Less Mammography in my future

[Tuckervill]

ScienceDaily (Nov. 16, 2009) — A comprehensive analysis of various mammography screening schedules suggests that biennial (every two years) screening of average risk women between the ages of 50 and 74 achieves most of the benefits of annual screening, but with less harm. The results represent a unanimous consensus of six independent research groups from various academic institutions.

Link (http://www.sciencedaily.com/releases/2009/11/091116173149.htm)

Just in time for me...had one for year 47, and if I wait until I'm 50, I only get to skip 2 years. :p

What occurred to me first when I heard this news was that the reason there will be (and there has been) so much push back from the doctors, etc., is because, in theory, their business would be cut clean in half by this recommendation.

Karen

[roadie gal]

My first thought was that, with this recommendation, that insurance companies are going to use it as an excuse to deny payment to younger women who have a good reason (family history, etc.) to get mammograms. Breast cancer is being diagnosed in younger and younger women, a lot of them without any risk factors besides being a woman.

I'm getting really sick of people assuming that doctors are just in it for the money. MOST are not. MOST want what's best for their patients. Of course, the bad apples who are ripping people off get all of the news, so it seems like there's a lot of them. But they are the vast minority.

[KnottedYet]

My first thought was that, with this recommendation, that insurance companies are going to use it as an excuse to deny payment to younger women who have a good reason (family history, etc.) to get mammograms.

Yup.

People tend to forget that insurance companies exist to make a profit for their shareholders. The less they pay out, the bigger their profit.

[hoffsquared]

Here's an article from the Washington Post (http://www.washingtonpost.com/wp-dyn/content/article/2009/11/16/AR2009111602822.html?hpid%3Dtopnews&sub=AR). Hard to know what to think with all these conflicting views.

[MommyBird]

Drug prices being raised, mammography schedules changing...more changes will come as society prepares for socialized medicine.
The media is doing a great job of creating the "correct" enemy list in the public's minds. Propaganda at its finest hour in the USA.
Are drugs too expensive or is it expensive to develop new drugs?

Read Atlas Shrugged...It is prophetic.

[tulip]

I'm 42 and just had my third one last Thursday. I have no history of breast cancer in my family and no reason to need a mammo except that the Powers That Be said I did. So I did, not having any reason to do otherwise. Now, I will wait for 8 years for my next one. At least I have some good baselines.

[shootingstar]

I'm 42 and just had my third one last Thursday. I have no history of breast cancer in my family and no reason to need a mammo except that the Powers That Be said I did. So I did, not having any reason to do otherwise. Now, I will wait for 8 years for my next one. At least I have some good baselines.

I had my 2nd mammogram a few months ago. I'm 50. I'm clear. My lst mammogram was over 10 yrs. ago. No problems.

It was a decision that I made. I could have had one 2 yrs. ago but I kept forgetting to book the appt. It has nothing to do with socialized medicine. Here in British Columbia they advise women over 50 get a mammogram every 2years. I'm not even sure I want it in 2 years..abit later.

[Pedal Wench]

The thought that I could have a cancer growing undetected in my body for two years is petrifying. Under 10% of breast cancer patients had a family history, which means most people have no reason to go, except perhaps to save their lives.

[shootingstar]

Last time I was at the dentist I was told to have my teeth X-rayed.

What for? I got the x-rays 2.5 yrs. ago. At that time, they explained what needed to be done, type of dental self-care I had to do in-between dental visits.

At some point, an old filling needs to be replaced. But I can't afford it right now since I'm not working right now. And it's not hurting me yet. Canada's public medical insurance does not cover dental care.

So I quietly refused the x-rays with my reason and had my teeth cleaned as I originally requested.

Prior to this dentist, I only had my teeth x-rayed every time I switched to a new dentist. In Toronto, I had a dentist for over 15 yrs. with visits twice per year. I was only teeth x-rayed twice..when I started as a new patient and several years later when I had dental surgery to remove 4 wisdom teeth. That's all I wanted in terms of x-rays from any dentist. Minimal.

Unlike some people, I have good teeth. Just have to watch out for the gums.

Sorry..for digression. More about x-rays than mammos.

[indysteel]

My first thought was that, with this recommendation, that insurance companies are going to use it as an excuse to deny payment to younger women who have a good reason (family history, etc.) to get mammograms. Breast cancer is being diagnosed in younger and younger women, a lot of them without any risk factors besides being a woman.

My understanding is that the 50+ recommendation specifically does not apply to those at higher risk for BC, e.g., women with a family history and Africans/of African-descent. FWIW, I got my baseline mammogram done at age 30 because my mom had breast cancer at age 34. Despite the fact that I received my baseline 10 years before I would have otherwise gotten my first mammogram under the previous guidelines, my insurance carriers have never denied my claims. I'd like to think that I won't have problems under the current guidelines either.

