breast cancer

Birth Control’s Breast Cancer Curveball

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Hormonal birth control is bad. It just is.

I know there are women who say they took it for decades and it didn’t do any harm to their bodies. It’s possible that’s true for a very small percentage of women. Maybe it didn’t cause any noticeable harm, but I can guarantee it didn’t do anything good for their bodies.

Some new studies have convinced me that you can simply never let hormonal birth control off the hook when it comes to assessing its side effects.

Basics of Breast Cancer

The link between hormonal birth control and breast cancer has been pretty well established over the past few decades. A quick look at the types of breast cancer and a pinch of common sense help us grasp a better understanding of their association.

When a patient is first diagnosed with breast cancer, doctors test for three primary receptors within the tumor to help them identify it. Two of the three receptors are closely related to hormonal contraceptives. The most prolific type of breast cancer contains estrogen receptors (ER-positive). Nearly 80% of breast cancers are ER-positive. The presence of these receptors in a tumor indicates that it will grow more quickly in the presence of estrogens.

The high percentage of ER-positive tumors provides a stark reminder of the warning issued by Dr. Roy Hertz at the Nelson Pill Hearings in 1970:

“[Estrogens] are to breast cancer what fertilizer is to the wheat crop.”

No Safer Birth Control

You might think the safer solution would be to switch to progestin-only birth control. Unfortunately, about 65% of breast cancers contain progesterone receptors (PR-positive). Tumors containing one or both of these two receptors are known as hormone-receptor positive.

Knowing the tumor contains hormone-receptors helps the doctors create a plan of attack. For example, after the initial treatment, doctors will frequently prescribe a drug like tamoxifen to block hormone-receptors and hopefully prevent future metastasis.

The third of the three principle receptors in breast cancer isn’t as easily connected to hormonal birth control. About 20% of breast cancers test positive for human epidermal growth factor receptor 2, commonly called HER2. This protein receptor normally helps control breast cell growth, but when too much of it is produced, it paves the way for an aggressive tumor type.

Triple Negative

Tumors that test negative for all three receptors are known as triple negative breast cancer. This type makes up only about 10-15% of breast cancer cases, but it can be particularly aggressive and prone to relapse. It is also much more likely to metastasize, usually to the lungs and/or brain, and especially in younger women.

Because triple negative tumors test negative for hormone-receptors, doctors have always assumed drugs like tamoxifen would offer no benefit to these patients. But, that’s where things start to get interesting.

Birth Control and Brain Metastasis

A recent study from the University of Colorado Cancer Center stepped outside the box (or in this case, outside the cell) to study the condition of the tissues that surround and support the cancer. Diana Cittelly, PhD, an investigator from the study, offered this explanation, “The cancer cells aren’t responsive to estrogen, but estrogen influences the microenvironment. We found that astrocytes – one of the main components of the microenvironment in the brain – are estrogen-responsive. When they are stimulated with estrogen, they produce chemokines, growth factors, and other things that promote brain metastasis.”

Specifically, they found that estrogen induced the astrocytes to produce two growth factors: brain-derived neurotrophic factor (BDNF) and Epidermal Growth Factor (EGF). These two factors ‘turn on genetic migration/invasion switches in cancer cells,’ making the environment more conducive to metastasis.

Cittelly speculated, “This may explain why breast cancers diagnosed in younger women are more likely to metastasize to the brain – pre-menopausal women have more estrogen, and it may be influencing the microenvironment of the brain in ways that aid cancer,”

While the team didn’t specifically study the effects of birth control hormones, it doesn’t require too much of a leap to carry the speculation a bit further and consider that the flood of estrogens from contraceptives could also contribute to the higher likelihood of metastasis to the brain for women in their reproductive years.

It’s also interesting to note that EGF, Epidermal Growth Factor, a protein that is believed to play a role in how cells normally grow is the same protein that binds with HER2 as one of its receptors.

Surprised, Not Surprised

While we can’t fully understand the interaction of hormonal birth control with EGF and HER2, it would be hard to deny something bad is happening. In fact, the more we learn the harder it is to deny that something bad is going on pretty much anytime it comes to birth control and breast cancer.

In 2015, Breast Cancer Research published a large cohort study, which analyzed pooled data from 54 studies in the African American Breast Cancer Epidemiology and Risk Consortium. Not surprisingly, they found that both recent use and a long duration of hormonal contraceptive (OC) use were associated with an increased risk of breast cancer. They observed increased risks for up to 15 years or more after the women stopped taking OCs.

They compared three types of tumors: ER-positive, ER-negative, and triple negative, and all three demonstrated increased risks. Now, here’s the surprising part. The highest odds were associated with triple negative (TN) tumors. They reported, “Women who had used OCs in the past 5 years were estimated to have a 78% increased risk of TN breast cancer and those who had used OCs for at least 15 years had a 62% increase.”

By comparison, the increased risks related to OC use within the previous 5 years were 46% for ER-positive, and 57% for ER-negative versus non-users. Put another way, the one type of breast cancer that has been most closely linked to birth control because of its obvious estrogen dependence could ultimately pale in comparison to the increases caused in cancer types for which birth control had previously been given a pass.

Continuing Side Effects

Studies like these are what make me uncomfortable when a woman tells me how long she took The Pill and never experienced any side effects. It disturbs me because I fear she is almost certainly singing victory too soon.

As Dr. Victor Wynn warned at the Nelson Pill Hearings, all human carcinogens are latent, and it could take 10 to 20 years of patient history to determine the cancer impact.

