The Mammography Debate, Part I

This article was presented November 22, 2009, by Ralph W. Moss, Ph.D. in issue #418 of his free weekly newsletter. For further information, including subscription to his reports, see his website.

On Monday, November 16, the United States Preventive Services Task Force (USPSTF) revised its previous position and came out against annual screening mammograms. The new recommendations included the following points:

Women age 40-49 do not need to get routine mammograms.
Postmenopausal women need only get mammograms once every two years, instead of every year, as presently recommended.
Women over the age of 74 do not need mammograms at all.
Physicians should stop teaching women to perform breast self-examinations.

These recommendations pertain to the routine screening of the general population and do not apply to the small percentage of women who are known to be at heightened risk of breast cancer. 

When you consider how central mammography (and breast self-examination) have been to the "war on cancer" you realize how drastic a change this would be. The USPSTF is a very influential and prestigious group, made up of independent experts in prevention and primary care, appointed by the federal Department of Health and Human Services. Yet, immediately, the report became a political football. Some Republicans attacked this as the first sign of healthcare rationing while most Democrats have backed away from the findings as if it were overripe Limburger cheese.

HHS Secretary Kathleen Sebelius said that the report (which her office had commissioned) had caused "a great deal of confusion and worry" among American women. "My message to women is simple. Mammograms have always been an important life-saving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years – talk to your doctor about your individual history, ask questions, and make the decision that is right for you." 

Another prominent Democratic politician, Debbie Wasserman Schultz (D-FL) went on the attack:

"I am very concerned that these guidelines conflict with many of the well-established recommendations from the American Medical Association, the National Comprehensive Cancer Network, the American Cancer Society, and Susan G. Komen for the Cure. This conflicting information will inevitably lead to confusion among providers and women, resulting in fewer women getting screened for breast cancer," she said in a statement.

So I doubt if these recommendations will be implemented anytime soon. Indeed, I think this controversy throws a light on the much-discussed topic of health-care reform. There appears to be no mass constituency in the US for cool-headed, rational science, when such findings conflict with the fundamental interests of a large portion of the medical establishment. Mammography is now as American as apple pie.

The co-chair of the USPSTF said that the recommendations were aimed at reducing the harm caused by over-screening. But the very notion of "over-screening" gets short shrift from the cancer establishment, especially from the American Cancer Society (ACS). They have built their reputation on finding all "cancers" as early as possible, especially through mammography and BSE. This would be too radical a shift for their members. 

But, as Robert Aronowitz, MD, of the University of Pennsylvania points out in an op-ed in the New York Times, such recommendations are nothing new. They are the same as most thoughtful experts have been making since the 1970s. "You need to screen 1,900 women in their 40s for 10 years in order to prevent one death from breast cancer," said Aronowitz, "and in the process you will have generated more than 1,000 false-positive screens and all the overtreatment they entail." 

The backlash against the report began immediately. According to a statement by Otis Brawley, MD, chief medical officer of the ACS:

"The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40." He claimed that ACS has examined the same data as the USPSTF, and had also looked at additional data that the panel did not consider. Generously, he said that "sensible people" could differ over their interpretation of the data.

The National Cancer Institute (NCI) valiantly tried to defend the panel's decision. In its Cancer Bulletin, it soberly evaluated the new recommendations and commented:

"When compared with screening from ages 50 to 69, beginning screening every other year at age 40 produced a small additional reduction in mortality but increased the number of false-positive results by more than 50 percent" (Cancer Bulletin 2009).

Unless you have gone through one of these false positive scares you can hardly imagine what it entails. You are called by the doctor's office and told, usually in a very cryptic way, that there is something wrong with your mammogram and you urgently need to come back for further testing-a repeat mammogram, an MRI or a biopsy. This entails more visits to the doctor's office. Because you may need to arrange transportation and childcare, your friends and family members may get involved. The dreaded "C word" gets whispered abroad. Then comes a period of waiting for the results, which may seem endless. Figure on a few days of lost time and wages. The whole business, multiplied millions of times, puts an economic strain on the medical system.

