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<p>No, this particular study is not saying that. It’s saying that your chances of dying are not improved with the discovery on a mammogram verses manual discovery. </p>
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<p>I’m not in disagreement with his explanation of survival rates. They are a poor way to evaluate treatments success, imo. Quality of life is what most of us are interested in. Early detection can improve that, even if you eventually die of your cancer.
I’m not arguing for screening everyone. But I am arguing for early detection. Early detection actually can prevent more painful and aggressive treatments for those with cancer. It can also cure some people, although it won’t be clear early on who is cured and who might not be. </p>
<p>This study, in it’s conclusion, stated the importance of finding cancers before 2cm. The statistics do show that your odds of survival are better- not just survival rates, but mortality rates, are better if the cancer is found before this point. So if you can find it manually before then, great.<br>
There is a point at which the cancer invades the bloodstream, and for many this is even before the 2cm size. Breast cancer is as individual as the women who have it. So much more is not known than is known about breast cancer, how it behaves, how it metastasizes, that nothing regarding an individual breast cancer is all that cut and dried. </p>
<p>Yes, the study does not question the value of identifying cancers that are large enough to feel. All of the women in the study had annual examinations by trained nurses, and did self-examination as well.</p>
<p>Cardinal Fang says that 22% more women from the mammography screening group were treated for cancer, with no difference in outcomes. In fact, the study says that 22% of the cancer diagnoses from the mammography group were over-diagnoses, which means that 28+% more women from the mammography screening group were treated for cancer. Furthermore, my understanding is that the 22%/28% number is artificially low, because they did not count women who received treatment for DCIS as being treated for cancer, although in many cases they received treatment similar to what they would have received with a cancer diagnosis. According to the NY Times, if DCIS treatments had been taken into account, it would have meant that the mammography screening group received 50% more treatment.</p>
<p>CF, thanks for posting this study. I plan to take the info to my doctor, who has been bugging me about annual mammograms. For me, mammograms are extremely painful. I can’t take NSAIDs and acetaminophen doesn’t help, so I end up taking a Percocet for a couple of nights afterwards until the pain subsides enough to be tolerable. I’ve been told by a misguided tech or nurse that I might have cancer before having to wait up to a month for a re-test, only to hear - once again - that they were mistaken. Didn’t need that extra stress. In addition, I’ve had over a dozen CAT scans and dozens of x-rays for various health problems and have no desire to glow in the dark. ; ) </p>
<p>Finally, I have too much experience with medical procedures that caused more problems than they solved. I live with chronic pain from both unnecessary surgery and poor outcomes to surgeries that were the appropriate treatment but just happened to go badly for me. At some point, I can’t say when right now, I will refuse surgical treatment no matter what the odds. I’ve already made that choice in two other situations.</p>
<p>If my PCP pressed the point, I’ve thought about asking if he would accept a notarized statement from me that I have made an informed decision and will not hold him liable should I develop problems in the future (whether breast cancer, in this case, or anything else.) </p>
<p>“I’m not in disagreement with his explanation of survival rates. They are a poor way to evaluate treatments success, imo.”</p>
<p>Respectfully- survival rates in the face of malignancy are quite important, and in the end, absolutely the measure of success.</p>
<p>In the mammogram group of study, 484 cancers were diagnosed by mammography (and some other cancers were detected by other means). Of those cancers, 106 turned out to be “excess” compared to the no-mammography group. 106/484 = 21.9%.</p>
<p>So about 22% of the cancers detected by mammogram would never have caused a problem or have even been detected in the woman’s lifetime without a mammogram. Even though it’s not 28%, 22% is horrifyingly high.</p>
<p>That means that more than one out of five women who have a breast cancer detected by mammography are going through nasty expensive treatment for something that never would have caused them trouble. That’s a ghastly amount of fear, pain and sorrow for no reason. One out of five!</p>
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<p>Survival rates can be misleading, as Cardinal Fang so eloquently described. Often, they are using 5-year rates as their survival endpoints. That can tell us some things, but not everything. Overall mortality rates give us better information (as this study used.) Knowing how long these women lived is more valuable than knowing how many women survived over 5 years. That’s all I’m saying.</p>
<p>Also, CF is right, that if you count survival from the time of diagnosis, it’s really a very soft number anyway. How long did that person have the cancer before the diagnosis? If you don’t know that, the survival rate isn’t that meaningful.</p>
<p>Doctors fear lawsuits and failure to detect cancer is a lawsuit a physician doesn’t want to challenge. Doctors will continue to recommend mammograms. Currently, they are recommending a baseline mammogram at 35 and then yearly starting at 40. If I remember correctly, the reimbursement to radiologists is approximately $25.</p>
<p>Moonchild-</p>
<p>I actually don’t know what you mean in your last message. </p>
<p>I have read it three times, and I am unsure of your point.</p>
<p>The research shows solidly that breast cancer is Overdiagnosed ( my autocorrect forces me to capitalize it) and over treated in many instances. Screening mammography is not lowering overall mortality ( which I think was a point you were arguing against, but I am unsure) . </p>
<p>Mammography can cause real harm to real women, and at a not small rate. It is not lowering the number of women who die from breast cancer. </p>
<p>This video is a little bit ranty, but it’s a good explanation of mortality rates and survival rates. Dr. Carroll gives the thumb cancer example, which I had already heard about from another source.</p>
<p><a href=“Survival vs Mortality Rates: Healthcare Triage #7 - YouTube”>Survival vs Mortality Rates: Healthcare Triage #7 - YouTube;
<p>Sorry, decorative, if I’m being vague- I don’t mean to be.
