The Notion That “Good Science Means Less Screening” Has to Stop

Fast forward to a time when the predicted water shortage extends to the entire country. And rather than admit the shortage and the need to ration water, the government begins a campaign to convince the public that daily bathing is potentially harmful, and offers little in the way of health benefits. In fact, bathing is painted as an unnecessary luxury, and no one bathes like Americans anyway. We should slow down to every other day, or every week, or not at all. The population responds with the usual division – pro-bathers vs. anti-bathers, and those who cling to the middle. Journalists jump into the fray, pointing out the dangers of soapy water going down the drains, the unnatural alteration of our skin flora, and the harmful chemicals that are absorbed from perfumed soap. Finally, the government steps in and enforces weekly showering by mandating timed controls on our shower heads. “Once a week” becomes the new mantra taught to all in order to control the minds of the population.

Well, we are experiencing this very phenomenon when it comes to mammographic screening for the early detection of breast cancer. Rather than admit that it has become too costly (depending on how costs are calculated) to screen annually starting at 40, we are in the midst of a propaganda campaign designed to limit or eliminate mammographic screening. Out of the thousands of breast cancer books on the market, you might be surprised to learn that, other than textbooks and monograph/pamphlets, there are no books with the lay public in mind, having the single goal of justifying “start at 40, annually” screening guidelines. It’s a “dog bites man” issue, in that the justification for early diagnosis is self-evident. Or so we thought in years prior. Today, a concerted effort is being made to cut back or eliminate breast cancer screening, and these anti-screening forces are gaining ground even among some breast cancer lay activists. The new mantra is: harms outweigh benefits. You can find plenty of books to support this view as the American public is being re-programmed to bail out of their love affair with screening. So, if the title of my upcoming book seems self-evident, it is not. If the topic seems self-evident, it is not. Who would have thought that we would ever need a book to justify early diagnosis? The best I can tell, this book will be the first to tackle the anti-screeners head-on, and to justify a bottom line that has been misplaced – that is, less screening means more breast cancer deaths. Period.

Mammography and Early Breast Cancer Detection: How Screening Saves Lives is a polemic that justifies the pro-screening school of thought. Available later this fall, I’ll offer the Table of Contents below as a teaser. One can readily see that this will not be a dry recitation of medical facts, but instead, a tour through the smoke-filled rooms inhabited by public health experts who are, remarkably, peddling death, while claiming “Trust us, we’re doing what’s best for the population as a whole.”

Table of Contents

Acknowledgments vii
Preface 1
1. Last Word vs. Final Word 5
2. Early Diagnosis May Be the Key, but It’s Not a Lock 10
3. Biology Can Trump, but Size Matters 16
4. Prostate Is Not Breast, So Give It a Rest 22
5. The Four Horsemen That Inflate the Power of Mammography 31
6. The Four Horsemen Are Throttled by Clinical Trials, but O Canada! 41
7. The Mammography Civil War (1993-1997) 49
8. The Number Games 61
9. The (Over)Selling of Mammography 67
10. The Evidence for ¬Evidence-Based Medicine (or, How to Raise the
Bar of Bias: An Editorial) 74
11. Blame It on Canada (and Something’s Rotten in Denmark, Too) 82
12. Overdiagnosis: Embracing Your Inner Malignancy 88
13. Overdiagnosis Part 2: A Way Out of the Wet Paper Bag 95
14. The Task Force Opens Fire 105
15. The Zombies Among Us 121
16. Circumstantial ¬Evidence-Based Medicine 128
17. The Social Tsunami of ¬Anti-Screening 137
18. The 2015 ACS Peace Accord–Science or Societal Pressure? 144
19. A Journey to the Pathology Lab to View the ¬By-Products of Screening 152
20. Risk-Based Screening–It Feels So Right, but Wait… 168
21. The Greatest Story Never Told 178
22. The Myth of Mammography 184
23. Do These Genes Make Me Look Dense? 192
24. The Emperor of All Modalities 201
25. The Bright Side of the Dark Side of the Force 210
26. The Crystal Ball Is Fair to Partly Cloudy 222
Chapter Notes 229
Bibliography 241
Index 247

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