The Politics of Women's Health
Mammography Screening Controversy
Interview with Michael Baum, MD
Surgeon who headed a UK Mammography Program Becomes one of its strongest critics
An interview with Michael Baum, MD, by Maryann Napoli, Associate Director of the Center for Medical Consumers, October 2002.
Michael Baum, MD, emeritus professor of surgery at University College in London, U.K., has been a breast cancer surgeon for 30 years. After leaving the Breast Screening Programme for the National Health Service in the southeast of England, Dr. Baum became an outspoken critic of mammography screening, particularly for women in their 40s.
In this interview, Dr. Baum is asked to comment on the new Canadian Study results. In doing so, he argues for a new paradigm for how and why breast cancer spreads. Dr. Baum champions the ideas of the famed Boston-based researcher, Judah Folkman, who did the pioneering work on angiogenesis. This natural process, which is controlled by certain chemicals produced in the body, leads to the formation of new blood vessels. In adults, angiogenesis is involved in wound healing and menstruation. But angiogenesis can also have negative effects. The newly formed blood vessels bring the blood and oxygen that encourage tumor growth; and they also provide the means for cancer cells to travel to distant organs and form new tumors.
MN: What do you make of the increase in breast cancer deaths shown in the women given mammograms in the Canadian Study?
Dr. Baum: I believe that it is a real phenomenon and not simply an artifact of this one study. It appears in all the studies.
MN: There were more than twice as many cases of ductal carcinoma in situ [Latin for cancer in place] in the mammogram group. What do you make of that?
Dr. Baum: I'm very influenced by Judah Folkman's work. He believes that in situ is probably not a good word, and we should call it latent cancer. These latent cancers, particularly in premenopausal women, are grossly over-represented in women given mammograms--something like five times more, compared to what you would expect. This suggests that, if left to their own devices, these latent cancers might never trouble a woman. But if you identify these latent cancers and biopsy them, you have traumatized the area. You immediately trigger the natural healing mechanisms, and natural healing mechanisms involve angiogenesis. So, effectively, the biopsy could be considered an angiogenic switch. You take a latent cancer that would never hurt a woman, biopsy it, turn on the angiogenic switch, and it ceases to be latent. A latent disease becomes an aggressive disease.
MN: Is this true only for breast cancer?
Dr. Baum: You see this in other cancers. The most notorious is renal cell cancer. If you find a symptomless renal tumor by chance, and operate, [then] in no time the patient is riddled with metastasis. This happened to a dear friend of mine. I think that an angiogenic switch might be an explanation. It's really scary.
MN: And this is what you suspect happened to some women in the mammography trials.
Dr. Baum: My explanation sounds a bit farfetched, but it is strongly supported by basic science that is coming out of the work on angiogenesis. There are profound cyclical changes going on in the premenopausal breast, and these changes can also be seen in premenopausal breast cancer. So just by happenstance, you might get a surgical insult at a time in the menstrual cycle that favors the cancer cells. It's all quite alarming.
MN: In the Canadian Study, 71 cases of ductal carcinoma in situ (DCIS) were diagnosed in the mammogram group, compared to 29 in the no-mammogram group.
Dr. Baum: That tells you two things: 1) It emphasizes the quality of the study. If they had not detected so many cases of DCIS, then the screening zealots would say that the screening techniques in the Canadian Study were bad; 2) It demonstrates, yet again, that all screening programs will show an excess of cancers. And the excess is mostly DCIS. In women given a manual breast exam, only about 3% of cancers detected are DCIS; whereas in mammography-screened women, 20% of the cancers are DCIS.
MN: The breast cancer death rate was the same for both groups in the Canadian Study. Doesn't that indicate that early detection is of no benefit to any women with DCIS, even the minority with the type destined to become invasive?
Dr. Baum: Yes, I think so. I don't know if any lives are saved by screening, frankly. But the one argument about which I cannot be shaken is that women invited to screening should know these things. I was one of the people given the job of setting up a screening program in 1987-88 in the U. K. Then it gradually dawned on me that this was state interference with public health, and it was coercion. I resigned in disgust from the National Screening Committee because they were intentionally deceiving women [about the harms]. They went on record saying, “We mustn't let women know this because it might deter them from coming to be screened.” So I decided to work outside the system to inform women about the truth of screening. I can see how some women, fully informed, would accept screening over the age of 50, but to promote mammography to women under the age of 50 is absolutely unethical.
MN: The American Cancer Society has been promoting mammography starting at age 40 for 30 years.
Dr. Baum: Either the ACS is funded by the screening industry, or they've backed themselves into a corner and can't admit they've been wrong all this time. The message is so seductive: “The secret to cancer is catching it early.” That's rubbish. It’s so naïve. The only thing that influences cancer mortality is better treatment, as far as I'm concerned. The word “early” has no meaning to a scientist.
MN: Do you have an equivalent to the ACS in your country overselling the early detection message?
Dr. Baum: No, but we have “Black October,” which is what I call Breast Cancer Awareness Month, when lots of fine young women have these campaigns with runway models advising breast self-examination every month. And that gets across two false messages: 1) that self-examination is of any value; and 2) that the role model for breast cancer patients is a skinny girl of 23.
MN: Any parting thoughts about the current state of mammography research?
Dr. Baum: It ceases to be medical science now-it's egos. A proper scientist should learn that you go through life being humiliated again and again. You have to prepare yourself to admit you were wrong. That's the very mechanism of science. Scientific truths are only temporary expressions of reality that serve us for the time being. There’s no such thing as scientific truth. It’s all an approximation to reality. A true scientist has to accept that his version of reality will be overturned in the fullness of time. If you can't accept that, you’re not a scientist.
This interview was originally published in the October 2002 issue of the Center for Medical Consumers monthly newsletter, HealthFacts.
Written by: Our Bodies, Ourselves
Last revised: Jan 2007
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