Whether it’s eye exams or mammograms, I never go at the scheduled date for the main and simple reason that I DO get signals from my body that suggest trouble, and I like to have insurance ready to pay for the exam at that time, not telling me I have to wait or go for various doctor’s appointments first.
Mammograms in particular I take charge. When I was 42 I had a lump, had a clear mammogram, was told my breasts were just normally lumpy. Lumpy breast syndrome or some such. Well, after a year, an allergist got concerned and sent me to a surgeon. That was in January. In late April I had what I guess was a third lumpectomy and axillary dissection, then chemotherapy and radiation. Cancer had spread to the nodes. In short, the mammogram missed the lump, and my concerns were discounted.
In one’s 40s, cancers are more aggressive than in the 50s. In one’s 20s, they are even quicker to grow — the medical community agrees about that, so concerns should raise brighter red flags (itchy spots, red streaks, odd lumps) the younger a woman is.
But I am told that mammograms get a lot more accurate as one gets older, because there is less muscle in the breast, and more fatty tissue. I am still very dismissive. I tell them it takes a day out of my life to go for the exam, and I don’t trust it at all. If I had larger breasts, with more fatty tissue, I would probably have a different view.
But I like the new idea that doctors and patients can decide for themselves. I have hated being bullied to waste what I consider precious dollars, precious time, getting robo-call after robo-call from my insurer, to please get more radiation into my chest, don’t I know I’m late.

Sure! Anytime a woman gets the delicate tissue of her breasts smashed between two heavy blocks of metal while being bombarded with radiation…well, it’s gotta be good medicine, right? And the more often, the better!

Geez, is it any wonder that lumps are developing in women’s breasts these days? Too bad common sense isn’t.

Medicare won’t even pay mammograms every year if the patient is LOW RISK of having breast cancer but pcp or hospitals still insist the patient still patients will low risk of having breast cancer.

I have a question for the guest regarding the development of the task force’s recommendation. What communication occurred between the major physician stakeholders (e.g., American Cancer Society, American College of Obstetricians and Gynecologists, American Society Of Breast Surgeons) and the task force before the final recommendations were published? Would it have been helpful to have other groups on board to promote the recommendations?

My wife was diagnosed at 49 thanks to a self-exam. Her sister was diagnosed at 45 thanks to a mammogram. Two friends were diagnosed in their 30s thanks to regular screening. The list could go on.

Mammograms aren’t perfect and we should be looking for a better test with fewer side effects. But the new recommendations to forgo mammograms in one’s 40s and stop self-exams amounts to crossing one’s fingers and hoping for the best. That makes NO sense.

We need a far more granular look at this data. Are there regional variations? Are behavioral and lifestyle factors considered and, if so, do they make a difference? If they aren’t, why not? Only 10-15% of breast cancer is genetic. For the balance, we don’t know what the cause is. Screening less would seem to let us gather less data that could ultimately lead to a cure and an effective prevention protocol.

A lot of test are non medically necessary and it will cost the tax payers, doing all these test for no reason or the patients are low risk. mammograms,lab test,prostate screening test etc etc.

Medicare and Medicaid will not pay these test if the patients are low risk.

I would very much like to hear the explanation of the suggestion to stop self exams. If we no longer get mammograms (I understand the cost/benefit argument), why cut out self exams, too? How on earth will we discover ANY tumors then?

Actually the future is ultrasound. It is cheaper, easier, quicker and in dense breasts finds 40% more cancers than mammography does: http://www.sonocine.com/

I’m disgusted to hear about these new recommendations. It sounds to me like they’re laying the ground-work to refuse insurance coverage of mammograms. I can’t help but wonder if these guys are in bed with big insurance. In this day and age, what other conclusions can we arrive at?!

I have to say that I agree with this due to personal experience. As a young woman of 26, I found a lump on my breast through self-examination and ended up having a totally unnecessary biopsy, which was painful, uncomfortable, and extremely expensive (my insurance covered about 20% only).

My doctor kept saying that it was extremely unlikely that my case would be cancerous due to my age and total lack of risk factors, but told me to do the biopsy anyway. Worst yet, I was told I had to keep having ultrasounds every year and if the lump grew I should have it a biopsy again. Of course I did not follow the advice, and I have stopped the self-examination. It is very frustrating that doctors keep recommending those invasive tests that cost a fortune due solely to their fear of getting in legal trouble.

So, after decades of doctors telling everyone to know their bodies, now we are specifically telling women that they don’t need to know what is normal for this particular part of their body?

I found a lump in my breast by self-exam when I was 41. I was fortunate – it was a benign fibroid adenoma which was completely removed during the biopsy.

It would have been devastating for me if I had to pay for the biopsy directly. It seems that the risk/benefit formula will be an easy “out” for insurance companies not to cover biopsies.

Even if you discuss risks with your physician and you both decide it’s a good idea, would insurance cover it? I doubt that any woman would think that the potential “harm” outweighs self-exam, biopsies and treatment.

Extra biopsies as the result of mammograms are a small price to pay if it means that even a small percent of cancers are found! Another day of life is precious.

I also had a coworker who had breast cancer discovered during routine mammogram. An oncologist at Creighton Medical Center in Omaha was on WOWT last night telling how she found a cancerous lump during self exam.

Also, I believe they were reviewing “old” data that did not use “digital mammography” data.

Your speaker is talking about “risk” – would he feel the same if they found the same “risk” / low benefit for testicular cancer??

The insurance companies are not going to sort out all the subtleties your speaker is addressing. It’s obvious that they trying to deny / limit care whenever possible, including preventive.

Johnna Roberts, Ph.D. (and yes it’s real doctorate from Kansas University in Biology!)

I wonder if the high number of false positives are related to the fee for service medical care system in the US.

Have studies been looked at to compare the US to other countries in the number of false positives for mammograms?

The hospital where I get mammograms has new machinery, new costly machinery. I’m not sure what it does. But the hospital is having financial difficulties (few people undergoing procedures that can wait), laying people off, and if they’ve paid a lot for this machine, they probably think mammograms are the only cash cow they have left in this economy.

I’m a healthy 49 year old that breastfed 4 children and had no family history of breast cancer. I may not be alive today if I didn’t have a routine mamogram at age 40. An area of calcification led to surgery 7 years ago and a lumpectomy that discovered LCIS (lobular carcenoma in situ) or a cancerous growth in my breast. That diagnosis places me in a high risk category and my care has been very proactive and regular since that point.

I worry about insurance companies that will now deny the mammogram to those women who want to choose this option in their 40’s as your speaker indicated.

I also have a 43 year old niece that is currently undergoing chemotherapy after a double masectomy.

My close friend has stage 3 breast cancer and had mammomgrams all her adult life. It was not discovered until she had an ultrasound. The type of cancer she has(lobular invasive) does not show up on mammograms. Had she had this type of exam earlier on, it would have been caught sooner. We need to do more-including ultra-sound.

Doesn’t all this new data point towards the need for a new way to detect a leading killer of women, as well as better approaches to treatment? It is not a step backwards if it points to new technology and treatments, rather than using substandard old school thinking.

I am Reimbursement Specialist all unnecessary test done by a Specialist are not covered especially if the patient is low risk. We need to support Universal Healthcare for Primary Care Physicians and Specialist will not have to bite their fingers for future malpractice law suit by patients.

Family Genes can predict cancer. If your parents or grand parents were diagnose with cancer you and your siblings or children are more likely to have cancer in the future.

Sorry forgive me but it is true.

As a forty-year old woman, I welcome these recommendations. The general public is very poorly educated about the fact that all medical procedures pose risks that may in fact outweigh the benefits. This is seldom more pronounced than when the C-word is involved. Look, for example, at PSA screening, which does not improve longevity and poses great risks to the health and well-being of the men who undergo it. I have been steeling myself to resist having my healthy body bombarded with radiation, and this gives me more ammunition.

Isn’t it funny that now that the government is thinking about getting into the health insurance business, all of a sudden a report comes out saying you don’t need medical tests…. Are prostate exams for men going to be next?

