Chance of Harm Is 100%
Chance of Benefit Is < 1 in a 1000
The lifesaving benefit from the early
detection of cancer is over-exaggerated and the harms are way
understated. At the very most, the reward you may gain by testing will
be to reduce your chance of dying from a cancer, in the far distant
future, by one death for every one to two thousand examinations. But the
harms caused to you begin the very moment you allow the medical testing
businesses to enter your life. Common examples of early detection
methods are: prostate specific antigen (PSA) blood tests for prostate
cancer, mammograms for breast cancer, and colonoscopies for colon polyps
and cancers. A positive result from any of these exams will be
immediately followed by a biopsy in order to make the diagnosis. Simply
identifying the cancer will change your life for the worse, and maybe
forever. This article will not be addressing the even more egregious
damages from the treatments—surgery, radiation, and chemotherapy—that
follow the biopsy specimens revealing cancers, but rather the injures
caused by the testing alone.
Right now at this moment your day is going
along just fine. After a filling breakfast you kiss your spouse goodbye.
Everyone at the office this morning is friendly and offering you
compliments on the success of your recent project. You notice not a
single ache or pain in your entire body. At 11 AM today you have your
annual exam with your doctor. Your physical includes a breast
examination performed by your doctor (in the case of a man a digital
rectal exam of his prostate). You are embarrassed and made uncomfortable
by the doctor’s probing fingers, but nothing important was found, so no
real harm was done. At the end of your half hour visit your doctor
conscientiously reviews his findings with you. Your current state of
health is excellent. You think, “I’ve passed with flying colors and I
will be on my way.” Not so fast. Your doctor now wants to look for
“invisible disease.” He/she recommends that you have a mammogram and a
colonoscopy. If you are a male patient, the recommendation is for a PSA
and a colonoscopy.
It is now 11:30 AM; your thoughts have
turned ugly. “Do I have cancer? Could it be advanced? What other tests
will I have to undergo? I now have to miss more days of work to get
these tests done. I know a young woman who had her colon perforated
during a colonoscopy—she died the next day. I won’t accept chemotherapy,
even if I have cancer. If I become sick from the treatments I will not
be able to work or care for my children. Will my husband still love me
with one breast? My wife will be so alone without me. What will life be
like without erections? I won’t be able to get new life or health
insurance. Every body pain I get will make me think that the cancer has
come back. I am so anxious that I cannot work or face my friends and
family. When my friends and family find out I have cancer they will
think of me as a victim. I will become isolated from the rest of the
world. Why can’t I get these tests done today, so I can get on with my
life? It will be more than a month before the final results are in. Then
I can stop worrying—if the results are negative. I must force a
Think about it: just the recommendation to
have either of these two tests performed has already changed your life
for the worse. Considering the trauma already produced, in the end the
rewards had better be extraordinary.
The Day of the Mammogram
You arrive at the breast-imaging center
and after filling out forms and a short wait in a cold stark waiting
room, you are next moved into the room with the mammogram machine. Each
of your breasts is placed individually within its “jaws,” and
compressed. All that squeezing hurts. Overall, 81 percent of women
experience discomfort during mammography. As many as 46 percent of women
classify that discomfort as pain, and seven percent say the pain is
Pain may not be the only consequence of
all that compressing. There is also the real possibility that the
compression of the breast during the test may cause cancer cells to
spread.3-6 Animal research has shown that the degree to which a cancer
spreads can be increased by as much as 80 percent merely by mechanical
manipulation of the tumor. In one study, women under 55 who underwent
mammograms experienced a 29 percent increase in the number of deaths
from breast cancer during the first seven years following the test.
During that particular study protocol, the mammographers used "as much
compression as the woman could tolerate." Under compression,
precancerous cells (a condition called ductal carcinoma in situ) may be
spread outside of the milk ducts into the surrounding tissues and blood
vessels, turning a noncancerous state into an invasive deadly cancer.
