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Overtreatment of Ductal Carcinoma In Situ

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Nine out of ten women don’t realize that some breast cancers would never have caused any problems or even become known in one’s lifetime. This is an issue ductal carcinoma in situ has brought to the forefront.

The whole point of cancer screening is to “detect life-threatening disease at an earlier, more curable stage. Effective cancer-screening programs therefore both increase the incidence of cancer detected at an early stage and decrease the incidence of cancer presenting at a late stage.” Sounds reasonable because you’d find all those tiny cancers during screening that you would have missed before and be able to cut them out and pull them out of circulation. That’s not what appeared to happen with mammograms, though, as you can see at 0:30 in my video Overtreatment of Stage Zero Breast Cancer DCIS. As mammography ramped up in the 1980s, the diagnosis of early cancers did indeed shoot up. What we’d then like to see is a mirror image of this increase, with incidence of late-stage cancers dropping. If you caught the cancer early, it wouldn’t be around for late-stage cancer, right? Wrong. Late-stage cancer incidence didn’t seem to drop much at all.

Another way to look at this is by comparing mammogram rates around the country. The more mammograms you do, the more heavily screened the population is and the more early cancers you pick up. Great! And late, advanced disease should go down, too, right? Right, but it doesn’t. As you can see at 0:59 in my video, so many early cancers are being taken out of circulation with surgery, radiation, or other treatment, which should mean about the same number of late-stage cancers shouldn’t be found–that is, there should be an approximately equivalent drop in the number of late-stage cancers detected, but that didn’t happen. Mammograms catch a lot of small cancers, but with “no concomitant decline in the detection of larger cancers,” that would explain why the more mammograms you do, the more cancer you find, but death from breast cancer doesn’t seem to change much. Hold on. Tens of thousands of cancers are being cut out after screening. Why aren’t that many fewer women dying? “Together, these findings suggest widespread overdiagnosis,” meaning cancer picked up on mammograms that never would have progressed to the point of presenting during the woman’s lifetime and, so, wouldn’t have been noticed or caused any harm had it never been picked up at all.

So, going back to the graph I showed earlier, which you can see again at 2:00 in my video, if removing all those early-stage cancers didn’t lead to that many fewer late-stage cancers, that suggests that most would never have progressed during that time or may have even gone away on their own. That “could explain almost all the increase in incidence noted when mammography screening is done.” Indeed, “many invasive breast cancers detected by repeated mammography screening do not persist to be detected by screening at the end of 6 years, suggesting that the natural course of many of the screen-detected invasive breast cancers is to spontaneously regress,” that is, to spontaneously disappear.

We’ve known for more than a century that sometimes even serious metastatic breast cancer can just spontaneously go away. The problem is you can’t tell which is which, so if you find cancer, the natural inclination is to treat it. This can be especially tricky for ductal carcinoma in situ (DCIS), so-called stage zero breast cancer. Ductal means “in the breast ducts,” carcinoma means “cancer,” and in situ means “in place” or “in position,” not spreading outside of the duct. And, DCIS can create tiny calcifications that can be picked up on mammogram, as you can see at 3:07 in my video.

The whole point of mammograms was “to identify early invasive disease, so the large numbers of…DCIS diagnosed were unexpected and unwelcome.” “Prior to the advent of screening, ductal carcinoma in situ (DCIS) made up approximately 3% of breast cancers detected.” Now, DCIS accounts for a significant chunk. “The cells that make up DCIS look like invasive cancer…and therefore the presumption was made that these lesions were the precursors of cancer”–stage zero cancer–“and that early removal and treatment would reduce cancer incidence and mortality. However, long-term epidemiology [population] studies have demonstrated that the [surgical] removal of 50 000 to 60 000 DCIS lesions annually has not been accompanied by a reduction in the incidence of invasive breast cancers. This is in contrast to the experience with removal of colon polyps [with colonoscopy] and intraepithelial neoplasia lesions of the cervix [precancerous cervical lesions, thanks to pap smears], in which the removal of precursor lesions has led to a decrease in the incidence of colon and cervical cancer, respectively.” Those are cancer screening programs that work.