Did I hear Dr. Weiss correctly that breast cancer is the leading cancer in women? I thought it was lung cancer. I may have misunderstood or the data may have changed.

Re Mammograms: Another case of trying to save money. Woumen should continue to have mammograms, do self-exams, and continue to see their doctors. Insurance companies should not change their coverages of this. Definitely a way to try and save money on the parts of Insurance companies. I am not usually cynical, but this is blatant. What are women to do? Nothing???

Sean – you should hope that prostate exams are next. Prostate cancer is such a slow-growing cancer, and occurs at such an old age, that most men who have it will die of something else before the cancer gets them. On the other hand, prostate surgery is well known to cause urinary incontinence and impotence in many of the men who undergo it. This is a terrible price to pay for a procedure that doesn’t save lives.

The lesson here is that screening is not without risk, and the risk may outweigh the benefit.

It “only” reduces about 15%? What kind of numbers does that translate to? Double-digit percentages are considered statistically significant. If there was a test that reduced mortality for men by 15% you can bet it would be required.

The “survivability statistics seem to become nonsensical when you are talking about large populations. If instead we are talking about individuals I’m wondering if the 15% survivability improvement means the following: Out of 100 women who have cancer 15 more will survive if we have yearly screenings. One speaker mentioned that other studies show a 40% improvement. So does that mean out of 100 women who have cancer 40 more will survive?

Very interesting show. Two questions: 1. Without mammography and breast self-examination, how will breast cancer be discovered for a woman in her forties (or earlier) – simply by chance? Annual examination by a physician? 2. What role does ultrasound play in breast cancer detection today?

I’m not sure you’re hearing from enough women like me who, after having an annual mammogram starting at age 40, have been required to have many followup mammograms, ultrasounds, and two breast biopsies over the years. The last biopsy was in 2009. Thankfully, thankfully, they have all been negative. They haven’t, however, been without a great deal of worry and a great deal of exposure to radiation. Yes, I will still follow current guidelines, but hope that better diagnostics and technology will eliminate the need for all the followup tests and biopsies in the future.

I am truly torn by these new recommendations.

On one hand I do agree that the average woman, without a family history or other outstanding risk factors, can expect live a long and happy life following these new scaled back guidelines on the other hand if these were in place 3 years ago my mother would be dead.

As a woman in her 30’s who is now high-risk I will continue to talk to my doctors and will continue their recommendations to the tee – something I highly recommend ALL women do regardless of any blanket guidelines. And if your doctor can not bother to take the time to see you and discuss your concerns – get a new doctor.

This is one of many overly praised screening tools which fail to come close to their promise. For example, all the removal of “precancerous” skin lesions has not reduced the deaths due to skin cancer. Serum alpha fetal protein which is monitored in pregnant women has been a disaster with many false positives. The interpretation of PSA is likewise a conundrum.
Another highly accepted intervention, flu shots, hasn’t decreased death and morbidity from influenza, probably because those who are most susceptible don’t mount a good response to the vaccine.
Acombination of good intentions, “common sense”, compulsive behavior(encouraged in Med School) and the profit motive leads to these situatiions.

At one of the exhibits at the Science Museum you could try to find a lump in breast-like tissue. Although it was showing exactly where one should feel the lump, I was not able to find it. How many times in my life did I freak out over my lumpy, sometimes achy breasts?…
We have to find new ways to find the really potentially dangerous cancers.

This report is a shock to all women, but the reasoning is an insult.

Is it truly being suggested that women shouldn’t be screened because they may worry their pretty little heads too much over false negatives? How paternalistic!

The main reason for all this hub-bub is that American women have been oversold the success of early detection in improving survival. In slow growing tumors early detection often doesn’t improve survival since the tumor won’t be life-threatening for years. With aggressive tumors by the time mammograhy detects the cancer, it is often too late to improve survival. And mammography misses many cancers. There are a small number of women who will benefit from mammography. And so the question boils down to, what costs are we willing to bear to benefit this cohort of women?

In terms of self-breast exam, in my practice most women detect their lumps through normal activities of daily living,not on BSE.

Akilez, as a reimbursement specialist — I’m so glad to hear you’re for universal care — do you take into account a woman’s breastfeeding history in breast cancer? I understand that the more estrogen one has been exposed to (for estrogen-sensitive cancers), the higher the risk. American women don’t spend most of their reproductive lives either pregnant or breast feeding, so their risk is way higher. Plus environmental exposures to chemicals somehow is exposure to estrogen. Plus some women TAKE estrogen — or took. From age 15 to 20 I took huge amounts of estrogen to presumably re-kick-start my somehow frozen adolescent physiology, which in retrospect should have been a red flag for the rest of my life. As the panel is saying, most doctors don’t know what the risk factors are.
Do you?

if the claims for PSA or Prostate Cancer Screening test and Mammogram are net reimburse by Medicare. Hospitals are not allowed to bill the patient. it is written off
if you received a bill from a Hospital for PSA or mammogram you are not responsible for the balance if you have Medicare Part B.

Medicare will not pay low risk mammogram and hospitals are to write off that charge.

You are more like to be billed my HMOs or Commercial insurances for your denied claims on mammogram and the hospitals can bill you too.

Medicare is the other away around for denied mammogram

I’m wondering how often tumors in the breast resolve themselves without treatment. Is it possible that our bodies contain cancerous cells that, given enough time, heal themselves naturally?

And here’s another question: Why is all this money spent on mammograms, lumpectomies,etc., when we need the money directed to finding ways to PREVENT breast cancer?

Why isn’t the new digital mammogram the recommendation? These should be the standard of care and the panelists comment that the digital are not everywhere is just the point. Instead of saying no mammograms why not recommend the latest technology?

Until we have better diagnostic tools it is irresponsible to recommend against the tools that we do we have. One fear I have is that insurance companies will use this report to stop covering early mammograms.

My 42 year old niece found a lump by breast self exam. It was an invasive, aggressive cancer. She has two young children. I’m not willing to sacrifice her life and the lives of other young women to cut down on the so called harm of unnecessary procedures.

I also found my cancer by breast self exam. The Subsequent mammogram and ultrasound did not show the cancer. We need better tools. Why are we not spending our energy on that?

Aren’t mammography centers generally a dependable source of revenue for hospitals and clinics? Naturally the captains of these ships are going to resist a change in course because it’ll mean less money flowing in.

I think we should look at alternatives. I really like my thermascans. They use infrared to determine areas of concern in women’s breasts. The funny thing is with all this publicity people might call more often now, but he’s been doing this for 38 years. Because there’s no radiation and no compression, it’s safe and I don’t even need my doctor to prescribe it for me. Talk about empowerment!

As a researcher, I have to make the point that the researchers are looking at a statistical analysis and discussing it from that point of view. On the other hand, the proponents of pre-50 screening are approaching this from an individual protection point of view. You can legitimately take either point of view, but attacking the researchers and implying that their data or methods are unsound is absolutely counterproductive.

For the sake of our daughter’s lives:
Dr. Calonge should AVOID PUBLIC SPEAKING!

I am shocked and disappointed by the irresponsibly dangerous use of imprecise language by Dr. Calonge when speaking about such an important and still widely misunderstood topic as breast cancer. Perhaps the most egregious example of this came when Dr. Calonge authoritatively stated that “A woman does not benefit…[from being taught self exams]”, and when Tom Ashbrook astutely asked if he intended to instead say ‘most women’, Dr. Calonge, again demonstrating his lack of the precise language skills required by his position, replied “I don’t understand your question”.

For the sake of the lives of the women listening to your show today, let me clarify Mr. Ashbrook’s question: By saying, “a woman doesn’t benefit”, Dr. Calonge has advised each individual women listening that she does not receive any benefit from learning how to do a self-exam. That list of women would include myself, a 42-year-old who did learn how to do a self-exam, and who did, as a consequence, find a cancerous lump via self-exam that was missed by both routine mammograms and physician exams, and whose life would have been forfeit had I listened to the strict advice of Dr. Calonge that “a woman does not benefit.”

