Transcript: The Truth About Mammography | Mar 20, 2019

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, white shirt, and gray plaid tie.

A caption on screen reads "The truth about mammography. @spaikin, @theagenda."

Steve says FOR YEARS NOW THE
MESSAGE TO WOMEN OVER 50, AND
YOUNGER WOMEN WITH AN INCREASED
RISK OF BREAST CANCER, HAS BEEN
TO GET REGULAR MAMMOGRAMS.
SUCH ADVICE IS NOW SERIOUSLY
BEING CALLED INTO QUESTION, AMID
CONCERNS THAT SCREENING MIGHT BE
DOING MORE HARM THAN GOOD.
VETERAN JOURNALIST AND PRODUCER
RENEE PELLERIN'S NEW BOOK MAKES
THAT CASE.
IT'S CALLED "CONSPIRACY OF HOPE:
THE TRUTH ABOUT BREAST CANCER
SCREENING."
AND SHE JOINS US NOW FOR MORE.

Renée is in her late fifties, with brown hair in a bun. She's wearing a black blazer and a pink shirt.
A picture of her book appears briefly on screen. The cover features a pointillist style drawing of a female chest, with a yellow sonar-like image on one of the breasts.

Steve says RENEE, YOU'VE WRITTEN A VERY
IMPORTANT BOOK HERE AND IT'S A
VERY DISTURBING BOOK, AND I WANT
TO START RIGHT AT THE BEGINNING
WITH THE INTRO EDUCATION WHERE
YOU SAY THAT NOTHING IN MEDICINE
HAS EVER GENERATED AS MUCH
CONTROVERSY OR CONFLICT AS
MAMMOGRAPHY SCREENING.
WHY SO?

The caption changes to "Renée Pellerin. Author, 'Conspiracy of hope.'"
Then, it changes again to "Fiction versus science."

Renée says YOU KNOW, SCREENING WAS FIRST
BEGAN IN THE UNITED STATES IN
THE 1970s, AND SO THAT'S MORE
THAN 50 YEARS THAT WE HAVE BEEN
ARGUING ABOUT IT.
IT'S BEEN A HUGE DEBATE.
AND IT'S BEEN A HUGE FIGHT FOR
50 YEARS.
AND MANY PEOPLE HAVE TOLD ME
THAT IN MEDICINE, YOU KNOW, WHEN
THEY HAVE MEDICAL STUDENTS, THEY
SAY THAT THERE'S NOTHING THAT
PEOPLE ARGUE MORE ABOUT THAN
MAMMOGRAM SCREENING.

Steve says AND YOU SAY BECAUSE
IT HAS AS MUCH TO DO WITH
EMOTION AS SCIENCE AND FACT,
WHICH IS UNUSUAL, BECAUSE
USUALLY MEDICINE IS ALL ABOUT,
YOU KNOW, WHAT'S EMPIRICALLY
PROVABLE.
WHY THE EMOTION IN THIS CASE?

Renée says IT SHOULD BE.
I THINK IN THIS CASE THERE ARE
PEOPLE WHO SINCERELY BELIEVED IN
EARLY DETECTION, THAT EARLY
DETECTION WORKED.
THEY'VE INVESTED THEIR ENTIRE
LIVES IN THAT IDEA.
AND EVEN THOUGH THERE'S QUITE A
BIT OF EVIDENCE THAT IT DOESN'T
WORK NEARLY AS WELL, IF IT WORKS
AS ALL, AS WE THINK IT DOES,
IT'S HARD TO LET GO OF THAT
BELIEF.
THE SCIENTIFIC ARGUMENTS ARE,
YOU KNOW, COLOURED WITH THIS
KIND OF ANGER AND EMOTION, THAT
THOSE WHO WOULD ARGUE AGAINST
SCREENING ARE MURDERING WOMEN
AND THEY'RE CAUSING GREAT HARM
WHEN IN FACT IT'S JUST BASIC
SCIENCE AND EVIDENCE.