Radiologists argue that overdiagnosis isn’t so much the problem as is overtreatment. Certainly, it’s terrible to get a breast cancer diagnosis even though the cancer never would have hurt you, but you can’t know that at the time, so most women undergo aggressive surgical and radiation treatment. What happens when you compare the ten-year breast cancer survival rate for women with low-grade DCIS? Among those women who chose not to have surgery at all, 1.2 percent of them died of breast cancer within a decade. But, during that same ten years, of those women who did undergo surgery, having a lumpectomy or a full mastectomy, to cut out the cancer, 1.4 percent died from breast cancer. So, surgery appeared to make no difference.

Currently, randomized controlled trials are being conducted to put it to the test, but it is “incredibly difficult to convince a patient with a proven diagnosis of DCIS not to undergo the standard surgical therapy”–many just want to get it cut out. “The fear of cancer paralyzes patients…[who may] resort to drastic therapeutic measures that may not be necessary,” excessive measures like getting a double mastectomy. How can we prevent this? How about we change its name? “A U.S. National Cancer Institute working group has recommended dropping the term “carcinoma,” so maybe we should just call it an “indolent lesion of epithelial origin.” Let’s “use language that engenders less fear,” shall we? How bad can an “IDLE” tumor be?

Another option to avoid this dilemma? Just don’t get screened in the first place. Women aren’t typically told about any of this, though. Fewer than one in ten women were aware that mammograms carried any potential harms at all, and more than nine out of ten were unaware that some breast cancers never cause problems. Few had heard of DCIS, but when informed about it, most wished they had been told before they signed up for screening.

“Once a cancer is detected, it is currently not possible to distinguish life-threatening from indolent [potentially harmless] cases. Therefore, overdiagnosis can only be avoided by abstaining from breast screening” and skipping mammograms altogether.

That’s how researcher Alexandra Barratt explained her own decision to avoid screening: “I’m…worried by the possibility that I could be seriously harmed by the treatment of a cancer that would never have affected my health.” Given that the only way to avoid opening that “Pandora’s box” was by not getting mammograms, she decided to try to improve her diet and lifestyle to prevent getting breast cancer in the first place.

KEY TAKEAWAYS

The purpose of cancer screening is the early detection of life-threatening disease when it is at a more easily curable stage. As mammography screening ramped up in the 1980s, however, the diagnosis of early cancers increased while late-stage cancer incidence did not experience much of a decline.
Mammograms pick up many early cancers, which may then be eliminated by surgery, radiation, or chemotherapy, the reason there isn’t a decline in about the same number of late-stage cancers being found may be widespread overdiagnosis–the diagnosis and treatment of breast cancer that never would have even threatened the woman’s health.
Many invasive breast cancers identified during mammography screening may spontaneously disappear. Even serious metastatic breast cancer may spontaneously regress, something we’ve known for more than a century.
The natural inclination to finding cancer is to treat it, which is particularly challenging for ductal carcinoma in situ (DCIS), so-called stage zero breast cancer. DCIS can create tiny calcifications that can be picked up on mammogram, and its cells look like invasive cancer. However, surgical removal of DCIS lesions hasn’t been accompanied by a reduction in the incidence of invasive breast cancers.
In comparing the ten-year breast cancer survival rate for women with low-grade DCIS, among those who chose not to have surgery, 1.2 percent died of breast cancer within a decade. During that same period, 1.4 percent of those who had a lumpectomy or full mastectomy died from breast cancer. So, surgery didn’t seem to make any difference.
To help reduce the fear of cancer that can paralyze patients, a U.S. National Cancer Institute working group has recommending dropping the word “carcinoma” in DCIS and changing it to “indolent lesion of epithelial origin,” IDLE.
Avoiding screening is another option to avoiding overdiagnosis, but fewer than one in ten women are aware that mammograms carry any potential harms at all and more than nine in ten are unaware that some breast cancers never cause problems.

