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Mammodeniers

Mammodeniers

Huge British Mammogram study finds no benefit to routine screenings.

http://youtu.be/R7hiBUCSQIc

But it was settled science, and a critical part of the War on Women Democratic theme: Any cut in screening for anything, most particularly mammograms, was based on hatred of [insert patient type here]. Anyone who dissented was anti-science.

The NY Times reports, Vast Study Casts Doubts on Value of Mammograms:

One of the largest and most meticulous studies of mammography ever done, involving 90,000 women and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age.

It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation.

The study, published Tuesday in The British Medical Journal, is one of the few rigorous evaluations of mammograms conducted in the modern era of more effective breast cancer treatments. It randomly assigned Canadian women to have regular mammograms and breast exams by trained nurses or to have breast exams alone.

Here’s the summary conclusion from the study:

Conclusion Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.

Keep questioning authority, particularly when attached to a political agenda.

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Comments

I keep telling my wife that manual breast exams are very important but she rarely lets me help.

When you refuse to let markets allocate scarce resources (which ONE of many things markets do brilliantly), you are left with only one option…RATIONING.

And any rationing system will tend to be irrational AND political.

Meaning, for one thing, that women will have to politically fight others for scarce resources. Here, with mammograms, and everywhere else.

Welcome to the jungle…

You know, they’re trying to peddle the same nonsense with Prostate exams.

As someone who is a cancer survivor (no, make that “victor”), let me tell you this: go demand a prostate exam (blood test). Every year. And don’t back down.

And when it comes to mammographies, I suggest that you get together with your wife and snark all over those exams. Tell her that she doesn’t need them.

My wife, I’m going to insist that she get them. Because, noting reeks worse than the medical industry when they are trying to save money and are willing to sacrifice people to get those savings.

Is that clear enough for you?

    stevewhitemd in reply to [email protected]. | February 12, 2014 at 7:30 pm

    Paul, I’m a doc. I will make one point: these tests are not harmless. This is true of just about everything in medicine.

    If a PSA elevation leads to a man having unnecessary surgery for what turns out to be an indolent prostate cancer (one that is destined not to spread, which is common) or for something that isn’t cancer, he may be harmed from the complications of the surgery.

    Likewise, if a mammogram leads to a woman having surgery, radiation or chemotherapy for an indolent breast cancer, she may be harmed by these therapies with no benefit.

    That’s the issue. It’s one that we as docs care deeply about and one that we debate frequently in lots of different contexts. Nothing in medicine is risk-free, and we have to understand these risks and balance them as best we can.

    I’d prefer that politicians not pander on medical risks just to scare people and thus drum up votes. That leads to harm.

    “Demanding” medical tests leads to harm. I’d gently suggest that you reconsider your position.

      Thank you for your feedback.

      You’re a doc?

      Well, ok then. But please be aware that you fall somewhere on a sliding scale between “healer in the western tradition” and “butcher who is part of an industry that has never been dedicated to helping humanity maintain or acquire health”.

      Back to you, mate.

      Agree with Steve. The yearly mammogram for women with no history of breast cancer in the immediate family is ludicrous at best and dangerous at worst. I’ve had several friends who had “suspicious” breast cancer mammograms which then led to needle biopsies/or conal biopsies. All were negative, and they have the scars and the recovery time to prove it.

      My mother’s MD kept insisting she have a mammogram AND a PAP smear at age 80. She told him no, that even if she did have cancer, she was not going to treat it, and she wouldn’t want to know she had it. I couldn’t believe he was pissed at her for refusing both tests.
      She was also pleased with herself for saving Medicare $$$, LOL.

        Juba Doobai! in reply to Uh Huh. | February 13, 2014 at 1:22 am

        I had one of those biopsies, a lumpectomy, or something like that for a small mass, which I could feel, that hadn’t yet metastasized. Still have the scar. Still remember the shock, the fear, the inability to tell my family until I turned to God for comfort. After five years, I stopped doing the mammograms. There has to be a better way of looking at the breast without crushing it painfully.

    Paul, a little advice here…beware of ‘insisting’ that your wife do anything, especially having a mammogram.

Now, instead of mammograms, Dem Sen. Barbara Mukulski can demand Candygrams for every woman and for every Valentines Day (the day celebrated as an Armistice Day in the War on Women).

Otherwise she will lose ‘support’ for her ’cause.’

She could be a nose tackle for the redskins.

The problem is this is coming from the same people who are currently implementing the Liverpool Care Pathway and run hospitals in which patients are 45% more likely to die compared to American hospitals. The NHS is imploding and desperate to cut costs.

Maybe this study is true. Maybe the results haven’t been twisted to achieve political or financial goals. But I wouldn’t bet my life on it.

    amatuerwrangler in reply to Laura. | February 12, 2014 at 11:43 pm

    I heard this study described today as a “Canadian study”, something that touched my skeptic bone. Isn’t this the system that the PPACA was supposed to mimic as it was soooo good, even though many Canadians, when they found they needed care *right now* headed south to get seen at a US facility even though they had to pay real money for it.

