Food Over Medicine (22 page)

While mammography detects pseudo-cancers resulting in overtreatment, it does not reduce the risk of dying from real cases of breast cancer.

A research letter published in 2001 in
Lancet
reported the findings of a Cochrane Review that looked at the efficacy of mammograms for reducing breast cancer deaths. It is important to note that the Cochrane Collaboration is the most independent medical research organization in the world, and therefore its conclusions about various issues related to medicine are taken more seriously by many of us.

The article stated, “In 2000, we reported that there is no reliable evidence that screening for breast cancer reduces mortality. As we discuss here, a Cochrane Review has now confirmed and strengthened our previous findings.”
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Cochrane has further concluded that screening led to an increase in radical treatments due to overdiagnosis of 25 to 35 percent; that 49 percent of screened women would experience at least one false positive; and that the absolute reduction in risk of death was 0.1 percent.
⁵

The Cochrane researchers also concluded that studies showing that mammograms reduce the risk of dying from breast cancer do not take into consideration the deaths related to breast cancer treatments, and that more women are harmed from overtreatment than are saved with mammography. The groups stated, “There is no reliable evidence from large randomized trials to support screening mammography at any age.”

Another study published online by the
British Medical Journal
⁶
was conducted in Denmark, a great country for studying mammography outcomes. For the past seventeen years, only about 20 percent of women in Denmark have been screened, leaving a large control group from which data can be gathered.

Two geographic areas were included in the study: Copenhagen, where screening was introduced in 1991; and Funen, where screening was introduced in 1997. Between 1997 and 2005, deaths from breast cancer dropped by 5 percent for women between the ages of thirty-five and fifty-five in both of these areas. For women between fifty-five and seventy-four, the decline was 1 percent in mortality rate.

In the nonscreened population in Denmark, the death rate from breast cancer declined by 6 percent for women between the ages of thirty-five and fifty-five, and 2 percent for women between fifty-five and seventy-four.

The researchers also observed that the diagnosis of carcinoma in situ doubled in the population of women who were screened and remained the same in the nonscreened population, reinforcing the idea that mammography results in overdiagnosis of pseudo-cancers.

Studies even show that mammography is contraindicated for women who carry the BRCA1 or BRCA2 gene mutation, which predisposes them to a higher risk of developing breast cancer. In one study, researchers concluded that mammography screening beginning at twenty-five to twenty-nine years of age results in a higher risk of breast cancer due to increased lifetime radiation exposure, and that mammography may have a net harmful effect for these patients.
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GM:
What do you say to the person who reports that a friend or family member was diagnosed with breast cancer via mammography and it saved her life?

PP:
Since the data is clear that more women are harmed than helped, this is highly unlikely. In other words, what has happened in most cases, where women truly have survived and thrived for a long time, is that they were diagnosed with pseudo-cancer and treated for it. The treatments for metastasized breast cancer are not much more effective today than they were decades ago.

Another thing I would add is that, according to Cochrane, if two thousand women are screened for ten years, one woman will benefit from early detection. You may happen to know the one in two thousand who actually benefitted, but it’s statistically unlikely.

One of the best resources for understanding this issue is Peter Gotzsche’s book
Mammography Screening: Truth, Lies and Controversy
. It’s a technical book, but I would love to see it become required reading for women since this is such an important issue.

GM:
Let’s move on to CT scans.

PP:
In certain situations they can be valuable, but because the dose of radiation is so high, and it’s a well-established fact that CT scans increase your risk of cancer,
⁸
they really should be reserved for situations where it’s the only way to get the information you need. They’re way overused.

GM:
And they’re highly overused with children, isn’t that right?

PP:
Yes. Not only are they overused but they’re overused on the same people—individuals getting multiple scans. It’s not unusual to see CT scans that make the whole situation so much worse for them. CT scans should be the last resort, not the first line of action; unfortunately that’s not the way it goes.

GM:
MRIs?

PP:
Valuable and less dangerous. For example, in the case of breast cancer, it can sometimes be a valuable way to find out exactly what’s going on. The biggest risk may be that because the imaging is so good, you’re going to discover something else that you don’t want to know about. I was at a dinner party last night and listened to the story of a woman who is one of those people who goes to doctors all the time. She’s overmedicated and doesn’t want to hear what I have to say, so I just listened.

She apparently got an MRI for one reason, but they found something in her brain that they weren’t looking for. They sent her to specialists; she went through ninety days of testing and was scared half to death. The specialists put her on Coumadin because they weren’t sure it wasn’t a blood clot, but then found out that there was some type of tangled or turned vein in her brain. If you spend too much time allowing doctors to poke and prod you, you’re liable to find out things that you’re better off not knowing. The last doctor she saw about her condition said, “This isn’t even worth spending time on. Go live your life and forget about it.” Which was good advice, but that’s after ninety days, $10,000 worth of tests, and thinking she either had a brain tumor or was going to drop dead any minute. That’s a pretty frightening situation to be in for nothing at all.

GM:
Ultrasounds?

PP:
Not dangerous and very helpful sometimes. These are the least invasive of all of the forms of testing.

GM:
There’s really no risk to doing an ultrasound, right?

PP:
The main risk, and this is true of all forms of imaging, is finding something you may not want to know about.

GM:
Would you say the same thing about ultrasounds for pregnant women?