Shame on Dr. Calonge, chair of the U.S. Preventive Services Task Force, who should know better than to speak so publicly with such misleading language and kudos to Tom Ashbrook for calling him out on it.

The statistician is very brave to come out with this because most people will intuitively side with people like the doctor and assume this is about cost or etc. but it MAY NOT be. It is important to consider how hard it is on our bodies to have cancer screenings which expose us to radiation and follow the numbers AS WELL AS personal anecdotes.

Human beings are much more strongly swayed by anecdotal than statistical evidence (it’s why we play the lottery) and we are often poorly served by that.

A similar thing happened with recommendations about prostate cancer and the doctors who wrote in a newspaper their findings (that it would be better to be less aggressive in treating and screening for prostate cancer) received a very nasty public backlash, death threats etc.

People need to calm down and look at the evidence in order for us to make good decisions about our health. Intuitively we think more medicine/treatment is better, but it may cause harm, too.

This American Life just did a piece on this very phenomenom — strongly recommend (and it talks about the prostate cancer findings in there, too).

http://www.thislife.org/Radio_Episode.aspx?sched=1320

Dr. Weiss keeps attacking this survivorship study as old data and claims new procedures make the conclusions invalid. This completely misunderstands the point. She does not have an equivalent survivorship study using the new procedures. She is simply supplanting her own judgement from a handful of cases against a study using millions of cases. It may be that the new procedures make no significant difference. Dr. Weiss also seems to discount the negative effects of over treatment even though the study shows them to be significant.

I haven’t heard any comments about this, but it instantly came to mind when I heard of the new guidlines. This announcement comes on the heals of the health care reform plan. I am a staunch supporter of President Obama and this administration and I have defended the health care reform plan in discussions with my friends. Many of whom say that health care is going to be rationed, and that our health care system is going to end up like Canada and Europe, with long waits for proceedures….

Is it just a coinicidence that this report come out on the heals of the health care reform plan, or are they not linked at all?

Will I be eating my words about healthcare rationing?

It sounds like it is not a problem with the mammograms but rather with the type of care after a lump is detected. Some of the care is redundant are unnecessary as your guest said and leads to concern, anxiety, and unnecessary procedures. Perhaps we should look at that instead.

While I find an open, frank discussion about this topic and the emotions surrounding it productive, I find that you have left out one very important thing in the discussion. It is all well and good to come up with a new set of guidelines discounting current practices but I find it completely irresponsible to not recommend new practices to replace them. How can you tell a woman to stop doing self-exams and not have mammograms and then fail to give her alternatives to these for preventative care.

From a personal perspective I wish we would stop practicing numerical-statistical medicine and start practicing human medicine.

I understand that even with the new recommendations, women should make their own decisions. Unfortunately, what health insurance covers is typically based on the recommendations of leading medical organizations. So when the recommendation is to have a mammogram every year after 40, my insurance will pay for one mammogram per year after 40. If my insurance decides to pay for only one mammorgram every 2 years, and I decide to have a mammogram every year, now I have to pay for every other mammogram. This definitely sounds like an issue of cost.

It’s all well and good to speak about women having a “choice” whether or not to have a mammogram, but ultimately this policy is likely to put the insurance companies in the driver’s seat–as with so many other health issues. Women’s “choice” then, in actuality, becomes “insurer’s choice” and if the cost of a mammogram is no longer covered for women under 50, the choice has effectively been made for us…especially for those who have limited or no health coverage.

OBJECTS and is REPULSED with the government task forcel, announcing that women do not need mammograms until they are 50!!! I had my first mammogram at the age of 29 and needed to have one every year since. It saved my life! I was worth it…..evidently, government task force does not feel saving lives is the answer. Waiting till 50 will cost lives!!

My wife passed away this summer, 2009, of breast cancer at the age of 36. Cancer was found at the age of 26. My wife was french where self examination is not promoted and did not know anything about it when I found a lump. Once she was diagnosed her cancer was very advanced. She was first treated in France before coming to America cancer free. To find later she was not.

I cannot believe any other way, if she had been educated by self examination, she would have caught the cancer earlier. And, would be here today.

I was diagnosed with ductal carcinoma in situ by mamogram weeks after my 50th birthday. I was treated and am now 67. But after my diagnosois while I was pondering various options, i began to attend my local support group of perhaps 15 women. At least half of the women were in their 40s. Most of them died of their cancer. How do we find and treat this group of the popultion who’s cancer tends to be much more virulent?

Will these new recommendations affect what insurance companies offer? The recommendation is that women make their own choice about whether or not to have a mammogram. But if insurance companies use this research to scale back on preventative mammograms, women won’t have the insurance coverage to really be able to make a choice.

If you listen close enough you can hear the insurance companies doing a collective “ah-ha” and making plans to pull coverage for mammograms!

These new recommendations make as much sense as telling the “population” not to wear their seatbelts because they probably won’t get in a car crash. I hope that all the women I love will continue to self-examine and take advantage of mamography. I know I will.

Rebecca,

The release of this report has NOTHING to do with the latest push for health reform. The release of health research information is painfully slow and this report is the result of studies done years ago (most beginning and ending pre-Obama).

While some may try to draw a link between the two there truly is none.

I repeat what I posted above:

Actually the future is ultrasound. It is cheaper, easier, quicker and in dense breasts finds 40% more cancers than mammography does: http://www.sonocine.com/

Like many people, I don’t know where to begin.
As a physician and breast cancer survivor, I strongly disagree with taking this approach. I think the data is somewhat faulty on which these conclusions are based.
My cancer was found before age 50 on routine mammogram. I had ductal carcinoma and chose mastectomy to be as definitive as possible. While it is possible that it might not have killed me, no-one knows that for sure. I wasn’t really willing to sit around and see what would happen. The chance that it won’t go on to invasive cancer or kill me is a general statistic for which we have no idea to whom it applies beforehand and would only know until it’s too late.
We should not be leaving this to chance. This is not an area for which you want to later say “hindsight is 20/20″. Oops – now I have invasive cancer and require much more extensive therapy and/or I’m going to die. We have no treatments that guarantee survival, particularly late stage disease, therefore it is unfair to wait and see.

LONG WAIT ON OTHER COUNTRIES for a mammogram are not true. If they are True Those countrieS will not be on top of the list for healthcare. remember America is on the bottom of the list next to Costa Rica.

Fellow Americans the only way we can Treat our cancer patients is to support Universal Healthcare.

We did it in Massachusetts. We can cover the entire country. My health insurance hasn’t change for the last 3 years since Beacon Hill passed the Universal Healthcare of Senator Kennedy and 90% of residents of Massachusetts are covered.

The new recommendation is a huge step backwards in terms of women’s health. I know four women who were diagnosed with breast cancer before the age of 50 because they started getting regular mammograms at age 40. No amount of extra stress caused by extra doctors visits could outweigh the lives of these women.

By changing the recommendation, we are risking lives of our mothers, grandmother, sisters, daughters,wives, aunts, best friends, elementary school teachers…all of the women who impact our lives every day.

My understanding from my naturopathic doctor (and backed up by mammogram technicians) is that mammograms are most effective after a woman has gone through menopause; and mammograms are least effective for women who haven’t gone through menopause, who have large, dense breasts. However, early detection is critical — because the younger a woman is, the faster the cancer grows.
An alternative to mammography is thermal imaging. It’s cheap ($150), safe and very effective; it often detects thermal changes before a lump would be found by self exam or a mammogram. You get two images, three months apart, to determine your baseline, and then go once a year. That’s what I’ve chosen to do, starting when I was 35, and I feel very comfortable. It’s not accepted by mainstream medicine, but neither are lots of things I find effective.