How might someone improve their diet and lifestyle to lower breast cancer risk? See, for example:

Breast Cancer and Constipation
Cholesterol Feeds Breast Cancer Cells
Breast Cancer Survival Vegetable
Breast Cancer and Alcohol: How Much Is Safe?
Which Dietary Factors Affect Breast Cancer Most?
Is Soy Healthy for Breast Cancer Survivors?
Breast Cancer Survival and Soy
How to Treat Endometriosis with Seaweed
Tree Nuts or Peanuts for Breast Cancer Prevention?
Flashback Friday: Can Flaxseeds Help Prevent Breast Cancer?
The Food That Can Downregulate a Metastatic Cancer Gene
How to Help Control Cancer Metastasis with Diet
What Causes Cancer to Metastasize?
Is Heme Iron the Reason Meat Is Carcinogenic?

This is the ninth in a 14-part series on mammograms, which includes:

Nine out of Ten Women Misinformed About Mammograms
Mammogram Recommendations: Why the Conflicting Guidelines?
Flashback Friday: Should Women Get Mammograms Starting at Age 40?
Do Mammograms Save Lives?
Consequences of False-Positive Mammogram Results
Do Mammograms Hurt?
Can Mammogram Radiation Cause Breast Cancer?
Understanding the Mammogram Paradox
Women Deserve to Know the Truth About Mammograms
Breast Cancer and the Five-Year Survival Rate Myth
Why Mammograms Don’t Appear to Save Lives
Why Patients Aren’t Informed About Mammograms
The Pros and Cons of Mammograms

For more on breast cancer, see my videos Oxidized Cholesterol 27HC May Explain Three Breast Cancer Mysteries, Eggs and Breast Cancer, and Flashback Friday: Can Flaxseeds Help Prevent Breast Cancer?.

I was able to cover colon cancer screening in just one video. If you missed it, see Should We All Get Colonoscopies Starting at Age 50?.

Also on the topic of medical screenings, check out Flashback Friday: Worth Getting an Annual Health Check-Up and Physical Exam?, Is It Worth Getting Annual Health Check-Ups?, and Is It Worth Getting an Annual Physical Exam?.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

2019: Evidence-Based Weight Loss

2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers

2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

2014: From Table to Able: Combating Disabling Diseases with Food

2013: More Than an Apple a Day

2012: Uprooting the Leading Causes of Death

Read More

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Learn More Than 97% of Doctors About Lead-Time Bias

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After reading this, you’ll know more than an estimated 97 percent of doctors about a critical concept called lead-time bias.

While running for president of the United States, former New York mayor Rudy Giuliani ran a campaign ad contrasting his 82 percent chance of surviving prostate cancer in the United States with the 44 percent chance of surviving it in England “under socialized medicine” where routine PSA testing for prostate cancer is not done. “To Giuliani this meant that he was lucky to be living in New York and not in York, because his chances of surviving prostate cancer seemed to be twice as high in New York. Yet despite this impressive difference in the five year survival rate, the mortality rate”–the rate at which men were dying of prostate cancer–“was about the same in the US and the UK.” How could that be? PSA testing increased survival from 44 to 82 percent, so how is that “not evidence that screening saves lives? For two reasons: The first is lead time bias…The second is overdiagnosis.”

As I illustrate at 1:05 in my video Breast Cancer and the Five Year Survival Rate Myth, overdiagnosis is when a cancer that otherwise would have never caused a problem is detected. Consider this: Let’s say that, without screening, only 400 people out of a thousand with progressive cancer are alive five years later. That means that without screening, the five-year survival rate is only 40 percent. But, let’s say that with screening, an additional two thousand cancers are overdiagnosed, meaning cancers that would have never caused a problem or may have disappeared on their own are picked up. So, because those cancers are harmless, those overdiagnosed patients all still alive five years later, assuming their unnecessary cancer treatment didn’t kill them. In this way, the five-year survival rate has just doubled, even though in either case, the same number of people died from cancer. If that’s confusing, watch the video. That’s one way the changes in survival rates with screening may not correlate with changes in actual cancer death rates.

