Papas Fritas writes:
"In the United States, about 37 million mammograms are performed annually at a cost of about $100 per mammogram and nearly three-quarters of women age 40 and over say they had a mammogram in the past year. Now the NYT reports that a study involving 90,000 women and lasting a quarter-century has added powerful new doubts about the value of the screening test for women of any age finding that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not.
'It will make women uncomfortable, and they should be uncomfortable,' says screening expert Dr. Russell P. Harris who was not involved in the study. 'The decision to have a mammogram should not be a slam dunk.' An editorial accompanying the new study says that earlier studies that found mammograms helped women were done before the routine use of drugs like tamoxifen that sharply reduced the breast cancer death rate. In addition, many previous studies did not use the gold-standard methods of the clinical trial, randomly assigning women to be screened or not, noted the editorial's author, Dr. Mette Kalager. According to Kalager, with better treatments, like tamoxifen, it is less important to find cancers early.
Also, she says, women in the study were aware of breast cancer and its dangers, unlike women in earlier studies who were more likely to ignore lumps. 'As time goes by we do indeed need more efficient mechanisms to reconsider priorities and recommendations for mammography screening and other medical interventions,' concludes Kalager. 'This is not an easy task, because governments, research funders, scientists, and medical practitioners may have vested interests in continuing activities that are well established.'"
I saw a talk (perhaps TED) about the ineffectiveness of early screening. The "scientists" claimed that women who had had their tumor detected early lived longer compared to those that had waited. Of course, they didn't account for the fact that catching it early meant that the tumor required more time to do its deed. You just become aware of the problem earlier, which some may argue is not beneficial (ignorance is bliss).
There's also the cases where the detected tumor is actually benign, and the patient ends up with an unnecessary biopsy/surgery or treatment. There is an economic motive/bias for doctors to treat a patient. That being said, we are actually getting a lot better at determining what types of tumors patients have. Many research protocols involve genetic sequencing of these tumors to find out which treatments are effective against specific mutations. Expect things to get much better in this regard over the next 5 years or so.
There is an economic motive/bias for doctors to treat a patient.
It's not nearly as strong as the Shepard's Prayer [urbandictionary.com] motivation (and yes, I know that Shepard didn't actually put it this way): "Dear God, please don't let me fuck up."
False positives and over treatment are a real problem.
"Among 1000 US women aged 50 years who are screened annually for a decade, 0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly." [jamanetwork.com]
It appears "annual screening after age 40" recommendation is gradually being revised to reflect this issue, and I've seen, recently, recommendations more along the lines of "every couple of years after age 50".
Tell that to Lurleen Wallace. [wikipedia.org] It used to be common to shield the patient from unhappy news, to their detriment.
Two problems with this news. 1. It is many weeks old already, and 2. The research iÅ¡ confounded by old technology for mammography. Modern mammography has a better sensitivity and specificity. I would not advise women to avoid mammograms on the basis of this.
As it turns out, mammograms are also not very efective on women with dense breast tissue.
A real (though it sounds like a joke) factor these days is that the men who handle their women's breasts find any lumps very quickly. No medical test can achieve that frequency of testing.
Them was the good ol' days...I can still remember testing my woman's breasts more frequently than the mammogram machine...
In the good tradition of slashdot, soylenters will not have any occasion to test their lumps hunting skills, anyway.
And it seems I've come across a bit of a bug in the ancient version of Slashcode this forum is using!
Did you report it?
There's a bug tracker [soylentnews.org] but it requires an account, so if you don't feel like messing with that then just post it in a comment (here's fine) and we'll add it for you. If it's about Unicode, the devs already know ☺
This is different news though. That is, even assuming 100% reliability the screening and early detection is not measurably beneficial in the ultimate outcome of treatment.
'The decision to have a mammogram should not be a slam dunk.'
That sentence made me chuckle for some reason. Is that an actual figure of speech or was the poor guy under some kind of contractual obligation to use at least one sports related term or unit of measurement every time he's talking to a journalist? If so, he might have wanted to consider using "touch down" in this particular case.
It makes me imagine something extremely uncomfortable involving breasts, an x-ray machine, and a basketball hoop.
>> should not be a slam dunk
It should be a slam of the refrigerator door, however.
I know that for women under 50 years it is considered absolutelly irrelevant the use of mammograms.I think this study puts that age way above. Something like 100 years? ;)
Anyway, mammograms use some dosis of radiation in a very, very sensitive part of the body to cancer. The biggest finding, yet, of the study is that women who received mammograms were more prone to develop cancer (3250 x 3133). Slighly statistical relevant, but yet, relevant.
I believe that would be the textbook definition of irony for grammar Nazis: Getting cancer from a treatment meant to tell you whether you have cancer?