These recommendations are not supposed to consider cost but they should. I heard a woman on TV today say that if mammography saved one live it would be worth it. I’m sorry but that is not true; if it costs $1 billion to save one live it can not be done. The inability of the general American public (and the Congress) to understand this is also the reason why healthcare reform is doomed to failure. No country can afford to spend unlimited amounts on healthcare. There must be some restraint (rationing).

I can’t believe that 15% of women 40-50 are found with cancer isn’t a high enough number of women to have this be a useful tool. So my godchildren’s mom who has no cancer in her family and had 2 forms of breast cancer in the breast that needed to be removed (at 42) would have had to wiat till she was 50 to find out she had cancer? More likely it would have been found after she passed away because it wasn’t found early when it was still located in one breast.

That this report will have the influence in insurance companies is just stepping back in health care. My friend was lucky enough to have gotten cancer the year she did. If it was a year earlier a reconstruction breast would not have been covered. Thank you Mass legislation to make this a requirement that insurance must cover.

I know this is just one persons story but thank goodness my dear friend is still with us thanks to her routen mamogram.

Weiss was incredibly annoying, with her obvious “talking points,” fear-factor, monotonous repetition. She spoke like a politician determined to stay on her few simple points no matter their relevance to the question being entertained.

She calls others self-interested. And she, representative of the status quo, is not?

When I first heard the ammouncement of this recommendation yesterday, my first thought was: this is the first step to lack of coverage for mammograms under insurance and other healthcare payment programs. This factor has not been addressed in any of the news commentaries – until today by one of your guests and in the e-mail comments. There are, no doubt, legislators who will grasp this as one more way to reduce medical costs in the U.S., especially during this otherworldly discussion about why America really doesn’t need medical assistance for the many millions of its citizens who have none.

Also, most women are not going to be able to see a doctor and have the time to discuss this with their doctors; for those women lucky enough to have a Primary Care Physician, there just is not time, and women may not remember to bring it up when there may be other pressing health concerns to address. It will be put on the “back burner” until it is too late. If a woman does bring it up, she may have to fight through layers and layers of bureaucracy – that in itself can be costly and exhausting, even if successful.

As an aside, the amendment to the House Health Care Bill that would prevent women with even private insurance from obtaining abortions in consultation with their physicians if their insurance group receives federal funding, even though the right to this procedure is protected by law, will bring us right back to pre-Rowe v. Wade times — 1973, here we come.

I’m very disappointed with Ashbrook. He let Weiss go on and on saying the same things over and over, even when Miglioretti made it clear that the recommendations were not based on old data and outdated technology. Weiss completely dominated the conversation, which meant that we did not get a clear and helpful discussion about a VERY important topic. It bothers me when Ashbrook fans the flames, which he often does because it makes for more exciting radio. But it does nothing for the debate.
Unfortunately, Miglioretti sounded nervous and unsure, which did nothing to help her point. And where the heck did Calonge go? They are his recommendations–why wasn’t he defending them throughout the program?

I learned exactly zero from this show. Very disappointing.

Very confusing issue:
Various talking heads say follow the new guidelines (Onpoint guest, ABC medical reporter, etc.) and others say flawed study, old data, population vs. individual, etc.
One thing is clear:
Insurance companies will drop mammography coverage for 40-49 year olds. To say otherwise is ridiculous. So yes, women can choose, but only those who can pay for it, so poor women and their families will disproportionally suffer. If that is not your concern consider then these poor women will be in hospital emergency rooms with advanced cancers at age 55 and then the cost will be so much greater.

No one talks about what percentage of breast cancer is based on family history. I thought I had heard that only 20% of breast cancer was from a family history.

I am 43 and my point of reference for anecdotal stories is for women from 35 to about 55. Of those 100 or so women I know well or in my circle of acquaintances about 8 or so women have breast cancer and were all in their 40’s. I personally know only one woman (my aunt) who has breast cancer diagnosed at about 65 (she is alive and well). Remember when you are talking about women with breast cancer you are also talking about children in their families and a potential lose of a mother. That group of 8 has over 20 children between them.

Was the guest who spoke during OnPoint, who was pushing the guidelines saying that the women who called in and had breast cancer, wouldn’t have had it if they just left what they found?

It seems the study’s conclusions should have been more along the lines of this:
1). Mammography creates false positives so talk to your doctors.
2) Some tumors don’t turn into cancer, so discuss with your doctors based on your risks (history, pregnancies, breast feeding history, etc.). Perhaps waiting six months, then another, etc. to see if an invasive strategy is needed.
3)The dangers of treatment need to be communicated more fully with patients and have them sign off on decisions not to proceed if that is better than other alternatives.
3) Better technology is needed to one find better ways to find the cancer and then two better technology to determine if the breast cancer will be an aggressive cancer.

It seems that the study said well statistically, because women have to go back for additional mammogram on false positives and some have to have biopsies that determines no cancerous tumor and some turn to treatment for cancers that know one knows where it would go then, it is worth it to let some women die with cancers in their 40’s. To me that is an extreme overreaction.

I never heard them speak on the cost of the additional mammograms/tests/etc. to say that their overreaction is worth it. It is not like the information from medical studies they have on the PSA testing that actually does harm and no better outcomes. In the case of routine screening for women in their 40s for breast cancer, lives will be saved plain and simple.

I read here about thermal studies at $150 (self-pay, which would probably feed an orphan in Somalia for a year, but anyway), about ultrasound studies which are better for dense breast evaluation but has never been offered to me, and the new digital x-rays, which presumably are better since they are presumably more costly.
So do the new recommendations take into account the relative costs and accuracy of these modalities? Or only old-style mammograms.
I am very suspicious of anything that health insurance “wants” to pay for that is expensive. I think to myself, what lobby is being placated here? I am thinking not only of mammagrams but of bone densitometry, where my body pretty well tells me.
But in this case, from listening to the show, I think the recommendations are lagged, not keeping up with new research and new technologies. So I think the recommendation is a little irrelevant.
It’s really too bad that our primary care physicians have to consider the costs of various modalities (the most effective might be cheaper, but not covered, and therefore unaffordable) even when patients have standard-grade insurance.
I am suspicious that digital mammography might be significantly more costly, which might be driving this recommendation for less mammogram coverage; yet the digital mammography is not, apparently, what the statistics are based upon.

In the matter of potential “harm” done by the previously recommended regimen of annual mammograms, no one is mentioning the possibility of harm from the cumulative exposure to radiation posed by annual mammography itself.

What research has been done on yearly mammograms actually contributing to breast cancer risk over time? Are there alternative diagnostic tools available–sonograms? thermograms?–which would not involve a risk from radiation? HAVE WE INVESTED IN THE WRONG TECHNOLOGY?

One of your panelists, responding to a caller late in the program who suggested infra-red thermography, commented on “the self-interest of other technologies with no proven track record.” I have long suspected that mammography as a regular diagnostic technique has been foisted on women by the self-interest of a vast radiological industry to the exclusion of investigation into other less invasive and less potentially harmful techniques. For the sake of women across the country, COULD YOU PLEASE EXPLORE THIS SUBJECT AND SOME OF THE RESEARCH ON THIS TOPIC AND/OR CLINICAL EXPERIENCE WITH ALTERNATIVE DIAGNOSTIC TOOLS IN A FUTURE PROGRAM?

N. Smith, Addison County, Vermont

A follow-up to my comment about :50 into the show.

I suggested that interested parties “scrape” the relevant data about the mammography study (found @ http://www.ahrq.gov/CLINIC/uspstf09/breastcancer/brcanes.pdf)
and paste in the data sections of either Swivel http://www.swivel.com/ or ManyEyes http://manyeyes.alphaworks.ibm.com/ and then use their data visualization tools to display the data in different ways that may help build understanding, AND, to use the Web 2.0 threaded discussion tools on the site to try to have a real, data-driven dialogue about this important issue. (This is an issue I’ll treat @ length in my forthcoming Democratizing Data book http://j.mp/11pylw We need to build “data literacy” among the general public, and to make vital data such as this easily available outside academia so that we can reach intelligent decisions on vital issues).

