A Message from Dr. Love about the New Mammography Guidelines

[RhondaH]

http://blog.dslrf.org/?p=116

[hutchibk]

Wish I could be at SABCS to see the roast of her stance.

[StephN]

Here is what looks to me like a "smoking gun." Once the shock has worn off, my memory cells started working. I heard Dr. Love talk about the "intraductal approach" to breast cancer at San Antonio in 2004. Then I received an oversized brochure announcing the 3rd or 4th Annual Breast Cancer Intraductal Approach Symposium. From one of her organizations.

Anyone who says she does not stand to benefit by a change in the way breast screenings and diagnostics are done, should take a look (emphasis is mine):

Meeting report
State of the Science and the Intraductal Approach for Breast Cancer: Proceedings Summary of The Sixth International Symposium on the Intraductal Approach To Breast Cancer Santa Monica, California, 19–21 February 2009

Susan Rochman1 , Dixie Mills1 , Julian Kim2 , Henry Kuerer3 and Susan Love1
1Dr. Susan Love Research Foundation, Santa Monica, CA, USA
2Case School of Medicine and University Hospitals, Cleveland, OH, USA
3MD Anderson Cancer Center, Houston, TX, USA

BMC Proceedings 2009, 3(Suppl 5):I1doi:10.1186/1753-6561-3-S5-I1
Published:24 July 2009
Abstract

Researchers are using the intraductal approach to advance breast cancer risk assessment, prevention, diagnosis, and treatment. Procedures and technologies that can access and interrogate the ductal-alveolar systems include nipple aspiration, ductal lavage and ductoscopy. Ductoscopic papillectomy, ductoscopic margin evaluation, and intraductal therapy are considered promising investigational and innovative treatments. These techniques are used to explore the biology of the normal breast; collect and analyze breast fluid and cells to identify biomarkers that can be used in breast cancer detection and risk assessment; and to identify new ways to find and administer therapeutic and/or preventive agents to the breast tissue. This report summarizes the latest research findings in these areas, presented at The 6th International Symposium on the Intraductal Approach to Breast Cancer in 2009.

Maybe this will be a better way to work with breast issues, but IF it is so great and revolutionary, why is it taking so long to get approved and into mainstream use??

Perhaps by supporting the Preventative Task Force's latest guidelines, she is helping open the door to a rush in getting something she is involved in approved. Just speculating here, but I foresee SOMEONE riding into this gap with shining armor blinding the truth.

[WolverineFan]

I'm not buying her position at all. I am not saying that there might not be something better out there for screening, but until something better is determined, why on earth would we look at eliminating one of the tools we have to assess breast health for women under 50. It is crazy to me, and I just see red everytime I hear or read of this!!!

[hutchibk]

I seem to remember her last year talking about either this or another diagnostic tool/theory that she was in partnership with to start trials imminently in either China or Japan... and I seem to remember she had hopes that it would prove itself and be rushed into the market.

I would love to find the info. She was very excited about it and had high hopes if I remember correctly. I would like to see just how deeply involved she is in the technology.

[Debbie L.]

I'm not even going to try talk about this, with the level of bias, anger, and fear that abounds here right now. But I WILL sign my name (laughing). I see that the few who have tried to inject some reason into these rants haven't signed their name - whether from simple oversight or fear of flaming we won't know. Anyway - here's one fairly simple, calm and unbiased editorial from the NYT, sent by me,
Debbie Laxague, who agrees with this editorial:

November 20, 2009
Editorial - The New York Times

The Controversy Over Mammograms

An expert panel's recommendation that mammography
screening to detect breast cancer be scaled back
has caused consternation among women and doctors
and prompted some attempts to connect the results
to the debate over health care.

It is important to keep the findings and
recommendations in perspective. They are guidance
for women and doctors. The decision about whether
to be screened is properly left to each woman –
to determine with the help of her doctor what
risks and benefits she is most comfortable accepting.

The new recommendation came from the United
States Preventive Services Task Force, a
government-appointed group of 16 outside experts
created 25 years ago to advise the Department of
Health and Human Services on the effectiveness of
various screening techniques. Half are women. The
panel‚s mission and expertise are medical, to
determine whether mammograms do more good than harm for women of various ages.