The risk of radiation is not insignificant
either. In the past, researchers have largely discounted the damaging
effects of the low dose radiation used in mammography. However, newer
findings suggest that mammography may be four or five times more likely
to induce breast cancers than was once believed, and that the risk vs.
benefit of mammography may need to be re-examined.7,8 The
harmful effects of radiation are particularly important for younger
women and those with a higher risk for developing cancer (women with
The risk of having a false positive test
is over 56% for women having a mammogram every other year after the age
of 50 (a total of 10 mammograms).9 Of every 1,000 U.S. women who have
mammograms, about 10 to 15% will be called back for further tests. About
10 of these patients will be referred for a biopsy. On average, 35% of
these biopsies will show cancer. The mental anguish doesn’t stop even
after a good result from the biopsy; 26% of women report worries and
anxieties 3 months after they have been told they don’t really have
breast cancer.10 The distress caused by a suspicious mammogram has been
so overwhelming that women have been known to commit suicide as a
The Day of the Prostate Biopsy
You may think of the PSA test as an
innocent prick from the phlebotomist’s needle. This is a high risk
test—there is a 10% chance the results will be positive, leading to the
next test; a series of biopsies of your prostate gland, which will show
prostate cancer, on average, 30% of the time, depending on your age. In
the US the rate of microscopic prostate cancer is found in 8% of men in
their 20s, 30% of men in their 30s, 50% of men in their 50s, and 80% of
men in their 70s.12,13
In addition to the expected anxiety,
inconvenience, discomfort, and additional medical expenses, biopsies of
the prostate result in some rarely discussed, but common complications.
I say biopsies (plural) because a dozen samples, on average, are taken
from the prostate with a large bore (16 or 18 gauge) spring-loaded
needle during each session. Physical discomfort is reported throughout
the procedure. From the transrectal untrasound, 37% of men experience
pain, and even though they have received a local anesthetic, 55% of men
experience pain with the biopsies.14
The most common complications after the
biopsy are blood in the urine, pain while urinating, and rectal
bleeding. Blood in the semen and erectile dysfunction are often reported
following the biopsies. One month after surgery, 41% of men report
erectile dysfunction, and after 6 months the problem persists in 15% of
men.15 Male sexual dysfunction following the biopsy often
leads to female sexual dysfunction.16 The anxiety, fear, and
trauma from the procedure, and the presence of blood in the semen are
some of the reasons for these disturbances to sexual intimacy. However,
it is the needles themselves, which damage the nerves involved with male
erection, which are the actual cause of this permanent dysfunction. This
complication is increasing because doctors are doing more biopsies
during a single session and are practicing active surveillance repeating
sessions of needling over time. All this suffering is a reason that men
diagnosed with prostate cancer have a 40% increase in suicide.17
The Day of the Colonoscopy
After lying on a table on your left side,
a flexible 4 to 6 foot-long viewing instrument, called a colonoscope, is
passed through the lumen of your large intestine. During the procedure,
tissue samples can be collected (biopsied) and polyps can be removed.
Preparation for this exam begins with a low fiber or clear-liquid only
diet for one to three days and powerful laxatives to clean the colon of
fecal materials. Sedation is given during the procedure in order to
reduce the discomfort caused by the twisting and bending of the scope as
it advances through the tortuous large bowel. The procedure usually
takes 15 to 60 minutes.
Harms may arise from the preparation, the
sedation, and the procedure. In the United States, serious complications
occur in an estimated 5 per 1000 procedures. When biopsies or polyp
removals are performed then the risk of serious complications, including
bleeding, increases. One of the most serious hazards, often leading to
death, is perforation of the colon, which occurs in about one per 1000
Virtual colonoscopy, performed with a CT
scanner and computers, generates high-resolution views of the inside of
the colon. As with traditional colonoscopy, the bowel must be prepared
and cleared prior to the study. Virtual colonoscopy is less invasive
than traditional colonoscopy; however, the radiation exposure is
significant. A suspicious finding on this exam will usually require the
doctor’s scope for biopsies and removal of polyps.
Benefit Justify These Miserable Examinations?
The only positive result of early
detection exams is an almost undetectable reduction in death. One to two
thousand people must be tested in order to prevent one death in each
circumstance. Nothing else good comes from these investigations.