And now, with this new curveball, we can’t even rule out its effect on tumors that test negative for hormone receptors.

Read more about birth control’s vast problems in my new book, In the Name of The Pill.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

This article was published originally on June 10, 2019. 

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Tangled Ribbons, Tangled Lives

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Awareness ribbons looped on lapels. Around trees. Through chain-link fences. Yellow for missing children and bone cancer. Red for heart disease and HIV/AIDS. Blue for chronic fatigue syndrome and arthritis. Even ribbons spotted like Holstein cows raise awareness of birth defects.

The best known ribbons of all; pink for breast cancer.

Tangles of ribbons reminding us of human miseries we’d rather forget. Or have never heard of. But there are no satin ribbons for poor women who die young.

Even as their numbers climb.

Tie a Yellow Ribbon

Yellow ribbons first encircled trees in 1979, signifying hope for American hostages held in Iran. Red ribbons followed in 1992, to proclaim support for people with HIV/AIDS and encourage effort at finding a cure for the disease.

Pink ribbons fluttered on the scene in 1991. The earliest Komen Race for the Cure was held in Dallas, Texas in 1983. Participants in 1991’s Race in New York City were the first to receive the now-familiar pink ribbons.

Marshall McLuhan said “The medium is the message” more than 50 years ago, explaining:

The medium is the message because it is the medium that shapes and controls the scale and form of human association and action.

McLuhan didn’t have awareness ribbons in mind. He died in 1980. Though bright snippets and swathes of ribbon are a medium by McLuhan’s description. The ribbons convey messages that trigger emotional responses and actions.

But what messages are those ribbons sending? Especially the pink ones?

Dying Young

Most Americans expect to die old. We figure our lives will be longer than our grandparents. That our children will enjoy a few years more than we’ll have. Those are reasonable expectations. For most of us.

Not for poor white women. Their lives are shortening, not lengthening, according to a study published in Health Affairs in 2013. Researchers David Kindig and Erika Cheng compared female mortality across US counties. (The paper is available free here.)

They found life expectancy for some women has been dropping for decades. White women between ages 15 and 54 died younger than before in close to half of counties nationwide during the period from 1992 to 2006. The life expectancy for white men declined in just three percent of counties during the same time.

Other research (here, here and here) using different time periods and statistical methods, reach brighter–or gloomier–conclusions. All agree on the underlying fact that poor white women with little education are dying younger than better educated, better off women of similar ages.

Few states escaped increased female deaths. Only the counties in New England, along with Arizona, maintained or increased life expectancy for all women. Some states did much worse. Women across Appalachia, Oklahoma, the Deep South and northern Montana lost the most time.

The culprits that conspire to shorten lives aren’t surprising:

  • Smoking
  • Obesity
  • Narcotic overdoses
  • Suicide

Smoking, drug use and overeating are symptoms of deeper ills. Poverty, with its allies, hopelessness, no jobs, scanty education, are the true thieves of women’s lives.

The Urban Institute published a study in March, “Death Rates for US Women Ages 15 to 54: Some Unexpected Trends”. The authors Nan Marie Astone, Steven Martin and Laudan Aron, updated the findings from the earlier works. They also suggested a broader, more disturbing interpretation of the rise in women’s mortality:

The recent spike in white women’s mortality may be analogous to the spike in black mortality that accompanied the rise of the crack epidemic in the late 1980s and early 1990s. If so, one might predict that this mortality epidemic will ebb in the same way that several causes of death associated with the crack epidemic subsequently ebbed. The appropriate public health responses to such spikes are targeted interventions for the affected groups. A more troubling possibility is that white women are experiencing a systematic reversal in the long-term trend of mortality decline. Under this more pessimistic scenario, the high, stagnant, or rising death rates we observe among adult women now may persist as these women age, causing a substantial lowering of overall life expectancy in the United States. And because death rates are an indicator of population health, such a reversal in the trend of mortality decline would necessarily reflect widespread deficits in population health.

Ignoring the Evidence: Mammogram Wars

The relentless breast cancer screening debate stormed while poor women were dying in America’s heartland. Few subjects in health care are as acrimonious, riddled by politics and immune to science as the value of mammography.

Women, scientists, doctors and policymakers feud about whether breast cancer screening with mammograms saves lives. The fight has persisted for a generation without clear answers. If mammograms unquestionably saved lives, we’d know by now. We don’t.

Worse, mammography comes with risks. Over-diagnosis with its unnecessary treatment. Frequent false positives accompanied by anxiety, emotional distress and uncertainty that gnaw at women for years.

Truisms are reassuring because, well, they’re true. None truer than “A picture is worth 1000 words.” Two vivid infographics show the miniscule benefit of mammograms. The first is available on the NPR website. Published December 17, 2014, “What Happens After You Get That Mammogram”, estimates benefits and harms for 10,000 women who have yearly mammograms for ten years. It figures that:

  • 3568 women will have normal mammograms each year for ten years
  • 6130 women will have at least one false positive and 940 will have a biopsy they didn’t need.
  • 302 women diagnosed with breast cancer

Of the 10,000 women who have annual mammograms, 302 will be diagnosed with cancer. It sound like a positive outcome, right? Maybe not. Here’s the catch. Of those 302:

  • 173 would have survived with or without screening.
  • 57 will be over-diagnosed with a cancer that would never have become a problem.
  • 62 women will die despite being screened because of aggressive tumors.
  • Ten lives will be saved.

A 100,000 mammograms must be done to save ten lives!