Its most controversial recommendations – in
conflict with recommendations from the American
Cancer Society and other medical groups – were
that women in their 40s should not routinely have
mammograms and that women between ages 50 and 74
should have mammograms every two years instead of
annually. That recommendation was based on an
analysis showing that every-other-year screenings
could provide 80 percent of the benefits of
annual screening while cutting the risks almost in half.

These recommendations have shocked many people,
but the American College of Physicians made
similar recommendations two years ago and the
National Breast Cancer Coalition, an advocacy
group for patients, has been saying for years
that mammography screening has been oversold, has
significant limitations and can cause harm. It
urges women to make their own decisions based on the best available facts.

In suggesting that women in their 40s not get
screened (unless they are at high risk for breast
cancer), the panel argued that the harms of
mammograms for those women appear to outweigh the benefits.

Screening turns up lots of tiny abnormalities
that are either not cancer or are slow-growing
cancers that would never progress to the point of
killing a woman and might not even become known
to her. If a suspicious abnormality is found,
women usually get another mammogram or imaging
test to better identify it and often a biopsy to
determine if it is cancerous. If it is, most
women have it treated with surgery, radiation,
hormone therapy or chemotherapy, all of which carry risks for the patient.

The scientific argument is that it is not worth
taking such risks for the large number of women
whose cancers grow too slowly to kill them. But
it is difficult, in practice, to apply that kind
of scientific analysis to the immediate questions
confronting a woman and her doctor when a
mammogram turns up an abnormality. The only real
solution will come when researchers find a way to
distinguish the dangerous, aggressive tumors that
need to be excised from the more languorous ones that do not.

The task force acknowledges that mammography
saves lives among women in their 40s. But it
estimates that more than 1,900 women have to be
screened for a decade to save a single life.
Among women in their 50s, when breast cancer is
more common, only about 1,300 women have to be
screened; among women in their 60s, only 377.

The panel concluded that the benefits outweighed
the risks among those over 50, but not in the
younger group. It found insufficient evidence to
determine whether digital mammography or magnetic
resonance imaging, two newer and more costly
technologies, are any better than standard film mammography.

The panel also cites the anxiety and distress
that many women experience when a mammogram finds something suspicious. Many women find that
argument condescending. Women in their 40s are
perfectly capable of managing anxiety and
deciding for themselves whether the uncertainty
that follows the detection of an abnormality in
their breast is worth enduring to know whether they have cancer or not.

Opponents of the health care reform bills moving
through Congress have seized on the new
recommendations as evidence that the government
is seeking to put bureaucrats between you and
your doctor or that it would ration care by
denying coverage for some mammograms that are now covered.

There is virtually no chance that any insurers,
either public or private, will deny coverage to
anyone based on these recommendations. Government
and industry officials have said that explicitly
and, in fact, every state but Utah requires
private insurers to pay for mammograms for women starting in their 40s.

There is nothing in the reform bills that would
change the current Medicare laws, which require
that annual mammograms be included among the
preventive services covered, an important benefit
for more than a million women in their 40s who
get Medicare coverage because they are disabled
or suffering from end-stage kidney disease.

The only part of the reform bills that could
affect mammography would only make them more
accessible. Under the legislation, the secretary
of health and human services might be given
authority to waive Medicare co-payments for
prevention services that rank highly in the
opinion of this task force. Since the task force
gave a low grade to screening women in their 40s,
the secretary could not waive cost-sharing for them.

There is nothing wrong with a healthy public
debate about mammography within the medical
community and among women who must decide when
and how often to get screened. It should not be
injected into the partisan debate over health care reform.

[margiermc]

She was paid off - by the Task Force Panel.

I'm proud that I never bought any of her books, never
listened to her - realized she was just a researcher and
not a breast cancer survivor, nor any kind of specialist
in breast care - just, a dr., researcher and writer -
making money, but, wake up, she is not on our side!

I will fight tooth and nail - and - I don't care who i
tell - this is going to be a disaster -

your new health care will be passing on Saturday by
the senate

they are coming out with all kinds of new guidelines, the insurance co. are already gearing up, for new cuts,
and you have someone who was suppose to be on the side of breast cancer survivor's , Dr. Love - all she did was sell books.

margie

[Laurel]

Hmmm, I just do not know, Debbie. I was a faithful mammogram gal since age 40. At age 48 they saw a clustering of calcs and performed a bx. It was positive for BC. Subsequent surgery and testing indicated a small invasive tumor, 7mm, no vascular invasion, BUT it was Her-2. If this had not been found until I was age 50 would I be stage I? See, I think it is worth the expense to be screened annually. My annual mammogram singularly has gifted me with an early stage, early detected, aggressive tumor. Should I never recur I chalk it up to that mamo and Herceptin.