If you are lucky, the needle biopsy proves negative and you are left to heal your emotional and physical wounds. But sometimes the biopsy detects an abnormality. In rare instances this will be breast cancer. Or it may be ductal carcinoma in situ (DCIS), an amorphous category that sounds like cancer but may not be. What is the medical significance of DCIS? Will it surprise you to learn that, after decades of detecting and treating this condition, nobody seems to know? As the new USPSTF report states:

"Studies on overdiagnosis might also include long-term follow-up of women with probable missed cases of DCIS on the basis of microcalcifications that were missed in an earlier mammogram. Such studies could provide the percentage of these women who develop invasive breast cancer over the next 10 or more years" (Nelson 2009).

In other words, nobody knows how many of these DCIS lesions actually progress to invasive cancer. Since nobody really knows what DCIS means, nobody knows how best to treat it. Again, quoting the USPSTF report says:

"Although the standard treatments women receive for ductal carcinoma in situ (DCIS) include surgical approaches as well as radiation and hormonal therapy, considerable debate exists about the optimal treatment strategy for this condition" (Nelson 2009).

According to breastcancer.org, DCIS is not cancer and isn't life-threatening. But DCIS is routinely treated as if it were full-blown cancer, possibly entailing a mastectomy (surgical removal of the breast). Meanwhile, thanks to mammography, DCIS's growth has been astonishing. In 1983, there were 4,900 US cases of DCIS. By 2008, that number had increased to 67,770 (Nelson 2009). The over-treatment of DCIS has also swollen the ranks of "breast cancer survivors" and mightily improved the cure rate from the disease-because doctors are now "curing" a non-cancerous condition that in all likelihood would not have progressed to cancer.

TO BE CONCLUDED, WITH REFERENCES, NEXT WEEK

--Ralph W. Moss, Ph.D.

The RELATIONSHIPS spoke of the Wheel of Wellness

Let's consider another spoke of the Wheel of Wellness – RELATIONSHIPS (forgiving, compassionate, loving my neighbor as myself, at peace with others)

One of the most often repeated expressions in Scripture is this: “Love your neighbor as yourself.” References include Leviticus 19:18, Matthew 19:19 and 22:39, Mark 12:31, Romans 13:0, Galatians 5:14, and James 2:8.

The foundational statement, Lev. 19:19, was included in God's instructions to the Children of Israel through Moses: “Then the LORD spoke to Moses, saying, … 'You shall not take vengeance, nor bear any grudge against the sons of your people, but you shall love your neighbor as yourself; I am the LORD.'” Also included in that teaching were the Ten Commandments, the “Kosher” laws, and other instructions for daily living. God's teachings were for the benefit and welfare (good health, or wellness) of the Chosen People.

When Jesus first quoted the Leviticus passage (Matthew 19:19), he was responding to a young man of property who had asked, “Teacher, what good thing shall I do that I may obtain eternal life?” Along with other instructions, (do not murder, do not commit adultery, do not steal, do not lie, and honor your father and mother), Jesus told him to love his neighbor as himself. It seems to me that if those instructions are beneficial for eternal life, they are also worthwhile for present life. As I see it, eternal life is not a separate life from the present, but rather a continuation – a new chapter following at the end of the one we are writing now.

In the other gospel passages (Matthew 22:39 and Mark 12:31), Jesus was responding to the question of which is the greatest commandment. Jesus' response gave the first as “Love the LORD your God with all your heart, and with all your soul, and with all your mind, (Mark only: and with all your strength).” Then he added as the second greatest, “You shall love your neighbor as yourself.” That fits with our discussion here: last time we called the first spoke of wellness one's relationship with God, and now the second spoke is our relationships with one another.

The simple fact that this expression came from God through Moses and was repeated by Jesus three times, by Paul twice, and by James gives great weight to the concept. The only new twist I'm adding is that physical wellness is not really separable from spiritual wholeness. Just as separation from God can hamper one's wellness, so also estrangement from family or others can have an adverse effect on wellness. Unforgiveness, holding grudges, lack of compassion all can harm wellness. Remember 2 Corinthians 13:11 Finally, brethren, rejoice, be made complete, be comforted, be like-minded, live in peace; and the God of love and peace will be with you.

This, then, is one more spoke in the Wheel of Wellness.