NPR just had an All Things Considered segment on this [npr.org] on the 12th. There's also an op-ed in their health blogs [npr.org]. It's an interesting topic.
For my part, I believe that early detection is a great thing. Can't beat it. It's the reaction to detecting something that may/may not be cancerous that's dangerous. Overreacting to a blip on the mammogram is far more dangerous than keeping tabs on what's going on inside of your body.
I'm an (MD but not an oncologist); personally I'm not sure what to think. However, I do see the debate in the general literature. I think it is a bit more complex than just early detection.
First, there is debate whether breast cancer screening actually leads to improved survival/quality of life. Sadly the medical (but also public) debate is rather polarized which of course does not help to improve the situation. Proponents of screening say that studies have shown that it improves survival, while the opponents counter that the studies that show improves survival are quite old and generally included a limited number of patients. While larger and newer studies show much less improvement (to the point of being irrelevant, in their opinion).
Second, as others have mentioned a major difficulty in screening studies is "lead-time bias" http://en.wikipedia.org/wiki/Lead_time_bias [wikipedia.org], or finding improved survival from screening just by diagnosing earlier, not because survival is actually improved.
Third, as there is still a debate about whether survival is improved, you can (and should) ask the question whether it is ethical to screen for a disease if doing so does not improve outcome (related to the "right" *not* to know that you have a disease).
Fourth, not related to outcome, but screening has raised public awareness of breast cancer and made the taboos surrounding breast cancer less. This was highly necessary because, contrary to say colon cancer, breast cancer affects self image/identity as well (many women feel, understandably, less feminine after an operation for breast cancer, which is still an underappreciated aspect of the disease)
Can you comment on the efficacy of x-ray based mammograms versus the "copping a feel" method?
Is the manual method ineffective enough to be considered obsolete in comparison, or is this a case of "we have a shiny expensive toy, we'd better use it"?
As it is not my area, I won't make any comments on efficacy. A few global things though: in general, study/screening protocols contain both a clinical examination and a mammography, that makes a direct comparison of the two difficult (impossible if you are strict).
For more or less all clinical examination goes that there is a quite a lot of inter- and intra-observer variability (i.e. same patient different results of the examination by different doctors and same patient different result in subsequent examinations by the same doctor resp.) and technique matters a lot as well (which also goes for self examination). Finally, clinical examinations are really difficult to properly standardize.
In the end these issues make it extremely difficult to conduct a strict study on the value of clinical/self examination (in breast cancer, but the same is true in general).
"One who is fated to be hanged will not drown."
So far I've read 12 comments and none seem to be from a woman or Doctor of Medicine. To me it just seems wrong for a bunch of guys to decide what's right for women to do with their bodies.
Please tell: who here decided what's right for women? All I read is a discussion about pros and cons of early detection, reliability of screenings and statistics.Nobody here decides what's right for women: what you want to read is just not here. What would be wrong with us being just a bunch of guys? What did we do?!
Calm your roll Captain White Knight, nobody is deciding anything for anyone here.
Not sure why this is modded troll. Offtopic maybe, but it's not trolling. So anyway, as seemingly the token woman on the site thus far (or perhaps the only one willing to wade into this article, we get smacked with so many ehrmugerd yur boobies!!!1! articles that I at least suffer boob cancer article fatigue) I'll offer a perspective. And that is Thank God and Pass the Champagne. Mammograms, from what I've heard, HURT. I haven't had one; I'm young and I've got dense and irregular breast tissue. I've also got a family history of a bazillion cancers including breast.
I can also speak to the effects of false positives in testing. I got a false positive reading on a Pap smear once. The postcard arrived in the mail on a Friday with a highly cryptic comment and a note to call the office. The office was closed all weekend; I spent all two and a half days completely freaked out, crying spontaneously, hyperventilating, waking up in a cold sweat at night, unable to focus on anything I'd had planned and a real drag on my whole family. It was horrible. Turns out the doc had injured my cervix while collecting the samples and the repeat test came back perfectly normal - but now I have to report an abnormal Pap result every time somebody takes my history.
I spent all two and a half days completely freaked out, crying spontaneously, hyperventilating, waking up in a cold sweat at night, unable to focus on anything I'd had planned and a real drag on my whole family.
I realize this will come off as callous, but you're really not making me confident in our ability to have a reasonable, evidence-based discussion about this.
False positives are now known to take a serious toll, with the negative effects lasting quite some time. It's a non-negligible risk that must be weighed against the benefits of mammography. See here [annfammed.org], here [go.com], here [go.com] and here [ucsf.edu] for some data and discussion on the subject.