[shootingstar]

I suspect my mother had mammos less than 3-4 times in her whole lifetime.

She's clear..at 75. She has other long-term problems....high blood pressure and abit of gout.

(Oh yea, she still has excellent teeth. Maybe the best in the family so far.)
I did have an aunt who started to have abit of breast cancer. But she died from totally different reasons at 82.

I come from an extended family of many women. No. of females across 3 generations dominate by 70% over no. of males. So far the breast cancer is very low. Just that aunt I mentioned. Maybe there's another woman I don't know. But this is out of 30+ women.

We'll see. Dietary changes, environmental factors, etc.

[Tuckervill]

The guidelines are just falling in line with the rest of the industrialized world.

Karen

[ny biker]

It's statements like this that bother me:

"For women age 50 and older, cutting back to screening every two years would maintain 81 percent of the benefits of testing annually while reducing by half the number of false-positives, the computer modeling study estimated. "

Yeah I understand the problem of false positives, but I'd really hate to be one of the 19% that could have been helped. That's a big number.

Anyway I have pretty much every risk factor there is -- family history, no children, etc. I would be happy to avoid the pain of being squished, but I will continue to get them every year because it's worth it for me.

[smilingcat]

My first thought was that, with this recommendation, that insurance companies are going to use it as an excuse to deny payment to younger women who have a good reason (family history, etc.) to get mammograms. Breast cancer is being diagnosed in younger and younger women, a lot of them without any risk factors besides being a woman.

I'm getting really sick of people assuming that doctors are just in it for the money. MOST are not. MOST want what's best for their patients. Of course, the bad apples who are ripping people off get all of the news, so it seems like there's a lot of them. But they are the vast minority.

++1 and with KnottedYet.

Oh absolutely to make more profit for the insurance company. They are not denying payment. they will continue to collect the same amount as before but less payout because of the new guideline. WHAT A DEAL!! they are not the bad guy cause now the gov panel is going to deny you the test. Not the insurance company.

As far as Atlas Shrugged, I suggest you read Animal Spirits by George Akerlof and Robert Shiller. (BTW Dr. Akerlof is a prof. of Economics of UC Berkley. Maybe too left wing. How about his other crendential 2001 Nobel winner in Economics. and Dr. Shiller is a professor at Yale.) BTW, the book was used for a Yale grad students in economics and law. And you do need to know the basics of Keynesian theory/principles of economics. Its my book at the moment...I'm not going into diatribe about Ayn Rand.

We can flame each other via PM if you wish.

[Zen]

Drug prices being raised, mammography schedules changing...more changes will come as society prepares for socialized medicine.

Socialized medicine?
Don't even start that one.

[uforgot]

Every year for me too. Until my mom was diagnosed with breast cancer, we had no history either. It was diagnosed early, wasn't in the lymph nodes, but reappeared in the other breast within a few years and she lost the battle. Two years is too long. I've seen what it does.

[Tuckervill]

If annually is good, why not every six months? Or every quarter?

This is an honest question.

Karen

[Pedal Wench]

I did have an aunt who started to have abit of breast cancer. But she died from totally different reasons at 82.


A bit of cancer? You either do or don't.

Unfortunately, family history is only a very small indicator of risk - I believe under 10% of women diagnosed have had a previous family history.

[Pedal Wench]

If annually is good, why not every six months? Or every quarter?

This is an honest question.

Karen

It's thought that the growth of a tumor can be controlled if caught within a year.

[indysteel]

A bit of cancer? You either do or don't.

Unfortunately, family history is only a very small indicator of risk - I believe under 10% of women diagnosed have had a previous family history.

Someone correct me if I'm wrong, but I think the genetic link is stronger if your family history has incidents of premenopausal BC, rather than post. That's why I decided it was best to start young.

Uforgot---I'm so sorry about your mom. (((((()))))))

[melissam]

What bothers me about this is that this is the best tool we have for screening breast cancer. This is a disease that affects a huge number of women, and we're told that early detection is the best way to prevent death from breast cancer. Yet, the screening tool is bad enough that they now think its risks outweigh its benefits until women are over 50. And then it's only useful every 3 years.

Oh, and all that self-checking every month stuff -- no, never mind, it's not useful either. And if I read correctly, they're thinking that breast exams performed by a doctor aren't that helpful either.

Ahem. Pardon my language here, but WTF?

Is someone working on a better screening tool? Until we get one, this is the best shot we have at preventing breast cancer, so I'm a little pissed about the experts recommending that we limit the use of this tool.

