Why Mammograms?

A post by BreastScreen popped up in my Facebook feed today. For those from overseas, this Australian government initiative provides free mammograms to women, with a focus on those between 50 and 74 years of age.

The age restrictions aren’t arbitrary. They are based on evidence that this is the window where a mammogram is most likely to detect cancer. All Australian women within this group are offered a free test every two years.

Women between 40 and 50 are advised to talk to their doctor about whether or not a mammogram is advisable. They can attend BreastScreen for a free test if there’s a reason to do so, such as a family history of breast cancer, or a medical history that leads a doctor to conclude that a patient is at higher risk. This history might not be related to previous cancer or benign tumours. It could be that someone has ‘lifestyle factors’ like smoking, obesity or excessive alcohol consumption that put them at higher risk.

Mammograms are not routinely offered to women under 40 because the test is likely to be less effective. Breast density declines with age and it can be difficult to detect cancer using a mammogram in younger women. For women 75 and over, routine testing is no longer considered necessary. Generally, if you’re going to get breast cancer you will have developed it before this age. That’s not to say that women in this age bracket shouldn’t continue to practice self-examination and to request a test via their doctor if they suspect anything is wrong. It’s just that the incidence of cancer in this age group doesn’t justify the cost, inconvenience and small risk associated with testing.

Yes. Small risk.

It’s not uncommon to see any post about mammograms followed by at least a few comments recommending against them. The arguments usually state that the radiation is toxic and that testing may actually cause cancer. There are also concerns about ‘false positives’ which result in women receiving unnecessary and potentially life-threatening treatment, ‘false negatives’ where a woman with cancer is told she doesn’t have it, and a reliance upon research that is cited as evidence that free mammograms have no benefit. Here’s a typical article:

Why you shouldn’t have mammograms

This is another example of a very complex issue being dumbed down in pursuit of internet popularity. The truth is a lot more subtle. There’s the usual difficulty with any piece of research related to breast cancer; we’ve seen huge changes in treatment and technology in the last two decades. We now have lower radiation used in diagnostic equipment, better treatment following diagnosis and ongoing research that will continue to impact upon detection and treatment.

One of the greatest discoveries since the introduction of free mammograms and the subsequent analysis of data was that some early cancers seem to heal themselves. This is why the early detection of DCIS (ductal carcinoma in situ) may have previously resulted in treating a condition that would have gone away all on its own. But here’s the catch. Not ALL DCIS goes away on its own! If you were previously diagnosed and treated for DCIS then it could be that any treatment you had was entirely unnecessary. It could also be that this early treatment saved your life and your breast.

Research is now focused on figuring out which types of DCIS are likely to resolve all on their own. It’s hoped that in the future, doctors will be able to determine which cases need treatment and which should be given a bit more time to see if they resolve on their own. In the mean time, I would still be recommending screening on the basis that I’m not prepared to accept a dice roll when it comes to cancer.

Of course I need to declare a bias. BreastScreen detected four tumours in my left breast the very first time I had a free mammogram. This was not DCIS. This was full blown triple negative breast cancer. My tumours were doubling every three weeks and I was fortunate enough to have received my BreastScreen invitation at a Goldilocks moment; my tumours were just large enough to be detected but had not yet metastasised.

You should know that at the time, I was, to all outward appearances, physically fit. I was probably about 15 kilos over my ideal weight, but hardly obese. I was a non-smoker who enjoyed sharing a bottle of wine with my husband over dinner (before I discovered it was a category one carcinogen, just like cigarettes) and I regularly practiced self-examination after every menstrual cycle. I had no palpable lumps in my breasts but the mammogram found four tumours.

To say that this test saved my life is not an exaggeration. Without it, I would have had no indication that anything was wrong until the impact of the cancer spreading throughout my body became apparent. Triple negative is rarer and more aggressive than other types of breast cancer, with a lower survival rate.

You see this is my bottom line about research and data. None of it counts for anything much if yours is the life that’s saved. Here’s a link to one of the pieces of research that’s often cited when demonising breast screening:

Possible net harms of breast cancer screening

It’s always useful to go to the source when the internet scares you. The most significant thing about this research in my opinion is that they do not dispute the fact that mammograms save lives. Their argument is that screening also results in a reduction of quality of life in those women incorrectly diagnosed and treated because of the ‘months of psychological distress’ they experience. They also argue a reduction in quality of life for those whose cancer goes undetected.

I’ll deal with the last group first. If a mammogram did not detect your cancer then it is usually the case that you had no other evidence of cancer. Lumps, swelling, pain or any other abnormality of the breast would warrant further testing, including ultrasound and biopsy. The fact that screening does not have a 100% detection rate needs to be balanced agains the fact that mammograms save lives.

