筆者在某網站看到此文，覺得有必要share with 各位網友。 mammogram 不是risk free的。它會致癌致死的。 隻是致癌致死的比例比save的life低而已。 您如果Google Dr. David Brenner， Dr. Samuel Epstein, Rotterdam Study 等， 可以看到這些文獻的全文。
另外， 華人女性乳腺密度較高，mammogram 的效果不是最好。加州今年開始發乳腺密度高的警告了。超聲，MRI也能很好的診斷乳腺癌。可惜假陽性很多，因此沒有正式推出。
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(posted by “coffeelatte” July 2009)
How Many Women Actually Get Cancer from Mammograms?
According to calculations by Dr. David Brenner, professor of radiation oncology and public health at Columbia University, mammography is likely responsible for as many as 6,400 radiation induced cancers every year.
Dr. Samuel Epstein, a professor of environmental medicine at the University of Illinois at Chicago School of Public Health, argues that the radiation risks of mammography are notoriously underestimated.
Mary Helen Barcellos-Hoff, a radiation biologist at Lawrence Berkeley Laboratories in San Francisco, the average American gets about 360 millirems (a unit for measuring absorbed doses of radiation) of radiation annually, from natural background radiation coming from rocks, radon and cosmic rays, as well as man-made sources.”
To help protect women, the Food and Drug Administration limits the amount of radiation that X-rays can deliver to women’s breasts to 300 millirems per film per view, says Kramer. Even with that restriction, Epstein says, women receive too much radiation. Radiologists routinely take two films per breast.
Reporting in the International Journal of Health Services, Epstein and coauthors Rosalie Bertell and Barbara Seaman argue that the premenopausal breast is particularly sensitive to radiation. They estimate that every 1000 millirems of radiation exposure increases the risk of breast cancer by 1 percent.
The typical mammogram consists of two X-Rays of each breast for a total of 1200 millirems of radiation and many women get much higher doses do to technician error that require extra retakes.
The American Cancer Society says for every 1,000 women in their 40s screened for 10 years, there will be 600 who will be called back for a repeat mammogram for something suspicious, 350 who will get biopsied, and about five will end up with a diagnosis of breast cancer. And some women might get treated for a cancer that would never have caused a problem.
Therefore, women who start getting annual mammograms at age 40 would have at least a 12% increased risk of developing breast cancer due to the screening procedure by the time they turn 50. That does not sound like preventive care to me.
New Mammogram Study Stirs Debate
A new study from Sweden is stirring fresh debate over whether women in their 40s should get mammograms. It suggests that mammogram screening tests can lower the risk of dying of breast cancer by 26 percent or more in this age group.
According to Dr. Otis Brawley, the American Cancer Society’s chief medical officer, “If we screened all 22 million American women who are aged 40 to 49 this year, this study suggests it would translate to 2,000 to 2,200 lives saved.”
What your doctor and virtually all of the researchers have neglected to tell you is that radiation studies dating back to 1998 reveal that for every 66 women in their 40s whose lives are saved by mammography, 1 is killed by mammography. (J Med Screen 1998;5:81–87; Rotterdam Study; Petra Beemsterboer et.al.; Department of Public Health, Erasmus University, Rotterdam, the Netherlands)
That means that if all 22 million American women get annual mammograms, 33 women will die from the radiation, while 2200 will be saved.
According to the authors of the Rotterdam study, “For a screening programme, age group 50–69 (two year interval, 2 mGy, or 200 millirems radiation per view), the balance between the number of deaths induced versus those prevented was favourable: 1:242. When screening is expanded to the age group 40–49 with a one or two year interval the results may be less favourable, that is, 1:66 and 1:97.”
In plain English, this means that in women age 50-59 who get a mammogram every two years, 1 woman will die due to the radiation from mammography for every 242 women saved by early detection of a mammogram and treatment; in the 40-49 year old age group who get a mammogram every two years, 1 woman will die for every 97 saved, and 1 woman will die for every 66 saved in the women age 40-49 who get a mammogram every year.
Mammogram Radiation Kills
The National Cancer Institute estimates that annual mammography of 100,000 women for 10 consecutive years beginning at age 40 would result in up to eight radiation-induced breast cancer deaths. (J Natl Cancer Inst Monogr. 1997;(22):119-24. Radiation risk from screening mammography of women aged 40-49 years.)
Eight deaths out of 100,000 women doesn’t sound like too many, unless of course it is you or someone you love. However, extending that rate to the 11 million women aged 40-49 who get a mammogram every year in the U.S., means that 88O radiation-induced breast cancer deaths will likely occur in that group over their lifetime.
Women deserve to know that Mammography exposes them to considerable risk of death over their lifetime. The earlier a woman begins getting mammograms the higher her risk. Sadly women are not being warned of this risk. Dr. David Brenner, with the Center for Radiological Research at Columbia University, says that the real number may be much higher than estimated.
Dr. Brenner says that younger women have more cells that are actively dividing, making them even more vulnerable to radiation’s effects than women over the age of 50. Additionally, Mammograms are less reliable in younger women because of their denser breast tissue.
While the risk of getting cancer from a mammogram is extremely low for the individual woman, Brenner says, it becomes a complicated public health question. He points out that currently 30 to 40 million women get mammograms each year. According to his calculations, given these theoretical models, mammography is likely responsible for 4,800 to 6,400 radiation induced cancers every year.
At the current rate of 41,000 breast cancer deaths per 186,000 cases annually, that translates into as many as 1400 deaths caused by mammograms every year in the U.S.
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