I feel like the proverbial lobster in the pot of water, swimming away as the temperature rises. I'm just not lulled into lockstep on this one. Sorry. I think this is a bad go and will be proven so in years to come. I am a conscientious objector.....

[StephN]

Have I got this right?
"Cost-sharing" when the mobile mammography vans go around to poorer and underserved parts of cities and rural America attempting to reach higher risk parts of our population?

Will these screenings still be free, or even available?

I have so many questions. How will I be able to give support with a clear conscience if I do not stand up for the right of everyone to have some way to assess their breast health at a time when they are vulnerable? (Knowing what I do know about this fickle nature of breast cancer and the difficulty in proving who is high risk and who is not.)

[Rich66]

Screening turns up lots of tiny abnormalities that are either not cancer or are slow-growing cancers that would never progress to the point of killing a woman and might not even become known to her. If a suspicious abnormality is found,
women usually get another mammogram or imaging test to better identify it and often a biopsy to determine if it is cancerous. If it is, most women have it treated with surgery, radiation, hormone therapy or chemotherapy, all of which carry risks for the patient.

The scientific argument is that it is not worth taking such risks for the large number of women whose cancers grow too slowly to kill them

Well..that scenario, process and "science" would apply to all screening at any age. But..if a slow growing tumor is found in a young woman, it could be argued it has a greater chance of killing her since it has a greater head start. In fact, it is pretty well established that BC in younger patients tends to be the more aggressive types. More aggressive cancer, undetected..over a longer period of time. Hmmm.
I remember hearing this thinking about older women years ago. Now it's being played out at the other end of the age bracket.

That's a logical (I think) way to look at it. And it also fits with people's intuition and years of PSAs. Makes it a hard sell from both angles.

And yeah..mammography is oversold in the sense that it also has significant false negatives. I wonder how many women have taken false assurance from a negative mammo and stopped any self-exam. I forgot..those are unnecessary.

But..I'm glad it won't get run up the beancounter's flagpole. Might keep an eye on it anyway.

[Margerie]

Debbie,

I guess I should ask you if this is a rant or reason, LOL, I personally found your last opinion highly inflammatory.

For the record I agree with some medical opinions (not editorial boards) and find myself thinking not only about my own experience, but that of MANY other women diagnosed at a young age with aggressive cancers.

I think Dr. Weiss has a good summary:

http://www.breastcancer.org/opinion/...nes/letter.jsp

[Debbie L.]

Margerie said:
I guess I should ask you if this is a rant or reason, LOL, I personally found your last opinion highly inflammatory.

It was not MY opinion (although it reflects and agrees with my opinion). It was in THE NEW YORK TIMES, hardly a publication lacking respect nor track record for excellent and accurate reporting.
Debbie Laxague

[Margerie]

I was talking about your personal opinion about what is considered rants, reason and the like:

"I'm not even going to try talk about this, with the level of bias, anger, and fear that abounds here right now. But I WILL sign my name (laughing). I see that the few who have tried to inject some reason into these rants haven't signed their name - whether from simple oversight or fear of flaming we won't know"

And in light of Joe's last note, I think we should all tone it down.

[Debbie L.]

Margerie, I did not post anything political nor inflammatory. I simply said that I supported and agreed with the level-headed NYT editorial. If one agrees with what that editorial said, then the posts here that question and denigrate the motives of the USPSTF, Susan Love, NBCC, BCA, and other respected breast cancer groups - those ARE reactionary and paranoid.

Again, from the closing statement of the NYT editorial:

"There is nothing wrong with a healthy public
debate about mammography within the medical
community and among women who must decide when
and how often to get screened. It should not be
injected into the partisan debate over health care reform."

I have much more to say but am trying to remain calm and rational in this discussion. I do not wish to throw daggers at those who disagree with me. I am open to rational and polite debate. I WELCOME rational and polite debate. But I have not heard from anyone (yet) on this list who is willing to participate in that so I'll bite my tongue and leave it at that. For now.