[ny biker]

What bothers me about this is that this is the best tool we have for screening breast cancer. This is a disease that affects a huge number of women, and we're told that early detection is the best way to prevent death from breast cancer. Yet, the screening tool is bad enough that they now think its risks outweigh its benefits until women are over 50. And then it's only useful every 3 years.

Oh, and all that self-checking every month stuff -- no, never mind, it's not useful either. And if I read correctly, they're thinking that breast exams performed by a doctor aren't that helpful either.

Ahem. Pardon my language here, but WTF?

Is someone working on a better screening tool? Until we get one, this is the best shot we have at preventing breast cancer, so I'm a little pissed about the experts recommending that we limit the use of this tool.


+1000

[beccaB]

I'm just going to keep on keepin' on. My Mom died of that disease three years older than I am now. If I get a false positive, further tests will prove one way or the other. I've has numerous call-backs. I'd rather that than the alternative.I have had one every year now since I was 40, 8 years ago. I made it past that certain age milestone where my Mom was first diagnosed. Every time I have a clean mammo I go buy myself a treat from Victoria's Secret!

[OakLeaf]

Yeah I understand the problem of false positives, but I'd really hate to be one of the 19% that could have been helped. That's a big number.

It's more like the 0.1% who could have been helped. Statistically, they have to irradiate 1,000 women and biopsy 100 before they get one who meets the doctors' definition of having been helped... which may be a considerably broader definition of "helped" than many patients may have.

This latest recommendation is the distillation of the doctors' grudging realization that they were harming way, way, way too many women in the name of helping some. And as others have pointed out, it merely brings the USA in line with the rest of the developed world (which, at least some of the rest of the developed world is now considering further narrowing the pool of women to whom they recommend irradiation).

I was thinking about this while doing yardwork this afternoon. Basically, for the individual, it's no different from a religion. There is no way that any individual can know whether she's been helped. It's sometimes, but not always, easier to know when a woman has been harmed.

Each of us has to believe what we need to believe to get through the day. Considering what's at stake, what we may have been through on this front, and the indoctrination we receive, just thinking about it, just looking in the mirror, putting on a bra or a HRM, can be extremely distressing. I'm pretty sure I have a mild case of PTSD from it, and I'm very sure that a lot of other women do.

IMO, the best we can do, just as we do with religion, is try to make choices and choose belief systems that don't hurt ourselves or other people, but at the same time try to avoid attacking other people's belief systems - even if they seem to us to be hurtful.

[firenze11]

What bothers me about this is that this is the best tool we have for screening breast cancer. This is a disease that affects a huge number of women, and we're told that early detection is the best way to prevent death from breast cancer. Yet, the screening tool is bad enough that they now think its risks outweigh its benefits until women are over 50. And then it's only useful every 3 years.

Oh, and all that self-checking every month stuff -- no, never mind, it's not useful either. And if I read correctly, they're thinking that breast exams performed by a doctor aren't that helpful either.

Ahem. Pardon my language here, but WTF?

Is someone working on a better screening tool? Until we get one, this is the best shot we have at preventing breast cancer, so I'm a little pissed about the experts recommending that we limit the use of this tool.

I couldn't really put my finger on why this was bothering me so much, but you hit the nail on the head for me. I'm only 26 so maybe (hopefully) by the time I'm 40 there will be better means of detection and treatment. This just makes me feel confused and somewhat helpless. After watching my Mom's best friend battle breast cancer for over 10 years after late detection and seeing the pain her daughter faced and continues to face after she passed away this July, I can't help but feeling this is all too statistical.

[roadie gal]

MRIs and ultrasounds are both tests that are being studied. I'm not sure where either one stands at this time. Ultrasound is easy to get and does not irradiate you, but it's very operator dependent. It takes a very skilled technician to do it competently. MRI is extremely expensive and time consuming and a lot of people can't deal with the claustrophobia of the MRI machine. Also, if you have a pacemaker or other medical hardware you may not be able to get an MRI.

When I was in medical school in the last 70s to early 80s I was taught the incidence of breast cancer was one in 12 women. Now it's about one in 8. That's a HUGE increase. Some of it may be due to earlier detection of low level cancers that may have undergone spontaneous remission without treatment. But I believe those numbers do reflect a true increased incidence.

I've read some of the studies that look at mammograms as a screening tool, as well as self exam. None of the screening tools are great, but they're better than nothing. I'll keep getting my mammos until something better comes along.

[Running Mommy]

I just found out that my 63 yr old mom had a "bad" (her words) mamo in October. They are doing NOTHING at this point and just ordered another one in March. She's a bit freaked out as I am.
Last year I had my baseline mamo when I turned (ack) 40. They found lots of suspicious things and I was off for a battery of other tests, blood work and an ultrasound. Turned out ok. But I still feel like I need to keep an eye on it.
I had cervical cancer in 2001, so I am hyper sensitive to being diagnosed with another form of it. I just know of too many people who beat C the first time, but it got them the second time around.
I begged my mom to keep up w/the self exams and if she feels ANYTHING to make a beeline to the doc.
And now this comes out...
I don't really like it. I can see maybe doing it every other year, or even every couple. But to say that self exams are useless and to discourage them??
I would really like the "expert" that came up with that recommendation to explain their reasoning.