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I DID write this same letter to the Here and Now blog.

Well, I know where I stand with the U.S. Preventive Services Task Force. To THEM, I’m “statistically insignificant”!

Why? Because my invasive breast cancer was first detected, by a mammogram, when I was 47 — too young for them! Apparently, the cancer was probably already at least FIVE years old by the time it was detected, so I was actually even younger when it first started chugging away. By the way, there is NO known history of breast cancer in my family.

The U.S.P.S.T.F. was concerned that some women might experience the “anxiety” of false positive results from their mammograms?!! GIVE ME A BREAK!!! I have REAL, ACTUAL CANCER, and anxiety is NOT in my vocabulary!!! It WOULD be if I didn’t have health insurance — THAT’S the real ISSUE; THAT’s what separates one woman’s reaction from another’s!!! We should ALL have health insurance as citizens of the World!!!

The mammograms can “hurt” when they are administered?? GIVE ME A BREAK!!! It’s now 15 years since I was first diagnosed. NOW I have arrived at Stage 4 metastatic breast cancer. You want to know PAIN? When the cancer has spread to your bones, as mine has, THEN you’ll know pain!!! What is needed is better detection of metastasis AND better health insurance reimbursement for visits to cancer specialists once everyone THINKS you have “licked” the cancer!!

It is well known that younger women tend to have more INVASIVE breast cancer. How much do the study’s statistics look “better” for older women because the younger ones died before they could even be counted?! Also, this study is about DEATHS due to breast cancer. More and more women are “LIVING with cancer”. The QUALITY of that LIVING is DEFINITELY related to EARLY DETECTION! Are these researchers so IDIOTIC that they can’t take THAT into account? SORRY, but I use that word BECAUSE the QUALITY of my Stage Four life would be A LOT BETTER if Stage Four had been detected earlier in my case (thru an earlier bone scan and CAT scan). Perhaps I could EVEN have stalled the cancer at Stage Three, but at the very least, KNOWING the cancer was in my bones due to detection would have caused me to change some of my activities, and I would NOT have engaged in an activity that WRECKED my right pelvis where cancer already dwelled, but without my knowledge!!!

I heard an interview with one of the study’s professionals. I heard her admit that the study did NOT take race into account sufficiently. No matter WHAT your age, if you are African-American, your chances of having health insurance and of surviving your cancer are worse. Is the increased cancer risk due to genetics or because of factors related to increased likelihood of poverty and lack of adequate medical care? Let’s research THAT, at every level possible!

We women have to help each other, because THESE researchers are sure not helping us! They are not even asking US what we think should be researched, and what a SOURCE of ideas we ARE!!

On a related note: physicians think that women with estrogen-dependent breast cancer should stay away from phyto-estrogens (plant estrogens) in foods. YET, WHAT IS THE AMERICAN FOOD INDUSTRY DOING??? Adding SOY (a phyto-estrogen) to just about EVERYTHING! I fear for the generations of younger women who are eating so much of this soy that we might finally BE talking about “statistically significant” when members of their age group develop estrogen-dependent breast cancer!!!!!

The guest who kept complaining about women who had MASTECTOMIES when their cancer was “IN SITU” (which means it is NON-invasive) as talking ABOUT BAD MEDICAL PRACTICE, NOT the consequences of mammograms for women age 40 to 50!!! I know of a number of women who have had in situ cancer, and not a ONE of them has had a mastectomy. Their lives are ENTIRELY different than the lives of the women with INVASIVE breast cancer. And, MY life was basically a “piece of cake” at Stage One (reminding everyone that I was FORTUNATE TO HAVE HEALTH COVERAGE!), compared to what it is like at STAGE FOUR!!! YET, I AM alive at Stage Four BECAUSE I have received treatment. A woman with the SAME profile & age decided NOT to take our prescribed Stage Four medications. In a way, that is the same as NOT HAVING your cancer detected and/or not have the health insurance to cover treatment. She died within 5 or 7 months after I started TAKING the meds. I’m alive FIVE YEARS later. DO NOT TELL ME ABOUT THIS IGNORANT STUDY THAT ONLY LOOKS AT DEATH!! You have to look at the LIFE of the women who with early detection get to SLOW and/or STOP the COURSE OF THEIR DISEASE AT AN EARLIER STAGE!!!!!!!!! These mathematicians are TRAPPED in a world of nunbers. We WOMEN are out of their view. I, personally, an STATISTICALLY INSIGNIFICANT! (By the way, WHEN did a number as HIGH as 15% become “insignificant”???????

This show, as well as these new guidelines, raise more questions then they answer. I know from my own work how statistical data can be tricky to interpret and can easily be manipulated; I also know how anecdotal data is often unreliable.

I have to say, as a blanket recommendation, to tell women not to worry about getting mammograms before the age of fifty if no special risk factors, to not perform self exams as they are unreliable, not to mention intimating that lives lost can be viewed as statistical blips in the interpretation of the data as a way to establish best practices, seems irresponsible, and it approaches negligence. Within the context of guidelines for this, as well as other regular, preventive examinations, guidelines are just that, and they don’t force anyone to do anything, they merely present a kind of optimum of preventive measures, or they should, anyway. This doesn’t seem to follow a model of prevention.

That said, mammography may not be the best approach. There should always be an evaluation of a procedure that recommends anyone get ex-rays annually. There may be better approaches to detecting breast cancer early, even earlier. There may be better technologies yet to be developed. But to abandon the current guidelines without replacing them with some reasonable alternative of action rather than inaction just doesn’t seem to jibe with good, preventive medicine.

I wonder what if anything is driving this beyond truly best medical practices. This study’s data may have been collected and interpreted before the current health care debate; but, like some others commenting today, I wonder if any potentially competing technologies have a stake. I also wonder how the release of this study’s findings to the public will be manipulated by politicos wanting to spin the whole thing and use it as further fear-mongering.

Normally, I’d agree with all the posts suspicious that this is an insurance company ploy. I teach a “Women, Health, and Reproduction” course at a major university; I am a 12 year survivor of breast cancer diagnosed (by mammogram) at age 38. I’m clear on the problems with letting insurance companies dictate healthcare. And yet, I’ve been teaching my students this controversy for the last several years (it has been a hot topic in the UK for several years now), and I had concluded before this report that mammography poses too many risks. Mammography is radiation. For all the cancers it detects (mine included), it may well be CAUSING many more cancers. Annual mammograms from age 40 on dramatically increase lifetime radiation exposure. The guests on the show, by focusing on the “distress” of false positives, did not really make the point clear. And that is that mammography may well be doing more harm than good. (Please note that I’m not speaking of BSE; I’m not clear on why that is being dis-recommended, though my lump was never palpable.)

Let me cast another entity as possible bad-guy here: pharmaceutical company Astra-Zeneca. Mammography has been heavily promoted by that company by means of National Breast Cancer Awareness Month (trademarked by that company), hoping to be able to put millions of women on their anti-estrogen drugs.

We have plenty of reason to be suspicious of insurance companies and of the radiology industry, too. The real problem here is a for-profit healthcare system.

Christina, you say “physicians think that women with estrogen-dependent breast cancer should stay away from phyto-estrogens (plant estrogens) in foods.” I’m wondering what physicians those would be. The doctors in my sphere when I was dealing with breast cancer and midlife/menopause were doing just the opposite, telling me that phyto-estrogens were the safe way to get estrogen into me. Of the estrogens prescribable (estriol, estradiol, estrone, I’m forgetting…), they were particular which pharmaceutical replacements were bad, which were good. One is okay.
But soy — actually I think it’s great — and the cultures where people depend on soy as a staple have way lower rates of breast cancer than we do; I don’t think there is any question of that), and for me, 17 years later, I still am happy to use it, for its estrogenic component, with no recurrence of cancer. So I’m thinking you had some physicians being overcautious. I could be wrong.
It is very awful to hear about the track record in follow-up care post-cancer. I would say that rebuilt breasts seem to me to be an invitation for trouble. I wouldn’t put a foreign thing in my body unless it was a functional part like a foot.

