Is the need for routine mammograms a big lie? Exposing puts into question decades of research

He persuaded the National Cancer Institute to provide $ 6 million a year for the Breast Cancer Demonstration Project. For five years, 270,000 women aged 35 and over would receive screening mammograms free of charge in 27 centers across America. Radiologists had to be trained and the imaging equipment manufacturers suddenly had a new market. The mammography screening industry was born.

The problem was that the evidence that screening had saved lives was insufficient. There has been only one screening study, the New York Health Insurance Plan Study. Critics have said that this is not enough to prove the benefits. And there would be misdeeds of radiation.

The controversy surrounding the project has become so acute that the NCI and the American Cancer Society have issued an interim guideline that women under 50 should no longer be screened. In 1977, the National Institutes of Health called on experts and stakeholders to an unprecedented consensus development meeting to review science. The result was a call for more research. But by that time, the belief in early detection by mammography was already well established in the United States and was spreading rapidly in Canada.

"Why are you still pushing him back?" Asks a mother with a nagging, exasperated tone to her daughter, as if she had had the conversation several times before. It is an ephemeral moment in a television advertisement of busy professional women, elegantly dressed and perfectly coiffed, rushing through the frame, canceling appointments, claiming that they intended to leave but had not the weather.

Some women seem to be in their thirties and others a little older, but the frenetic camera never settles long enough to reveal their age. After about eight seconds of motion blur, almost colorless, we see that the advertisement is about GE's breast cancer detection system. What these restless women continue to delay, is a mammogram.

An authoritative male voice says in a reprimanded tone that the GE system can help boost breast cancer survival to 99%. A door in a clinic slams alarmingly and the last message, in big white letters, flashes on a black screen: "A mammogram. Do not push him back. Advertising on US television networks in the late 1980s and early 1990s would have been broadcast in Canada as well. GE Healthcare, a division of General Electric, is one of the largest manufacturers of mammography imaging equipment in the world.

Despite the 1977 consensus meeting and the recommendation to discontinue screening of women under 50, the American Cancer Society formally recommended in 1980 that women aged 35 to 40 years basic mammogram. In 1983, it recommended that women aged 40 to 49 be screened every 1-2 years, and that women over 50 be given a mammogram once a year.

The Breast Cancer Demonstration Project had made mammography a growing industry, and by the time of the "Do not Get It" campaign, many advertisements in magazines and billboards were already announcing to women : mammograms you need more than your breasts examined "or" Give your mother the gift of life, give her a mammogram for Mother's Day. " A campaign of the American Cancer Society in 1987 told women: allows your doctor to "see" breast cancer before there is a lump when cure rates are close to 100% . "

The claims of the American Cancer Society and GE regarding these high cure rates were exaggerations, whimsical manipulations of partial data.

Charles Wright did not buy any. Wright was a young surgeon at the University of Saskatchewan in Saskatoon when the mammography screening application was made in the early 1980s.

The rhetoric of the American Cancer Society crossed the border, Canadian doctors attended medical conferences where screening was discussed and promoted, and Canadian women saw commercials. Wright was a general surgeon with a special interest in breast surgery and noticed a "line" of women appearing at a surgical consultation after a screening mammogram they were told would benefit them.

"There you go, there was a suspicious lesion on the mammogram," remarked Wright curtly. "What woman will be happy to stick to that and say, well, we'll see how it goes?" He asks. The suspect lesion would result in surgery, treatment and downstream problems.

He began to fear that women will undergo unnecessary biopsies and other surgeries, while suffering from all this anxiety, for a mild illness. He decided to look at the evidence on mammography screening and found that he was missing. In 1986, he wrote an article for the journal Surgery, concluding that the disadvantages outweighed the benefits.

This paper made Charles Wright a controversial figure. It did not bother him. he was used to being criticized for his unpopular views. Wright immigrated to Glasgow from Glasgow in 1971 almost by accident. He did a research at McGill University in Montreal, where his work earned him a gold medal from the Royal College of Physicians and Surgeons of Canada.

At that time, he was back in Glasgow, but he returned to Canada for the awards, where he met with the head of surgery at the University of Saskatchewan, who promptly offered him a employment. He would be an assistant professor and surgeon at the University Hospital and would also have his own research facilities. He remembers that the salary was correct too.

Wright is nervous and thin with his straight blue eyes and his frank and determined attitude. He always speaks with a flawless Scottish burr that was to be much more pronounced when he moved to Canada, but his accent was not the only reason he stood out in Saskatoon.

In Britain, where Wright had been trained, breast surgeons had stopped practicing radical mastectomy against cancer. In Saskatoon, he began to think that even simple mastectomies were too drastic and started to do lumpectomy, believing that minimal surgery would always eliminate breast cancer and that radiation and chemotherapy would treat the possibility that cancer spread. He did not see how tearing the muscles and lymph nodes could be helpful.

Researchers abroad may have been wondering about radical mastectomies for many years, but in day-to-day clinical practice, surgeons in Canada and the United States have always preferred them. In Saskatchewan, no one has done lumpectomies, Wright says. His colleagues did not approve and were so antagonistic that at one point he even feared losing his license because "there was a group who felt that this young British surgeon was clearly incompetent, because that he was not treating breast cancer properly. . "

He tells this story with some thought and suggests that his colleagues should have read the literature. But at the time, advocates of minimal surgery for breast cancer were lone pioneers.

It's with the same questioning about the status quo that Charles Wright touched on the subject of breast cancer screening. In his 1986 article entitled "Breast Cancer Screening: A Different Look at Evidence," he reviewed data from the initial screening trial, the 1960 HIP study, and the ten-year demonstration project. years later.