[fastdogs]

I'm thinking I'll stick to once a year still- except that probably after this, most insurance will not pay for it.
My sister never saw a doctor till she was 50. She felt a small lump and went in for her first mammogram. She found out she was stage 4 breast cancer- they removed both breasts and over 20 lymph nodes. It had already spread through most of her organs. She is still with us, but won't tell us how long she has left. The latest test was to see if it's spread to her brain, the only place it hasn't been found. Unless they can find the right chemo blend, she'll be on and off chemo and on heavy pain meds for however much longer she lives.
Before her, there was no history in my family.
vickie

[Pedal Wench]

I'm trying to figure out why this has made me so, so angry. I think I'm getting a grasp on it.

This task force has said that all the false positives just make women unnecessarily worried. It's all so degrading -- women are just so fragile that they can't make up their own minds and take charge of their bodies and health. Don't do a self-exam because you might not be able to handle the results or the stress while determining if it's a cancerous growth that might be silently killing you.

Even some of the opinions here - you might not feel that you want to know what's going on in your body, but for the government to tell women not to worry about it until they're 50, when so, so many women are dying because their cancer wasn't caught earlier is infuriating. Don't tell women to put their heads in the sand and their hands in their pockets. Feel your boobs, learn them, and know what your options are. It's my body, and I'll be damned if I'll let a government task force decide what's best for me.

In the interest of full disclosure, I"ve had numerous suspicious lumps, some discovered by self-exam, some on mammogram. I've had biopsies on most of them, and wear the scars proudly, because I know they're a symbol of me taking charge of my body and proactively fighting for my life.

[Pedal Wench]

Someone correct me if I'm wrong, but I think the genetic link is stronger if your family history has incidents of premenopausal BC, rather than post. That's why I decided it was best to start young.

Uforgot---I'm so sorry about your mom. (((((()))))))

From the American Cancer Society:
Family history of breast cancer

Breast cancer risk is higher among women whose close blood relatives have this disease.

Having one first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman's risk. Having 2 first-degree relatives increases her risk about 5-fold.

Although the exact risk is not known, women with a family history of breast cancer in a father or brother also have an increased risk of breast cancer. Altogether, about 20% to 30% of women with breast cancer have a family member with this disease. This means that most (70% to 80%) women who get breast cancer do not have a family history of this disease.)

[ny biker]

Actually the recommendation regarding self exams was that having a doctor instruct the patient on how to do them was not helpful. It did not say that doing self exams was useless. I guess that means we are able to figure out how to do them on our own??

Anyway, as I said, due to my own risk factors I will continue getting annual mammograms unless my doctor advises otherwise. And I will be very surprised if he advises against them for my situation.

[Thorn]

I'm trying to figure out why this has made me so, so angry. I think I'm getting a grasp on it.

This task force has said that all the false positives just make women unnecessarily worried. It's all so degrading -- women are just so fragile that they can't make up their own minds and take charge of their bodies and health. Don't do a self-exam because you might not be able to handle the results or the stress while determining if it's a cancerous growth that might be silently killing you.

Even some of the opinions here - you might not feel that you want to know what's going on in your body, but for the government to tell women not to worry about it until they're 50, when so, so many women are dying because their cancer wasn't caught earlier is infuriating. Don't tell women to put their heads in the sand and their hands in their pockets. Feel your boobs, learn them, and know what your options are. It's my body, and I'll be damned if I'll let a government task force decide what's best for me.

In the interest of full disclosure, I"ve had numerous suspicious lumps, some discovered by self-exam, some on mammogram. I've had biopsies on most of them, and wear the scars proudly, because I know they're a symbol of me taking charge of my body and proactively fighting for my life.

+ 10^infinite

Well said.

[OakLeaf]

PW, I'm glad you feel you came through your biopsies unscathed.

I'll just say that it wasn't the same for me, and leave it at that.

The potential damage from a false positive is far more than "worry." (Although the health effects of worry are significant in themselves.) PTSD, even a mild case, is not fun.

The potential damage from unnecessarily treating a cancer or abnormal cells is enormous. Didn't you read the other studies released this week - that 50% of women have chronic pain after breast cancer surgery, and some enormous fraction of men leave their wives after a cancer diagnosis. If only 1/3 of those cancers could benefit from treatment, that's a huge amount of damage.