Steve says WELL, YOU TELL THE
STORY IN THE BOOK ABOUT THE...
YOU'RE GOING TO HELP ME WITH HIS
NAME.
TRACKS, IS THAT HIS NAME?

Renée says PHILIP STRAX.

Steve says WHO WAS A DOCTOR
WHOSE WIFE DIED OF BREAST CANCER
AND THAT GOT HIM INTERESTED IN
FINDING A CURE AND HIS BONA
FIDES COULDN'T BE MORE PURE IN
THAT REGARD, RIGHT?

Renée says FROM ALL ACCOUNTS HE WAS A
VERY SINCERE MAN WHO TRULY CARED
ABOUT WOMEN AND HE DID NOT WANT
OTHER WOMEN TO GO THROUGH WHAT
HIS WIFE HAD GONE THROUGH.
BUT HE WAS INVOLVED IN RESEARCH,
THE VERY FIRST STUDY IN THE
UNITED STATES, AND THOSE
RESEARCHERS, IN MY VIEW, TOOK A
PRETTY MODERATE TONE WITH
SCREENING.
THEY REALLY WANTED TO FIND OUT
WHETHER IT WOULD WORK OR NOT.
IT'S KIND OF SINCE THEN REALLY
THAT THE EMOTIONAL BAGGAGE CAME
ALONG WITH THE IDEA OF EARLY
DETECTION AND SCREENING.

Steve says LET'S FOCUS ON THE
SCIENCE THEN FOR A SECOND HERE.
WHY WOULD MAMMOGRAPHY SCREENING
BE TRICKIER THAN OTHER KINDS OF
CANCER SCREENING?

The caption changes to "Renée Pellerin, @ReneePellerin."
Then, it changes again to "Tricky to get right."

Renée says WELL, OKAY.
FOR STARTERS, MAMMOGRAPHY IS
LOOKING AT THE TISSUE OF THE
BREAST, RIGHT?
X-RAYS CAME ALONG WAY BEFORE
PEOPLE STARTED TO FIGURE OUT HOW
THEY COULD PICTURE BREASTS.
YOU COULD PICTURE BONES QUITE
EASILY, BUT SOFT TISSUE IS VERY,
VERY DIFFICULT.
AND THEN THE BREAST HAS FATTY
TISSUE AND FIBROUS TISSUE AND SO ON.
SO FINDING SOMETHING THAT LOOKS
LIKE A TUMOUR IN ALL OF THAT
REQUIRES A PARTICULAR SKILL ON
THE PART OF THE RADIOLOGIST.
MAMMOGRAMS MISS CANCERS
SOMETIMES.
THEY DON'T SEE ALL CANCERS.
SO IT'S NEVER BEEN A PERFECT TEST.
IT IS AN IMPERFECT TEST WITH
FALSE NEGATIVES, FALSE POSITIVES AND MISSES.

Steve says THE NATURAL CANCER
INSTITUTE SET UP COMMITTEES ALL
OF WHICH REPORTED THAT THERE WAS
NO EVIDENCE THAT SCREENING WOMEN
UNDER 50 SAVED LIVES AND YET
BREAST CANCER DETECTION
SCREENINGS FLOURISHED.
HOW COME?

