A major new study on mammography screening was published in the New England Journal of Medicine earlier this month. Its findings, however unwelcome in some quarters, are becoming harder to dismiss; like several other recent studies, this one concluded that screening actually leads to more overall harm than good.
There may be no ideal time to release disheartening findings that challenge established practice, but their arrival in the midst of Breast Cancer Awareness Month, during which pink is ubiquitous and the mammogram is exalted as the thing to do, is conspicuously awkward.
The investigators of this latest study reviewed data from 1975 to 2012 in order to assess the impact of the large scale screening initiatives that began in the 1980s. If they really were effective, we’d expect to find a reduction in the emergence of sizeable and dangerous tumors over time.
But that’s not what they found; unfortunately the incidence of the most lethal form of cancer (metastatic) remained stable, and that of larger tumors in general dropped only minimally. Adding to these disappointments was their finding that screening has resulted in a considerable increase in the detection of smaller, non-threatening tumors that never required any of the resulting treatment in the first place.
In short, mammograms are not terribly helpful in doing what they are presumed to do: saving lives. The gains made in terms of reduced mortality over the past decades, as the authors conclude, are much more attributable to improved treatments.
Further investment in research and treatment therefore seems abundantly warranted, whereas the role of the mammogram stands in need of recalibration.
Other nations sensibly recommend that screening begin later in life, end earlier in life, and occur at less frequent intervals. The roughly $8 billion a year expended upon this underperforming screening measure – which neither prevents disease nor treats it – provides further impetus to revisit its role.
This study did make the headlines, but I‘d venture to guess that many more people heard the conventional wisdom reinforced while watching any NFL game this month: those broadcasts all found time to announce that “screening saves lives”.
At any rate, the problem is that women do tend, by and large, to overestimate the benefits of mammography (as well as the danger of failing to get screened). Wildly overestimate it. And why wouldn’t they? Its putative importance has been repeatedly conveyed – and the concept itself makes abundant sense.
The outdated notion that mammography screening is universally indispensible is probably the biggest fault of the mass media messaging campaigns – well, the biggest error of commission at any rate. By that I mean one in which a misleading message is actively communicated.
But there is also an important error of omission that also misleads. By that I mean that a highly relevant message is purposely not communicated. An entire category of factors pertaining to reproductive health fails to receive appropriate attention, but the role of induced abortion in particular remains willfully unacknowledged.
The link between induced abortion and breast cancer is still denied by the authorities despite the strong preponderance of evidence from scores of epidemiological studies all over the world – and despite the fact that there is a sound, highly plausible physiological mechanism of action that explains the cause and effect relationship.
Detailed explanations are now available in the literature, but in a nutshell, it has to do with the fact that fully developed and thus protective breast tissue only emerges in the final stages of pregnancy. This is why childbirth (particularly earlier in life) has a protective effect against breast cancer. No one contests that.
In fact, the onus would seem to be on the authorities to explain why premature delivery (especially prior to 32 weeks) – doubles the risk of subsequent breast cancer, but induced abortion does not.
In both cases, a woman experiences a massive spike in estrogen in the early stages of pregnancy which triggers a proliferation of tissues susceptible to cancer; in both cases, a woman is deprived of the development of protective tissues that only emerge near the standard time of birth. How convincing does it sound that only one of these outcomes would be relevant to breast cancer?
Are we further to suppose that the meteoric rise in the practice of abortion over the last several decades has nothing to do with the roughly 40% increase in the incidence of breast cancer corresponding to that time frame?
Au contraire; according to a 2007 study published in the Journal of American Physicians and Surgeons, which featured linear regression modeling from the data of several European countries, having had an abortion was actually the best predictor of subsequent breast cancer. Indeed, this study determined that a nation’s abortion rates could predict with very close to 100% accuracy its future rates of breast cancer.
That sounds pretty significant. So too are the slew of eye-opening findings over the last few years in several Asian countries pointing to a substantial elevation of relative risk attributable to induced abortion.
Meanwhile, it has become somewhat common to hear messaging campaigns tarnishing certain supposed villains as the embodiment of the Tobacco Executives of old – who denied the link between smoking and lung cancer. We see this charge leveled against the manufacturers of e-cigarettes; we see it leveled against the NFL for allegedly suppressing anything about brain injuries that might be detrimental to their brand.
Leaving aside the merits – or lack thereof – of such claims, the more pressing problem is: what do we do when the health authorities themselves are the New Tobacco Executives? Without their complicity in the politicization of medicine, the likes of Planned Parenthood couldn’t ply their trade as if they were part of the “health care” workforce.
In fact, the way Planned Parenthood’s activities are typically characterized by their partisan supporters epitomizes the most misleading errors – of commission and of omission – on breast cancer awareness that I’ve sketched above.
Whenever their most gruesome practices encounter scrutiny, the rejoinder is always that they are heavily invested in the good work of providing mammogram screening. That’s precisely the kind of exchange that arose in the last presidential debate.
The veracity of the claim that they are seriously active in mammogram screening is highly dubious, but let’s choose not to focus on that. And let us further table, just for the sake of argument, any moral considerations and evaluate that stance on the basis of epidemiology alone.
The verdict: even if they mainly trafficked in mammograms, they would not really be contributing to reduced breast cancer incidence or mortality. But their main “service”, their raison d’etre – ensuring the premature and unnatural termination of pregnancy which when carried to full term is quite protective – adds to the burden of breast cancer.
Awareness, alas, knows bounds. Raising it in the name of health is supposed to be an unquestionable good, but suppressing it, you see, is sometimes absolutely necessary.
Matthew Hanley is a Senior Fellow with the National Catholic Bioethics Center. The opinions expressed here are his own and not those of the NCBC.