The other infographic illustrates an article from the New England Journal of Medicine. The piece was written by two Swiss doctors, members of the Swiss Medical Board, recommending against routine mammography screening for women 50-69 years old.

“Abolishing Mammography Screening Programs? A View from the Swiss Medical Board” is free at NEJM. The graph with the review compares American women’s perceptions of mammography benefit to the actual effects. It supposes 1000 women screened every two years for ten years:

  • Women assume with screening 881 women will live, 80 will die from breast cancer and 39 will die from other causes.
  • In reality, 956-957 screened women will live, 4 will die from breast cancer, 39 or 40 will die from other causes.

But, the surprising numbers are:

  • Women expected 801 women to be alive without screening, 160 to die from breast cancer and 39 to die from other causes.
  • When, in fact, 956 women will live without screening, 5 will die from breast cancer and 39 will lose their lives to other causes.

These numbers are central to the never-ending mammogram wars because women believe two crucially erroneous things about mammograms:

  1. Many more women will die without mammography, 16%, when in reality, it is one half a percent (0.5%)
  2. There’s a large difference in death rates between screened and unscreened women. The difference is just one woman.

No Free Lunch

The dismal performance of mammography screening matters regardless of cost. A screening test with little benefit and recognized harms isn’t a bargain even if it’s free. But mammograms aren’t free. (The Affordable Care Act requires that preventive mammograms be “free”. They aren’t. You pay for them with increased premiums and higher deductibles on other care.)

The annual cost of mammography screening was calculated at $7.8 billion in 2010 by a group of researchers writing in the Annals of Internal Medicine (gated) last year. The group then estimated the total costs for several proposed mammography guidelines for women 40 to 85 years old. Screening every year starting at 40, every other year from age 40 or every other year from 50 to 74. They assumed 85% of women would be screened (probably a high estimate). The price ranged from $10.1 billion for the most frequent screens to $2.6 billion for the least aggressive guidelines.

That is base cost. It does not include the extra fare when false positives and over-diagnoses are added. Mammography over-diagnosis runs another $4 billion per year, according to a recent calculation in Health Affairs. The price is likely much higher because the authors of the study only included women 40 to 59 years old. Older women needed fewer biopsies to find one case of cancer, but women ages 60 to 74 still had false alarms.

Americans are spending roughly $11 billion to $12 billion each year for a test of uncertain value and unneeded follow-up.

So what? Remember the dying women?

Zero Sum Game

The federal government is frozen in place, unwilling or unable to give ground on spending money to save lives. Most state governments are tied in knots, especially the states with climbing female death rates.

Politically powerful women and men fight to head off any cuts to mammography programs. An anguished howl was heard after the US Preventive Services Task Force (USPSTF) updated its 2009 Draft Recommendations last month. The panel found harms of mammograms for women 40 to 49 may outweigh benefits and downgraded their recommendation to “C”, threatening the “free” mammograms.

Senator Barbara Mikulski (D) of Maryland made her displeasure known at once to Secretary Burwell at the Department of Health and Human Services. The senator warned the secretary that:

[S]hould the draft recommendation be finalized, I will actively and aggressively pursue all legislative options available to ensure that women aged 40 and older are able to continue receiving free annual mammograms.

Money spent to care for people is now a zero sum game. One group’s win is another group’s loss. Money devoted to “free mammograms” may be money lost for care to Appalachian women.

After 30 years of worldwide research, billions of dollars and reams of federal legislation, we still don’t know whether mammography saves lives in the end. We don’t know whether $12 billion spent on women in Appalachia, Oklahoma and the Deep South will save lives, either. It’s time to find out.

The Color Of Shadows

What color awareness ribbon for women who die young? No ribbon, but the shadow of ribbons. The shadow cast by every pink ribbon should be their awareness symbol. Komen supporters Race for the Cure in the sunlight. Poor women race for their lives in the shadows.

When breast cancer activists run in races, the shadows running alongside are those of women dying too young.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

This article was first published on May 26, 2015. 

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Mammography Screening – When an Educated Consumer is not the Best Customer

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The purpose of preventive mammography screening is to diagnose breast cancers that would result in death at an early stage, thereby decreasing the incidence of late stage breast cancer and overall breast cancer mortality.

A number of reviews and studies have been published over the past several years to determine the effects of mammography screening in achieving these goals. They reveal that mammography screening provides little to no benefit in terms of reducing breast cancer mortality, and yields significant risks and harm to women who receive false positive results and especially to those who are overdiagnosed and overtreated. The risk of overdiagnosis of cancers that would never have been a threat to or even discovered by women in their lifetime includes future treatment-induced cancers.

Statistical percentages such as a 20% or 30% reduction in mortality, ordinarily referenced in reports promoting mammograms, mislead women into thinking that a large number of lives are being saved. However, by looking at the actual number of lives saved by preventive screening in light of the total population screened and the actual number of women harmed by false positives and overdiagnosis we have a truer picture of the effects of mammography screening on breast cancer mortality. Real numbers show that the actual risk to women of dying from breast cancer is far less than women are led to believe while the risk of overdiagnosis, rarely mentioned, is far greater than they would expect. Studies showing a mortality reduction with mammography screening often manipulate statistics to misrepresent the perceived benefits.

The perception that mammography is of great benefit is also influenced in part by the promotion of screening as a life saver and by overdiagnosed women believing their lives were saved.

Despite evidence to the contrary, medical and charity organizations support continued mammography screening of women. Women are not made aware of the real evidence against screening. This is in part because of vested interests and in part because of consumer demand for preventive testing based on the even miniscule possibility that it may save their life. However, if women were aware that the possible harm is far more significant than any possible benefit, they would probably opt out of preventive mammography screening.