A Miracle of Modern Medicine

As you may have noticed, my primary focus is wellness by treating my body as it was designed to be treated. But occasionally, I learn of ways that physicians have assisted a patient to wellness using such techniques as surgery.

One current such example is found on a National Public Radio report of November 9, 2009. The report begins, "Trigeminal neuralgia is a rare condition that causes pain so intense it used to be known as the suicide disease." In at least one instance, the unbearable pain was relieved by surgically pulling out and away from the nerve a blood vessel that had become trapped in a loop behind the nerve.

See the report and included video of the patient and the surgery (not for the squeamish) at this link.

A Ticking Time Bomb

I recently had an opportunity to view the film “Under Our Skin.” If you have even the slightest interest in Alzheimer's, Parkinson's, arthritis, Chronic Fatigue, ALS (Lou Gehrig), MS, or other difficult-to-diagnose disease, you will not want to miss this challenging and provoking film.
I'm sure that I didn't catch everything, and quite likely I misunderstood parts, but following are some of my observations.

• The most effective treatment for Lyme Disease is that administered immediately and aggressively.

• For severe cases, the greatest improvement comes after about three years of treatment.

• Research has found Lyme DNA connections to many chronic conditions, such as Alzheimer's, Parkinson's, Chronic Fatigue, ALS, and MS.

• "Chronic lyme disease" is not recognized by medical authorities as a treatable condition.

• Treatment recommended by medical authorities, as reported at http://www.journals.uchicago.edu/doi/full/10.1086/508667?cookieSet=1, is very restrictive. “A single dose of doxycycline may be offered to adult patients (200 mg dose) and to children 8 years of age (4 mg/kg up to a maximum dose of 200 mg) (B‐I) when all of the following circumstances exist: (a) the attached tick can be reliably identified as an adult or nymphal I. scapularis tick that is estimated to have been attached for 36 h on the basis of the degree of engorgement of the tick with blood or of certainty about the time of exposure to the tick; (b) prophylaxis can be started within 72 h of the time that the tick was removed; (c) ecologic information indicates that the local rate of infection of these ticks with B. burgdorferi is 20%; and (d) doxycycline treatment is not contraindicated.”

• The treatment that has been found most effective by treating physicians includes several years of care, using antibiotics. Physicians in several states have been hounded out of practice by aggressive regulators following the recommended guidelines. For example, see http://blogcritics.org/politics/article/the-state-of-connecticut-vs-dr/ or http://www.casewatch.org/board/med/jemsek/charges.shtml

This is a subject to watch. It has every appearance of being one in which patients will have to search far and wide to find a physician who is able and willing to treat their condition.

Love That Olive Oil!

This research report fits right in with my emphasis on wholesome, natural foods such as extra virgin olive oil. Other than my daily flax oil and an omega 3 capsule, about the only fat I consume is extra virgin olive oil.

September 30, 2009 | Research
Another Reason to Love Olive Oil

Compound found in extra-virgin olive oil may help prevent Alzheimer’s
By Megan Fellman

This may help explain some of the benefits of the Mediterranean Diet.

Review: A Cancer Therapy – Results of Fifty Cases and The Cure of Advanced Cancer by Diet Therapy, by Max Gerson, M.D.

This handy (434 page) book reports on one of the landmark discoveries of modern medicine. When Dr. Gerson had presented testimony on his success before the subcommittee headed by Senator Claude Pepper, he prepared this book to report to the general public on the possibility of healing cancer without conventional medical treatment (surgery, radiation, and chemo). Even today, half a century later, the US medical community has not accepted this work as valid – Senator Pepper was unable to get funding for further research, so Gerson Therapy is still not recognized in the US. A cancer patient wanting the best possible outcome has three choices: self care, or travel to Mexico or Germany where Gerson clinics are available.

Dr. Gerson developed his therapy the hard way – he lived it. Attending medical school with severe migraine headaches, he was advised that he would just have to live with them; they are incurable. He proceeded to cure his own migraines, then went on to find cures for tuberculosis and eventually cancer. The technique he developed was to provide sufficient nutrition to the cells and to remove toxins from the body. That simple approach enabled him to accept patients who had been released as incurable by other physicians. Having nothing to lose, they were willing to accept the severe discipline that Dr. Gerson imposed as the means to effect the cure. Not every patient recovered, but remember that his pool of patients was limited to only the hopeless.

