It is a constant battle for the woman who does not want x-ray
mammography. The medical establishment is slow to move to new techniques and
away from x-rays. First, they have a monetary investment in their expensive
x-ray equipment, their CT scanners, and their traditional radiological
training. Secondly, they do not want the risk of using new methods that have
not been recommended by their professional societies, or they would be at increased
risk of liability if there is a bad outcome. Third, they do not want to miss a
diagnosis, again for fear of being sued, and will order as many x-ray films as
they need to diagnose a breast tumor. For a woman with dense breasts, that are
difficult to analyze with x-rays, this can produce a hefty dose of radiation.
X-ray diagnostics and treatment methods became prominent in the 20th
century, but shouldn’t belong in our 21st century. We know that
x-rays, high energy ionizing radiation, can cause breaks in DNA, our genetic
material. These breaks, if not repaired, can cause mutations and cancer. Yes,
we have our body’s repair systems to repair the radiological damage. But
sometimes the repair systems fail, especially if we are old or weak or sick. A
study of mammary cells exposed to x-rays in culture showed that older cells
accumulated more DNA breaks than younger cells.1 Ironically, older patients tend to get sicker
than the general population, and therefore get more x-ray diagnostics and
treatments. They also develop more cancer.
Women with dense breasts, who require more x-ray films, get more breast
cancer.2 Pardon my skepticism that this is a coincidence.
Some women have known defects in their repair systems, namely those
with mutations in the BRCA1 and BRCA2 genes.3 As a result,
they are more likely to develop breast cancer at an early age from just natural
background radiation. So what does our medical community recommend? More
frequent screening with x-rays to check for breast cancer. What insanity! They
recommend increased screening for cancer with an agent that can cause cancer,
on a patient who is less able to fix the damage that causes the cancer. When x-rays were the
only diagnostic method available, this made some sense. It was worth the risk of causing future
cancers to have the benefit of knowing if there were already a cancer present, so
it could be treated. Now, however, with several non-ionizing screening tools
available, it is not necessary to put up with this added risk.
MRI (magnetic resonance imaging) is a safe non-ionizing radiation
method that is actually more sensitive than x-ray mammography.4 It is useful for women with dense breasts,
whose cancer is not so easily detected by x-rays. However, MRI has not been
used for general screening because the method is much more expensive than
traditional x-ray mammography. An MRI may cost over $1000, compared to an x-ray
series for about a hundred dollars. There
is a new fast MRI method that in some institutions costs only $350.5
Another plus for MRI is that this method
does not require the painful breast compression that is required for x-ray
mammography, where the breast is placed between two glass plates that are
squeezed together. If breasts are dense, the squeezing is greater, as the technician tries to get clearer images.
MRI does have its negatives. One
is that a contrast agent has to be injected. Another is that older machines are
uncomfortably noisy, even with ear plugs. Inquire if your clinic is using a
modern, quiet machine.
Another non-ionizing method for breast cancer screening is ultrasound. It has become well characterized, depending for accuracy on having
well trained technologists. There is a 3-D ultrasound method approved by
the FDA in January 2014 that holds much promise.
Ladies, insist on MRI or ultrasound. If enough of us do, the resulting increase in use of these alternatives should eventually drive the costs down.
References:
1 Laia Hernández, Mariona Terradas, Marta Martín,
Purificación Feijoo, David Soler, Laura Tusell, and Anna Genescà, PLoS One.
2013; 8(5): e63052.
2 Warwick J, Birke H, Stone J, Warren R, Pinney E, Brentnall
AR, Duffy SW, Howell A, Cuzick J, Breast Cancer Res. 2014 Oct 8;16(5):451.
3 Rosen EM, Pishvaian MJ, Curr Drug Targets. 2014
Jan;15(1):17-31.
4 Lord SJ, Lei W, Craft P, Cawson JN, Morris I, Walleser S,
Griffiths A, Parker S, Houssami N, Eur J Cancer. 2007 Sep;43(13):1905-17.
5 Kuhl CK, Schrading S, Strobel K, Schild HH, Hilgers RD,
Bieling HB, J Clin Oncol. 2014;32:
2304-2310.
NIH summary:
http://www.cancer.gov/cancertopics/factsheet/detection/mammograms
