"More than half of these mammograms were performed in women under the age of 50, for which there is questionable evidence as to whether screening mammography is effective in reducing mortality... Unless an organized program for breast screening for women age 50 to 60 years is implemented in Ontario, it is estimated that only 30 percent of women who will benefit from screening will be screened and that reduction in mortality will be in the order of 80 lives saved per year as opposed to 300."

Dr. Rosalie Bertell is against this screening program. By 1995, she calculates that X-ray exposure from this program will result in between 15 and 40 cancers, of which seven to 18 will be fatal. Most of these cancers will not appear until after age 70 years, when the women are no longer in the screening program. She claims the other cancers would be detected by a physician or the woman herself.

Dr. Bertell suggests that women who start in the program should complete it so that these radiation induced cancers won't be missed.

In addition, Dr. Bertell estimates that 10,000 women will have false positives and have to be retested, and about 163 women will have unnecessary surgery due to the program. True, she says, 307 will not die of breast cancer but less than three percent (eight or nine women) would be due exclusively to the program. The other breast cancers would be detected by a physician or the woman herself.

She is also concerned that X-ray exposure is known to promote or accelerate cancers which are hereditary and are caused by other environmental or life style carcinogens. "How many tumours are promoted or accelerated will be learned from the experiment on Canadian women," says Dr. Bertell.

"Since the Hippocratic oath demands that physicians at least "do no harm," says Dr. Bertell, "I assume the breast mammography program had considered the serious problem of increasing breast cancer incidence rate by X-ray exposure as a method of reducing the overall breast cancer death rate."

"As a woman, I am not ready to trade off lives in order to improve fatality records. Every breast cancer and every surgery is tragic. Every life is precious and I do not believe physicians can justify killing some women to "save" other women."

British Columbia is the only province that is screening women 40 to 49 years with yearly mammograms. Alberta and Saskatchewan have screening programs for women age 50 and over, accompanied by physical exams.

The Politics Of Breast Cancer Research

In the U.S. research for AIDS has received 1.28 billion dollars while research on breast cancer only 90.2 million. Virginia Soffer, founder of the Breast Cancer Action group in Burlington, Vermont, puts it this way, "This is a major feminist issue, and people haven't caught onto that. If one in nine men had testicle cancer and their testicles were being cut off, there would be an outcry, you can be sure, and something would be done (Insight, Feb/92)."

Many cancer research dollars are spent on researching new drugs for treatment and not on prevention. Dr. Susan Love, Director of the Breast Clinic at the University of California School of Medicine, called for more research into the possible promoters of breast cancer such as diet, birth control pills and hormones. "We need to invest our dollars in promising new leads in genetics and immunology, not just in new ways of giving chemotherapy." Love also maintains that women with breast cancer need to be included in the development of study design and decisions about which trials should be funded.

Important environmental causes of breast cancer are just beginning to be studied. Pat Kelly, founder of the Breast Cancer Action group in Canada, says it's not surprising that so little is known about the environmental co-factors. The total research budget for breast cancer research in Canada in 1991-2 was less than four million dollars.

Fortunately, women are organizing themselves at a grass roots level in groups such as Breast Cancer Action, to educate themselves about cancer prevention, detection and treatments and to lobby politicians about funding cancer research and future directions.

What's A Women To Do ?

• HIGH RISK GROUPS: If you are in a high risk group, you may want to consider having regular mammograms, especially after age 50. The U.S. Preventive Services Task Force suggests that so called high risk women start mammograms at age 35 despite the absence of good evidence.