The over treatment of some women is a serious issue and there can be no doubt that waiting several weeks (rarely months) while you worry about a suspicious lump is definitely distressing. There can be no question that the research into reducing this type of event will greatly improve this situation. In the mean time I’d like you to consider things from a personal perspective. These are the possible outcomes from your routine mammogram:

  1. It detects a cancer that you didn’t know you had and this detection saves your life.
  2. It detects a cancer that you didn’t know you had and that cancer ultimately kills you. Treatment may or may not give you a few more precious months or years with those you love. Certainly early detection will improve your chances.
  3. It detects a cancer that you didn’t know you had and you die as a consequence of your treatment (neutropenia, staph infection, heart failure during surgery etc) but left untreated the cancer was killing you in any case.
  4. It detects a cancer or a pre-cancerous condition that you didn’t know you had that would have resolved itself without medical intervention and this results in you being anxious. It may also result in you having a lumpectomy that reveals a benign lump. This will be frightening but will ultimately reassure you that you don’t have cancer (and probably also inspires you to reassess your life and the choices you make).
  5. No cancer is detected, even though you have cancer. In time your cancer will either resolve itself or become apparent. If you have any symptoms you should request other forms of testing and not rely upon a negative mammogram.
  6. No cancer is detected because you do not have cancer.

Here’s the thing. There is absolutely no way of knowing which of these categories you fall into without actually having the mammogram. Take a good look at point number one again and ask yourself, “Am I prepared to take that risk?”

Before you roll that particular dice it would be a good idea to know your odds. I mean, if the risk of getting breast cancer was one in a million you’d be justified in wondering if the discomfort and low radiation dose associated with a mammogram was worth it. But if you’re an Australian woman your odds of developing breast cancer are one in eight.

One in eight.

The risk is similar throughout the developed world. Here’s a link with the current statistics:

Breast cancer statistics

Add to that the clear evidence that early detection improves survival, and helps to minimise the risks and side effects associated with treatment.

Thanks to early detection I had no spread of cancer to my lymph nodes. Once triple negative escapes to the lymphatic system it spreads, typically to bone, lungs or brain. Give me early detection.

Early detection might also mean that you can have a lump excised and keep your breast, rather than having the breast removed. It could mean that you avoid the risks, discomfort and possible side effects of chemotherapy or radiation. It could mean faster and fuller recovery from cancer.

So the next time someone tries to tell you that a mammogram will kill you, you might like to respond with this:

How do you know that?

It’s my favourite question for people quoting an internet article. In fact the research clearly shows that mammograms save lives. You might also like to send them this excellent article about the mammogram controversy:

Mammograms save lives

I know. It would be easier to just smile and nod and walk away, but these people are dangerous. I have met women that refuse to have free testing because of the scare campaigns. I just hope they aren’t one of the one in eight that will develop breast cancer, because, by the time they do it might be too late to save them.

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The stuff we put on our bodies

Yesterday my daughter sent me a link to an article. Researches have established a causal connection between dark hair dyes, chemical hair relaxers and breast cancer. Here’s the link:

Breast cancer and hair products

I started finding grey hairs when I was in my early 20’s and started dyeing my hair shortly after that. Because I was naturally dark brown, I chose to dye it to something close to my natural colour (apart from a scary auburn period during the 80’s, but hey, it was the 80’s!). That’s more than 30 years of what my husband referred to as ‘soaking your head in toxic chemicals’ about every six weeks.

It was at Graham’s suggestion that I stopped colouring it. I also shaved it off to raise money for blood cancers, because this seemed like a great way to break the dying addiction and support a charity. Two years later I lost it all again thanks to chemotherapy.

I’m now naturally grey. To my surprise and delight I get more compliments about my hair than I have at any time in my life. It’s got this great thing going on that looks like I’ve paid a fortune for highlights. I haven’t. It just grew back like this. Meanwhile I see lots of girls in their twenty-somethings colouring their hair grey!

It has always seemed odd to me that we have strict laws about food and very few about cosmetics. We know that the skin is great at absorbing chemicals. That’s why nicotine patches work. It’s why you can now get transdermal patches for all kinds of medical conditions. They allow you to absorb chemicals over a long period of time rather than getting it all at once from an injection or a pill.

So why is don’t we have the same kind of regulations around cosmetics? We are essentially consuming everything we put on our bodies. It turns out that a large number of cosmetic products contain known carcinogens and that even those that don’t contain chemicals with unknown risks to our health. Yuck.

And it’s not just cosmetics we need to be concerned about. It’s everything that comes into contact with our bodies. Take triclosan. You’ll see it listed as an antibacterial ingredient in hand sanitiser, toothpaste, dish washing detergent and liquid soap. Pretty much anything claiming to be ‘antibacterial’ either includes triclosan or has been treated with it, including furniture coverings, bedding and underwear. Triclosan is a hormone disruptor. Here’s an extract from the Wikipedia article about it.