The other way is lead time bias. Imagine a group of patients who were diagnosed with cancer because of symptoms at age 67 and all died at age 70. Each patient survived only three years. So, the five-year survival rate for the group is 0 percent. Now, imagine that the same group underwent screening. By definition, screening tests lead to earlier diagnosis. Suppose that with screening, the cancers were diagnosed in all patients at age 60 instead of 67, but, nevertheless, they all still died at age 70. In this screening scenario, each patient survived ten years, which makes the five-year survival rate for this group 100 percent. Survival just went from 0 to 100 percent! You can imagine the headlines: ” Cancer patients live three times longer with new screening test, ten years instead of three.” All that really happened in this screening scenario, though, is that the people were treated as cancer patients for an additional seven years. If anything, that would likely just diminish their quality of life.

So, that’s the second way that changes in survival rates with screening may not correlate with changes in actual cancer death rates. In fact, the correlation is zero, as you can see at 3:14 in my video. There is no correlation at all between increases in survival rates and decreases in mortality rates. That’s why “[i]f there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down. There is no way to disentangle lead time and overdiagnosis biases from screening survival data.” That’s why, “in the context of screening, these statistics are meaningless: there is no correlation between changes in survival and what really matters, changes in how many people die.” Yet, that’s what you see in the ads and leaflets from most of the cancer charities and what you hear from the government. Even prestigious cancer centers, like M.D. Anderson, have tried to hoodwink the public this way, as you can see at 3:57 in my video.

If you’ve never heard of lead time bias, don’t worry, you’re not alone. Your doctor may not have heard of it either. “Fifty-four of the 65 physicians [surveyed] did not know what the lead-time bias was. Of the remaining 11 physicians who indicated they did know, only 2 explained the bias correctly.” So, just by having read to this point in this blog post, you may already know more about this than 97 percent of doctors.

To be fair, though, is it possible the doctors don’t recognize the term but understand the concept? No. “The majority of primary care physicians did not know which screening statistics provide reliable evidence on whether screening works.” In fact, they “were also 3 times more likely to say they would ‘definitely recommend’ a [cancer screening] test” based on “irrelevant evidence,” compared to a test that actually decreased cancer mortality by 20 percent.

If physicians don’t even understand key cancer statistics, how are they going to effectively counsel their patients? “Statistically illiterate physicians are doomed to rely on their statistically illiterate conclusions, on local custom, and on the (mostly) inaccurate promises of pharmaceutical sales representatives and their leaflets.”

KEY TAKEAWAYS

Overdiagnosis, the detection of cancer that otherwise would never have caused a problem, can result in unnecessary cancer treatments and affect survival rates of breast cancer patients.
For example, without screening, the five-year survival rate is 40 percent. With screening, however, overdiagnosis results in more cancer patients, despite the likelihood that their cancers are harmless or may disappear on their own. And, those overdiagnosed patients should be alive after five years, which doubles the five-year survival rate, even though the same number of patients died from cancer.
Lead time bias is also an issue. Symptomatic patients may be diagnosed at a later age than had they been with screening, which, by definition, leads to earlier diagnosis. In this case, imagine patients were diagnosed without screening at age 67 and died three years later, so the five-year survival rate is 0 percent. Now imagine the group underwent screening and the cancers were diagnosed at age 60, so they were alive for ten years before dying at 70. In the screening scenario, the five-year survival rate for the group is 100 percent.
In fact, there is no correlation between increases in survival rates and decreases in mortality rates.
It is not possible to disentangle the biases of lead time and overdiagnosis from screening survival data.
The overwhelming majority of doctors–54 out of 65 physicians surveyed–are unfamiliar with lead time bias, and of the 11 who indicated they did know, only 2 explained the bias accurately.
How can doctors who don’t even understand key cancer statistics effectively counsel their patients?

