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Mammography Screening: Truth, Lies and Controversy Paperback – Jan 21 2012
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About the Author
Peter C Gotzsche Professor of Clinical Research Design and Analysis, Director, The Nordic Cochrane Centre and Chief Physician, Rigshospitalet and the University of Copenhagen, Denmark
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Peter C., M.D. Gotzsche
This is a great book. If you are interested in breast cancer you must read it. If you have concerns about ethics in medical research and the influence of self-interest, power, or money on research and publication, this is the book for you. If you are a woman undergoing routine screening, you will want to read this. If you are a physician who deals with cancer or women you must read this book.
This is the personal story of an heroic Danish researcher who was asked by the Danish Board of Health to "take a look at" breast cancer mammographic screening because of a pending vote. The book details a 10 year odyssey and battle to expose the truth and lies and harms of routine mammographic screening. Peter Gotzsche discovered that no one knew, or at least no one was discussing, the harms of screening, and further, that the benefits were severely overrated.
The basic premise of screening, "find cancer early, treat it when it is small, results will be better," is questioned. Does screening decrease the number of mastectomies? No, and you will discover why. What has happened to the incidence of breast cancer since screening has started? Why is there such an increase in the number of women being treated for non-malignant breast disease (called cancer in situ)? Has screening decreased the amount of advanced breast cancer? Clue: no. Why does a decrease in 5 year breast cancer mortality mean nothing?
If you start to get bogged down in the book, jump to the last few chapters. To see current recommendations from Dr. Gotsche see this:[...]
Finally, Dr. Gotsche will explain how to decrease the incidence of breast cancer by one-third.
Gotzsche clearly shows that mammography screening does not prevent breast cancer and has little effect on mortality from breast cancer. Women need to hear that it's reasonable to refuse mammograms and that the most effective way to decrease women's risk of becoming a breast cancer patient is to avoid this screening. They need to understand that by accepting mammography screening they are exposing themselves to the possibility of totally unnecessary biopsies, surgeries, and sometimes even chemotherapy or radiation. For a short summary of these statements see the author's 2008 Cochrane Report on mammography at [...] cochrane.dk
Gotzsche makes it clear that for every 2000 women who are screened annually for ten years only one life is saved while at the same time ten women are given false diagnoses that can lead to extreme emotional distress and unnecessary medical treatment, sometimes even costing them their breast unnecessarily. I recently experienced this after a mammogram showed microcalcifications. After a very painful inconclusive needle biopsy in three areas I was told I needed a surgical biopsy (a lumpectomy where I lost part of my breast). I couldn't stop feeling that I had been trapped into two unnecessary, painful, emotionally traumatic procedures even though no cancer was present and my atypical (non-cancerous) cells may have regressed on their own without ever giving me a problem. I know this experience affected my life negatively for months, leaving me shaken and fearful. Thankfully I have now informed myself through this book and will reject further mammograms.
Gotzche makes it clear that many times cancer regresses and that ductal carcinoma in situ (DCIS) often never becomes invasive and that up to 40% of observed cancers had limited malignant potential and would have regressed if undetected. Women need to read this book and invite their physicians to read it so they have this information and can make informed decisions about screening and treatment.
I found this book to be eye-opening. I believe every woman needs to be aware of its conclusions so she can protect her health and emotional well-being and avoid unnecessary treatment.
For those like myself who have watched the politics of cancer over the past 30 years there is nothing surprising in this book. But for those who rely on the media for information about cancer screening, they will find much of the contents unbelievable.
The politics of cancer screening is almost identical to that behind the similar controversies of the cholesterol debate in relation to heart disease and the debate about global warming. Many people ask the simple question: How can 95% of the experts be wrong?
Peter Gotzsche's book explains in fine detail how the majority of so called experts apparently don't understand the basic principles of how to run, and how to interpret the results of a randomised controlled trial.
What is shown in this book probably also applies to all of the other types of cancer screening that have been evaluated using randomised controlled trials: screening for prostate, lung, bowel and ovarian cancers. In none of these areas has there been any clear evidence that earlier surgery made possible by screening has produced any saving of lives. Yet In all of these areas the experts have been promoting cancer screening in their area after misunderstanding the results of these trials.
The only shortcoming I found in this excellent book is the author's failure to grasp the significance of his findings: screening doesn't help people with cancer because cancer is a systemic disease. If tumours are only symptoms of a systemic disease, it is not surprising that surgery doesn't help, or that earlier surgery made possible by screening also doesn't help. It in fact causes more harm than good.
Gilbert Welch's excellent book "Overdiagnosed: making people sick in the pursuit of health" shows how screening and other testing often causes more harm than good by finding symptoms that would not have led to death if left alone.
With these two books we are at last getting some of the nitty gritty behind the findings in the earlier ground-breaking books such as Ivan Illich's "Medical Nemesis (1975), Richard Taylor's "Medicine Out of Control" (1979) and more recently Ray Moynihan's "Too much medicine" (1998).
However none of these authors hs concluded from the lack of progress with cancer over the past 70 years that the reason is the unproven assumption that cancer starts locally and later spreads.
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