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11-28-2009, 01:16 PM
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#1
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Senior Member
Join Date: Feb 2008
Location: South East Wisconsin
Posts: 3,431
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Re: Revised Guidelines Say Most Women Can Begin Mammograms At Age 50
Again,
All of this is based on looking back at treatment from the past 30 yrs and assuming treatment is not improving and will not improve. With known blood markers that are rarely found in cancer-free women, perhaps additional focus could be placed there in while continually improving therapies and low-dose imaging are developed. Significant changes in Her2 yesterday and Triple negative today suggest things may be moving at a speed that could benefit those who detect and treat their cancer earlier now. Last I heard, surgery with clean margins was the largest contributor to survival. That's a bit easier in the early stage.
Quote:
Early detection may just mean patients spend a longer time knowing they have cancer, and yet die at the same time they would have died anyway if the tumor had been diagnosed later. A decision to forgo cancer screening can be a reasonable option.
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That line of thinking, if logical, could be applied to any age.
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11-28-2009, 01:41 PM
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#2
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Senior Member
Join Date: Aug 2006
Location: Pennsylvania
Posts: 1,080
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Re: Revised Guidelines Say Most Women Can Begin Mammograms At Age 50
Rich
I totally agree. Surgery with clean margins is the largest contributor to survival. Whoever has been cured of cancer, began with an operation. Not only in the early stage, I would recommend it in the later stages also.
Some researchers believe the reason for better survival for patients who could undergo complete resection without any tumor left behind is that these tumors are biologically less aggressive and would do better regardless of the type of treatment they receive, and that the removal of lymph nodes at the time of surgery may additionally contribute to a better outcome.
Surgery is an integral part of the multimodality treatment of many cancers. The line of reasoning frequently used to explain the value of surgery included five points.
First, surgery is thought to remove resistant clones of tumor cells and thus decrease the likelihood of the early onset of drug resistance.
Second, the removal of large masses likely to be associated with poorly vascularized areas of tumor improves the probability of delivering adequate drug doses to the remaining cancer cells.
Third, the higher growth fraction in better vascularized small masses enhanced the effect of chemotherapy.
Fourth, smaller masses required fewer cycles of chemotherapy and thus decreased the likelihood of drug resistance.
Fifth, removal of bulky disease enhances the immune system. Patients who present with a large mass are suffering because of that mass and they need that tumor out to relieve symptoms and to save life due to symptoms. It's important to deal with the bulk.
Sources:
Mayo Clinic
American Board of Surgeons
Society of Surgical Oncology
Don't forget, the signaling pathways in solid tumors are very complex and many. Cancer cells can use any of dozens of biochemical pathways to proliferate and spread. Stop one pathway and the cells can turn on a different. And the more recalcitrant tumors have redundant systems to let them escape from numerous anti-cancer agents.
A goal is the choose therapies so they target the precise proliferation pathways the cancer is using. We have the ability to profile tumors so that oncologists would know not to use one particular drug (or combinations of drugs) because it won't help, but utilized some other particular drug (or combination) because it shows that it is synergistic (cooperative) to the cancer cells (killing them).
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11-29-2009, 10:21 PM
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#3
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Senior Member
Join Date: Aug 2006
Location: Pennsylvania
Posts: 1,080
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Mammography and the Corporate Breast
The USPSTF would seem as unlikely a target for attack as Santa's elves. For a quarter-century, this squeaky-clean, underappreciated group of doctors and nurses who are specialists in preventive medicine has toiled away in obscurity in the selfless service of public health.
Appointed by the Agency for Healthcare Research and Quality, the task force panel is independent and does not take costs into consideration and it evaluates only the risks and benefits of preventive medicine strategies. The task force must be reeling over the vicious reaction to its latest recommendations regarding screening mammography.
The guidelines are based on an exhaustive analysis of recent studies from Sweden, the United Kingdom, and the U.S. Breast Cancer Surveillance Consortium involving a total of more than 830,000 women, and a specially commissioned study funded by the National Cancer Institute in which six separate teams studied the risks and benefits of 20 screening strategies through mathematically modeling.
The panel recommended against routine screening mammograms for women 40-to-49 years old, and screening every two years for women 50 to 74. These not-exactly-radical recommendations are almost identical to the World Health Organization guidelines, which recommend screening every one-to-two years between ages 50 and 69.