There is just so much confusion when it comes to mammography, combined with the corrupting commercial interests of a billion-dollar industry. As with any important health decision, everyone should be fully informed of the risks and benefits, and make up their own mind about their own bodies. This is one installment in my 14-part series on mammograms, which includes:

Nine out of Ten Women Misinformed About Mammograms
Mammogram Recommendations: Why the Conflicting Guidelines?
Flashback Friday: Should Women Get Mammograms Starting at Age 40?
Do Mammograms Save Lives?
Consequences of False-Positive Mammogram Results
Do Mammograms Hurt?
Can Mammogram Radiation Cause Breast Cancer?
Understanding the Mammogram Paradox
Overtreatment of Stage 0 Breast Cancer DCIS
Women Deserve to Know the Truth About Mammograms
Why Mammograms Don’t Appear to Save Lives
Why Patients Aren’t Informed About Mammograms
The Pros and Cons of Mammograms

For more on breast cancer, see my videos Oxidized Cholesterol 27HC May Explain Three Breast Cancer Mysteries, Eggs and Breast Cancer and Flashback Friday: Can Flax Seeds Help Prevent Breast Cancer?

I was able to cover colon cancer screening in just one video. If you missed it, see Should We All Get Colonoscopies Starting at Age 50?.

Also on the topic of medical screenings, check out Flashback Friday: Worth Getting an Annual Health Check-Up and Physical Exam?, Is It Worth Getting Annual Health Check-Ups? and Is It Worth Getting an Annual Physical Exam?.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

2019: Evidence-Based Weight Loss

2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers

2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

2014: From Table to Able: Combating Disabling Diseases with Food

2013: More Than an Apple a Day

2012: Uprooting the Leading Causes of Death

Read More

Continue Reading

Business

Learn More Than 97% of Doctors About Lead-Time Bias

Published

on

After reading this, you’ll know more than an estimated 97 percent of doctors about a critical concept called lead-time bias.

While running for president of the United States, former New York mayor Rudy Giuliani ran a campaign ad contrasting his 82 percent chance of surviving prostate cancer in the United States with the 44 percent chance of surviving it in England “under socialized medicine” where routine PSA testing for prostate cancer is not done. “To Giuliani this meant that he was lucky to be living in New York and not in York, because his chances of surviving prostate cancer seemed to be twice as high in New York. Yet despite this impressive difference in the five year survival rate, the mortality rate”–the rate at which men were dying of prostate cancer–“was about the same in the US and the UK.” How could that be? PSA testing increased survival from 44 to 82 percent, so how is that “not evidence that screening saves lives? For two reasons: The first is lead time bias…The second is overdiagnosis.”

As I illustrate at 1:05 in my video Breast Cancer and the Five Year Survival Rate Myth, overdiagnosis is when a cancer that otherwise would have never caused a problem is detected. Consider this: Let’s say that, without screening, only 400 people out of a thousand with progressive cancer are alive five years later. That means that without screening, the five-year survival rate is only 40 percent. But, let’s say that with screening, an additional two thousand cancers are overdiagnosed, meaning cancers that would have never caused a problem or may have disappeared on their own are picked up. So, because those cancers are harmless, those overdiagnosed patients all still alive five years later, assuming their unnecessary cancer treatment didn’t kill them. In this way, the five-year survival rate has just doubled, even though in either case, the same number of people died from cancer. If that’s confusing, watch the video. That’s one way the changes in survival rates with screening may not correlate with changes in actual cancer death rates.

The other way is lead time bias. Imagine a group of patients who were diagnosed with cancer because of symptoms at age 67 and all died at age 70. Each patient survived only three years. So, the five-year survival rate for the group is 0 percent. Now, imagine that the same group underwent screening. By definition, screening tests lead to earlier diagnosis. Suppose that with screening, the cancers were diagnosed in all patients at age 60 instead of 67, but, nevertheless, they all still died at age 70. In this screening scenario, each patient survived ten years, which makes the five-year survival rate for this group 100 percent. Survival just went from 0 to 100 percent! You can imagine the headlines: ” Cancer patients live three times longer with new screening test, ten years instead of three.” All that really happened in this screening scenario, though, is that the people were treated as cancer patients for an additional seven years. If anything, that would likely just diminish their quality of life.