The tissue trauma and the massive doses of radiation involved in biopsying abnormal cells has the potential to cause invasive cancer when none would have resulted otherwise.

It's not about "worry."

As I said - we each have to believe what we have to believe, but let's be gentle with each other.


But I guess I will say that this is all academic for me, not only because they'd recommend six-month mammos for me in any case, but also because I am never having another one. I spent a lot of time and energy researching the risks and benefits, and one thing is certain, no one is ever going to touch my breasts without love again. A life lived in a constant state of objectification, pain and terror is just not worth it, to me, especially when there's a 90% chance that I'd receive no benefit from it. Maybe someday I'll even be able to enjoy the touch again.

[lunacycles]

I'm 44, and I've had two. Such fun! But I do feel a little mixed, and I am really not pro-screening for the reasons they just upped the recommended age to 50. Having said that, I have a friend who had one in her late 40's (with little or no family history), and it literally saved her life (or we hope, double mastectomy and 3 rounds of chemo later...)

I also find it interesting that, even with all the new drugs and ways of testing for cancer, that survival rates haven't changed much in the last few decades.:(

[Pedal Wench]

I also find it interesting that, even with all the new drugs and ways of testing for cancer, that survival rates haven't changed much in the last few decades.:(

Margo, at the 3-Days, they've been saying that survival rates, with early detection, have gone from about 75% up to something like 98%

These stats stress the extreme importance of early detection:

Stage I:100%

Stage IIA: 92%

Stage IIB:81%

Stage IIIA:67%

Stage IIIB:54%

Stage IV:20%

[KnottedYet]

Have we seen any studies saying men shouldn't bother having their prostates looked at during their annual check-ups?

Have we seen any that say men shouldn't bother doing their self exams for testicular cancer, because they are too fragile to touch themselves and it would stress them out?

ETA: Because of family history of breast cancer and personal history of cancer, I've been getting mammos every year since I was 35. They are about as comfy as lying face-down on a hardwood floor, but not nearly as painful as all the excisions I had for cancer here, there, and everywhere. (I like my cancer fresh and little and REMOVED.) I get more radiation from my monthly flights to San Francisco than I do from my annual mammo, and even more if I have a whiskey and coke during the flight. (did you know a fifth of whiskey emits 400 beta rays per minute?)

I may glow in the dark, and I may have some entertainingly cheloided excision scars; but dammit I'm not dead yet (Knottedyet, get it?) and I'm going for the gusto!

[ny biker]

Interesting column in the Washington Post today:

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/17/AR2009111703140_pf.html

[OakLeaf]

Have we seen any studies saying men shouldn't bother having their prostates looked at during their annual check-ups?



As a matter of fact, yes. This was the medical consensus over a year ago, and all along, it's been much easier for physicians to dispute the corporate wisdom on prostate cancer screening than breast cancer. (I could point out the massive amount of profit in breast cancer screening vis-a-vis prostate...)

None of this is new, and the only part of it that's "news" is that the public health authorities have decided to bring their recommendations more in line with a real risk/benefit analysis. This has been building for at least 15 years, and there have been several well-publicized studies this past year alone. I don't know why this seems like it's a new issue to so many people here.

If you want to analyze the gender issues, my take is that (1) in general, women tend to be more easily led by their physicians or any supposed "authority;" and (2) physicians in general love to practice "bikini medicine" on women, whereas a physical exam of a man usually takes a much closer look at the whole body, even de-emphasizing the sex organs.

I'll just repeat two things, and then I'm outa here.

Screening is not harmless. Screening has known and well-recognized harms that go far, far, far beyond "worry." In coming up with these recommendations, public health authorities try to balance the known/potential harm against the known/potential benefit. If an individual is asymptomatic and not in a risk group, then they stand a much, much greater chance of being harmed by screening than of receiving a benefit.

In any individual case, there is no way to know whether treatment for an identified cancer has been beneficial, harmful, or had no net effect. All the public health authorities have to go on is retrospective statistics. This is true of most procedures. But making an individual decision is more complex, and involves looking honestly at quality of life issues. People who have already been through the procedures believe what they need to about the decisions they've made in the past; people contemplating a future decision need to be smart about it.

Is it worth turning over complete control of your life to the medical establishment, being treated like a piece of meat without emotions, intellect, pain, or, indeed any body parts other than the one(s) being treated for cancer, in exchange for a 10% to 30% chance of extending the duration of one's life? That's a decision each individual has to make for herself.