Renée says THE EVIDENCE AT THAT TIME, IN
THE 1970s, WAS THE STUDY THAT
PHILIP STRAX DID.
IT LOOKS PRETTY PROMISING.
THEY WOULD... THEY THOUGHT THAT
THE SCREENING WAS SAVING LIVES.
BUT IN THAT PARTICULAR STUDY, IT
WAS NOT APPARENT IN WOMEN UNDER
50.
BUT... AND THEN IT WAS QUITE
CLEAR THAT MORE RESEARCH WAS
NEEDED TO ANSWER SOME OF THE
QUESTIONS.
HOWEVER, ALONG COMES 1971 AND
PRESIDENT NIXON'S WAR ON CANCER
AND THEN THERE WAS A LOT OF
MONEY FOR CANCER RESEARCH.
THE AMERICAN CANCER SOCIETY HAD
SUCCESS WITH PROGRAMS TO GET
WOMEN INTO CERVICAL SCREENING
WITH PAP SMEARS, SO THIS IS KIND
OF THEIR NEXT BIG IDEA.
SO WITH THE POSSIBILITY OF
RESEARCH MONEY, THEY WENT TO THE
NATIONAL CANCER INSTITUTE AND
SAID, LET'S DO WHAT THEY CALLED
A DEMONSTRATION PROJECT.
LET'S PROVE THAT WE CAN GET
WOMEN TO COME AND GET
MAMMOGRAMS, AND THAT WAS A
FIVE-YEAR PROGRAM TO GET 250,000
WOMEN INTO FREE SCREENING AND
HENCE...

Steve says THE MOMENTUM BUILT.

Renée says MOMENTUM BUILT.

Steve says THAT'S IN THE STATES.
HOW ABOUT IN CANADA?
HAVE WE DONE ANY WORLD CLASS
SCREENING... MAMMOGRAPHY
SCREENING STUDIES HERE?

Renée says I WOULD SAY THE BEST
SCREENING STUDY WAS DONE IN
CANADA, THE CANADIAN NATIONAL
BREAST SCREENING STUDY.

Steve says WHAT WAS THAT?

Renée says IT STARTED IN 1980.
THEY SCREENED WOMEN FOR FIVE
SCREENINGS OVER FOUR YEARS,
ANNUAL SCREENING.
STUDIED WOMEN DISTINCTLY UNDER
THE AGE OF 50.
TRIED TO ANSWER SOME OF THE
QUESTIONS THAT PREVIOUS RESEARCH
COULDN'T ANSWER.

The caption changes to "The Canadian connection."

Steve says AND WHAT CONCLUSIONS
DID IT COME TO?

Renée says THEY'VE ALSO CONCLUDED THAT
THERE WAS ABSOLUTELY NO LIVES
SAVED IN WOMEN UNDER 40 OR FOR
WOMEN OVER 50.

Steve says NO LIVES SAVED BY
HAVING MAMMOGRAMS?

Renée says THAT'S CORRECT.

Steve says WHAT KIND OF
RECEPTION DID THAT OUTCOME GET?

Renée says YOU CAN IMAGINE.
BY THIS TIME, OF COURSE,
MAMMOGRAPHY HAD ALREADY BECOME
AN INDUSTRY.
THE RADIOLOGY COMMUNITY WAS
PROMOTING STRONGLY, THE AMERICAN
CANCER SOCIETY WAS PROMOTING
STRONGLY.
IN CANADA, WE WERE TRYING TO GET
SCREENING PROGRAMS UP.
SO BY THE TIME THE CANADIAN
RESEARCH WAS ACTUALLY PUBLISHED
IN THE FIRST... FIRST IN 1992,
WE ALREADY HAD A SCREENING
PROGRAM IN BRITISH COLUMBIA AND
IN ONTARIO.
SO YOU CAN IMAGINE, WITH ALL OF
THESE PEOPLE SORT OF... IT WAS
VESTED IN THE IDEA OF EARLY
DETECTION, AND ALONG COMES THIS
MASSIVE STUDY IN CANADA OF
90,000 WOMEN THAT TELLS YOU,
WELL, WAIT A MINUTE.
IT'S ACTUALLY NOT SAVING LIVES
ACCORDING TO THE DATA THAT WE
HAVE AT THIS POINT.
AND THEN OF COURSE THE CANADIAN
STUDY FOLLOWED UP AND IT
CONTINUED TO FIND THE SAME
RESULT, THAT IT DOESN'T MATTER
HOW LONG THEY LOOKED AT IT, THEY
FOLLOWED WOMEN FOR 25 YEARS, AND
STILL, IT WAS THE SAME RESULT.
IT DID NOT HAVE IMPACT ON
MORTALITY.
YOU KNOW, THAT... IT WAS
CONSIDERED HERETICAL TO SAY
THAT.
THE RADIOLOGISTS AND THE
SCIENTISTS WHO TRULY BELIEVED IN
EARLY DETECTION SAID, WAIT A
MINUTE.
THEY GOT THE WRONG ANSWER.
THERE MUST HAVE BEEN SOMETHING
WRONG WITH THE STUDY.