Because mammography is less effective at distinguishing cancers from normal breast tissue in premenopausal women, mammograms miss cancers in some younger women and raise a false alarm in others. This can cause real harm; one woman may ignore a cancerous lump because her mammogram was normal; another may undergo an unnecessary surgical procedure because her mammogram was suspicious.
http://www.thehastingscenter.org/Bio...t.aspx?id=4194
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11-30-2009, 12:25 PM
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#4
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Senior Member
Join Date: Aug 2006
Location: Pennsylvania
Posts: 1,080
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The Politics of Mammograms
Rather than explaining the science behind the recommendation, the news media exploited the politics of it. The press has succeeded in sowing seeds of confusion and doubt.
"USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms."
According to Diana Petitti, MD, MPH, Vice Chair, USPSTF, “You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values.”
According to Dr. Steve Woloshin of the Veterans Affairs Outcomes Group, "over a ten-year period, a woman age 40 to 49 has a 0.28% chance of dying of breast cancer if she goes for regular mammograms, and a 0.33% chance of dying of breast cancer if she doesn't. A 40-year-old's chance of developing breast cancer over the next decade is 1.4%, according to the National Cancer Institute.
Mammograms cut your risk of death by breast cancer by 0.5% for women over 40 who have mammograms, and 0.4% for those that do not have mammograms.
Dr. Donald Berry, head of biostatistics at the M.D. Anderson Cancer Center, calculated that a decade of mammograms for a woman in her 40's increases her lifespan by an average of 5 days.
However, these are the numbers that get lost in the media rhetoric, according to Gary Schwitzer, the dean of health care journalism. But thanks to fourty years of instilling breast cancer awareness in the minds of American women, most remain convinced that breast cancer represents a real and imminent danger.
Unfortunately, there has been a failure to recognize the difference between "cost-benefit analysis" (which focuses on costs) and "comparative effectiveness research" (which considers risks and benefits for patients, regardless of cost). The USPSTF is not charged with comparing the benefits of a treatment to the cost, its mission is to compare benefits to risks.
According to Dr. Diana Petitti, "The US Preventive Services Task Force reviewed the evidence without regards to cost, without regard to insurance, without regard to coverage."
And for the nativist out there, the Task Force is an independent panel of private sector experts in prevention and primary care, set up in 1984 by a physician then serving in the Reagan administration. The idea was to fund a group that could operate outside of government to review ongoing research and data in an effort to determine how well certain strategies to combat disease actually worked.
Obstetrician and gynecologist Dr. Peter Klatsky says, "the USPSTF is composed of physicians and scientists whose only motivation is to improve the health and wellness of women nationwide. Being invited onto the USPSTF is a huge honor. These are our best and brightest. They strive to determine what is best for our patients, our community, and our loved ones."
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01-12-2010, 11:13 AM
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#5
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Senior Member
Join Date: Aug 2006
Location: Pennsylvania
Posts: 1,080
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Follow the mammogram money
Wall Street Journal's Alicia Mundy reported that the final health care bill in Congress is likely to require coverage for more mammagrams than the US recommended after women's groups, doctors and imaging equipment makers stepped up pressure on lawmakers.
From the article:
Adriane Fugh-Berman, a professor at Georgetown University's medical school in Washington, D.C., said the evidence supports less-frequent mammograms. "You have to ask if there's conflict of interest, because breast-cancer advocacy has become a big business," she said.
Ties between nonprofits and companies have been under attack by some consumer watchdogs. Sen. Chuck Grassley, an Iowa Republican, sent letters last month asking 33 major nonprofit groups including the American Cancer Society to disclose their industry funding.
The American Cancer Society said it has received less than $1 million from screening-device makers in the past five years. Its spokesman said the donations, which are small relative to the society's annual revenue of more than $1 billion, don't influence its recommendations.
The American College of Radiology, a trade group, called the new government guidelines scientifically unfounded, and said that if the guidelines are adopted, "two decades of decline in breast-cancer mortality could be reversed and countless American women may die needlessly."
Its flagship research program studies the role of radiology in medicine. It received donations of at least $1 million each from General Electric Co.'s GE Healthcare and Siemens AG, according to the trade group's 2007-08 annual report. Both companies make mammography equipment and MRI scanners. Several other medical-device makers donated at least $100,000.
