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posted by Dopefish on Tuesday February 25 2014, @02:00AM   Printer-friendly
from the breast-cancer-awareness dept.

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.'"

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  • (Score: 3, Informative) by jaap.h on Tuesday February 25 2014, @09:51AM

    by jaap.h (1773) on Tuesday February 25 2014, @09:51AM (#6515)

    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" [], 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)

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  • (Score: 1) by TK on Tuesday February 25 2014, @07:58PM

    by TK (2760) on Tuesday February 25 2014, @07:58PM (#6881)

    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"?

    The fleas have smaller fleas, upon their backs to bite them, and those fleas have lesser fleas, and so ad infinitum
    • (Score: 2, Interesting) by jaap.h on Wednesday February 26 2014, @08:57AM

      by jaap.h (1773) on Wednesday February 26 2014, @08:57AM (#7205)

      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).