Steve says AND WAS THERE?

Renée says NO, THERE WASN'T.
ALTHOUGH YOU... NO STUDY IS
PERFECT.
BUT THERE WERE ACCUSATIONS THAT
THERE WAS A SCREW UP IN THE
RANDOMIZATION, PURPOSELY PUTTING
WOMEN IN ONE GROUP AS OPPOSED TO
ANOTHER TO GET A DIFFERENT
RESULT.
AND THE ACCUSATIONS WERE SO
STRONG THAT THERE HAD TO BE A
FORENSIC AUDIT.
AND WHEN THAT WAS DONE,
INVOLVING DISTINGUISHED
SCIENTISTS LOOKING AT THE DATA
AND INVOLVING AN ACCOUNTING
FIRM, FORENSIC ACCOUNTING FIRM
TO ALSO HELP LOOK AT THE DATA,
THEY WERE COMPLETELY EXONERATED
AND FOUND THERE WAS ABSOLUTELY
NOTHING WRONG WITH THE STUDY.

Steve says I WANT TO BE CAREFUL
WITH HOW I ASK THIS NEXT
QUESTION.
I DON'T WANT TO PAINT EVERYBODY
WITH THE SAME BRUSH.
HOWEVER, I THINK IT'S FAIR TO
SAY, DOCTORS, RESEARCHERS,
CLINICIANS, THE PEOPLE WHO ARE
INVOLVED IN THIS WORLD, THEY'RE
VERY BRIGHT PEOPLE AND THEY HAVE
A LOT OF EDUCATION, AND RELATIVE
TO MOST PEOPLE IN SOCIETY,
THEY'RE WELL PAID.
AND THEY'VE GOT EGOS.
HOW MUCH OF THAT DO YOU THINK IS
GOING ON HERE?

Renée says I DON'T KNOW IF IT'S EGO OR
IF IT'S... YOU KNOW, WHEN YOU'VE
INVESTED YOUR LIFE IN SOMETHING
AND YOUR ENTIRE COMMUNITY IS IN
THE SAME BOX AS YOU, YOU KNOW,
THERE'S AN ELEMENT OF... IT'S
NOT EGO, EVEN ARROGANCE.
I THINK THERE'S AN ELEMENT OF...

Steve says TUNNEL VISION?

Renée says GROUP-THINK I THINK CAN COME
INTO PLAY.
AND IT'S VERY HARD FOR SOMEBODY
WHO WANTS TO BE A CRITICAL
THINKER IN THAT ENVIRONMENT TO
QUESTION.
AND I DON'T THINK IT'S JUST...
IT'S NOT JUST RADIOLOGISTS.
I THINK WE SEE THAT IN DIFFERENT
AREAS IN THE MEDICAL PROFESSION
WHERE IT'S VERY DIFFICULT TO
CHALLENGE SOMETHING WHICH IS,
YOU KNOW, BECOMES PART OF THE
STATUS QUO.

Steve says ONE OF THE SIDE
EFFECTS OF HAVING SO MANY WOMEN
GETTING MAMMOGRAPHY'S,
REGARDLESS OF WHAT AGE THEY ARE,
IS, AS YOU HAVE POINTED OUT, A
LOT OF FALSE POSITIVES, A LOT OF
OVERDIAGNOSIS, A LOT OF
NEGATIVES THAT ARE NOT PART OF
THE PLAN.
HOW BIG A PROBLEM IS THAT?