I don’t see how this is a conspiracy against women. The panel isn’t telling women to not get mammograms, it is saying it doesn’t show an overall benefit for women in their 40’s but that each woman needs to weigh the risks and decide for herself.

The results from studies done on prostrate cancer are similar, but people went crazy over that too. Men who have elevated PSA’s have to decide along with their doctor if they should proceed with a biopsy, etc…

The problem is that science is good enough to detect cancer, but not good enough to determine which ones are going to kill us. The theory is that our bodies are constantly eliminating small cancers without treatment.

And by-the-way, I have a cousin who had breast cancer in her early 40’s so I do understand that young women get cancer. Again, we have to work with the technology we have at this moment in time and the technology isn’t perfect.

As one of the expert quest stated this new reverse of course is long over due. She stated that Canada and Europe had already adopted these new guidelines and hinted that America should follow their lead.
Quess what ladies? Don’t these countries have government rule healthcare systems. Could this be a glimpse of what we could see coming if we decide to follow their lead? Cost cuts will come as they have in these countries. As more and more people get onto the roles of this plan, the plan soon becomes in need of money or cuts. Cuts, as reducing the need for exams is just another word for rationing. But! we have data to help mask that word into unneccessary exams. My mom found a lump from a self-exam, it was cancer, she is now 87 years old and well. The science is not perfect, but would you rather have medical professional exam you or the government? Just a thought.

After reading all of these comments, these are good arguments, but I still think the discussion and our dollars should be more focused on the root cause of breast cancer and others, because it has taken over! Let’s look at our foods, the accountability of our companies, the toxins in our environment, and the pace and way we live. I’m 26 and am terrified of getting mammograms or anything that exposes me to radiation; I’d much rather opt for an alternative form.
On another front, I’m curious what percent of women who have been diagnosed have chosen to wait before invasive treatment. Have the majority who have been diagnosed shown signs of sickness before getting diagnosed? Or have they felt completely healthy, and then jumped to radiation and chemo right away? Has anyone studied how long they would live had the cancer gone undetected? Is it possible that the majority of women who are treated would otherwise live a healthy life? Are there countries with very low prevalence of cancer and have we studied these? I agree there should be a follow-up show, or several…I’m just not sold that we’re going about any of this — from preventive research to treatment– the right way.

Clearly nothing more than the administration reducing cost for the “public option”.

Dear Tom,
This whole discussion, like the “breast cancer industry” in general, totally ignores the fact that the best way to heal breast cancer is PREVENTION: take the toxic chemicals and pollution out of our environment, improve our diet, etc. Detection – early or late, and treatment are not as effective as prevention! Focusing exclusively on details of detection and screening does not serve women’s health. It does, however, serve the drug companies and others who make huge profits from treating breast cancer with highly-toxic chemicals, which often kill the patient, while also manufacturing other chemicals which have been shown to cause cancer.

All the best,
Laura Sue – as the daughter of a woman who died of breast cancer in 1968, I have spent the last 40 years studying and living this!

The first question to ask is, if patient oriented outcomes are improved with a particular test.
As with any test the potential harm from an abnormal test is important as it could lead on to unnecessary additional procedures and risks associated with them including patient anxiety worrying about a potentially false positive test.
Shared decision making between the patient and physician/provider would go a long way in tackling many of these issues.
Ongoing evaluation of new data and evidence based practice which takes into account patient preference would result in more compassionate and improved patient care and overall health.

Is there any data on thermal imaging for evaluating breast health and screening for breast cancer?

It is clear, after listening to this show and recent news that mammograms do save lives. The choice that this panel made was to choose sacrificing those lives for the “greater good.”

This would never even be a discussion if this cancer was killing men and not women.

What the panel should be recommending – is not taking this important tool away – but improving upon the treatment after a lump is found. The problem is not with mammograms but with the overtreatment that follows them. Instead of degrading our medical care – the panel should be recommending that their be a huge increase in the development of less invasive biopsies and better ways to keep an eye on lumps without jumping to unecessary treatment.

Instead they’ve decided to “kill the messenger” and would rather not deal with the real problem of overtreatment.

On the show I hear a lot about data and statistics, how about actual numbers of women who lived because they tested themselves early. How many survived,,, that should be the question.

Nobody has mentioned the dogs that can detect cancer. I see mentions of that on TV documentaries every several years, and I believe it. Why not take advantage of that? Again, “false positives,” most likely, is the reason, those cases where the body is dealing with it on its own. Or the fact the dog can’t tell which kind of cancer, I suppose.
I don’t think the anxiety factor should be as great as it is for breast cancer diagnosis. This is not terra incognita. When I had cancer — surgeries, chemo, radiation — I was not even aware of making decisions; I went with the flow, picked my way, planned to die soon or not. It seemed to me that cancer was one disease where the medical protocol was pretty clear. Actually, I had doctors both traditional and holistic in bent, so I could take the best of both worlds. I made my own carrot juice in a juicer, organic carrots, and more or less swam in fresh juice for several months, for one thing. I served it to my guests with pride.

It’s sad emotion beats out science.

If a women wants multiple mamm’s done let, but before so give her the up to date information and risk involved before she does.

Also Dr. Marisa Weiss seem far less trustworthy than the other two and seem to play on people emotions instead of the stats, starting by saying all the data is outdated from this study then by the end when question about her statement went to most, to some.

In the end its a women choice, i just hope she follows science over emotions.

This new recommendation is cost based regardless of what is reported. Isn’t it odd that health care reform is a hot topic, particularly with the amount it is estimated to cost (because our health care system is based on one word: greed) the first thing to be discussed is cutting women’s health benefits. I had my first mammogram at 44 at Lankenau Hospital while I was getting a third opinion on surgery. I sat in a room in a gown while other women were told they could go home but I had to get another picture. That happened again and finally I was told I had to see the doctor. I walked in as he was talking into a recorder and all I heard was “I favor benign”. He suggested a biopsy and I went to a breast expert at Jeannes Hospital who gave me the option of waiting 6 months and I opted for the biopsy. Glad I did because worrying for a weekend as opposed to 6 months? No brainer. I have to laugh that this task force is concerned about unncessarily worrying women with false positives. They’re concerned about one thing only – saving money. What happened to the flu vaccines???

“On the show I hear a lot about data and statistics, how about actual numbers of women who lived because they tested themselves early. How many survived,,, that should be the question.”

No, it wouldn’t be. Anecdotes aren’t data.

This discussion was depressing today, especially Dr. Weiss’s annoying repetition. Human brains really aren’t wired to believe statistical evidence more than personal stories. It’s a shame, but as someone wrote above, it’s why people play the lottery.

@Go with…so very true. The discussion about mammograms is also a useful opportunity to learn more about the effect of cognitive biases on behavior. Now, that would be a show.

Ellen Dibble,

Thanks for the thoughts about the estrogen. You mentioned that you TOOK estrogen for medical reasons when young, but I didn’t see in your postings if YOUR breast cancer was ESTROGEN-DEPENDENT. I believe you said that it was 17 years ago that you had treatment for breast cancer. I’m not at all SURE that they had the ability THEN to determine whether or not a patient’s tumors WERE estrogen-dependent.

My tumors ARE estrogen-dependent. Somehow or other, estrogen GIVES my cancer-type a PLACE to grow (I THINK that’s how it works – something like that.) THEREFORE, the oncologists at my university hospital think, that in the absence of sufficient information about phytoestrogens, that I should stay away from soy, etc., until more is known. I WAS taking anti-estrogens as my treatment, but they stopped working — probably because the cancer got “smart” and morphed just enough to find a way to start growing again. Thankfully, there is an oral chemo pill that I am now taking. Therefore, I am no longer taking a pill that specifically blocks my estrogen. I think the doctors therefore believe that the LESS estrogen I have in my body the better. ( They DO admit they are NOT sure about the phyto’s.) The fact that so many Asian women don’t get breast cancer could be as much a genetic factor as a food/environmental factor; they DO seem to be more susceptible once they start consuming a more Western diet; but, it could STILL be that their cancers tend to NOT be estrogen-dependent.