Debbie Laxague, hoping that there are some (silent?) readers on this list who still have open minds.

[Rich66]

Was my post inflammatory?

[Laurel]

Well, if it was, Rich, I recommend Fish Oil, and a host of anti-inflammatory supplements!

I think the discussions are great. I am enjoying the process, personally. As for the Times, well, I've always considered it an over-priced rag, but that's just me. When I lived on Long Island many years ago my boyfriend and I would go to Jones Beach on Sundays with the Times, of course. I'd read through my favorite sections, take a long walk, a dip, and then I was ready to go. My boyfriend loved to bake in the sun, the "bronzed Adonis" I called him, which drove me nuts. I suppose I should give the Times credit for keeping me distracted while he roasted himself.

Has anyone signed the petition over on BreastCancer.org? It is sponsored by Dr. Weiss. There is also a survey regarding the new guidelines.

[swimangel72]

So Debbie, because I disagree with the NY Times article you quoted and also disagree with Dr. Susan Love - that makes me "reactionary and paranoid" ? I think not.........and most of the women who have responded to this thread seem intelligent and thoughtful - yes they are angry, and they have a right to be so, but certainly not "paranoid".

I am totally dismayed and depressed that doctors on this task force are more like actuarians than healers.........and that they are willing to permit an increase in breast cancer deaths to save money. Still, I AM hopeful that this firestorm of controversy will have a benefit in the long run............that more of our breast cancer fund-raising dollars will go towards real RESEARCH to find the "evidence" that they are basing all these guidelines on...........that scientists will pursue more reliable and safer breast cancer screening tools (cheaper MRI's would be fantastic)..........and that more money will go towards the education of future doctors, especially radiologists, to teach them HOW to properly read the results of these tests to avoid the false-positive dilemna. And finally - that more money will be spent on finding a cure, especially for Stage IV breast cancers. May God's angels watch over and protect all of us.

[Debbie L.]

So Debbie, because I disagree with the NY Times article you quoted and also disagree with Dr. Susan Love - that makes me "reactionary and paranoid" ?

Not at all. Disagreement and polite debate is how we all learn. We don't necessarily come to agreement, but we learn more about our thoughts and beliefs, and gain an understanding of others thoughts and beliefs also, when we debate politely and with respect.

But to start talking of conspiracy, financial gain, lack of concern for women's health, "death panels" -- as motives for the guidelines that are currently under discussion - yes that's reactionary and paranoid. The panel (USPSTF) took the information available (and they tell us what that information IS, if we want to read their references) and they evaluated both that information and its reliability (how well the studies were done), and they used it to draw their conclusions.

These guidelines are not based on new information. This information (that mammography is not as great as the awareness campaigns would have us believe) has been debated, re-examined, and supplemented by new studies for many years. And still there's controversy about mammography's value in saving lives. Everyone would agree that it's not a very good tool, at best, but it's what we have so we use it.

It has been known for a long time that the solution to breast cancer is much more complex than "early (small) detection", yet the awareness and early-detection campaigns have taken on a life, and a (false) reality of their own, and they have most women believing that if you have a mammogram, you will not die of breast cancer.

There's lots more to say on this subject, but the experts have said it far better than I could. If you're interested, check out the explanations at Susan Love's, NBCC's, or BCA's website. These organizations exist SOLELY to find out how to eradicate breast cancer, or at least to eradicate breast cancer deaths. To disagree with what they say is your right. To imply that they have some ulterior motive (finance or power, for example) is insulting and (again) reactionary and paranoid.

Debbie Laxague

[Rich66]

With all due respect, Debbie, I would appreciate a response to my post. If you disagree with the points, knock 'em down. No worries.

[Sherryg683]

Am I ignorant or something for them to say quote "the panel argued that the harms of
mammograms for those women appear to outweigh the benefits.", just sounds plain stupid. I'll take a little radiation and
risk of stress anyday over what I've had to deal with the last 4 years. Trying being diagnosed stage IV..now that's pretty stessfull, you know what... it's deadly too. I had no family history of breast cancer so I guess if what they are saying, I shouldn't have had that mammogram. Until something better comes along that's all we have. I worry about whether they will eventually decide that it's not "worth it" to even treat us stage IV patients properly as we are very expensive to treat..Oh well, I guess I'm just one life to them and that means nothing compared to the whole picture. sherryg