The caption changes to "Overdiagnosis."

Renée says I THINK IT'S A HUGE PROBLEM.
AND I THINK WE'RE BEGINNING TO
LEARN MUCH MORE ABOUT THE HARMS
OF SCREENING.
YOU KNOW, FALSE POSITIVE IS ONE
THING, WHERE IT'S YOU HAVE A
SCREEN AND IT LOOKS LIKE
SOMETHING AND YOU GO BACK AND
THEY LOOK AGAIN AND IT MAY EVEN
RESULT IN A BIOPSY.

Steve says AND MAYBE NOTHING.

Renée says AND MAYBE NOTHING THERE.

Steve says HOW OFTEN DOES THAT HAPPEN?

Renée says THAT CAN HAPPEN... I'VE HEARD
DIFFERENT ESTIMATES.
YOU KNOW, WOMEN WHO ARE SCREENED
OVER 10 YEARS, I'VE HEARD
ESTIMATES IT CAN HAPPEN TO
50 PERCENT OF WOMEN WHO ARE
REPEATEDLY SCREENED.
EVERY TIME YOU GET SCREENED, THE
CHANCE OF THAT OCCURS.
NOW, I THINK WE KNOW THAT, AND I
THINK THAT'S A HARM THAT I
THINK... I THINK MOST WOMEN ARE
FAIRLY COMFORTABLE WITH.
I THINK THEY KNOW THAT THAT CAN
HAPPEN.
BUT LET'S TALK ABOUT
OVERDIAGNOSIS, BECAUSE THAT IS
NOT THE SAME THING.
OVERDIAGNOSIS IS WHEN YOU HAVE
BEEN DIAGNOSED WITH A CANCER,
BUT THAT CANCER, IF YOU HADN'T
SEEN IT ON THE MAMMOGRAM, YOU
WOULD NEVER HAVE FELT IT, IT
WOULD NEVER HAVE GROWN, IT MAY
HAVE NEVER CAUSED YOU ANY
PROBLEMS, ANY HEALTH PROBLEMS,
YOU WOULD HAVE NEVER KNOWN THAT
YOU HAD IT.
HOWEVER, ONCE IT'S SEEN ON THE
MAMMOGRAM, YOU ARE SUBJECTED TO
THE SURGERY AND THE TREATMENT
THAT GOES ALONG WITH IT AND
POSSIBLY UNNECESSARILY.
NOW, WE DON'T KNOW HOW OFTEN
THAT HAPPENS.
THE ESTIMATES VARY FROM, IT
DOESN'T HAPPEN AT ALL TO IT
HAPPENS 50 PERCENT OF THE TIME.
I THINK GENERALLY SPEAKING, IN
LOOKING AT DIFFERENT SCREENING
PROGRAMS, THAT RATE OF
OVERDIAGNOSIS HAPPENS AROUND
30 PERCENT, IN 30 PERCENT OF ALL
MAMMOGRAPHY DETECTED CANCERS.

Steve says LET ME TACKLE
ANOTHER ANGLE HERE, WHICH IS,
EVERY TIME A WOMAN GOES FOR A
MAMMOGRAPHY, SHE DOES GET A
LITTLE SHOT OF RADIATION, RIGHT,
SO THAT THEY CAN GET THE SCAN.

Renée says YES.

Steve says DO WE KNOW HOW
HARMFUL THAT IS?