Included in the book are Dr. Gerson's Theory to guide physicians to apply the treatment properly, a few similar cancer theories, some preliminary thought by Paracelsus, and a survey of other authors' attempts to use diet to treat cancer.

One topic which became central to Gerson Therapy is understanding of the liver and its function in wellness and disease. Building on the results of others' research, Dr. Gerson identified the relation of liver function to mineral balance in the body, especially the loss of potassium and potassium-group minerals. Not unrelated is the role of salt in the diet, especially sodium.

Along the way, Dr. Gerson recognizes the impact of insecticides and soil depletion on declining wellness. Modern nutritionists have developed many supplements to offset the declining nutritional value of soil as it is depleted by continuous cultivation. Some physicians have finally recognized that supplementation is vital to wellness.

The diet used in Gerson Therapy is limited primarily to fresh juices of fruits, leaves, and vegetables, large quantities of raw fruit and vegetables, vegetables stewed in their own juice, oatmeal, special soups, and salt-free rye bread. As treatment progresses, some selected animal protein may be included (salt-free and fat-free cottage cheese and yogurt, and buttermilk). The diet is sodium-free and high in potassium to speed up restoration of the mineral balance of the body that is essential for wellness. Along with provision of adequate nutrition, it also is vital to remove toxins rapidly. The main tool for that purpose is enemas, especially coffee enemas. Such treatment has been found very effective for eliminating pain that would be suffered from the toxins that accumulate as proper nutrition forces them out of the cells, as well as stimulating the liver to release the accumulated toxins.

The latter half of the book is primarily devoted to details of fifty of the case histories of patients that Dr. Gerson treated. Considering the advanced state of disease in each of them, the results achieved by Dr. Gerson are astounding, especially at a time when medical practice had few effective treatments to apply. Here are some sample cases:
1) Pituitary tumor, patient unconscious – returned to work in eight months.
11) Testicular cancer metastasized to both lungs and periaortic glands, prognosis hopeless; released to die – within 18 months on Gerson Therapy, feeling fine and working.
15) 8 month-old boy with active neurogenic fibrosarcoma; physician wanted to amputate left arm and shoulder – recovered and grew up normally.
16) Breast cancer with brain metastases – totally recovered with Gerson Therapy.

Review: Dr. Dean Ornish's Program for Reversing Heart Disease The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery

This book is neither small nor new, but it is worth its weight in gold. With copyright date 1990, the book reports on the rigorous research conducted by Dr. Ornish and his staff at Presbyterian Medical Center and the University of California San Francisco School of Medicine beginning 1984. Research findings were published in The Lancet in Summer 1990.

The research approach, “Opening Your Heart”, combined dietary modifications, stress reduction, avoidance of smoking, and regular exercise. Preceding studies had considered individual components, but no one had combined them all in the same study. By the end of one year, 82% of the participants who followed the directions (made the comprehensive lifestyle changes described in the book) demonstrated some measurable average reversal of their coronary artery blockage. Overall the average blockage reversed from 61.1 to 55.8 percent; more severely blocked arteries showed even greater improvement. Improvement was measured by a cardiac PET (Positron Emission Tomography) scan; there was nothing subjective about it. That measured improvement was in spite of the universal belief of the time that heart disease could not be reversed.

The components of the Opening Your Heart program are
1.Techniques for increasing intimacy and managing stress more effectively,
2.A diet very low in fat and cholesterol,
3.A system to help the participant stop smoking and let go of other addictions, and
4.A program of moderate exercise.
Details of each of the components are included in separate chapters in great detail.

Part Three, a major portion of the book is devoted to recipes used in the program. The diet supplies vibrant colors, rich flavors and textures, variety of fresh vegetables, tangy herbs, pungent spices, wholesome grains, savory beans, elegant pastas, and sweet, enticing fruit dishes. Vegetables, grains, and dried beans are the backbone of the diet.

I can not do justice to a 631 page book of this magnitude and value in a single page. To realize the full worth, you need to study it for yourself. If you will approach the book with an open mind and a willingness to learn, you will come away in better health than you began.