Afterwards, you don’t look or feel any better. Your body parts are no
more functional. Your physical performance has not been improved. You
are no healthier nor wealthier. However, you should be a bit wiser and
more cautious after learning what really goes on in these businesses.
The U.S. Preventive Services Task Force
estimates 1904 mammograms for women aged 40 to 49 years and 1339
mammograms for women aged 50 to 59 years must be performed in order to
save one life.19 The Cancer Screening Evaluation Unit,
Institute of Cancer Research, Sutton, UK concluded that there may
possibly be one less death for every 2512 younger women undergoing
annual mammography for 10 years.20
A recent Cochrane Review on the lifesaving
benefits of mammography came to a remarkably similar conclusion: “This
means that for every 2000 women invited for screening throughout 10
years, one will have her life prolonged and 10 healthy women, who would
not have been diagnosed if there had not been screening, will be treated
unnecessarily. (Over-diagnosis and overtreatment are the most harmful
effects of early detection testing.) Furthermore, more than 200 women
will experience important psychological distress for many months because
of false positive findings. It is thus not clear whether screening does
more good than harm.”21
The results from screening men for
prostate cancer are just as dismal. The recently published Prostate,
Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial found that
screening with prostate specific antigen (PSA) testing and digital
rectal examination had no effect on the rate of death from prostate
cancer.22 About the same time, in 2009, The European Randomized Study of
Screening for Prostate Cancer reported that 1410 men would have to be
screened and 48 additional cases of prostate cancer would need to be
treated to prevent one death from prostate cancer.23 (This
means 47 men would be over-diagnosed and over-treated.)
The results from colon cancer screening
programs are about the same: to prevent one death from colorectal cancer
1250 people would need to have a colonoscopy.24 Plus, the
benefits of a reduced risk for death are limited to those abnormalities
arising from the left colon, but not from the right colon.25 The left
colon can be easily examined by the shorter, safer, simpler, and less
expensive flexible sigmoidoscope, passed with a lot less rigmarole.
Tens of millions of these early-detection
tests are performed annually at the cost of tens of billions of dollars
and that’s only to make the diagnosis (no treatments are included in
that amount). Early detection is the biggest business builder ever
instigated on the believing public, bringing tens of millions of people
into doctors’ offices, clinics, laboratories, imaging facilities,
outpatient surgeries, and hospitals. For a moment set aside the medical
expenses and financial burden on our healthcare system created by these
scams. Focus only on the human suffering, and decide whether or not
“early-detection testing” fits the first rule of medicine, and that is
to do no harm.
1) Watmough DJ, Quan KM. X-ray mammography
and breast compression. Lancet. 1992 Jul 11;340(8811):122.
2) Austoker J. Screening and self
examination for breast cancer. BMJ. 1994 Jul 16;309(6948):168-74.
3) van Netten JP, Mogentale T, Smith MJ,
Fletcher C, Coy P. Physical trauma and breast cancer. Lancet.
1994 Apr 16;343(8903):978-9.
4) van Netten JP, Cann SA, Hall JG.
Mammography controversies: time for informed consent? J Natl Cancer
Inst. 1997 Aug 6;89(15):1164-5.
5) Levallius B. Screening mammography.
Lancet. 1994 Mar 26;343(8900):793.
6) DanielB. Kopansa, J. P. van Netten, T.
Mogentale, P. Coy, C. Fletcher and M. J. Ashwood Smith. Physical trauma
and breast cancer. Lancet. 1994 28 May 1994; 343(8909):
7) Heyes GJ, Mill AJ, Charles MW.
Mammography-oncogenecity at low doses. J Radiol Prot. 2009
8) Heyes GJ, Mill AJ. The neoplastic
transformation potential of mammography X rays and atomic bomb spectrum
radiation. Radiat Res. 2004 Aug;162(2):120-7.
9) Elmore JG, Barton MB, Moceri VM, Polk
S, Arena PJ, Fletcher SW. Ten-year risk of false positive screening
mammograms and clinical breast examinations. N Engl J Med. 1998
10) Devitt JE. False alarms of breast
cancer. Lancet. 1989 Nov 25;2(8674):1257-8.