Because of potential health concerns spanning from antimicrobial resistance to endocrine disruption, triclosan has been designated as a “contaminant of emerging concern (CEC)”, meaning it is under investigation for public health risk. “Emerging contaminants” can be broadly defined as any synthetic or naturally occurring chemical or any microorganism that is not commonly monitored in the environment but has the potential to enter the environment and cause known or suspected adverse ecological and(or) human health effects.[34] Triclosan is thought to accumulate in wastewater and return to drinking water, thus propagating a buildup that could cause increasing effects with ongoing use.[35]

In an article from May 2015 on the current status of triclosan, Gurpreet Singh Dhillon and colleagues cite various studies that report “emerging health concerns related to the use of TCS such as microbial resistance, dermal irritations, endocrine disruption, higher incidence of allergies, altered thyroid hormone metabolism and tumors development due to TCS and its by-products”.[36]

 

Interestingly, it’s still considered safe ‘in small amounts’ but how much is too much? If you’re working in a hospital and sanitising your hands several times a day, wouldn’t you be absorbing a huge amount of triclosan? And here’s the kicker; it doesn’t work as well as soap and water when it comes to cleaning your hands.

Of course this is just one example of one chemical. The list of potentially toxic substances that wind up in our homes is a long one. You can spend a disturbing time googling and reading for more information. This chart is a pretty comprehensive one, but it only has household products, not cosmetics or all personal care products:

Toxic products in the home

If you’d like to really spoil your day then here’s a couple of articles about those:

The 20 most harmful ingredients in beauty products

15 toxic beauty products that most women use anyway

So what to do? Well, educating ourselves is the first step. Know that ‘organic’ is nonsense then it comes to beauty products or household cleaners. It might just mean they’ve included a few organic ingredients with the chemicals. It might mean they’re using the scientific definition of ‘organic’ (hint; everything is organic!) rather than the commercial use which is supposed to indicate that food has been grown or manufactured using only a limited range of approved chemicals (another hint; there is no such thing as ‘chemical free’ because everything is made of chemicals.)

It’s a good idea to read labels and choose products that avoid the known nasties. True, the thing you buy could contain something that gets proven to cause disease next week (or next year, or whenever) but at least you’ll have limited your exposure to things that are known to be bad for you. This might mean having slightly less shiny hair, but you’re worth it.

Know that most liquid things that come in plastic bottles will also be contaminated by the plastic bottle. If you want to go hard core you might consider decanting shampoo and conditioner into glass or ceramic dispensers (most people won’t) and give up liquid soaps and body wash products completely in favour of a bar of soap.

Go natural. Okay, it’s not practical for a lot of women because there’s still this weird expectation that we all look a certain way, a requirement that strangely does not apply to men. If you have to wear makeup, or you love to wear makeup, you might want to avoid cheaper brands, opt for a less ‘made up’ look so that you wear less, and choose things with fewer ingredients and none of the nasties. A simple rule of thumb is to buy things labelled ‘fragrance free’ or ‘sensitive skin’ because they will have less dangerous chemicals than the perfumed varieties.

And finally, have a long hard think about your hair and what you would like to do with it. Now that there’s a clear link between dark hair dye, chemical straighteners and cancer, do you really want to keep putting that stuff on your head. If the answer is ‘yes’ then perhaps consider hunting for safer products and going lighter. Or perhaps it’s time to get a really flattering cut from a great hairdresser using all the money you’re going to save on hair products. There’s an obvious pun here about dying for dyeing but I’m not going there.

If you are a man reading this then please start telling the women in your life how great they look when they haven’t put makeup on their faces. Love them as they are and support their decisions about kicking the dyeing. I read a comment from a woman recently who said her husband tells her to colour her hair so she doesn’t look old. Seriously.

I’m pragmatic about all of this. A ‘chemical free’ home is almost impossible to achieve. If you don’t have tank water then there’s chlorine in your water and it evaporates into your home every time you shower. But you can reduce the toxic load by making smart choices about what you choose to use.

As a final tip, avoid redecorating disease. Lounges, cushions and soft furnishings like mattresses are typically treated with flame retardants that are, you guessed it, highly toxic. Get something with washable covers or just keep the things you already have until they fall apart. You’re probably rolling your eyes at all this. I don’t blame you.

That’s enough about chemicals. I’m off to the garden to put my feet into some healthy dirt. Apparently, there’s something in the soil biome that helps us to avoid depression. It turns out that lots of bacteria are beneficial to human life and that trying to kill them all off with disinfectants, herbicides, fungicides, antibiotics and solvents was a really stupid idea. Imagine.