So, that’s the second way that changes in survival rates with screening may not correlate with changes in actual cancer death rates. In fact, the correlation is zero, as you can see at 3:14 in my video. There is no correlation at all between increases in survival rates and decreases in mortality rates. That’s why “[i]f there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down. There is no way to disentangle lead time and overdiagnosis biases from screening survival data.” That’s why, “in the context of screening, these statistics are meaningless: there is no correlation between changes in survival and what really matters, changes in how many people die.” Yet, that’s what you see in the ads and leaflets from most of the cancer charities and what you hear from the government. Even prestigious cancer centers, like M.D. Anderson, have tried to hoodwink the public this way, as you can see at 3:57 in my video.

If you’ve never heard of lead time bias, don’t worry, you’re not alone. Your doctor may not have heard of it either. “Fifty-four of the 65 physicians [surveyed] did not know what the lead-time bias was. Of the remaining 11 physicians who indicated they did know, only 2 explained the bias correctly.” So, just by having read to this point in this blog post, you may already know more about this than 97 percent of doctors.

To be fair, though, is it possible the doctors don’t recognize the term but understand the concept? No. “The majority of primary care physicians did not know which screening statistics provide reliable evidence on whether screening works.” In fact, they “were also 3 times more likely to say they would ‘definitely recommend’ a [cancer screening] test” based on “irrelevant evidence,” compared to a test that actually decreased cancer mortality by 20 percent.

If physicians don’t even understand key cancer statistics, how are they going to effectively counsel their patients? “Statistically illiterate physicians are doomed to rely on their statistically illiterate conclusions, on local custom, and on the (mostly) inaccurate promises of pharmaceutical sales representatives and their leaflets.”

KEY TAKEAWAYS

Overdiagnosis, the detection of cancer that otherwise would never have caused a problem, can result in unnecessary cancer treatments and affect survival rates of breast cancer patients.
For example, without screening, the five-year survival rate is 40 percent. With screening, however, overdiagnosis results in more cancer patients, despite the likelihood that their cancers are harmless or may disappear on their own. And, those overdiagnosed patients should be alive after five years, which doubles the five-year survival rate, even though the same number of patients died from cancer.
Lead time bias is also an issue. Symptomatic patients may be diagnosed at a later age than had they been with screening, which, by definition, leads to earlier diagnosis. In this case, imagine patients were diagnosed without screening at age 67 and died three years later, so the five-year survival rate is 0 percent. Now imagine the group underwent screening and the cancers were diagnosed at age 60, so they were alive for ten years before dying at 70. In the screening scenario, the five-year survival rate for the group is 100 percent.
In fact, there is no correlation between increases in survival rates and decreases in mortality rates.
It is not possible to disentangle the biases of lead time and overdiagnosis from screening survival data.
The overwhelming majority of doctors–54 out of 65 physicians surveyed–are unfamiliar with lead time bias, and of the 11 who indicated they did know, only 2 explained the bias accurately.
How can doctors who don’t even understand key cancer statistics effectively counsel their patients?

There is just so much confusion when it comes to mammography, combined with the corrupting commercial interests of a billion-dollar industry. As with any important health decision, everyone should be fully informed of the risks and benefits, and make up their own mind about their own bodies. This is one installment in my 14-part series on mammograms, which includes:

Nine out of Ten Women Misinformed About Mammograms
Mammogram Recommendations: Why the Conflicting Guidelines?
Flashback Friday: Should Women Get Mammograms Starting at Age 40?
Do Mammograms Save Lives?
Consequences of False-Positive Mammogram Results
Do Mammograms Hurt?
Can Mammogram Radiation Cause Breast Cancer?
Understanding the Mammogram Paradox
Overtreatment of Stage 0 Breast Cancer DCIS
Women Deserve to Know the Truth About Mammograms
Why Mammograms Don’t Appear to Save Lives
Why Patients Aren’t Informed About Mammograms
The Pros and Cons of Mammograms

For more on breast cancer, see my videos Oxidized Cholesterol 27HC May Explain Three Breast Cancer Mysteries, Eggs and Breast Cancer and Flashback Friday: Can Flax Seeds Help Prevent Breast Cancer?

