Actually they do. Mortality statistics are age-adjusted. </p>
<p>Do not be deceived by survival rates. Survival rates are useless for comparisons at a population level. You can improve survival rates just by doing a lot of screening. You detect diseases earlier that way. People won’t be one bit healthier, and they won’t die one minute later than they would have without the screening, but your survival rates will look great.</p>
<p>Here’s the famous cancer of the thumb example. Suppose a new kind of cancer of the thumb springs up, both here and in Canada. Five years after the cancer starts in your body, you can notice a bump on your thumb. Four years after that (nine years after the initial appearance of the cancer) you die. The five year survival rate is 0%, because four years after you detect the cancer (by feeling a bump), dead, dead, dead. No treatment does any good.</p>
<p>In the US, we invent a screening test. GREAT! Now we can diagnose the disease seven years before it kills, instead of four years. Our five year survival rate is now 100%, because we detect the disease earlier! Whereas in Canada, which is smart enough not to pay for useless screening, the five year survival rate is still 0%.</p>
<p>Notice that the US screening test is completely useless. If we screen everyone for cancer of the thumb every year, that’s expensive wasted effort. Americans aren’t surviving any longer with cancer of the thumb; they’re just getting diagnosed earlier. Mortality rate is unchanged, and when you do population comparisons, you should not use survival rates (meaningless for population comparisons) but rather mortality rates. </p>
<p>This exact scenario happens when we compare prostate cancer survival rates in the US and in Britain. US survival rates are way higher, but when you look at mortality for prostate cancer, it’s pretty much the same in both countries. </p>
<p>Emily–don’t mean to put in a huge scare over CAT scans. I’ve had one, also, and hope now to avoid if at all possible in the future. I thnk they were way overdone for a long time, though they have their place when needed.</p>
<p>This is not true. If you’re talking about “cured” as opposed to “treated”, perhaps, but it is almost always easier to treat cancer that has been found earlier. And effective treatment can add years to the quality of life, as well as years of life.
The study isn’t saying that early detection doesn’t matter. It’s saying that mammogram detection isn’t better than manual examination. Early detection still matters.</p>
<p>Please don’t tell your daughters that early detection doesn’t matter.</p>
<p>I hope that people realize that, even according to this study, using mammograms for diagnostic purposes is still valuable, even if yearly "screenings’ are not helpful (as far as mortality statistics.) Women need to do monthly self-exams, and yearly exams with a professional, like a GYN, who knows what to look for. If a lump is found, a mammogram can be very helpful in diagnosing the lump and determining if it is something to biopsy or not. </p>
<p>I’m going to advise my Dd to start her mammos every other year at age 45. In the meantime, she needs to check herself monthly and to be examined yearly by her doctor. If there is a lump, and there is any doubt about what that lump is after a mammogram and ultrasound, get a biopsy. It’s the only definitive test for cancer. </p>
<p>At my age, as I’ve said, I’ve lost a number of friends, acquaintances to breast cancer. For many, it was a matter of how much time they were able to have. My close friend just lost her SIL who died of an aggressive cancer that was not found till it had pretty much spread to other organs. Had it been discovered and treated earlier, say a 3 years ago when it certainly would have showed up on the mammogram, she might be alive today. NOt cancer free, but undergoing treatment and possibly living for another 5-7 years. Hers had spread quickly and with that much of a disease load, it could not be beat back. So, yes, there is that statistic that being caught earlier there might have been years of treatment that made no difference, but there is also the fact that the treatment could have extended her life. I’ve known and know some women who have been fighting breast cancer for 20 years now. Had they not discovered it early, it could have been a very quick death. The only reason they’ve made 20 years is keeping the disease beat back to a degree for that time. </p>
<p>The problem is- and what more detailed looks into the information from multiple studies reveals is that certain tumors of a certain makeup- no matter when discovered, they will eventually cause your death. Which is awful. But there are other tumors and abnormalities that can be co-existed with and that sometimes even resolve. And those are not going to take your life. No matter if /when they are detected or not. </p>
<p>It’s where the issue of over treatment comes into play. </p>
<p>But what the information is stating is that early detection does not make a difference in that. I understand focusing on the tumor size and seeing that as a key to justifying early detection, but with a closer and more in depth review, that isn’t actually what the numerous studies support. </p>