[lunacycles]

pedal wench said:

Margo, at the 3-Days, they've been saying that survival rates, with early detection, have gone from about 75% up to something like 98%

These stats stress the extreme importance of early detection:

Stage I:100%

Stage IIA: 92%

Stage IIB:81%

Stage IIIA:67%

Stage IIIB:54%

Stage IV:20%

Thanks for that. I haven't heard that. I wasn't speaking specifically about breast cancer. I read, NYTimes I think (that's the only news source I really read regularly these days), but who knows for sure, that over the last few decades overall cancer survival rates have barely changed/improved...despite all the new treatments out there. Please understand I am not stating an opinion that I think screening is a bad idea AT ALL. Like I said, I think it saved the life of a friend of mine, and I bet we all know someone for whom it did.

[shootingstar]

Each healthy woman makes an individual choice how often she would like to have a mammo...regardless of what her country's health care system advises.

I figure my chances on the bike on the road, I have greater chance of being doored, falling on the road (I have already --twice on ice.) or hit by a car (was hit as a pedestrian in front of a life insurance company)...are higher than breast cancer, at this time.

So I don't want to get a mammo yearly. Every 2 years ..continues to be the norm up in our jurisdiction...if a woman wants it that often.

As for being safe while cycling, that's why I would like my city to keep on building cycling infrastructure to make it safer. Meanwhile I continue to cycle my favourite routes that are quiet, etc.

Yes, it's all a risk. Meanwhile we all vigorously defend why we cycle so often on the road while other people think we are risking our lives/health.

[OakLeaf]

The National Women's Health Network (http://www.ourbodiesourblog.org/blog/2009/11/mammograms-guidelines-are-causing-confusion-but-they-make-sense) has a detailed discussion.

(Posting a link doesn't count as jumping back into the thread after I said I was out. :p)

[Tuckervill]

Thanks for posting that link, Oak. I was listening to Dr. Laura Berman on Oprah Radio today (only got to listen to a little bit), talking about this issue. The amount of misapplication of the facts, and lack of critical thinking and logic, even on the part of the host, is really astounding. I'm looking forward to reading the link.

Karen

[Trek420]

These stats stress the extreme importance of early detection:

Stage I:100%

Stage IIA: 92%

Stage IIB:81%

Stage IIIA:67%

Stage IIIB:54%

Stage IV:20%

That can depend on who you are, if you have access to health care. From http://www.sistersnetworkinc.org/news.html

"An estimated 19,540 new cases of breast cancer are expected to occur among African American women in 2009

The overall incidence rate of breast cancer is 10% lower in African American women than white women.

African American women have a five year survival rate of 77% after diagnosis as compared to 90% for white women."

I don't know the statistics for other communities.

Access to health care, making it available & affordable, promoting a culture of wellness saves lives (not to politicize the board).

If I was uninsured and a clinic offers free exams if I fear that if something is found I could not get care or worse would never be insurable in the future would I go?

[SLash]

I am high-risk for breast cancer and yet no family member has ever been diagnosed with breast cancer. I emailed my breast doc yesterday to see what he thought about the findings of the task force. I learned that prior to 1993; the National Cancer Institute endorsed mammography every 1-2 years in women age 40-49. Then in 1993 the NCI changed their policy and recommended mammograms at age 50. In 1996 the NCI changed its tune yet again and decided on “no policy”, then in 1997 they reinstated their original policy of mammograms ever 1-2 years for women in their 40s in accordance with the pre-1993 standards. Reportedly, none of these changes were based on new clinical trials either. Interesting huh… :rolleyes:

In contrast, the American Cancer Society has maintained age 40 as the starting point for screening mammography from the beginning.

It is important to remember many women diagnosed with breast cancer have no known family history of breast cancer; and under the new guidelines if they are under the age of 50 they will not be targeted for a screening mammogram. According to the Task Force it is not statistically valid to screen women under age 50 because of the infrequency of cancer. I would say to the 1 woman per 1900 women in their 40’s that is found to have breast cancer, it is.

Dr. Otis Brawley, American Cancer Society's chief medical officer said it this way: the Task Force advice is based on its conclusion that screening 1300 women in their 50's to save one life is worth it, but that screening 1900 women in their 40's to save one life is not."

If you are a conspiracy theorist like myself ;) you have to wonder what is behind this change. For one thing there is a lot of money spent each year on biopsies generated often by mammograms and often resulting in a negative finding. The woman looks at that as great news, her insurance company may look at it as proof of an unnecessary and more importantly to them, expensive test. So, to avoid the cost of the mammogram, plus the potential costs generated from further tests and procedures, you stop doing the test that identifies the problem in the first place.

One of the real dangers is that because of this change in mammogram guidelines that in time some insurance companies will either not cover mammograms for women under the age of 50, or will cover them in very limited situations and that will result in fewer women getting them.

The fact is, coverage of mammograms expanded when the guidelines for mammograms changed to recommend them annually for women 40 years of age and older it is not unreasonable to think they will change again with the new guidelines.