A spokesman for GE said the new guidelines conflict with successful early-screening programs. A representative of Siemens didn't respond to a request for comment. The college of radiology said sponsors haven't influenced its research. It has spent $480,000 on lobbying in the past two years, while the imaging industry spent more than $2.5 million.
One of the largest breast-cancer-awareness groups, Susan G. Komen for the Cure, has worked with GE and other companies. Komen turned to GE in October when it lit the Great Pyramids pink to mark a major screening initiative in Egypt. Neither GE nor the Komen group would say how much the event cost.
In 2007, GE sold limited-edition pink cameras to Home Shopping Network, which donated a portion of the sales to Komen. Imaging and film companies whose products go into mammography equipment have made pink DVD players, pink computer flash drives and pink cellphones, a portion of whose sales raise money for Komen and other breast-cancer groups.
In events at the Capitol, Komen for the Cure founder Nancy Brinker has praised GE's digital mammography technology, and she received a public-service award from the company.
Ms. Brinker, sister of the late Susan G. Komen, said some patient-advocacy groups tended to represent industry views, but her organization's push has always been early detection.
A traveling mammogram van purchased this fall by the American Cancer Society, Komen and other advocacy groups for the Dana-Farber Cancer Institute in Boston touts a new GE Healthcare Senographe Essential digital-mammography system.
A lobbying group leading the charge in Washington against the new guidelines is the Access to Medical Imaging Coalition, whose members include GE and Siemens and several nonprofit patient groups, the college of radiology and leading doctors societies.
The coalition's director, Tim Trysla, is a lobbyist at a Washington law firm. He has been working in Congress against proposals to cut billions of dollars in Medicare spending in the health-overhaul bill that could hurt imaging-device makers.
http://online.wsj.com/article/SB126325763413725559.html
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01-13-2010, 11:32 AM
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#6
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Senior Member
Join Date: Aug 2006
Location: Pennsylvania
Posts: 1,080
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Mammography Screening for Women Under Fifty
The storm that greeted the USPSTF guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries.
The Journal of the American Medical Association (JAMA) published an article, "The Benefits and Harms of Mammography Screening: Understanding the Trade-offs," reminding physicians and women about the serious health costs of adopting that policy.
The authors, Dartmouth's Steven Woloshin and Lisa Schwartz, used the "number needed to treat" analysis to point out:
Without screening, 3.5 of 1000 women in their 40s will die of breast cancer over the next 10 years (ie, 996.5 of 1000 will not die of the disease).
Screening reduces the chance of breast cancer death from 3.5 to about 3 of 1000. In other words, 2000 women between 40 and 49 must be screened annually for the following ten years to save one life.
For most women with cancer, screening generally does not change the ultimate outcome; the cancer usually is just as treatable or just as deadly regardless of screening.
Finding cancers that were never destined to cause symptoms or result in death is the biggest problem with mammography, especially among younger women. Since it is impossible to know which cancers caught early are benign, all are treated with surgery, chemotherapy, radiation, or some combination. Overdiagnosed women undergo treatment that can only cause harm, and must live with the ongoing fear of cancer recurrence.
While only 7% of women believe there could be breast cancers that grow so slowly that leaving them alone would not affect their health, randomized clinical trials have consistently shown that the groups undergoing mammography have more breast cancer, even after 15 years of follow-up. This persistent difference represents overdiagnosis.
Estimates of the rate of overdiagnosis range from 2 women overdiagnosed for every breast cancer death avoided in one trial, to 10 to 1 in another.
Woloshin and Schwartz concluded: "The politicalization of medical care is wrong. Promoting screening irrespective of the evidence may garner votes but will not create healthier voters. People need balanced information. Simplistic slogans touting only the benefit are deceptive. Simple, standardized summaries about the benefits and harms of testing would help foster good decision making."
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01-18-2010, 06:16 PM
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gdpawel
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This message has been deleted by gdpawel.
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09-09-2010, 07:08 AM
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#8
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Senior Member
Join Date: Aug 2006
Location: Pennsylvania
Posts: 1,080
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Lessons from the Mammography Wars
A thoughtful piece was published in the New England Journal of Medicine about the miscommunication that took place last November of what the USPSTF tried to convey and the complicity of certain organizations in adding to that confusion.
http://healthpolicyandreform.nejm.org/?p=12525
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