I was able to cover colon cancer screening in just one video. If you missed it, see Should We All Get Colonoscopies Starting at Age 50?.

Also on the topic of medical screenings, check out Flashback Friday: Worth Getting an Annual Health Check-Up and Physical Exam?, Is It Worth Getting Annual Health Check-Ups? and Is It Worth Getting an Annual Physical Exam?.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

2019: Evidence-Based Weight Loss

2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers

2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

2014: From Table to Able: Combating Disabling Diseases with Food

2013: More Than an Apple a Day

2012: Uprooting the Leading Causes of Death

Read More

Continue Reading

Business

Does Laptop Wi-Fi Affect Fertility?

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Should laptops not be on laps? What is the effect of WiFi exposure on sperm motility and DNA damage?

“It is impossible to imagine a modern socially-active man who does not use mobile devices and/or computers with Wi-Fi function.” Might cell phones or wireless internet be harmful for male fertility? You may recall that I’ve previously discussed how the sperm of men who use Wi-Fi tend not to get along as swimmingly, but that was an observational study. You don’t really know if Wi-Fi actually damages sperm until you put it to the test, the topic of my video Does Laptop Wi-Fi Lower Sperm Counts?.

The title “Use of laptop computers connected to internet through Wi-Fi decreases human sperm motility and increases sperm DNA fragmentation” kind of gives it all away. That was “the first study to evaluate the direct impact of laptop use on human spermatozoa.” As you can see at 0:43 in my video, the data from human sperm DNA fragmentation levels in samples placed near and far away from a laptop with an active Wi-Fi connection suggest that one might not want to position a Wi-Fi device near the male reproductive organs as that “may decrease human sperm quality.”

Indeed, Wi-Fi exposure may decrease human sperm motility and increase sperm DNA fragmentation, but the effect is minor. Is a 10 percent decrease in “progressive motile” sperm really going to make a difference? Fertile men release hundreds of millions. What has yet to be done is a study looking at bouncing baby endpoints. Do men randomized to a certain WiFi exposure have a tougher time having children? It’s actually a harder study to perform than one might think. You can’t just have men avoid cell phones and laptops for a day. Yes, we make millions of new sperm a day, but they take months to mature. The sperm with which you conceive today started as a preconceived notion months before. So, you can imagine why such a study has yet to be done. You’d have to randomize men to essentially avoid wireless communications completely, or maybe come up with some kind of Faraday cage underwear.

Another reason one may not want to use a laptop computer on their lap is that the heat generated by the laptop, with Wi-Fi or not, “can warm men’s scrotums,” undermining the whole point of scrotum possession in the first place–namely, to contain the male gonads in such a way as “to allow the testes and epididymis to be exposed to a temperature a few degrees below that of core body temperature.” This all dates back to a famous series of experiments conducted in 1968.

It was an illuminating study, one might say, as the subjects’ “scrota were heated with a 150-watt electric light bulb…In some of the trials, the heat from the 150-watt bulb was increased by the use of an ordinary reflector, although the bulb alone was just as effective if placed somewhat nearer the skin. This was simpler, but was more likely to cause accidental burning by contact.” (Why can’t I seem to get Jerry Lee Lewis’ “Great Balls of Fire” out of my head?)

Now, we have nice, cool fluorescents instead of 150-watt bulbs, but heated car seats remain a “testicular heat stress factor.” Saunas aren’t a good idea for men trying to conceive. At 2:52 in my video, I show a chart of sperm counts before and after sauna exposure. Sauna exposure apparently cuts sperm production in half, and the sperm count was still down three months later. There was an apparent full recovery by six months, though. This is why you may want to go with boxers, not briefs, or even go commando. Who makes money on going au naturel, though? Enter the “scrotal cooling” industry, though a review noted that “more acceptable scrotal cooling technique” really needs to be developed. Why? Whatever are the researchers referring to?