<p>Mammograms are useful in a certain age range. That are also useful diagnostically. But as a screening tool for the vast majority of the population? Not really. </p>
<p>Early detection does make a difference, even if you eventually die of your cancer. It can mean the difference between lumpectomy and mastectomy. It can mean the difference between a life with lymphodema or a life with normal use of your arms. It can mean the difference between years with hormonal treatments to keep the cancer dormant, or needing more aggressive chemotherapy.<br>
And early detection can definitely save lives for many with less aggressive cancers.</p>
<p>
What doctors do not know is which early detected cancers will kill you and which ones will not. Don’t believe it if you hear otherwise. Remember, these studies look at women at the endpoint. They can’t tell you in advance who is going to die, and whose cancer will die with them from some other cause. Your best chance of surviving is find the cancer before it’s over two centimeters, and to have it removed and to start hormonal treatment if the cancer is receptive to it. </p>
<p>I don’t disagree with this. I just don’t want people to believe that early detection doesn’t matter. Our young women need to do monthly self exams and yearly doc exams. </p>
<p>Also, I agree that some breast cancers will return at some point, even with early detection and aggressive treatment. But which ones? When they figure that out, it will be a major breakthrough.</p>
<p>Mammograms detect cancer before it can be detected manually. The study is saying that amount of earliness does no good: detecting the cancer manually is good enough, even though manual detection will be somewhat later.</p>
<p>I might be the exception, but I’m happy I was screened in my 40s. A routine mammogram uncovered high grade triple negative BC, which is very aggressive and doesn’t have a lot of options for treatment, since it doesn’t respond to hormones or herceptin. Because it was caught early, I was able to be treated with surgery only. If I had waited until it was big enough for a lump or until my 50’s, it would have been an entirely different ballgame. We have no family history of BC. I have no doubt that my quality of life is much better than it would have been. Of course, I can’t say with absolute certainty, but I think it also bought me more years.</p>
<p>It can also mean the difference between painful treatment that doesn’t do any good, and no treatment.</p>
<p>The study says that in the mammogram regime, 22% more women were treated for cancer. But mortality statistics remained unchanged-- nobody survived longer. All that happened was more people being treated. A lot more women, being given treatment that didn’t do any good.</p>
<p>If for some reason you favor more women going through breast cancer treatment, with no improvement in lifespan, then you should love mammograms. If on the other hand you’d rather have fewer treatments and just as good lifespan statistics, you should prefer the no-mammogram regime.</p>
<p>Less treatment. Less screening. Same results. What’s not to like?</p>
<p>Sowest, what the data is saying is that whether or not you were early or not, you are going to either survive this, or you are going die from it. The mortality stats are saying whether you were in the group where you found this with mamogram, or whether you found it a few months later due to a dimpling or lump, it wouldn’t make a difference as to whether you die from it or not. As an aside, my SIL’s SIL had the exact same scenario as yours and hers was big enough for a lump and she’s been around 10 years without a relapse. She was in her 40s too, high grade triple neg, aggessive does not respond to Herc or hormones) Removed both breasts and had high level chemo with adriamycin, cytoxin and methotrex. Then radiation. We dare to hope it’s gone, even though hers was not caught early. </p>
<p>It’s not always easy to feel a small tumor, less than 2 cm. There are women who discover the tumor on their own while it’s small, but sometimes not until it’s much larger. Breast density, cysts, just not being very sensitive to what you’re feeling, can make it hard for women to know what they are feeling. Women from 20+ should have a professional manual exam yearly. After 40,
the benefit of a mammogram should be looked at from the standpoint of each woman’s individual risk. </p>
<p>Women like SoWest are more common than one might think. Her “exception” that may not be statistically relevant, but is certainly relevant to SoWest!</p>
<p>@cptofthehouse, it’s great the your SIL is doing well with no recurrence. Since triple neg tends to recur early, hopefully she is out of the woods. And as @moonchild pointed out, my exception is relevant to me! Having cancer discovered in a less invasive state meant the difference between me having surgery only or chemo and probably radiation. I am certainly not saying that I think everyone should make the same decision I did. How you manage your health should be between you and your Dr. But I am forever grateful that my Dr.'s office reminded me it was time for my screening.</p>
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