The demonstration project was not a randomized trial, did not have a control group, and therefore could not offer any information comparing women screened to women who were not screened. But he also reviewed a new clinical trial in Sweden published in the Lancet in 1985.

Enthusiasts for mammography screening have promoted the study of the Swedish National Board of Health and Welfare, also known as the Swedish trial of both counties. This is a large study started in 1977, with 163,000 women from Kopparberg and Östergötland counties enrolled and randomized into two groups, screened and undetected. The report in Lancet analyzed seven years of data.

The results were similar to those of the New York HIP study, indicating a 31% reduction in mortality among women screened over 50 years of age compared to the unscreened control group. But the Swedish study, like the HIP study, also did not find a reduction in mortality among women aged 40 to 49 years.

When Wright reviewed the data from the demonstration project, he found that 3.58% of the women screened had been referred for surgical consultation and 0.54% had cancer, which means that 3.04% had negative biopsies. . When he examined mortality statistics from Swedish studies and HIP, he found that, indeed, there appeared to be a 25-30% reduction in mortality among women over 50 years of age screened.

In a different context, Wright looked at the absolute number, asking, 25 to 30% of what? To understand this, he looked at the actual number of deaths. Ten-year data from the HIP study revealed 146 deaths among the 33,000 women in the screening group and 192 deaths among the same number of women in the control group. So there was a difference of 46, about 25% of 192. But in absolute numbers, 46 lives saved out of 33,000 are .144% of all women screened.

The absolute figures in the Swedish study revealed an even lower reduction in mortality, only 0.049% in the group tested. Wright wrote in his diary another way to express it: a study out of 694 in the HIP study had benefited from a screening and one in 2 041 had benefited from the Swedish study. In calculating that the damage far outweighed the benefits, he wrote that the recommendations of the American Cancer Society should be ignored and that only women at high risk of breast cancer should be screened.

Shortly after the article was published, Wright accepted an invitation to a mammography lecture at Johns Hopkins University in Baltimore. He has a vivid memory of what happened.

"They spent a whole day telling this great national audience how wonderful the mammography was, and then I was there with a contrary opinion, with evidence that I thought was pretty strong. I introduced this article which was greeted with a death silence and many people were visibly angry.

A coffee break followed his speech and he stood, avoided by everyone except the conference organizer, "who felt he had to take care of me," Wright guesses. Then, "a very angry looking senior radiologist came in and kind of hit me in the chest with his finger and said," You do not understand, boy; you have your hand in your pocket. "

The radiologist did not have to fear for his pockets. Charles Wright continued to talk about screening, but he could not compete with a mammography machine that is gaining scale.

In October 1987, a White House announcement boosted momentum: Nancy Reagan was about to be operated on for breast cancer. The first lady had an annual check-up and a screening mammogram. When the nurse who performed the mammogram said that she needed to repeat some x-rays, Reagan's stomach was tied.

After the additional tests, the White House doctor, John Hutton, entered the room with the bad news. "We think we have seen something," he said. "We think it's a left breast tumor. We will need a biopsy. The next day, a cancer specialist told Reagan that she had a choice between a lumpectomy to remove the tumor and some surrounding tissue or a modified radical mastectomy.

Even though light therapy was becoming popular, she chose mastectomy, not wanting to interrupt her busy schedule with weeks of radiation therapy that a lumpectomy required. In addition, she was concerned that she would never stop worrying about what could have been left behind if she did not take all her bosom. Only 11 days after her mammogram, she entered the Bethesda Naval Hospital for surgery.

The surgeon planned to do a biopsy of the frozen section first. If the tumor was malignant, he would immediately proceed to a mastectomy. "Please, do not wake up to have a conversation about it. Do it, "Reagan ordered.

It turned out that the first woman had a tiny, non-invasive tumor, of a diameter of only seven millimeters, confined in a milk duct. From the size of a lemon seed, the width of a pencil, it was the smallest tumor that a mammogram could detect. When a press conference at the White House released the details, some experts criticized such an extreme response to such a small cancer.

Journalist and lawyer Rose Kushner, who was reportedly disappointed that Reagan had accepted the one-step mastectomy she had been fighting for so long to stop her, accused her of "bringing women back to 10 years". triumph for mammography.

When asked about the mastectomy, Reagan said the decision seemed right to her, but she did not try to influence other women to do the same. She defended him as a feminist choice, his to do. With regard to screening, however, she insisted that every woman should have an annual mammogram from 40 years old.

She became a mammography ambassador and actively participated in a promotional campaign of the American Cancer Society. Millions of women have witnessed a serene Nancy Reagan, perfectly coiffed and dressed in a simple gray dress, staring directly through their television screens. She urged them to know a word: mammography. There could not be a more powerful endorsement.

The American Cancer Society had the intention of convincing women that with early detection, breast cancer could be cured at 100%, although there was no cure truthful proof. Charles Wright took note of his advertisements and collected his advertisements in the magazines. In an interview for a 1991 CBC documentary, he accused the American Cancer Society of leading a conspiracy of hope.

"These are honestly understandable lies, interpreted by the desire to generate that hope and, of course, certain medical, financial and political implications."

When he gave this interview, Wright had recently left Saskatoon and had been operated on to become Vice President of Medicine at the Vancouver General Hospital. In 1995, he held another administrative position as Director of the Center for Clinical Epidemiology and Evaluation at the University of British Columbia. He finally stopped talking about mammography, frustrated that no one seemed to listen.

Excerpt from Chapter 4 "Conspiracy of Hope," originally published in Conspiracy of Hope: The Truth About Breast Cancer Screening copyright 2018 by Renée Pellerin. Reprinted with permission of Goose Lane Editions.