When insurance companies do not cover preventative tests, people are not nearly as apt to get them, and when people do not get the preventative tests diseases such as cancer are not caught as early and the survival rate goes down. That's the real shame in all this.

Getting off soapbox now... ;)

[Tuckervill]

I heard on the radio today that every state except Utah has laws that require insurance companies to cover mammograms for women 40+.

Karen

[shootingstar]

Access to health care, making it available & affordable, promoting a culture of wellness saves lives (not to politicize the board).

If I was uninsured and a clinic offers free exams if I fear that if something is found I could not get care or worse would never be insurable in the future would I go?

Have wondered about this for a long time, Trek with respect to U.S. present health care system.

But that's another long, long separate discussion.

[SLash]

I heard on the radio today that every state except Utah has laws that require insurance companies to cover mammograms for women 40+.

Karen

The Natonal Women's Law Center has ranked each state's policy. See: http://hrc.nwlc.org/Policy-Indicators/Addressing-Wellness-and-Prevention/Mammogram.aspx#footnote

"States that require private insurers to cover annual mammograms for women age 40 and older (1) are considered to have comprehensive breast cancer screenings and therefore receive a "meets policy." States receive a "limited policy" if they require private insurers to cover annual mammograms for women age 50 or older, or "if required by a physician." States receive a "weak policy" if they only require insurers to offer mammogram coverage as a benefit in employer-sponsored insurance plans, but have not required that it be a mandated benefit in all of these insurance plans. States that do not have any requirements regarding insurance coverage for mammograms receive a "no policy."

They show 20 states "meet policy", 27 states "limited policy" and 3 states "weak policy". The data is from 2007.

[Trek420]

Have wondered about this for a long time, Trek with respect to U.S. present health care system.

But that's another long, long separate discussion.

I'm not in the medical field, no training in it whatsoever etc. I do work in a busy call center where most of the folks I talk to are both poor and disabled and have done so over 13 years, so I've heard a lot.

Difficulties like being unable to get to preventative and after care appointments are common challenges. Some live in areas with no public transportation, one illness where suddenly you can't drive and preventative and after care is out of the question if you do not have an awesome support network. Others can't afford the time off required to do all that.

You'd be surprised the number of tales I hear of one disease or diagnosis, a lost job or being on disability and a spiral into poverty or maybe you wouldn't.

If I had $5.00 for every time I've heard "I used to be like you with a good job, never thought this could happen to me ...." I'd be retired .... and probably being an activist for this cause full time. :rolleyes:

I'd really like to see figures on cancer survivorship by income level :( but you are right .... that's a whole 'nother discussion.

[nc tam]

http://www.acr.org/HomePageCategories/News/ACRNewsCenter/UPSTFDetails.aspx

The fact that this is from the American College of Radiology will automatically make it suspect for some of you. Just thought you might be interested in what radiologists think of the recommendations since radiologists are reading the mammograms.

And from the American Cancer Society:
http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Responds_to_Changes_to_USPSTF_Mammography_Guidelines.asp

As far as other possibilities for screening... ultrasound is very operator dependent and is too insensitive for microcalcifications, a common presentation of both in situ and invasive ductal cancers. MRI is too time consuming, requires IV contrast and has too many false positives (more than mammography in some series) to be a screening study. Researchers are working on all sorts of things. Only time will tell.

[SLash]

I'm not sure if this is allowed, if not I'll remove the link/post, but I think it tells a side of the story on the new mammography/self-exam guidelines better than anything else I have read (or written). The link is to a FB page (I know, FB :eek:), it is the Young Survival Coalition fan page. It appears to be open to everyone because I logged out and tried the link and it worked. It starts about mid-page.

I think their stories and comments help us to understand why there is the outrage toward the new guidelines and also maybe help those younger than 50 understand the risk of following them. http://bit.ly/3S1Wy6

I hope this isn't viewed as political or something, but I think it is just too important a subject not to post this.

[Tuckervill]

Ultimately, the public needs to set aside automatic enthusiasm for screening and develop a new kind of savvy—one that balances hope with a certain dose of healthy skepticism and leads people to embark on testing only after considering a host of variables, both personal and scientific. As it turns out, in cancer screening, as in so much else, there really isn't a free lunch.

link (http://www.slate.com/id/2235898/pagenum/all/#p2)

Pretty much sums up how I think about it.

Karen

[OakLeaf]

New meta-analysis (http://rsna2009.rsna.org/search/event_display.cfm?em_id=8012231&printmode=y&autoprint=n) on the risks of radiation - mammography more than doubles rates of breast cancer in high-risk women.

[KnottedYet]

I'm always a little hesitant to embrace met-analysis "results."

The farther you get from the actual research, the less faith you can have in your findings.