    Could it be that the wait to get meaningful treatment in Canada contributes to the “survival” rate, making early detection not so valuable because there is no corresponding early treatment.

    Be it a mammogram or a PSA, the underlying concept is the same: if we die quickly we do not use a lot of medical care. I am waiting for the study showing that we don’t need seat belts or air bags. Think how much that would save, in ambulance costs if nothing else.

I’ve worked in radiology for 20 years as a tech and a systems engineer and I’ve come to the conclusion that 80% or more of all imaging exams are not needed. Doctors have become lazy and it’s much easier to schedule a patient for multiple x-rays, CTs and MRIs than to do a thorough physical exam. I’m still shocked at all the exams many, many patients endure. We’ve got 95 year olds getting $5,000 MRIs and CTs because they have back pain or are suffering from mental confusion. You’re 95! You’re lucky to be breathing! Even if something shows up, what can a doctor do? Doctors should be ashamed for pandering to the unreasonable demands of their patients (and patient’s families.) I’m sure fear of a negligence lawsuit also factors in. 99% of mammos are normal. Totally unnecessary unless someone in your immediate family had breast cancer. Even then, once every 3 or 4 years would be plenty. But try saying this as a politician and you’d be crucified for hating women or trying to ration health care.

    Bruce Hayden in reply to PaddyORyan. | February 13, 2014 at 1:18 pm

    Part of it is fear of malpractice suits. If the standard of care is an MRI and CAT scan, then do it, or at least order it, JIC. Then, if they get sued, they have that to cover them.

    I think things may be improving a bit though in jurisdictions with strong tort reform. The standard of care required to get into court is typically notably lower. It may be bad care, but it isn’t legally negligent care.

Rules for Medical Radicals:

1. Always follow the consensus, not the data.

2. See Rule 1.

Color me skeptical on this one . . . considering the source. As others have noted, this sounds a lot like the sort of “political science” that brought us the AGW hoax. It’s about rationing care, just as it was in 2009 when Obama’s government produced a (surprisingly) similar “study.”

Obama’s government released a “women don’t need mammograms in their 40’s and 50’s government study” that caused such an uproar that they backed off (but quietly included mammograms only every 3 yrs for these women). On the left and right, columnists and bloggers were citing study after study that this is the time frame (in their 40s and 50s) when most women are diagnosed with breast cancer, and that these mammograms save lives. I wrote about it at the time: http://fuzislippers.wordpress.com/2009/12/09/a-fetus-is-a-disease-but-breast-cancer-not-so-much/

Of course, now that Obamacare doesn’t cover annual mammograms for women in their 40’s and 50’s, they are stating that they aren’t needed after all. Curious.

This is not the first study to reach the same conclusion. Other studies have shown that routine screenings are also not system cost-effective in the big picture.

Of course, there are also studies that conclude the earth is hollow with the entry point near the North Pole and that many world leaders are actually aliens who can morph their appearance. So, it’s never enough to accept a study or poll as offered. You have to examine the study/polling protocols and consider reliability.

But, if studies hold true showing that routine screening for breast cancer doesn’t meet risk/benefit requirements and isn’t cost-effective, then yes, our government leaders need to be right there pitching for it.

    Hey Henry, I usually agree with you, but my problem is that there are substantial non-governmental studies that also show that such screenings do save lives. However, women no longer have the option, under Obamacare, to continue getting the annual screenings covered by their insurance as before. It’s no longer “legal.” This doesn’t only affect the “new” poor forced into Medicaid and/or Obamacare (i.e. the people Obama cares least about).

      Henry Hawkins in reply to Fuzzy Slippers. | February 13, 2014 at 10:47 am

      I was pretty clear about the multiplicity of studies ‘confirming’ contradictory results and the need to study a study to determine its reliability, something few are able or willing to do, while many simply consider true the study of which conclusion most pleases them.

      I was being sarcastic that this government habitually backs the wrong science.

BannedbytheGuardian | February 12, 2014 at 10:27 pm

There has been a similar conclusion in a Scandinavian study.

The false positives ( ductal carcinomas in situ ) are upping the survival rates sky high . Of course one is going to survive cancer when the don’ really have cancer.

There are very serious cases but like my doctor sis – in -law – one day out of the blue a tumour appears. Nothing they could do to stop the spread .the tumour lodged on the chest wall & short of excising lungs it was a slow waiting game . She made the 5 year mar k upping the false figures & got a congratulatory note , knowing all too well the end was coming.

Keep your weight down & boobs a manageable size .

BannedbytheGuardian | February 12, 2014 at 10:29 pm

If it is in the family then get rid of them & nice new set.

If left to politicians the compromise will be that women do get mammograms, but only on one breast.

