[Mtngrl]

This is an interesting and informative discussion. Thanks to all.

I'd like to point out that early detection of breast cancer does not actually improve overall survival. I know that goes against common sense, but it's a fact. The small drop in death rates from breast cancer in recent years is from better treatments, not from "catching it early." In less-developed countries, breast cancer is a leading cause of death. I suspect that the disparity is not so much due to the lack of mammograms as to the weakness in the health care systems in general (not to mention misogyny/undervaluing girls and women.)

Alaska Angel rightly questions the reflexive, blanket use of a drug that is never effective for some patients (for example, our beloved, dear departed Mandamoo) and becomes ineffective for many others. She says the money spent on that one-size-fits-all approach might be better spent otherwise. That goes double (at least!) for routine mammography. Billions are spent on it, yet there is no demonstrable benefit. There is also no evidence that routine breast self exams save lives.

Mammography, ultrasound, and MRI are necessary and essential for diagnosis of symptoms that might indicate that a person has breast cancer. That is a very different proposition from "let's screen everyone whether they're symptomatic or not." The main outcome of early detection is the opportunity to boast of five-year survival rates that look pretty great. Yet overall survival hasn't budged much. If you find it early you just have more years of knowing you have cancer, and being a cancer patient (and, hopefully, getting to NED and staying there.)

We are, indeed, lucky to have Herceptin and other targeted treatments for HER-2+ breast cancer. But don't fall too far down the "early detection" hole. After all, finding it "early" still means you have cancer. Chrissy was first diagnosed and treated at Stage 0. Yet her cancer metastasized, and she died. It happens.

Alaska Angel makes a great point about Herceptin that can be applied to all current cancer treatment protocols. There is no way to know if a particular person was "saved" by her specific cancer treatment. If she's alive, it's not unreasonable to assume the slash/burn/poison worked. But some cancers are slow-growing and indolent, and never become deadly. A good example is prostate cancer. Virtually all men who live into their 90s have prostate cancer, yet most of them die "with" it and not "of" it. That's true of some breast cancers. (Not HER-2+, but some other types.) Some are deadly no matter what, some are curable, and some never become deadly. We don't have a great way to tell which is which.

Substantially more research and attention should be going into preventing or curing metastatic cancer. That's what kills, and there's no known cure. All our expensive new treatments do appear to prolong survival for some people, but there's still no cure and, as the recent results published for Kadcyla, some brutally expensive new drugs are really no better than the old ones.

With cancer, an ounce of prevention is worth about a ton of cure. Lung cancer is virtually incurable. But lung cancer rates dropped substantially as smoking rates declined. Stomach cancer used to be widespread. With the advent of refrigeration and food preservatives, it's now very rare in developed countries. I'm very happy about the HPV vaccine, and hope it becomes ubiquitous.

Breast cancer doesn't seem to be caused by a specific virus. My money is on environmental pollutants and endocrine disruptors. The "vaccines" that are being studied train the body's immune system to go after the cancer cells in some way.

If we're going to spend billions of dollars on breast cancer, cleaning up toxic waste, developing clean energy, and finding safe alternatives to pesticides, herbicides, plastics, and other industrial chemicals (and ways to neutralize the ones we have dumped into the environment) appear to be better uses of the money. Increasing the budget of the NCI would be a fabulous place to start.