Renée says WELL, I DON'T THINK THAT
THERE IS A HUGE CONCERN OVER
THAT LEVEL OF RADIATION.
IN THE VERY BEGINNING, ONE OF
THE ISSUES WITH MAMMOGRAPHY WAS
THAT IT DID DELIVER A
SIGNIFICANT DOSE OF RADIATION
AND PEOPLE WERE FREAKING OUT
ABOUT THAT AND SAID, NO, WE
SHOULDN'T DO THIS.
SO THERE WERE MANY, MANY EFFORTS
TO DECREASE THE AMOUNT OF
RADIATION WITH EACH MAMMOGRAPHY
SCREEN.
NO ONE, AS FAR AS I CAN TELL,
WILL SAY THAT IT'S PERFECTLY,
PERFECTLY SAFE.
BUT I ALSO HAVE NOT ENCOUNTERED
ANYBODY WHO WOULD SAY THAT
THERE'S A HUGE CONCERN OVER IT.
THERE IS A CONCERN.
YOU KNOW, WITH RADIATION, IT'S A
REPEATED... IT'S REPEATED DOSES
OF RADIATION, AND IF YOU HAVE
OTHER KINDS OF DOSES OF
RADIATION THROUGH OTHER TESTS,
YOU MAY WANT TO TAKE THAT INTO
CONSIDERATION.
I WOULDN'T LIKE TO OVERBLOW IT,
THAT THAT'S A MAJOR CONCERN.

Steve says I WANT TO ASK THIS
NEXT QUESTION CAREFULLY AS WELL
BECAUSE I'M NOT MAKING ANY
ALLEGATIONS HERE, BUT I DID READ
IN YOUR BOOK WHERE YOU POINT OUT
THAT THERE IS A SIGNIFICANT
FINANCIAL INCENTIVE, YOU KNOW,
REGARDLESS OF WHAT CORNER YOU
TURN IN THE HEALTH CARE SYSTEM,
FOR SCREENING TO TAKE PLACE.
WHAT DO WE DO ABOUT THAT?

The caption changes to "In conclusion."

Renée says BY INCENTIVE, I TALK ABOUT
THAT IN A COUPLE OF DIFFERENT
WAYS IN THE BOOK.
ONE IS THAT IT IS AN INDUSTRY.
SO YOU HAVE RADIOLOGISTS, YOU
HAVE THE PEOPLE WHO MAKE THE
EQUIPMENT, THE RADIOLOGY
EQUIPMENT, THE MAMMOGRAPHY
EQUIPMENT.
YOU HAVE CANCER CHARITIES WHICH
BENEFIT FROM THE MESSAGE OF FEAR
THAT GOES ALONG WITH PROMOTING
MAMMOGRAPHY.

Steve says A LOT OF PEOPLE HAVE
A STAKE IN THIS...

Renée says A LOT OF PEOPLE HAVE A STAKE.
AND I STARTED OUT WHEN I WAS
RESEARCHING THINKING THAT THIS
HAD TO BE THE DRIVER, AND I
CHANGED MY MIND ABOUT THAT
ALONG... I THINK THE DRIVER WAS
LARGELY EMOTION AND JUST PLAIN
HOPE THAT WE WANTED SOMETHING TO
WORK AGAINST THIS DREADFUL DISEASE.
BUT WHERE WE HAVE THE FINANCIAL
INCENTIVE, WHICH I THINK IS
HIGHLY QUESTIONABLE, IS RIGHT
HERE IN ONTARIO... NOT IN OTHER
PROVINCES BUT HERE IN ONTARIO.
FAMILY PHYSICIANS HAVE A BONUS
INCENTIVE, WHEN A CERTAIN NUMBER
OF THEIR PATIENTS, A PROPORTION
OF THEIR PATIENTS, COMPLY WITH
THE INVITATIONS THAT WE GET TO
SCREENING.
SO IT'S NOT A CASE OF DOCTORS
REFERRING WOMEN TO SCREENING,
IT'S WOMEN'S COMPLIANCE IS
MEASURED SO IN EVERY FAMILY
PRACTICE, THE NUMBER OF ELIGIBLE
WOMEN WHO GO FOR SCREENING ARE
TALLIED AND THE DOCTOR GETS THE
FEEDBACK.
AND A FAMILY PHYSICIAN CAN EARN
AROUND 2,000 dollars EXTRA A YEAR,
DEPENDING ON IF A SIGNIFICANT
NUMBER OF WOMEN GO FOR
SCREENING, WHICH IS A VERY...
YOU CAN SEE RIGHT AWAY THAT SETS
UP A CONFLICT.

