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Breast Cancer Screening

I was recently asked by a woman in her mid 30’s if she should begin annual screening for breast cancer. Her family doctor knew that her mother had been diagnosed with breast cancer, and he began pressing her to get annual mammograms. Many women find themselves in similar circumstances. They are concerned about the possibility of developing breast cancer and would like to detect it early rather than risk waiting until it’s too late. However, much controversy exists surrounding screening mammograms, and after hearing this controversy, many women feel unsure whether to undergo screening mammograms, wait, or abandon them altogether. They simply want to know what course of action is best. Unfortunately, the issue is fairly complicated – for both women and their physicians. A multitude of scientific studies, reports, and institutional guidelines and recommendations exist, many with dissenting opinions and conclusions. Having studied and reviewed many research articles and other documents on this topic, I hope I can offer some valuable insights and lay out some of the facts so that you, too, can make an informed decision.
Can taking supplements make a difference? The answer may be more complicated than you think. Dietary supplements can be a good an option to fill the gaps in your diet, but relying too much on nutritional supplements can be expensive, cause side effects, and take away the motivation to pursue a healthy lifestyle. That being said, supplements can provide significant benefits if selected wisely and taken appropriately. Many supplements can also be used medically as an integrative treatment for certain diseases and conditions.

First and foremost, I maintain that the best course of action for any woman to take is to visit your naturopathic doctor and have a candid discussion with him/her about breast cancer screening. By taking into account a variety of factors such as your lifestyle and health habits, your genetics and family history, and your current state of health, your doctor can help illuminate some of your risk factors for breast cancer. Together, you can decide if annual or biennial mammograms might be worthwhile.

In addition to misdiagnosis, screening mammography creates a problem of overdiagnosis. Overdiagnosis refers to the patient who is correctly diagnosed with breast cancer and undergoes appropriate treatment. However, although the patient truly did have breast cancer, the cancer that was detected wasn’t actually harmful to the individual and would never have created any symptoms in her lifetime nor ever led to death.7 It may be counterintuitive to think that you may be better off if some cancers go undetected. But the fact is, in some cases, a cancer diagnosis can actually cause more harm than good.9 Some cancers are characterized by slow growing tumors, non-growing tumors, or tumors that may resolve on their own. These tumors are actually do less harm to the body than chemotherapy or radiation treatments. Treating these tumors causes the patient to experience psychological stress, financial burden, wasted time and energy, and harmful side effects of surgery, chemotherapy, and radiation.

When mammography became instituted as the standard tool for breast cancer screening, the rate of breast cancer diagnosis rose dramatically.1,2,8 On its own, this statistic might sound like a step in the right direction in the fight against breast cancer. Unfortunately, the rate of death from breast cancer did not improve much 3, if at all 9. Studies have shown that most women think that breast cancer screening cuts the number of deaths from breast cancer in half,4 but the real numbers suggest that if 5 out of 1000 women will die of breast cancer if they do not receive mammography screening, while 4 out of 1000 will die if they do receive screening.5 So there indeed may be some modest benefit (about 0.1%).5 But with increased annual screening comes an increased rate of misdiagnosis, or false positive diagnosis. A false positive breast cancer diagnosis is like a breast cancer “scare” – an abnormal but non-cancerous mass in the breast is detected by mammography and misdiagnosed as breast cancer until biopsy proves it to be benign. False positive diagnoses place an emotional and financial toll on female patients and on society as a whole, because women must take time off from work or family to undergo subsequent testing and examination, all while worrying that they have breast cancer. For every life saved with mammography, between 2 and 10 people will be overdiagnosed.6

There are other inherent downsides to mammography screening itself, such as increased exposure to radiation, pain from the compression of the mammography machine, and the emotional stress of awaiting results. Yet virtually all life-saving medical tests have their downsides, and these should not be taken as compelling reasons to avoid screening. However, studies show that overdiagnosis remains the most serious downside of screening.8 One survey showed that 50% of women would turn down annual screening if they knew the full story of how screening leads to overdiagnosis and overtreatment, yet 90% of women do not know the full story.6. In a self-perpetuating cycle, the rising rate of breast cancer overdiagnosis actually generates more overdiagnosis, because an ever-increasing portion of the population knows someone who claims she “owes her life” to early cancer detection. This has been called THE PARADOX OF SCREENING.9

This being said, it is important to understand that when a breast tumor in the early stages of cancer is detected by mammography, there is no sure way of knowing whether it is a slow growing/benign/not-worth-treating tumor, or if it is a more aggressive tumor that warrants treatment. Therefore, completely disregarding your mammography results is not a good idea either. If a tumor is detected, having both an oncologist and your naturopathic physician on board is the best plan.11 An oncologist will present you with conventional treatment strategies, and your naturopathic physician can help treat you supportively. When treating individuals with cancer, naturopathic physicians employ many natural adjunctive treatment methods to optimize the immune system, manage side effects of cancer treatment, support healing after surgery and radiation, and reduce the risk of cancer returning in the future. Your naturopathic physicians can also inform you of alternative ways to support cancer treatment such as high dose vitamin C IVs. And, very importantly, a naturopathic physician can help you heal emotionally and spiritually while fighting breast cancer.

References

  1. https://www.ncbi.nlm.nih.gov/pubmed/16737949
  2. https://www.ncbi.nlm.nih.gov/pubmed/1960750
  3. https://www.ncbi.nlm.nih.gov/pubmed/23737396
  4. https://www.ncbi.nlm.nih.gov/pubmed/24738641
  5. https://www.bmj.com/content/341/bmj.c4830
  6. https://www.ncbi.nlm.nih.gov/pubmed/25011404
  7. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/breast-cancer-screening1
  8. https://www.ncbi.nlm.nih.gov/pubmed/23171096
  9. https://www.ncbi.nlm.nih.gov/pubmed/20413742
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825646/
  11. https://academic.oup.com/jnci/article/110/1/121/4064136

If you have questions regarding any of these supplements, or if you would like to schedule a free consultation for you or your family member to assess your current nutrient status or find the best supplement for your needs, please give us a call at MedRoyal in Chandler, AZ, at (480) 783-0708.
Or email us at FrontDesk@MedRoyalAZ.com