The breast cancer industry benefits from women’s lack of knowledge. It is not in their best interest to tell women the truth.

Marketing Mammography by Disregarding Data

Preventive mammography screening is supposed to save lives by detecting and treating cancers at an early stage, before they become clinically evident. This is supposed to reduce the numbers of late stage breast cancers and the overall mortality from breast cancer.

This is what every woman who goes for preventive mammography screening believes and what organizations like the American Cancer Society promote and charities such as the Susan G. Komen Foundation will have you believe with those ubiquitous pink ribbons and their “Run for the Cure”.

While you continue to wait for them to finally discover a cure, be aware of the following: despite the assertion that “mammograms save lives” the truth is that millions of women are being misled into undergoing a screening that has been shown over the years to do more harm than good in multiple ways.

If the end result was a really significant reduction in breast cancer mortality we might concede that some of those harms are worth the risk. Unfortunately, too many studies have shown that although more early stage cancers are being detected there is no reduction in the overall mortality from breast cancer and that screening significantly harms more women than it helps. The dangers of screening include many false positives with additional diagnostic testing and, more critically, a high rate of overdiagnosis — the detection of cancers that would never have been a threat to or even discovered by women in their lifetime. Overdiagnosed cancers lead to overtreatment with surgery, radiation, chemotherapy, and hormone therapy that needlessly put women at risk of future treatment-induced cancers. Preventive breast cancer mammography screening has really been a colossal failure and the wool continues to be pulled over women’s eyes.

What the Research Really Shows

Consider the following reviews and studies (published between 2011- 2015):

  • In a retrospective trend analysis on mammography screening, researchers Philippe Autier, Mathieu Boniol, Anna Gavin, and Lars J. Vatten compared 3 pairs of neighboring European countries having  similar population structure, socioeconomic circumstances, quality of healthcare services, and access to treatment where mammography screening was implemented many years apart in order to determine the effect on mortality that such screening had on early detection of breast cancer. “Our study”, they concluded, “adds further population data to the evidence of studies that have used various designs and found that mammography screening by itself has little detectable impact on mortality due to breast cancer.”
  • Drs. Archie Bleyer and H. Gilbert Welch discussed their 30 year review of United States data related to mammography screening of women 40 years of age or older. They found that while screening mammography has been associated with a doubling in the number of early stage cancers detected, it has only resulted in a decrease of 8 cases of late stage cancer per 100,000 women. This disparity is attributed to an estimated overdiagnosis (and overtreatment) in the past 30 years of 1,300,000 women or an overtreatment rate of 31% of all diagnosed breast cancers.
  • The Swiss Medical Board, an independent health technology assessment initiative, performed a comprehensive review of mammography screening, noting the controversy over the previous 10-15 years regarding mammography’s benefits. Reviewing mammography screening from the first trials 50 years ago in New York City to the most recent led to the determination that it’s possible that of 1,000 women screened, one death attributable to breast cancer might be prevented although there was no evidence showing that overall mortality was affected. However, the prevalence of false positive tests and overdiagnosis, they concluded, causes women more harm than good. For every breast cancer prevented over a course of ten years of screening, beginning at age 50, between 490 and 670 women will have a false positive diagnosis and repeat examination; between 70 and 100 women will have an unnecessary biopsy; and between 3 and 14 women will be overdiagnosed.
  • The Nordic Cochrane Report, an independent reviewer of scientific studies, reviewed 7 eligible studies comparing women ages 39 – 74 who were and were not screened using mammography. The authors, Peter C. Gøtzsche and Karsten Juhl Jørgensen, determined that breast cancer screening reduces mortality by approximately 15% and that overdiagnosis and overtreatment is at 30%. Realistically, this means that for every 2000 women invited for screening over the course of 10 years, one woman will have avoided dying of breast cancer while 10 healthy women will have been overdiagnosed and overtreated. In addition, over 200 women will have a false positive diagnosis requiring additional screening.
  • The 25 year follow-up for the Canadian National Breast Screening Study, by Anthony B Miller, et al., which compared screened and unscreened women ages 40 – 59 for breast cancer mortality, found no reduction in mortality as a result of the screening. They determined that there was an overdiagnosis of breast cancer of 22% among women with screen detected invasive cancers. Screening 44,925 women resulted in an overdiagnosis of 106 women or, in other words, for every 424 women screened, one woman was overdiagnosed.

Statistical Shenanigans in Mammography Numbers

The article that I like most however (a touch of sarcasm here) is this one that headlines:
National screening programme has markedly reduced breast cancer mortality

Read only the headline or just the first two paragraphs and you will have confirmed that mammography screening reduces breast cancer mortality between 20 – 30% in the women who undergo testing.

Continue to the third paragraph and you will find that the study actually corroborates all the other ones listed above – that very few lives are saved by preventive mammography screening and that a far greater number of women are overdiagnosed and overtreated. It reads:

“The evaluation examined a number of sides to the national screening programme and determined among other things that the probability of being overdiagnosed by screening is five times higher than the probability of avoiding death by breast cancer. Overdiagnosis in this context means that without being screened, the women would never have noticed, been aware of or died from the disease. Under the Norwegian Breast Cancer Screening Programme, all women aged 50 to 69 are invited for mammography screening every two years. Under the programme, for every 10,000 women invited to 10 rounds of screening, roughly 377 cases of tumours or pre-malignant breast lesions will be detected. From this group, roughly 27 women will avoid death from breast cancer as a result of early diagnosis and treatment. However, roughly 142 of them will be overdiagnosed with a disease that will turn out to be harmless.”