It seems the “devices used to achieve testicular cooling” currently on the market are “not practical for day-to-day use. One device was a curved ice rubber collar filled with ice cubes,” and another was similar to a freezer gel pack “inserted in the participants’ underwear every night,” but don’t worry because it thaws in three to four hours, “resulting in a cooling effect.” Holy snowballs, Batman!

Do not, I repeat, do not put an ice pack on your scrotum. A few frozen peas and carrots in a strategically placed surgical glove can give you frostbite. (Maybe the one time vegetables can be bad for you!) Then, there’s the schvitzer, “a cotton suspensory bandage that releases fluid (water or alcohol) to keep the scrotum damp,” and, finally, a device attached with a belt that “achieve[s] scrotal cooling” with a continuous air stream.

With so many options to choose from, do laptop users really need protection from scrotal hyperthermia? You don’t know…until you put it to the test. Indeed, an increase in scrotal temperature was found in laptop computer users, scrotal temperatures up a feverish 5? Fahrenheit.

A little scrotal warmth didn’t sound that bad until I read this case report: A previously healthy 50-year-old scientist typed out a report one evening, sitting comfortably in his favorite chair with laptop on lap, but awoke the next day with “penile and scrotal blisters” that then “broke and developed into infected wounds that caused extensive suppuration,” that is, oozing pus.

Even third-degree burns have been reported, requiring surgical intervention with skin grafts. In one report, a man drank 12 units of vodka and passed out while watching a film on his laptop, which was resting on his bare thighs. The laptop burned his leg. The surgeons called for a “public education campaign” to “educate the public against the risks of using a laptop in its most literal sense.” That’s one approach, but why not educate the public instead against drinking 12 units of vodka?

KEY TAKEAWAYS

Researchers suggest positioning Wi-Fi devices away from male reproductive organizes as Wi-Fi exposure may decrease the quality of the sperm–decreasing its motility and increasing its DNA fragmentation.
Heat generated by a laptop, with or without Wi-Fi capability, is another reason not to place the device on the lap, as it can warm men’s scrotums. This undermines its functional purpose–that is, to contain the male gonads such that the testes and epididymis can be exposed to a temperature a few degrees lower than core body temperature.
Similarly, heated car seats can warm testes and sauna exposure has been found to cut sperm production in half, though there was full recovery by six months.
The “scrotal cooling” industry has emerged with devices intended to “achieve testicular cooling,” such as a rubber collars to be filled with ice cubes and freezer gel packs.
Among laptop computer users, scrotal temperatures were found to be elevated by 5?F, which seems insignificant. However, in one case report, a previously healthy middle-aged man typed out a report with his laptop on his lap and awake the next day with blisters on his penis and scrotum that broke and oozed pus.
In fact, even third-degree burns have been reported with laptop-on-the-lap use, requiring surgeries with skin grafts.

This may not just be an issue for men, as I described in my video Do Cell Phones Lower Sperm Counts? and Flashback Friday: Do Cell Phones Lower Sperm Counts? & Does Laptop WiFi Lower Sperm Counts?

For more on brain issues, check out:

Does Cell Phone Radiation Cause Cancer?
Cell Phone Brain Tumor Risk?
Do Mobile Phones Affect Brain Function?
The Effects of Cell Phones & Bluetooth on Nerve Function

I cover male fertility in videos such as:

The Role of Diet in Declining Sperm Counts
Dairy Estrogen and Male Fertility
Xenoestrogens and Sperm Counts
Soy Hormones and Male Infertility
Male Fertility and Diet
Yellow Bell Peppers for Male Infertility and Lead Poisoning?
The Effects of Obesity on Dementia, Brain Function, and Fertility

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

2019: Evidence-Based Weight Loss

2016: How Not To Die: The Role of Diet in Preventing, Arresting, and Reversing Our Top 15 Killers

2015: Food as Medicine: Preventing and Treating the Most Dreaded Diseases with Diet

2014: From Table to Able: Combating Disabling Diseases with Food

2013: More Than an Apple a Day

2012: Uprooting the Leading Causes of Death

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