatives she discusses: monthly self breast exams to detect clinically relevant cancers, limited role for thermography/ultrasound (she finds them unreliable for universal screening), and an FDA-approved modality called QT imaging (radiation-free, 3D sound-based imaging with high resolution) which she sees as a likely future replacement. She recommends self-exam until QT imaging becomes widely available.
Chapters
Hi there, it's Dr. Jen. You asked and I answered. Today we are going to talk about the alternatives to mammogram. Let's first talk about the mammographic screening program, what it is and what it isn't. So originally in the 1970s, when the mammographic screening program was rolled out, it was intended to save lives. And that is the slogan that it has used for decades. But we never asked, how does it save lives? Does it really save lives? Because these are really important questions. So the mammographic screening program is based on the premise that breast cancer grows in a linear fashion, that it grows in a predictable fashion, and if you intervene early, you can change the trajectory of that disease. And it is a lovely theory. It just doesn't happen to be true. Now, there are other cancers that it's true for, and things like colon cancer do grow in a linear and predictable fashion, but breast cancer does not. Unfortunately, breast cancer is what it is from the beginning. So if it's going to be an aggressive process, it's going to be an aggressive process from the very beginning. And it doesn't start at some small size, grow to some critical size, at which point it is more likely to metastasize. It just doesn't happen like that. The characteristics and the behavior and the biology of breast cancers are what they are from the beginning. So if it's going to be an aggressive breast cancer, it's going to be an aggressive breast cancer. And it doesn't matter if you find it when it's 5 millimeters or 1 centimeter or a centimeter and a half. This is going to have aggressive biology and needs to be treated aggressively no matter when you find it. Whereas there are many, many situations in the breast one where you have a formation of a tumor that will never grow to any significant size, will never metastasize, and these tumors sometimes even regress on their own. And so they do not require treatment. When we screen the entire population, we often find these lesions, these lesions that are not meaningful, these lesions that are not significant, these lesions that would have never become clinically relevant. And we treat them, we give people a diagnosis of breast cancer. We subject them to surgery, to radiation, to chemotherapy, to anti hormonal drugs. And in doing that, we actually shorten their lifespan, because all of these treatments take their toll on lifespan. They markedly decrease our health and they decrease our ability to deal with other toxins, they increase our toxic load, and they decrease our ability to deal with other toxins in the environment. So the treatment for breast cancer Is very detrimental to many of the people that use it. And no matter how many women we screen, no matter how many women we treat, the exact same number of women die of breast cancer every single year. We know that mammogram is not. Not impacting that bottom line. And no matter how many mammograms we do, we see the same number of women present with advanced disease. People who are screening every year present with advanced disease. So screening does not change the bottom line. It does not change the ultimate impact of breast cancer. And unfortunately, it doesn't save lives. So let's talk what it actually does. Mammograms utilize radiation and radiating the tissues of the breast year after year after year after year. And when you think about it, when we recommend that screening starts at 40 and continues to 70, that is 30 years of repeated radiation to the breast, A tissue that is already sensitive, that is already subject to the insult of the environment. The breast is already more inclined than other tissues in the body to be significantly damaged by radiation. And what radiation does is it. It destroys DNA and it actually causes cancer. We know that radiation is a proven carcinogen, a known carcinogenic. When we're radiating women year after year after year after year, supposedly to screen for breast cancer, we're actually going to cause breast cancers in that population. I do not believe that there is any benefit to screening our population with mammogram. This is why there are countries around the world that have abandoned their mammographic screening programs because they don't save lives, because they don't contribute to public health, and it is nothing more than an expense on the system and putting people's lives in danger. There is no survival advantage to screening with mammogram. We know that with population studies that women who screen with mammogram do not live longer than women who don't screen with mammograms. So there is no benefit to screening. And I am not in support of screening mammograms. So people often ask me, and that is the question for today, what is the alternative to mammogram? Well, I believe that breast cancers that are going to be clinically relevant will show themselves. So I do believe that we all need to be examining our breasts. We need to be doing it on a monthly basis, not on a daily basis. I don't want everyone obsessed with doing it, but that on a monthly basis, you should look at your breasts, you should feel your breasts, and you should know where your breasts are. In terms of. So many people say, like, oh, Well, I have lumpy breasts, so I don't know what is what. Well, get to know your lumps, get to know your breasts, get to know the texture of your breast, what it feels like normally, what it looks like normally, so that you can recognize when there's been a change and when there's been a change. I believe in using what we have to help you to determine what is happening. So I don't believe in throwing the baby out with the bathwater. I don't think that mammograms are going to have no role in the future. They will have a role in the future, but the role will be far different than what it is now. People often ask me, can they use thermography to screen for breast cancer? I have seen too many breast cancers not be detected by thermography, so I don't think it's a reliable enough method. And so I don't generally recommend thermography for screening. People ask, can I use ultrasound for screening? There are a lot of new ultrasound techniques on the market. Ultrasound still has pretty low visibility. There is a lot of variability from person to person, from reader to reader, and I don't think that the images are good enough to really use it universally for screening. So I don't think that that is a solution. There is a solution available on the market now that is FDA approved. It's called QT imaging. I know that, I'm bringing it the East Coast. It already exists on the west coast. It is not universally available now, but it will be universally available. This uses sound waves to create a three dimensional image of the breast with 40 times the resolution of MRI. There is no compression, there's no pain. It is relatively fast in that most women can be screened in 15 minutes. Some will depending on your breast size, some will require a little longer. But again this is a radiation free, safe and comfortable test. So the days of compression, the days of radiation, they're over. It is not necessary to screen with radiation, with compression, with pain, with trauma. So I, I believe that those days are behind us. And until QT comes to a town near you, self exam is pretty much all you need. If you want to supplement with ultrasound, you can supplement with ultrasound, but I don't, I don't think that that is universally necessary. And again I am confident that that all of this screen, that this screening issue will be solved in the next five years. It's Dr. Jen, bye for now.