It should also be noted that the prevalence and harms of false positive results, although not discussed in the article, are considered in the evaluation report. They are also not insignificant.

Although the other reports cited above show even more harm and fewer lives saved, we can clearly see from the intentionally misleading Norwegian report, just how inconsequential mammography screening is in reducing breast cancer mortality.

Declaring a reduced mortality rate of 20-30% due to screening without providing actual numbers is highly deceptive. The key isn’t the percentage but the actual numbers upon which those percentages are based. If we found that 5,000 of these 10,000 screened women were diagnosed with a breast cancer that would have metastasized and 25% are saved from death by early screening, then 1250 women would have been helped. However, given the actual figure of 27 women saved, a 20 – 30% reduction of mortality takes on a very different meaning.

In reality, the headlined “marked mortality reduction” figures were actually calculated based on the assumption that without screening either 135 women (20% reduction) or 90 women (30% reduction) will have been assumed to die of breast cancer. In other words, among 10,000 women not screened, from 9/10 of one percent to 1.35% of the women would likely die from breast cancer. This also means that between 63 -108 women will die of breast cancer regardless of having been screened. (It has been found that breast cancers which metastasize are quite aggressive and often become palpable within a year after screenings that yielded negative results. False negative results can also be to blame.)

The 377 women diagnosed with tumors or pre-malignant breast lesions out of the 10,000 women screened represent almost 3.8% of the screened population. The 27 treated women who avoided death by screening represent not quite 3/10 of one percent (.0027) of the 10,000 screened women. The 142 women needlessly diagnosed and treated represent 1.4% of the 10,000 women screened.

Overdiagnosis Feeds Misperception and Profits

When looking at the actual number of women involved, the 20-30% mortality reduction doesn’t sound so wonderful anymore – but then neither does the risk of breast cancer seem as scary.

Nevertheless, this estimate of breast cancer mortality with or without screening is far less than most women believe population and personal risk to be. According to the Swiss Study cited above women believe that for every thousand women screened 80 will die from breast cancer while for every thousand women not screened 160 will die from breast cancer. The real effect of screening, they found, is that for every thousand women screened 4 will die from breast cancer and for every thousand women not screened 5 will die from breast cancer.

Why the great disparity between women’s real and perceived risk of dying from breast cancer?

As expressed in the Norwegian study’s evaluation report, just the fact of the screening programs alone increase women’s perception of the risk of and mortality from breast cancer.

More importantly, however:

 “Overdiagnosis creates a powerful cycle of positive feedback for more overdiagnosis because an ever increasing proportion of the population knows someone—a friend, a family member, an acquaintance, or a celebrity—who “owes their life” to early cancer detection. Some have labeled this the popularity paradox of screening: The more overdiagnosis screening causes, the more people who feel they owe it their life and the more popular screening becomes. The problem is compounded by messages (in the media and elsewhere) about the dramatic improvements in survival statistics, which may not reflect reduced mortality, but instead be an artifact of overdiagnosis—diagnosing a lot of … women with cancer who were not destined to die from the disease.[1]

This all raises the question: Why the continued emphasis on screening when we have so many studies that all show little benefit to mammograms and in reality significant harms?

Science writer John Horgan in his article Consumers Must Stop Insisting on Mammograms and Other Ineffective Cancer Tests blames the continued use of mammography screening on financial benefits and on consumer demand for testing. About the profit motive he points to an editorial about mammography screening in the British Medical Journal:

“The BMJ editorial urges health-care providers to reconsider priorities and recommendations for mammography screening and other medical interventions.”

“The editorial adds, ‘This is not an easy task, because governments, research funders, scientists, and medical practitioners may have vested interests in continuing activities that are well established’.”

About the consumer demand for testing he says:

“… ultimately, the responsibility for ending the testing epidemic comes down to consumers, who too often submit to — and even demand — tests that have negligible value. Our fear of cancer, in particular, seems to make us irrational. When faced with evidence that PSA tests [yes, prostate cancer as well as thyroid and lung cancer are also overdiagnosed – CL] and mammograms save very few lives, especially considering their risks and costs, many people say, in effect, ‘I don’t care. I don’t want to be that one person in a million who dies of cancer because I didn’t get tested.’ Until this attitude changes, the medical-testing epidemic won’t end.”

Perhaps if they knew that testing may cause them to be one of those several thousand who increase their risk of dying from testing, they would reconsider.

I still remember the commercials made by Sy Syms of discount designer clothing store fame. He would always say: “An educated consumer is our best customer.” For the medical industry, it seems, their best customers are the ones they keep in the dark.

Additional Resources and Reading

Cancer Active
Breast Cancer Action
Screening For Breast Cancer with Mammography
Exposed
The Mammogram Myth: The Independent Investigation Of Mammography The Medical Profession Doesn’t Want You To Know About
Overkill: An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

This article was published originally on Hormones Matter in June 2015. 

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 


[1] http://jnci.oxfordjournals.org/content/102/9/605.full

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Birth Control and Breast Cancer: A Classic Cover-up

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“Estrogen is to cancer as fertilizer is to the wheat crop.”

It was the first headline-grabbing quote from the Nelson Pill Hearings, and it threw birth control proponents into a tizzy. They complained vociferously that the hearings were alarming women everywhere, and causing them to stop taking The Pill. Senator Nelson’s reply was simple, if women had been warned about the side effects before being prescribed, they wouldn’t be alarmed hearing it now.