PP:
Today, having an ultrasound is a routine part of medical care for pregnant women. No one questions it, but the problem is that it often finds things that look suspicious, even when there is nothing wrong. One analysis of fifty-six studies showed that follow-up testing for abnormalities detected as a result of ultrasound would result in more miscarriages than confirmed diagnoses.
⁹

GM:
So ultrasounds aren’t inherently bad, but it sounds like they cause more problems than they prevent sometimes. What about other imaging procedures?

PP:
There is a great book on this topic by Dr. Gilbert Welch called
Overdiagnosed
. I recommend that all of our members read it. It describes how imaging and testing tends to identify clinically insignificant abnormalities that would be better left alone, but this is seldom the response to finding them. Tiny abdominal aneurisms and small thyroid nodules are examples of conditions often found in completely asymptomatic people who are subjected to testing. All imaging, including ultrasounds, should be used with caution. In the book, Dr. Welch
¹⁰
discusses the new epidemic of thyroid cancer. How did we suddenly get an epidemic of thyroid cancer? Is it something in the water? No, what’s happening is that people are getting X-rays and MRIs and they’re finding thyroid cancer. They’re not necessarily looking for it, but they end up with an image of it, anyway. A lot of people have little nodules on their thyroids, which they now call cancer. They are then advised to have to have surgery for it because the American Cancer Society has gone all out to make sure everybody now gets screened for the new epidemic of thyroid cancer!

GM:
Well, I have a friend who it happened to. He had an ultrasound performed for neck pain, and they found a nodule on his thyroid, completely unrelated to the pain, of course. They did a biopsy and told him he has cancer. He faces the choice of an operation with serious risks or “watchful waiting.” I’m certain he’ll opt for the “watchful waiting.” I asked him if he would rather never have known. He didn’t hesitate for a moment. He would much rather never have known. The diagnosis has taken an enormous emotional toll on him and his family, to no good end.

Let’s move on to another test. Is there any point to an angiogram?

PP:
The value of it really would be to scare somebody half to death. To put the image up there, if doctors did this right, and say, “See this? This is going to kill you. Now, medicine says I’m supposed to put a stent in that artery. I can do it, I know how to do it, I’m trained to do it; I’m just telling you it’s useless, even though your insurance company will pay for it. Or you can change your diet. If you don’t change your diet, this is going to kill you.” So it has some value in terms of scaring people a little bit, if doctors would be willing to engage in the right conversation with their patients. Unfortunately, that’s not what they’re doing.

GM:
Okay, if somebody was having chest pain and was willing and eager to start a change of diet and lifestyle that you would endorse, would there be any point in his doing an angiogram? Or should he just get started eating a low-fat, plant-based diet?

PP:
He should just start eating the low-fat, plant-based diet. Now, there are factors like how much chest pain, was there a myocardial infarction, have there been previous events? It’s hard to answer these questions in general because, in the real world, they’re always specific, which is why people really should consult with a medical doctor. But if your current doctor won’t discuss the importance of diet and won’t even entertain the idea that you ate your way into coronary artery disease and will probably be able to eat your way out of it, you may want to consider finding another doctor. There are docs who are more open-minded, even if they don’t completely understand the issues we’ve been discussing.

GM:
Are there any times you feel a situation is so severe that, even though they’re going to eat their way out of it, it might help them now to have either a surgical intervention or a pharmaceutical intervention?

PP:
Yes. If there is severe damage to the left ventricle, I’d think we’d all agree, then bypass surgery is probably valuable then. The other is relentless chest pain, which is not usually the way these patients present. They usually present with intermittent chest pain or pain from exertion. But if somebody has constant, relentless chest pain and it keeps him from sleeping, I think that person should be in the care of a good interventional cardiologist because surgery is needed. I would endorse it under that scenario.

There are few drugs or surgeries that I would say have absolutely no value. It’s the misapplication of them that causes me to say the things that I do. I don’t think we should eliminate bypass surgery. I’m saying instead of performing five hundred thousand of them annually, we should perform about fifteen thousand.

GM:
What about colonoscopies? During my first checkup after I turned fifty, my rather humble and very decent doctor said to me, “You know, Glen, honestly, there isn’t a lot that doctors can do for people, but the colonoscopy is one thing we do that’s really helpful for the general public. I recommend having one at fifty.” And I said, “Well, are there any downside risks?” He said, “Occasionally, we perforate the colon.” I said, “Hey, it’s been very nice visiting with you, doc.”

PP:
They’ve now found out that the colonoscopy is not any more valuable than a sigmoidoscopy. A couple of researchers at Columbia University looked at three different studies and determined that a colonoscopy does not offer any advantages over a sigmoidoscopy.
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However, it does offer significantly more risk, and the pleasure of a tube up your rectum, if that’s something you’ve always pined for.

GM:
Exactly what is a sigmoidoscopy?

PP:
Sigmoidoscopy involves the use of a flexible endoscope. It provides a view of the large intestine from the rectum to the sigmoid, the most distal part of the colon. It does not allow examination of the entire bowel, but the portion that is examined is where colorectal cancer is most likely to occur.

GM:
So should people do a sigmoidoscopy?

PP:
I wouldn’t have one. By eating a high-fiber, low-fat diet, people will reduce their risk of colon cancer as much as they possibly can.

GM:
What’s the value of a PSA test, in your opinion?

PP:
Zero. Worthless. And that’s not just my opinion, that’s also the opinion of Dr. Richard Ablin, who discovered the PSA protein. To his credit, he’s said that he didn’t realize that his discovery would lead to “the overdiagnosis, the overtreatment, and the billions of dollars that are basically wasted on a test that can’t do what it’s purported to do.”
¹²