Just as an aside, I didn’t have replacements; perhaps you were just referring to those generally speaking.

One of the main points I was trying to get across is that managing the pain and stamina loss of STAGE FOUR is a very difficult, not always successful, balancing act; and some of the treatments have side effects that are really quite something. My jaw is dying, for instance, from medication side effects. They’ve taken me OFF that med, but it has a LONG half life, so the necrosis continues; if it were to get really bad, my teeth would fall out, and there would be no jaw there for implants. Yikes!!! SO, I still say there should be EARLY DETECTION OF EACH AND EVERY STAGE OF CANCER. My early mammogram helped me “sail thru” Stage One for ten years; but, as I said before, a bone scan & CAT scan perhaps at year 5 and 7 MIGHT have prevented my bones from being as RADICALLY affected as they became as a slipped, unknowingly into Stage Four. Everyone thought I had the cancer licked once I passed 5 years; certainly when I pass 10 years. Not so, BUT, I am STILL alive THANKS to the wonderful medicines that HAVE worked for me. Again, they WORKED because I had HEALTH INSURANCE so they were AVAILABLE to me. Everyone deserves sufficient health insurance, and I would WILLINGLY pay higher taxes to help all my fellow citizens get coverage. That’s what they have in Denmark, and the Danes are consistently rated the HAPPIEST people in the World! (I know that’s a slightly different topic, but it IS related. Even WITH early detection, without treatment, you’re sunk! Thanks for your thoughts!

Ellen Dibble (again — i.e., a correction FROM Christina)

Re-reading my phrase “it could STILL be that their cancers tend to NOT be estrogen-dependent”.

I INTENDED the phrase to mean that their cancers COULD or COULD NOT be estrogen-depenent; that we don’t know which they are, if there is even a tendency toward either predominantly.

But, re-reading my phrase, I’m afraid it sounds like I’m saying there is a generous consensus that their cancers are NOT estrogen-dependent. I don’t think there is any such consensus. Sorry for the bad wording!

To: Go with the data, not gut feelings,

The trouble is these study statisticians have ASKED THE WRONG QUESTION!!! Please see my two main posts, above.

They should be asking about LIVING WITH CANCER, not about DYING FROM CANCER. The women who have mammograms where cancer IS found will all LIVE with cancer, even if their life is only brief. THE QUALITY OF THAT LIFE IS AFFECTED BY THE STAGE AT WHICH DIAGNOSIS IS MADE!!!!! I know this. I am LIVING WITH CANCER. I lived with Stage One cancer — it was a breeze, for ME. I’ve been living with Stage Four for the last five years, and it is NOT a breeze at all; and I fear the worst is yet to come! SO, how DARE these researchers WASTE OUR TIME and THREATEN the Quality of Life of Women Yet to be Diagnosed by ASKING THE WRONG QUESTION! IF MAMMOGRAMS HELP WOMEN FIND THE CANCER AT STAGE ONE OR TWO INSTEAD OF STAGE FOUR, THEIR QUALITY OF LIFE WILL BE IMMENSELY IMPROVED!!!

These folks are LOST in their numbers. They should go to a cancer support group sometime — spend some time with “the people”!!!

I found this in wikipedia: “Perhaps the most widely discussed false positives in medical screening come from the breast cancer screening procedure mammography. The US rate of false positive mammograms is up to 15%, the highest in world.[17] The lowest rate in the world is in the Netherlands, 1%.[18

I typed into google “mammogram false positive rate” and got a wiki site re statistics and scrolled down to medical screening heading.

COSTS AND SPENDING DO MATTER.

Perhaps in the month of the ubiquitous pink ribbon the U.S. Preventative Services Task Force couldn’t have done a worse job of public relations with a report that calls for less and not more, one that targets women, and using representative with the communication skills of … well … inarticulate number crunchers.

HOWEVER, what we call “health insurance” is really a pool of funds used to hide the cost of health care from patients. Those same clients routinely complaining about the 25% or 30% portion of their employer provided health insurance premium souring 10% per year.

Health economist Uwe Rheinhardt has pointed out that it is the volume of health care spending that keeps driving up health insurance premiums. Mammograms are just one form of mass screening that consumes a significant portion of this pool of funds.

But if a group of researchers show how we might better spend that pool of funds perhaps reigning in cost inflation we prefer to resort to emotional arguments and anecdotes.

This topic was also hour one of the Diane Rehm show this morning. At least one expert guest was explicit in stating that, despite the protestations of the researchers, this data is in part about costs.

While the researchers did not consider cost in their analysis, anyone wanting to do REAL health care reform and not that joke “health insurance reform” being pushed by the White House would face extreme obstacles when trying to decide what should be paid for based on efficacy.

Just as we should encourage the use of generic drugs or less costly procedures all things being equal the same logic applies to screenings like mammograms.

Christina, I do wonder what proportion of breast cancers are estrogen-dependent. I have deduced from the fact that women with the staple of soy have way lower rates of breast cancer that most cancers are estrogen-dependent, because those would be the ones suppressed if the phytoestrogens are really so positive. I don’t know how that works; maybe the plant estrogens elbow in and keep the bad estrogenic factors out of the way.
I don’t think mainstream science has figured out how that works, so you got the advice you got. However, they have figured out enough to create their own estrogen blockers. Back in 1992, there were trials of Tamoxifen being offered, “free,” and if my surgeon hadn’t had a baby right before my surgery was scheduled, pushing me into the care of another surgeon and a month later for surgery, I would have been taking Tamoxifen. And I count my lucky stars, because I think I would have to be taking that forever, and I think I plain wouldn’t. I would have gone rogue, so to speak. I don’t know if it would have been provided free forever either. That drug might have scrambled up my efforts to weather menopause even worse.
As to cost, in 1992, the cost was a shocker. I think the hospital and surgery was $20,000, and the drugs were about $600. The radiation was the most shocking, with $500 two times a week, which wasn’t covered. And I began to fall apart, with other unrelated surgeries due to my immunities closing down. So I had to abort the chemo regime.
What is happening now is that far more costly chemo regimes are available, and it seems to me that physicians have to use the most costly or risk being sued. The days when someone could get themselves cured for $30,000 are gone. The low-cost cures are probably unworkable for legal reasons.
I don’t know what the answer is in terms of health insurance. Clearly cost has soared. Sored. Sorry.
Anyway. Prevention is best. Catching things early is better. I know breast cancer can recur even 17 years later, maybe in my brain, maybe in my bones, or my lungs… I always take that into consideration when something goes wrong. It’s much harder to catch these spinoffs. A mammogram won’t catch these things. That’s why I keep thinking I’d like a cancer-sniffing dog to give me a once-over and give me a clean bill of health.
I never had to go to the extremes of care that you have, Christina, and I’m thinking if I get to late stage cancer, have I got the grit to hold out? Thanks for keeping us informed. (I would run for the unsweetened soy milk and guzzle it day in and day out, and to heck with the doubting doctors; it’s my life I’d figure, and my body does well with phytoestrogens.)
Oh. Yes, my cancer was (is?) an estrogen-dependent cancer.

Christina, I absolutely wish you the best regarding your disease. I can’t imagine what it’s like to live with cancer.

But you’re kind of making my point for me. Your response was emotional – understandably so – and emotions can get in the way when making scientific decisions based on evidence. We need dispassionate analysis, based on data, not stories, to decide what’s the best way to save lives.

The US Preventive Services Task Force did not actually conduct any scientific study, here. What they did was to look at an array of other studies and base these recommendations on an analysis of those studies. What is significant about this (aside from the fact that many thought of this as some scientific study in and of itself) is that the task force picked which studies to analyze. To follow a scientific protocol and impartially examine and interpret data in the manner the task force used to determine these recommendations was scientific. To pick and choose which studies and which studies’ data to rely on was political. It is fairly standard for people who are in the business of interpreting data, such as this, to follow a process of interpreting the data properly; it is questionable, however, to decide which data to throw out, which data to keep, which studies to look at, which studies to not look at, etc.