Summaries of meta-analyses even more so. Once this is published in a journal, peer reviewed, original articles are listed, and the students explain how they made the jump from "early cancer found by mammogram in women with a family history" to "cancer caused by mammogram;" then I'll be glad to read it. Tumors don't wear a little banner saying "I was caused by ---"

Original research is grindingly slow and frustrating work. (2 years down and results presented at an international conference, now the long process of getting published) But at least I know my data, and every single one of the subjects in my study, and exactly what I did, and how I came to my conclusions. I stand behind my results. If instead I had done a re-structuring and re-filtering and re-assessing book report of the published work of 5 other groups... well, I couldn't in good faith stand behind that.

The headline could just as easily be: "mammography more than doubles rates of early cancer detection in high-risk women." As time passes and technology advances it is inevitable that we begin finding cancers earlier in one generation than it was found in the previous generation.

Detection method does not imply cause. Kind of like if my Grandma never went to a dentist until she was 50, and they found a bad cavity and the tooth had to be pulled. She tells me I'm at high risk of cavities, so I go to the dentist every year. He finds a small cavity when I'm 30. Do I turn around and say that seeing the dentist early and regularly caused my cavity? Nope. But I could do a meta-analysis that would "prove" exactly that. And should I stop flossing my teeth and looking at my teeth until I'm 50, and then start going to the dentist? Nope.

[OakLeaf]

All points well taken.

But no one disputes that radiation causes cancer, and that there is no safe dose. The only question they're trying to resolve is the precise degree of the harm.

When I had my biopsy, I asked about the radiation dose. At that point I had decided to have it done, but I wanted the information so I could make decisions about future radiation exposure. The surgeon told me the radiologist would tell me. The radiologist told me the radiation physicist would tell me.

And the radiation physicist - I do not exaggerate - called me up four or five months later and tried to explain to me that radiation is actually good for me, because there's some village in Eastern Europe located on a radioactive lake where the cancer rate is lower than that of the entire United States. And despite my telling him several times that I wasn't particularly upset about it or interested in arguing costs vs. benefits, he never did give me the information.

[KnottedYet]

Radiation dose of a digital mammogram: 0.7 msv
Normal background radiation dose: 2.4 msv

Your exposure to daily background radiation is nearly 4x what you get from a digital mammo.

This is like the difference between standing outside in the sun waiting for the bus vs. standing in a dark room while someone shines a flashlight in your face. What's the sunburn risk? I don't get a sunburn waiting for a bus. Someone with severe light sensetivity will get sunburned from a flashlight.

Your exposure is even higher if you live at high elevation or where there are high radon concentrations in the ground or groundwater. The background radiation in Denver CO is higher than what the gov't deems safe. If Denver followed the lowest safe dose reccommendations set by the government, it would be evacuated as dangerously radioactive. Yet Denver has an extraordinarily low cancer rate.

Women with a genetic tendency to develop cancers have a genetically moderated problem in which their bodies don't correct the normal everyday damage/rogue cell we all experience every single day. Every single day of your life, your body is killing mutated cells. (apoptosis) You have "cancer" in your body at all times. Every moment.

Women whose bodies don't recognize damaged/mutated cells as well as everyone else will have more cells slip through the cracks. If those mutated cells get a foothold, they will become a tumor. Younger tissue has a higher radiosensitivity, meaning it is more susceptible to damage from any source of radiation. Cigarettes. Airplane rides. Trips to Denver. Clutching a book (paper is radioactive) to your bosom. Even though mammo radiation is much less than background radiation, most doctors will tell younger women with a history of poor apoptosis control to have breast MRI instead until they are older.

Of 1,000,000 women getting mammograms over their lifetime, there will be an estimated 2-10 tumors induced by the radiation (which are found in the next mammo and treated). 1,000,000 lifetimes of mammograms saves 1,000 lives.

[OakLeaf]

0.7 msv per view (more for dense or large breasts). Two views (minimum) per breast, two breasts per most women. 2.8 msv. And that's just the screening mammos.

Background radiation is unavoidable, but that doesn't mean that doubling it is good, or even that it's okay.

Here's Barbara Ehrenreich (http://www.latimes.com/news/opinion/commentary/la-oe-ehrenreich2-2009dec02,0,5052221.story) (a breast cancer survivor herself) weighing in today.

[KnottedYet]

I've got it all covered!
http://www.infabcorp.com/index.php/curtains/patient-protection/lead-lined-brassiere.html

And this:
http://www.huffingtonpost.com/marty-kaplan/bra-helps-fight-breast-ca_b_359451.html

[OakLeaf]

:D:D Now even A-cups can have muscle imbalances like large-chested women!

[KnottedYet]

Get down and dance!

http://www.youtube.com/watch?v=OEdVfyt-mLw

Yay, rockin' hospital librarians! Pink glove dance!