11) Weil JG, Hawker JI. Positive findings
of mammography may lead to suicide. BMJ. 1997 Mar
12) Sakr WA . The frequency of carcinoma
and intraepithelial neoplasia of the prostate in young male patients.
J Urol. 1993 Aug;150(2 Pt 1):379-85.
13) Stamey TA, Caldwell M, McNeal JE,
Nolley R, Hemenez M, Downs J. The prostate specific antigen (PSA) era in
the United States is over for prostate cancer: What happened in the last
20 years. J Urol. 2004 Oct;172(4, Part 1 Of 2):1297-1301.
14) Essink-Bot ML, de Koning HJ, Nijs HG,
Kirkels WJ, van der Maas PJ, Schrˆder FH. Short-term effects of
population-based screening for prostate cancer on health-related quality
of life. J Natl Cancer Inst. 1998 Jun 17;90(12):925-31.
15) Fujita K, Landis P, McNeil BK,
Pavlovich CP. Serial prostate biopsies are associated with an increased
risk of erectile dysfunction in men with prostate cancer on active
surveillance. J Urol. 2009 Dec;182(6):2664-9.
16) Tuncel A, Kirilmaz U, Nalcacioglu V,
Aslan Y, Polat F, Atan A. The impact of transrectal prostate needle
biopsy on sexuality in men and their female partners. Urology.
2008 Jun;71(6):1128-31. Epub 2008 Apr 18.
17) Fang F, Keating NL, Mucci LA, Adami
HO, Stampfer MJ, Valdimarsdottir U, Fall K. Immediate Risk of Suicide
and Cardiovascular Death After a Prostate Cancer Diagnosis: Cohort Study
in the United States. J Natl Cancer Inst. 2010 Feb 2.
18) Levin TR, Zhao W, Conell C, Seeff LC,
Manninen DL, Shapiro JA, Schulman J.† Complications of colonoscopy in an
integrated health care delivery system. Ann Intern Med. 2006 Dec
19) US Preventive Services Task Force.
.Screening for breast cancer: U.S. Preventive Services Task Force
recommendation statement. Ann Intern Med. 2009 Nov
20) . Moss SM, Cuckle H, Evans A, Johns L,
Waller M, Bobrow L; Trial Management Group. Effect of mammographic
screening from age 40 years on breast cancer mortality at 10 years'
follow-up: a randomised controlled trial. Lancet. 2006 Dec
21) Gotzsche PC, Nielsen M. Screening for
breast cancer with mammography. Cochrane Database Syst Rev. 2009
22) Andriole GL, Crawford ED, Grubb RL
3rd, Buys SS, Chia D, Church TR, Fouad MN, Gelmann EP, Kvale PA, Reding
DJ, Weissfeld JL, Yokochi LA, O'Brien B, Clapp JD, Rathmell JM, Riley
TL, Hayes RB, Kramer BS, Izmirlian G, Miller AB, Pinsky PF, Prorok PC,
Gohagan JK, Berg CD; PLCO Project Team. Mortality results from a
randomized prostate-cancer screening trial. N Engl J Med. 2009
23) Schroder FH, Hugosson J, Roobol MJ,
Tammela TL, Ciatto S, Nelen V, Kwiatkowski M, Lujan M, Lilja H, Zappa M,
Denis LJ, Recker F, Berenguer A, Mattanen L, Bangma CH, Aus G, Villers
A, Rebillard X, van der Kwast T, Blijenberg BG, Moss SM, de Koning HJ,
Auvinen A; ERSPC Investigators. Screening and prostate-cancer mortality
in a randomized European study. N Engl J Med. 2009 Mar
24) Richardson A. Screening and the number
needed to treat. J Med Screen. 2001;8(3):125-7.
25: Baxter NN, Goldwasser MA, Paszat LF,
Saskin R, Urbach DR, Rabeneck L. Association of colonoscopy and death
from colorectal cancer. Ann Intern Med. 2009 Jan 6;150(1):1-8.