So, while I would agree that in terms of data collection, facts and statistics are to be relied upon more readily than anecdotal information, many problems can still exist with the ways data are gathered and the analysis and interpretation of those data. By virtue of the fact that this task force chose which studies/data to pay attention to indicates they may well have gone into the endeavor with a desired outcome in mind, and the task force relied upon the data that supported their view of a desired outcome, which is biased and unscientific. Also, the more I read about the compilation of data and the studies that were used, the more it became apparent to me that the reasoning behind this task force’s recommendations has little to do with good, preventive medicine and more to do with cost containment.

The USPSTF is an obscure organization with an independent panel of experts funded and appointed by the government. They have only a couple of medical experts on the panel, and the rest are from the insurance industry sector. This task force worked on the preparation of these recommendations in a secretive manner, so to speak, in that they did not keep their government overseers apprised of their work and when they reached their conclusions. They also did not reveal when they were going to go public with these recommendations. Supposedly, they finished work with this a year ago and sat on their findings. It remains to be seen why they made their recommendations public this week.

Cost containment will–and should–always be part of any system of healthcare. It is a standard part of current health care practices for the clinical part of health care, as well as the insurance coverage part. So, I would urge anyone to be leery of the “rationing” scare tactics many conservative politicians and media outlets have begun spinning about these recommendations.

Also, to sum up the factual-statistical side of data versus the anecdotal side: I would always go with statistical data over anecdotal data. That said, it would be unwise to dismiss anecdotal data altogether, though. Of the women who report having been diagnosed with cancer in their 20’s, 30’s and 40’s, their feelings about what they have endured may be emotional, but the facts of the methods of determining their diagnoses, which include self examination and mammography, can not be denied.

It is important to note that the American Cancer Society has been very critical of these recommendations. It is also important to note that in Sweden, where the protocol is for women to routinely get mammograms starting at age 40, breast cancer rates have plummeted. So, if the recommendations of this task force become standard protocol in the US, increased incidences of women dying from this change in protocol will result; there’s no question. I feel it would behoove researchers to explore the effects of radiation from annual mammograms, and perhaps some reasonable solutions in the way of alternative technologies can be developed or, at the least, some study of having women scale back mammograms to every other year (or every three years) could be studied.

I feel the take away here is that each individual woman can direct her own destiny by gathering information and being in charge of her own health care decisions (the financial impact implications of these task force recommendations notwithstanding). Doctors will be frank in private, and cross-referencing information usually gives one a fairly good picture of which facts to individually follow.

Most breast cancer is discovered by women them selves. All of this advice delays the discovery of cancer, therefore Bruce Nedrow (Ned) Calonge is saying that to delay breast cancer discovery will not effect mortality. This goes against common sense.

When I was 35, a doctor insisted that I get my first mammogram. I did not have any family history of breast cancer or any symptoms that suggested I get a mammogram so I refused.

Later, I meditated on the issue, because my doctor laid a huge guilt trip on me for not taking responsibility for my health. In the meditation a small voice/intuition told me to refuse mammograms and that in the future information would surface showing the danger of the radiation from mammograms.

So for years I did just that, I refused the test as I do many invasive medical tests. Another doctor mistook one of my ribs for a lump. I got an ultrasound and nothing was found. The doctor still insisted that I get a mammogram to make sure and she gave me all this literature on chemotherapy and radiation therapy, not that I would ever to choose to go those routes. The stress from this situation nearly gave me a nervous breakdown.

I think every woman needs to choose for herself. Doctors need to refrain from pushing their beliefs and agendas on their patients–and please stop with all of the statistics, fear tactics and breasts cancer stories. Awareness is one thing, manifestation through obsession is another.

I wonder if a study was done on the media and breast cancer awareness campaigns and if all the attention has actually increased breast cancer cases or decreased them. Since breast cancer appears to be on the rise, I would think that fear has a lot to do with it and the fact that some women probably loathe their bodies thinking that cancer could sprout in their breasts at any time certainly on an emotional level could lead to manifesting cancer. Fear and stress are known to cause disease in the body–so I think we need to shift consciousness here. Compassion for women enduring this disease heals and compassion for all women who are forced to hear about breast cancer everyday of their lives would also heal. Stay aware, but stop obsessessing.

Ellen Dibble!

THANK YOU SO VERY MUCH for the FULL DISCUSSION about the phytoestrogen issue! Because you spoke so FULLY about it, I believe I can present THIS ALTERNATIVE POINT OF VIEW to my doctor, and I will when I see him next month!

Vis a vis the tamoxifen: I think your experience with it might have been FINE IF you were either ALREADY menopausal, OR if you were thrown INTO menopause by taking chemotherapy. If you did NOT have chemo and were pre-menopausal you might have experienced a tremendous loss of short-term memory and of enthusiasm. Whether those side effects go away with time, I don’t know. I NOW think that they are NOT side effects that should cause a woman to NOT take the medicine; BUT, women should be TOLD that those side effects CAN occur, and in certain circumstances, women MAY need to completely re-think their life circumstances (job, schooling, etc.) WHILE they are taking the drug. The MAIN thing for women to be concerned about at the time (1992-94) was: tamoxifen was ONLY tested on MENOPAUSAL women!!! (I KNOW because I went to the library and got help sending thru inter-library loan for EVERY paper on tamoxifen studies that were published!! LOTS of work!) WHY didn’t they do a separate study on PRE-menopausal women??? WHEN WILL THEY ASK THE RIGHT QUESTIONS!!!!! The usual course of treatment, at that time, was only about two years; sometimes up to five years; but not for forever.

I’m going to REALLY HOPE for you that your cancer does NOT come back. (I only didn’t say ‘pray’ because I don’t speak that way — but, the WISH is the same!) THANKS for YOUR thoughts!

Patricia,

I dare say, MOST women with breast cancer did NOT obsess about getting it: they GOT it, for WHATEVER reason. “Manifestation thru obsession” you say?????

STOP blaming “the victim”.

I for one REJECT YOUR kind of compassion: it’s too patronizing!!!

You’re so LUCKY to not have this disease. There IS a reason for breast cancer, for all cancers, for all the diseases of this world. But the reason is NOT “manifestation”!!!!!

As I’ve said several times above, I believe that ONE reason we don’t understand breast cancer enough is that the researchers do NOT ASK THE RIGHT QUESTIONS. And, they should be asking the women WITH breast cancer WHAT QUESTIONS TO ASK!!!!! That would be a start; but, even that is insufficient. Nature NEEDS disease. Can you imagine the over-population if there were NO disease? But, GIVEN that, HOW do we understand disease enough so that people WITH disease can LIVE with the highest quality of life until they die, and HOW do we help them avoid SUFFERING??

Christina, why do you capitalize words at random?

Dear THIS is VERY -

I capitalize the words I would emphasize if I were speaking. Friends who know BOTH my speech patterns and my writing say that READING my emails feels like HEARING me. That’s why. Thanks for ASKING!

I keep forgetting to mention that I had a routine clerical job at an Ivy League medical school decades ago, on a medical research project that had been extended. That’s why I got hired as a temp. The extension was due to the fact that the M.D./PhD. research faculty members had FORGOTTEN TO TAKE SMOKING INTO ACCOUNT.

If you want to talk about emotions VERSUS data: let me tell you how EXTREMELY NERVOUS the principals on that research project were about EVER getting NIH and NIMH funding again within their academic lifetimes!!! The entire staff of epidemiologists was working on FUDGING THE DATA to contrive a slightly different research design wherein SMOKING would not seen to be the important MISSING FACTOR that it actually was!!

Ah, yes…emotions…those guys were sweating bullets!! Ah, yes…Emotions versus…data!