Steve says WELL, IS IT POSSIBLE
TO DESIGN A SYSTEM THAT TAKES
THE FINANCIAL INCENTIVE OUT OF IT?

Renée says WELL, THERE'S NO REASON TO
INCENTIVIZE FAMILY PHYSICIANS
TO, YOU KNOW, TO BE PROMOTING
WOMEN TO GO FOR THIS KIND OF SCREENING.
YOU CAN IMAGINE WHAT HAPPENS IN
THE DOCTOR'S OFFICE WHEN A WOMAN
WANTS TO HAVE A CONVERSATION
ABOUT HARMS AND RISKS, AND YET
THERE IS THE MESSAGE FROM THE
ONTARIO GOVERNMENT THAT THIS IS
A REALLY GOOD THING TO DO, EVEN
THOUGH IT'S NOT A HUGE FINANCIAL
INCENTIVE.
THE MESSAGE IS THERE THAT WE
WANT YOU TO DO THIS.

Steve says WELL, YOU ASK THE
QUESTION IN YOUR BOOK THEN, IF
NOT MAMMOGRAMS, WHAT?
SO IF NOT MAMMOGRAMS, WHAT?

Renée says WELL, YOU KNOW, THAT'S A
REALLY GOOD QUESTION.
I DON'T THINK THAT THERE'S A
CLEAR ANSWER TO THAT JUST YET.
THERE ARE PEOPLE WHO ARE
RESEARCHING OTHER MARKERS, A
BLOOD TEST POSSIBLY LOOKING FOR
A SIGN, PEOPLE TRYING TO FIND
OUT, CAN WE IDENTIFY WHO IS MORE
AT RISK THAN OTHERS AND MAYBE
NOT SCREEN THOSE WOMEN AS OFTEN?
CAN WE HOLD ON THE SURGERY IN
SOME CASES AND MAYBE NOT PUT
WOMEN THROUGH TREATMENT?
WE WATCH AND WAIT FOR SOME TIME
AND BEFORE WE SUBJECT... SO
THERE ARE ALL KINDS OF IDEAS,
TRYING... OUT THERE IN THE
RESEARCH AMONG PEOPLE WHO ARE
TRYING TO RESOLVE THIS ISSUE OF
OVERDIAGNOSIS AND HARM THAT'S
BEING DONE.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Steve says LET'S COME FULL
CIRCLE HERE.
I WANT TO RETURN TO THE
INTRODUCTION, BECAUSE YOU ASK
FOUR GOOD QUESTIONS IN THE
INTRODUCTION, AND I WANT TO PUT
THEM TO YOU RIGHT NOW.
LET'S DO A LIGHTNING ROUND.
FOUR QUICK QUESTIONS, FOUR QUICK
ANSWERS.
NUMBER ONE, DOES SCREENING
REALLY SAVE LIVES?

Renée says IT SAVES VERY FEW LIVES, IF
ANY.
IMPORTANTLY, EVEN IN THE
RANDOMIZED TRIALS WHERE IT
SHOWED THAT IT COULD POSSIBLY
SAVE LIVES, OVERALL MORTALITY
DID NOT CHANGE.
SO THERE'S A DIFFERENCE BETWEEN
BREAST CANCER MORTALITY AND
OVERALL MORTALITY, AND THAT'S
THE BOTTOM LINE.
YOU WANT TO IMPROVE OVERALL, THE
STATISTICS OF OVERALL MORTALITY.

Steve says THE MONEY IS
PHENOMENAL HERE, RIGHT?
I THINK I REMEMBER YOU SAYING
8 BILLION IN THE U.S. SPENT ON
THIS.