I'll go ahead and weigh in as another token. I, like the gp, have yet to undergo mammography, though I am considered "of an age", and will likely continue to postpone thanks to this research. I started getting nagged in my mid-thirties to begin annual mammograms, despite the recommendation at the time being to wait until after 40, and despite a lack of family history that would indicate I was at increased risk of breast cancer. I said, "No, thanks. I'll wait until I'm at least 40." Now I plan on waiting until I'm past 50. Every one is, of course, different and has a different family history and risk profile which must be taken into consideration when making such a decision. For me, the benefits of early/annual screening do not appear to outweigh the risks.
Did I mention the extensive family history of cancer? I lost my grandmother to uterine and colon cancer.
Yeah, I mean, really. Why can't she control her emotions and sleep well at night when she knows there is a higher than normal probability that she has cancer? I mean, even if it doesn't kill her, the treatment will probably only make her very sick where she's puking her guts up for weeks on end. Why would that upset her?
You want a reasonable discussion? You took her quote out of context. Just because she freaked about it then doesn't mean she can't have a reasonable conversation now. Finding out about cancer is a traumatic experience and the callous attitudes that many doctors and doctor's offices have about this just makes this whole thing awful. Even smart people with access to the Internet will have problems finding the right information about something as emotional and an informationally-dense topic as cancer.
I nearly broke when my best friend became a paraplegic a couple of years ago... and I had experience working with paraplegics professionally. I consider myself a reasonable guy with a lot of control on my emotions, but there are things than can strip me down, make me cry, and challenge my ability to have a reasonable discussion for a period of time. That doesn't mean I can't have a reasonable discussion about my friend or about paraplegia today and it doesn't mean that having a callous attitude is the best option when dealing with a person who needs help in a period of need.
Mammograms, from what I've heard, HURT. I haven't had one; I'm young and I've got dense and irregular breast tissue.
It's different for different women, but they can very much hurt. My wife told me about one she had. She hurt for two or three weeks after that. She's never been back for a mammogram and I can't blame her. I question the validity of any "scanning procedure" that hurts someone for weeks afterward.
I spent all two and a half days completely freaked out, crying spontaneously, hyperventilating, waking up in a cold sweat at night, unable to focus on anything I'd had planned and a real drag on my whole family. It was horrible.
I'm sorry you had to go through that. In my experience, doctor's offices do not know how to deal with patients at all. Not me. Not my wife. We have been lied to (yes, on more than one occasion), stolen from (yes, but there is no legal recourse), and treated like cattle. We've moved several times in our marriage and it takes us years to find someone I'm happy with and she is merely "ok" with. She'll never feel comfortable with doctors. Gee, I wonder why.
I suppose I say this to let you know that you're not alone and to vent my frustration. What they have done to my wife (and me as well) is unforgivable. I have other stories involving my grandparents and my best friend who became a paraplegic not too long ago, but that goes even further away from the this article. To say I'm angry with with the medical profession is an understatement. Not all doctors are bad, but there is only one person who can properly take charge of your health: you. The doctors don't care about you. Maybe they like helping people and maybe they are competent, but even the best doctors don't have time (money?) to address your personal problems properly.
Should be obvious for this crowd, but:
This type of study is not to determine whether an individual patient (regardless of age) should get a mammogram. It's to help set up policy for the nation (or internationally).
In this setting, the more interesting thing is to look at the NNT (number needed to treat). In other words, how many mammograms need to be performed to save one life. Multiply that by the average cost of a mammogram and you'll have how much it will cost society to save one individual from (female) breast cancer.
This particular study seems (by design) to shy away from those implications.
FYI: Link to the study: http://www.bmj.com/content/348/bmj.g366 [bmj.com]
Humans are the only animals on the planet who voluntarily wear restrictive harnesses to unnaturally alter the appearance of their bodies. Women stopped wearing corsets a long time ago. Chinese foot-binding stopped a long time ago. But women today choose to wear these harnesses that restrict the flow of the lymphatic system, cause unsightly bulges and creases in flesh, unnaturally transfer breast weight to the shoulders, cause the atrophy of natural breast tissue and Cooper's ligaments (which causes sagging, the opposite of what bras are intended to do), increase the temperature of the breasts relative to the rest of the body--and we wonder why so many women get breast cancer.
Just spend a few minutes googling about it. Clinical studies have been done showing that women who wear bras regularly have a higher incidence of breast cancer than women who don't wear bras.
And no, this isn't some puerile troll joke hoping to see more nipples poking through clothing. (Everyone has nipples; what's the big deal?) Women today are torturing themselves on a daily basis and causing themselves to get cancer--and for what? To unnaturally conform to some artificial ideal cooked up by some ad exec at Playtex or Victoria's Secret? To make their breasts sag more when they do take off their bras? Because some immature people are afraid to see the shape of a--gasp--nipple?! (But seeing fat men's nipples poking through their shirts is okay.)
Do the women in your life a favor: encourage them to free their bodies from their self-imposed oppression, stop wearing bras, and have healthier breasts and healthier bodies.