That one little quote about synthetic estrogens catalyzing cancer and the uproarious reaction it inspired epitomize the beauty of the hearings. It was one of the few times in recent history that the pharmaceutical industry had almost no control of the message.

Hormonal Birth Control: Fertilizer for Breast Cancer

Prior to the hearings, Big Pharma managed to suppress knowledge of their product’s link to certain cancers, particularly breast cancer. However, in the hearings, those connections came to light, and stunned viewers as they tuned into the nightly news. (Perhaps I should inform my younger readers that this was a time when our country only had three networks, none of which featured a 24-hour news cycle. Consequently, the nightly news was still a pretty big deal).

Here’s a breakdown of some key facts presented by leading physicians in those hearings:

  • The American Cancer Society recognized the possible risk of breast cancer as a side effect of hormonal contraceptives as early as 1961. – Dr. Max Cutler, Page 6664
  • It’s imprudent to prescribe oral contraceptives to a woman with a family history of breast cancer. – Dr. Max Cutler, Page 6666
  • There was statistical evidence that breast cancer associated with pill takers in the FDA files had been dramatically underreported. – James Duffy, Page 6069
  • All human carcinogens are latent. And, it could take 10 to 20 years of patient history to determine the cancer impact. – Dr. Victor Wynn, Page 6309
  • Not only had the synthetic hormones used in The Pill been proven to cause breast cancer in all five species of animals that had been injected with it, but it also caused the very rare condition of breast cancer in human males. – Dr. Hugh Davis, Page 5927
  • There should be no chronic use of The Pill. It is a cancer time bomb with a fuse that could be 15 to 20 years. – Dr. Max Cutler, Page 6669

The most important statement as it relates to us today came from Dr. Hugh Davis:

“Now, there are some 75 to 80,000 women in this country per year who are developing diagnosed carcinoma of the breast. If the chronic taking of steroid hormones eventually increased this by only 10 percent, we would have a very, very hazardous situation on our hands…” (Monopoly Subcommittee, Page 5931)

I know how easily our eyes can glaze over when someone starts quoting statistics, but please pay attention to these numbers. In 1970, 1 out of every 20 women developed breast cancer sometime during her life (Dr. Max Cutler, Page 6666). You just read that Dr. Davis said it would be ‘a very, very hazardous situation’ if we saw a long-term increase of 10% over the 75 to 80,000 diagnoses each year.

Today, we have witnessed a 210% increase; 1 in every 8 women will develop breast cancer in her life. Over 246,000 cases of breast cancer will be diagnosed this year. If the vastly underestimated 10% was considered very hazardous, then our reality hit a level of hazard that defies description.

Message Control

The hearings also pulled back the curtain on how the pharmaceutical industry manipulated the message to the media and the medical community.

In 1967, Child & Family Quarterly started a section called, “Recent Setbacks in Medicine,” which seemed to be largely inspired by the introduction of hormonal birth control. Here’s what they had to say:

The Pill quickly became big business, so that drug manufacturers began to manipulate professional opinion at an early date, stressing the wonders of the Pill and minimizing its dangers.

Speaking to this point, Sen. Nelson pointed out the conflicting statements of Dr. Louis Hellman, who chaired the FDA’s study on The Pill. He said:

I doubt whether there is one person, one doctor in a thousand in this country who is aware that [Dr. Hellman] said, “Now, in discussing the chairman’s report, the right statement has to be made. We cannot just hide behind rhetoric. We are going to have to say something, and we have an opinion; that these are not safe, and the Commissioner might have to take them off the market if he believes this. We can say these are safe and our scientific data did not really permit that kind of statement.”

The FDA committee’s official statement ended up being that hormonal contraceptives were “Safe within the intent of the legislation.” This strangely mitigated reference to Kefauver-Harris legislation was all the pharmaceutical industry needed because it contained the word ‘safe.’ Despite admitting they were of the opinion that The Pill wasn’t safe, Dr. Hellman then hit the media circuit to reassure women everywhere that it was.

Further evidence that Big Pharma was seizing control came in the testimony of Dr. Edmond Kassouf. He read the Senators an unnerving conclusion to a New York Times review of Barbara Seaman’s book, A Doctor’s Case Against the Pill. Reviewer, Christorpher Lehman-Haupt wrote, “One wonders why the drug companies have been so exercised about it. In a way, their attempts to warn book reviewers against it are more disturbing than the book itself.” To which, Dr. Kassouf responded:

Mr. Lehman-Haupt has performed a public service in exposing the drug companies’ attempts.

Cures Not Causes

At Big Pharma, manipulation is the modus operandi, but no example is more disgusting and deplorable than Breast Cancer Awareness Month. Yes, that is what I meant to say. Let me explain by first asking you a question. If an organization started promoting Lung Cancer Awareness Month but they never mentioned smoking, would you think there was something fishy in the air?

For all this search for the cure, there is no talk of avoiding the cause. There’s a good reason for that. Jim Hightower festoons the irony amusingly in his book, There’s Nothing in the Middle of the Road but Yellow Stripes and Dead Armadillos.

Breast Cancer Awareness Month is a front that was conceived, funded, and launched in 1985 by a British conglomerate with a name that could come straight out of a Batman comic book: Imperial Chemical Industries. But the $14-billion-a-year multinational behemoth is all too real. It is among the world’s largest makers of pesticides, plastics, pharmaceuticals, and paper. “Organochlorines R Us” could legitimately be its slogan, though “Pollution R Us” would also fit – one of its Canadian paint subsidiaries, for example, has been held responsible for a third of the toxic chemicals dumped into the St. Lawrence River.