That’s the government solution.

    Henry Hawkins in reply to Anchovy. | February 13, 2014 at 3:06 pm

    OT, but Mrs. Hawkins has the odd birth defect where her breasts are on her back. I fell in love with her the first time we slow danced.

    Sorry, the approach of Valentine’s Day is making me all mushy.

SoCA Conservative Mom | February 13, 2014 at 12:18 am

We are going the way of the UK. You can’t get a Pap in the UK until after the age of 25. Why? Because few women get cervical cancer at such a young age… never mind that it also screens for HPV and precancerous changes of the cervix. Oh, and if you are over 65, you don’t get them either. Here’s the silver lining, if you do have cervical cancer, the UK rations drugs and outright bans some of the most effective (and costly) treatments available. They joys of socialized medicine!

    BannedbytheGuardian in reply to SoCA Conservative Mom. | February 13, 2014 at 6:31 am

    Not all national health services are the same. There is nothing to stop those under 25 & over 65 paying for one in the UK . Statistics must be that the outside ages are rare & not deserving of public monies willy nilly.

    Top up private insurance is available in the UK. Do you know that not everyone is forced to go public? They have choices .

      SoCA Conservative Mom in reply to BannedbytheGuardian. | February 13, 2014 at 12:16 pm

      So, if you don’t like the healthcare you get from the NHS, you can continue to pay for it, but then go private and pay for that as well? I bet you think the NHS is free.

        BannedbytheGuardian in reply to SoCA Conservative Mom. | February 13, 2014 at 12:52 pm

        There are sections of the NHS you would use if it suits you . If you want something extra you pay . Sure what is wrong with that?

        It is like public schools – it costs to have the schools in place even if you send your kid private. I don’t know any parents who want the local schools closed up . Or roads or water supply . A nation decides to supply the basics & if you want more , you pay for it.

          SoCA Conservative Mom in reply to BannedbytheGuardian. | February 13, 2014 at 7:00 pm

          Are you sure “the nation” decided, or was it bureaucrats with an eye on the bottom line making the decision?

          BannedbytheGuardian in reply to BannedbytheGuardian. | February 13, 2014 at 7:28 pm

          It is their business how they allocate funds . The latest numbers are that british women are diagnosed at a similar stage to Canada Australia Norway Sweden but fare worse . Danes are diagnosed later but one done fare equally . The other 4 have survival rates equal or better than the USA.

          Today it was announced that the newest life extension drug ( a mix of Herceptin & chemotherapy agent ) Will be offered FREE to English women in the terminal stages . Scotland & Wales may follow suit. Herceptin was already free to genetic qualified patients. A team of nurses come to you home for the 1 & 1/2 hours the infusion takes . That is pretty good . ( we have to goto outpatients ) .

          This could bring the survival rates up . This drug costs six thousand pounds per month & initially 1,300 women will benefit .

          Brits can get on county & local medical boards & school boards , get elected for local councils etc . They are not powerless.

          BannedbytheGuardian in reply to BannedbytheGuardian. | February 13, 2014 at 7:34 pm

          My possible mistake – water was privatised by Thatcher ? Do you have private water or trust your bureaucrats?

So much is made political these days, especially where medicine is concerned. So, I reflexively go where the surgeon (the guy had magical soft and healing hands) who did my lumpectomy recommended. Regular manual exams to intimately know your breast. It’s amazing how many women may not know of the different kind of breast tissues and how they feel. Standing and lying flat exams of the breast during the period when tissue changes are obvious, and after the period when the tissue is back to normal. Plus, if we keep our weight down, it’s easier for us to note changes.

Those of you advocating a cut off point for mammograms, wise words. Nobody gets out of life alive.

My wife has opted for thermography.

Not everyone is compelled by this study. As a physician I tend to check with experts. This is the position of world renowned cancer center, the City of Hope in Duate, CA, has to say about the study.

http://breakthroughs.cityofhope.org/mammograms-breast-cancer/11540/

    Cat Herder in reply to katasuburi. | February 13, 2014 at 4:46 pm

    Thanks for that link. Information from people who know how to analyze the weaknesses in a study is very valuable to those of us who do not know enough to assess the merits of the work. I think I will continue with regular mammograms for now.

I think the US has markedly better recovery rates when diagnosed with breast cancer than Canada or England. I believe women do not wait for treatment here as I have read they do in other countries that utilize ‘governmental’ health care delivery systems. That being said, perhaps the study would have a different out come here, as we survive breast cancer better than anyone & possibly/probably treat more aggressively. Also, we have numerous (but expensive) ways to combat side effects of treatment (nausea, dehydration, weight loss, etc) that often can stop treatment if not adequately addressed.
I believe the government does not want to fund yearly mammograms & feels the loss of what they consider to be a small % of women’s’ lives makes good budgetary sense. My good friend would be dead if not for yearly mammograms. I’m happy with how we do it now.

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