Renée says ANNUALLY ABOUT 8 BILLION
ANNUALLY, YEAH.
YOU KNOW, AND 90 MILLION pounds IN
ENGLAND.
AND BRITISH COLUMBIA, YOU KNOW,
20 MILLION dollars A YEAR.

Steve says TENS OF MILLIONS
HERE AS WELL.

Renée says TENS OF MILLIONS HERE IN
ONTARIO.

Steve says WHAT ARE THE
BENEFITS?
WHAT ARE THE HARMS?

Renée says THE BENEFITS ARE THAT IT MAY
SAVE A FEW LIVES... MAY.
I SAY "MAY" BECAUSE I THINK THE
RESEARCH HAS SHOWN THAT IT'S OF
VERY MODERATE BENEFIT.
IT DOESN'T HAPPEN AS MUCH AS WE
WOULD LIKE IT TO HAPPEN.
AND THE HARMS ARE OVERDIAGNOSIS,
OVERTREATMENT, ANXIETY, THE
PSYCHOLOGICAL ANXIETY.
THE MAMMOGRAPHY THAT FAILS AND
RESULTS IN A FALSE NEGATIVE,
WHICH MEANS FALSE REASSURANCE.
THAT'S ALSO A SIGNIFICANT HARM.
SO MY POINT IS, PEOPLE... WOMEN
HAVE TO KNOW, AND WE'RE NOT
GIVEN THIS INFORMATION WHEN
WE'RE ASKED TO GO FOR SCREENING.
WE'RE JUST TOLD IT SAVES OUR
LIVES.
WE'RE MADE TO FEEL THAT WE'RE
RIDICULOUS IF WE DON'T COMPLY
WITH THIS INVITATION, WHEN IN
FACT I THINK IT SHOULD BE A
DECISION, A PERSONAL DECISION,
BASED ON GOOD INFORMATION,
TRUTHFUL INFORMATION, ABOUT BOTH
THE HARMS AND THE RISKS.

Steve says AND LASTLY, HAVING
LOOKED AT THIS WHOLE THING, AT
WHAT AGE DO YOU THINK PEOPLE
OUGHT TO START HAVING THEIR
FIRST MAMMOGRAPHY?

Renée says WELL, YOU KNOW, OTHER THAN A
COUPLE OF PROVINCES IN CANADA
AND OTHER THAN RADIOLOGICAL
ORGANIZATIONS HERE IN CANADA AND
THE UNITED STATES, NO ONE REALLY
RECOMMENDS MAMMOGRAPHY SCREENING
SHOULD START UNTIL THE AGE OF 50
FOR PEOPLE WHO ARE AT NORMAL
RISK.
ENGLAND, EUROPE, MOST PUBLIC
SCREENING PROGRAMS ONLY INVITE
WOMEN STARTING AT AGE 50.
BUT, YOU KNOW, WOMEN HERE ARE
SENT AT AGE 40 BECAUSE DOCTORS
THINK IT'S A GOOD IDEA.

The caption changes to "Producer: Meredith Martin, @MeredithMartin."

Steve says WELL, THERE'S A
DOCTOR WHO YOU QUOTE ON THE
FRONT OF YOUR BOOK, BRIAN
GOLDMAN, WHO HAS BEEN ALL OVER
THE PLACE, INCLUDING ON THIS
PROGRAM, WHO SAYS THIS BOOK IS A
DEVASTATING CRITIQUE OF THE
FOLLY OF BREAST CANCER
SCREENING.
IT'S CALLED "CONSPIRACY OF HOPE:
THE TRUTH ABOUT BREAST CANCER
SCREENING," AND IT'S BROUGHT
RENEE PELLERIN TO OUR STUDIO.
THANKS A LOT, RENEE.

Renée says THANK YOU FOR HAVING ME.
MY PLEASURE.

Watch: The Truth About Mammography