In 1993, Monte Paulsen of the Detroit Metro Times wrote, “ICI has been the sole financial sponsor of BCAM since the event’s inception. Altogether, the company has spent ‘several million dollars’ on the project, according to a spokeswoman. In return, ICI has been allowed to approve – or veto – every poster, pamphlet and advertisement BCAM uses.”

ICI’s pharmaceutical division, Zeneca Group PLC later split off to become AstraZeneca, taking Breast Cancer Awareness Month with them. Kudos to Mr. Paulsen for digging into this. Most journalists who know about AZ’s ‘ownership’ of BCAM see the move as philanthropic. AstraZeneca can’t lose. They actually strategized a way to make breast cancer a win-win situation for their shareholders.

Jim Hightower continues:

It gets gooier. Zeneca’s pharmaceutical arm is also the maker of Nolvadex, the leading drug used in breast cancer treatment. Nolvadex is a highly controversial drug – it does not cure existing breast cancer, but it can help stop it from spreading in some women who are diagnosed early; however, it can also cause blood clots, uterine cancer, and liver cancer in those who take it… What a racket this company has going! It make billions selling industrial organochlorines linked to breast cancer, it finances its BCAM front to divert public attention from cancer causes to cancer detection, then it sells Nolvadex to those who are detected.

Industrial waste and toxic chemicals may be responsible for the spike in breast cancer; and synthetic estrogens may be the fertilizer that feeds it, but, ultimately, it’s Big Pharma that’s spreading the manure.

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Testosterone and Breast Cancer: Quick News

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Estrogen receptor positive (ER+) cancers account for approximately 75% of all breast cancers. In ER+ the cancers respond to the presence or absence of estrogens (estrone, estradiol). Almost 65% of ER+ cancers are also progesterone receptor positive (PR+) meaning the cancer also responds to presence or absence of progesterone. In contrast, the HER2 strain of cancers involves an over production of the protein epidermal growth factor. HER2+ cancers are not amenable to hormone treatments and have not been linked to hormone levels, until recently.

A study published in Cancer Epidemiology Biomarkers and Prevention (Sieri et al. 2009) found that high circulating levels of testosterone were associated with an increased risk of breast cancer in menopausal women. The association was strongest for ER+ cancers, but was also present ER- cancers such as the HER2 strain.  Though the association between testosterone and HER2+ cancers was not as strong as observed in the ER+ cancers, it was significant and merits additional research.

The role of androgens in breast cancer is controversial and there are differences between the hormone levels locally in the breast tissue versus those in circulation. Nevertheless, this study suggests that broader research, diagnostic and potentially treatment approach may be warranted.
To read this study go to: (Cancer Epidemiol Biomarkers Prev 2009;18 (1):169–76).

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Decline in Mammograms – Good or Bad?

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In 2009, the US Preventive Services Task Force (USPSTF) released a statement in which they recommended against mammograms for women aged 40 to 49, which contrasted with the recommendation made seven years prior that women begin screening at the age of 40.

What’s a Mammogram?

Mammograms are x-ray examinations that help doctors determine if there are any changes to the breast tissue that could not be felt during clinical breast examinations. It’s normal for breasts to change, but doctors specifically look for changes that may indicate the patient has breast cancer.

Doctors use mammograms to try to determine if lumps in the breasts are cancerous and compare findings to previous mammograms to identify physical changes in the breast.

Breast Changes May Be Hormonal

Of course, it’s important to note that changes in the breasts are not necessarily cancerous, and can actually be hormonal. The University of Maryland Medical Center refers to this as “fibrocystic change,” in which the breasts become lumpy and painful right before one’s menstrual period, a result of hormones being produced in the ovaries.

More than 50% of women experience fibrocystic changes during their menstrual cycle, which means a majority of women experience physical changes in their breasts regularly.

As a woman, it is helpful to be aware of cyclical changes that the breasts undergo, and if possible, keep track. Hormonal changes in the breast don’t usually begin until a woman is 30, symptoms may be impacted by hormonal drugs (such as hormone replacement therapy or birth control pills), and fibrocystic changes usually stop after menopause.

Understanding natural changes to the breasts can supplement a doctor’s knowledge during mammography screenings. Such knowledge may even help a woman better plan breast examinations according to her menstrual cycle, so doctors can identify new changes as opposed to recurring ones.

So Why Delay Mammography?

Even in 2002, the USPSTF stated there was little evidence that women benefited from screening for breast cancer sooner than 50 years of age. The report noted that negative consequences of mammograms include “anxiety, discomfort and cost associated with positive test results, many of which are false positive, and the diagnostic procedures they generate.”

In addition, since the breast is exposed to small doses of radiation during mammography, the repeated exposure can increase a woman’s risk of cancer. The risk of getting cancer is small, however, and the benefits of mammography usually outweigh the risks. But the USPSTF started to question whether the benefits outweigh the risks for women in their 40s.

Though mammograms can benefit those with breast cancer, the incidence of breast cancer in women in their 40s is much lower than it is for women in their 50s. Since most women are not likely to have breast cancer in their 40s, women in this age group are more likely to suffer adverse effects from the examination.

The USPSTF stated the decision to have a mammogram should be an individual one that takes into account family medical history and other pertinent information.

Decline in Mammograms among 40-year-old Women

The impact of these recommendations can be seen in recent data recorded by Mayo Clinic, which shows there have been 54,000 fewer mammograms among women in their 40s, or a 5.72% decline.

It’s difficult to determine whether this decrease in mammography among women in their 40s is good or not, as some experts still recommend screening as early as 40, including Mayo Clinic, which follows the recommendations given by the American Cancer Society.

Now What?

Women should identify any regular physical breast changes, continue to conduct self breast examinations along with clinical breast examinations, and openly discuss this information, as well as any possible genetic predisposition to breast cancer, with their doctors. Through discourse, women can decide what the best course of action is for their specific needs.

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Celery Flavinoid: A Possible Treatment for Breast Cancer?

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Millions of women routinely receive hormone replacement therapy (HRT) to treat the myriad of symptoms associated with menopause. HRT formulations contain either estrogen (synthetic estrogen-like compounds) alone or a combination of estrogens and progestins (synthetic progesterone like compounds). The use of combination HRT  (estrogen + progestin) has been linked to the rapid onset of a certain type of progestin-dependent breast cancer tumor. Research by a team of scientists from the University of Missouri, shows that apigenin, a flavinoid found in many common foods, especially celery and parsley, reduces breast cancer tumor growth in mice.

Progestin Dependent Breast Cancer Tumors

Medroxyprogesterone acetate (MPA), a progestin derived from testosterone used in HRT and several oral contraceptives, is associated with an increased risk of breast cancer and an increased growth rate of a particular type of tumor, the HER2/neu-positive. The HER2 cancers are typically very aggressive and difficult to treat.

Researchers believe MPA stimulates cancer cell growth by:

  • Inducing the expression of vascular endothelial growth factor (VEGF), a potent pro-angiogenic factor in breast cancer cells. (Angiogenesis means the growth of new blood vessels. Tumors need a blood supply to survive.)
  • Activating several genes that increase cell motility (movement) and the rate of cancer metastasis
  • Inducing receptor activation of nuclear factor kappa-B ligand (RANKL) – higher RANKL may correlate with higher rates of mammary cancer in mice

Apigenin and Breast Cancer Tumors: The Research

For the current study,  researchers investigated the effect apigenin, which is ubiquitous in fruits, nuts, vegetables, and plant-derived beverages, on the progression and development of MPA-dependent BT-474 xenograft tumors (HER2/Neu-positive) in nude mice (lab mice without a thymus that cannot mount an effective immune responses). They found that apigenin (21 daily 50 mg/kg subcutaneous injections) significantly inhibited the growth of BT-474 xenograft tumors. Cancerous tumors grew rapidly in the mice which did not receive apigenin. In the apigenin-treated mice, breast cancer cell growth dropped to that of the control group, and the tumors shrank.

Apigenin is an natural component that humans and animals consume already. In the dosage used for this and other studies, no side effects were observed. By virtue of its ability to selectively induce apoptosis (cell death) in rapidly growing breast cancer cells, while having no effect on normal breast cells, apigenin would seem to be an extremely useful cancer treatment.

Apigenin may also reduce the production by tumor cells of pro-angiogenic VEGF, which is essential for growth and maintenance of blood vessels in the tumor. The potential use of a natural antiprogestin would therefore appear to possess a number of advantages. Authors suggest exploring the combined use of apigenin and tamoxifen or aromatase inhibitors. They would also want to examine the effects of apigenin on breast cancer progression promoted by other synthetic progestins and the endogenous hormone progesterone.

Although much research remains, early indicators suggest that apigenin may be a promising new therapeutic option for certain cancers.

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Mammograms: What Would Dolly Parton Do?

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If names always signified what they actually were, getting a mammogram would mean that upon your 40th birthday, you’d get not a telegram, but the sensational Nathan Lane would appear on the “Wipe Your Paws” welcome mat outside the front door, wearing only a shimmery paper gown and belting out a peppy tune. What a toe-tapping treat. Turns out this rite of passage fills us with dread like hearing Psycho shower scene music. As if, by 40 your boobs haven’t been handled rough enough?! Maybe this was the REAL reason Janet Leigh screamed her little wet head off. She finally realized doing the “Breast Self Exam” was not the end-all-be-all.

Maybe it’s for the best that mammograms become a required, yearly blow to one’s dignity. By middle age, most women have been-there-done-that at no less than 10x over. In short, we just simply don’t have the time, patience, energy or pride to give a rat’s ass. When the appointment date arrives, these leather-tough broads slap a tit on the X-ray slide like a child gleefully inserts a plump pastry into an Easy Bake Oven.

But even these warriors had a first time. Don’t you dare chicken out! Think of yourself as a soldier going to war against the dastardly army of breast cancer and your lieutenant is none other than that tiny tart from Tennessee – Dolly Parton. Put on your big girl panties and don your WWDPD plastic wrist band and buck up! Time’s a wastin’! Your tits are defenseless without ya!

However, don’t barge into battle blindly: just leaving the house with no deodorant, perfume or lotion on – per the mammogram commandments – is a bold move. By the time you undress in the doctor’s office, you could very well reek like a Subway meatball foot-long. Your extremities get squeezed to the extreme and will look like something straight from Looney Tunes. On the flip side, the female technician touches your breast so tenderly and coos such foreplay sweet talk like “Move a little to the left” or “Hold your breath”- that you seriously consider asking her out for coffee after.

Then lickety-split you’re done and dressed. Quite suddenly you feel important and wise and well…powerful. The results of your test will be whatever they will be, as these things always are, when left up to God or the fates. But at least you have begun the battle. Imagine Dolly’s huge boobs coming in for a victory hug. Deep in that smothered, Southern-fried  embrace, you grin. You done good soldier, you done good.

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