Often, “survival rates” are use to determine if a treatment is worthwhile or not. As the sole determinant, this is not a good measure because these rates are created with an artificial endpoint. In other words, a study may show that a group of women had "a five year survival rate of 50%. " Well, how many of those women died a year later? How many lived 20 or more years? So when researchers use the term “survival rates” they are not necessarily talking about how long someone actually lives. They are talking about how many are still alive at a certain endpoint when the study was concluded. And, of course, we have the unknown “start time” of the disease, which makes it even harder to determine the value.
One thing different and valuable about the research for this particular study we are discussing is that they used mortality rates. This is more information than we usually have, but it lasted over 25 years, so women had a chance to die from their disease. It’s very unusual to have this kind of data because most studies don’t go on that long. </p>
<p>It would be great if mammos were only given when there is a reason for it, (high risk, a perceived problem) and women were diligent and knowledgeable about doing their own breast exams.</p>
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<p>No, I am not arguing against this point. This is the first study I’ve seen that presents this info- so I don’t know any more about it than anyone else, and less than many, I’m sure. What I do believe is that early detection (manual, if nothing else) can save lives, and can reduce pain and suffering in those who do have cancer. I’m not arguing for mammos. I’m arguing that, as this study states in the last paragraph, it’s still important to find the cancer before it’s larger than 2cm, as treatments are more effective if it’s caught in the earlier stages. I would argue that self exam, and a yearly doc exam, is the best protection against dying of BC, for most women. High risk women may benefit from a more thorough kind of screening, such as mammo, MRI, or ultrasound.</p>
<p>Ah. I see what you mean. </p>
<p>I do understand the distinction between the two terms (although I appreciate you taking the time to explain it), and I am glad for the clarification on your position. </p>
<p>I think we probably still disagree on the usefulness of screening mammography, though. It’s too much, too often, bringing too much harm, to too many women, with no benefit in the end. </p>
<p>If you read my previous posts, you’ll see that I’m not for “screening mammography” for everyone. I think used as a diagnostic (not screening) tool, it is very valuable. By that I mean if you have a lump, or you have previous risk factors, it’s a good tool. It also can be useful for older women (over 50) whose breasts are less dense, and for older women the radiation risk is less as well. </p>
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<p>Except that we now know it is NOT useful for women between 50-59. </p>
<p>Cardinal Fang: If 22% of the cancers in the mammography group were over-diagnosed, that means that the mammography group had 28% more cancers diagnosed than the control group. 106/484 = 22%, but 106/(484-106) = 28% When you use the word “more,” you have to pay attention to what’s in the denominator.</p>
<p>There are three ways in which early screening can improve survival rates, but only one of them has social utility. First, as Cardinal Fang explained beautifully, diagnosing a condition that is fatal and not treatable early automatically lengthens the period of time the patient survives after diagnosis, but without necessarily lengthening her life. Second, as the study shows, early screening has a very high rate of what are essentially false positives, and these of course have a very, very favorable long-term survival rate, because the condition was not going to be fatal in any event. Third, of course, early detection may enable more effective treatments, saving or prolonging lives. That’s what we want. </p>
<p>The problem is, if early detection is saving or prolonging lives, the women whose cancers were detected earlier ought to be living to an older age than those whose cancers were detected later. And the study (like other, previous studies) shows pretty definitively that that isn’t happening. The two groups as a whole died at the same ages. More importantly, they even died of breast cancer at the same ages. More of the mammography group were treated for cancer, and for longer periods of time, and they survived longer after their initial diagnosis, but their lives were not prolonged.</p>
<p>Silpat - my doctor suggested that I try eliminating caffeine for 3 months before mammograms to reduce the need for getting additional images, which makes the appointment last forever (hours). I tried it, and it worked. A surprising (to me, but not to my doctor) extra benefit was that the process didn’t hurt nearly as much. If you do keep getting mammograms, you might want to try this.</p>
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<p>What stuck me about the study is this:</p>
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<p>The sizes of the tumors found between the two groups are very close! 1.91cm vs 2.10 cm. I’m actually surprised that the mammo groups sizes weren’t smaller.<br>
Given that the differences in the found size were so similar, it’s not surprising at all that the outcomes would be similar. </p>
<p>JHS, I understand what you’re saying, but it’s a little misleading to compare the way you’re comparing. The mammography group didn’t have 28% more cancers diagnosed. They had 666 cancers detected, 484 by mammography and the rest by other means. The no-mammography group had 524 cancers detected. That’s 142 more cancers in the mammography group: 154/(666-154) is 30%. </p>
<p>But then, after the five year study period and into the follow-up period, the no-mammography group “caught up”: the cancers that were going to be detected later were detected. Eventually there were 106 “missing” cases of cancer, which means that of the 484 cancers detected by mammography, 106 of them would never have been clinical. </p>
<p>So suppose you have only the results of the no-mammogram group, and you want to apply your 28% number. 28% of what? There’s no number in the no-mammogram group that you can apply 28% to, to get the number of overdiagnoses in the mammogram group. </p>
<p>That’s why I think it’s more useful to say that 22% of the mammogram positives were over-diagnoses. Not saying you’re wrong, just saying I don’t think 28% is as useful in this case.</p>
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<p>Even if the numbers are corrected as per JHS, women are not treated for cancer if they don’t have cancer. The mammogram is only the first screen, or diagnostic screen. After that, a biopsy is always done to provide the actual diagnosis. Over-diagnosis in real life means that the mammo showed cancer, but the biopsy showed no cancer. In that case, there would be no treatment. Biopsies are not fun, but they are the end of the treatment if there is no cancer present. </p>
<p>I’m sorry, moonchild, but have you actually looked at this study? You don’t appear to understand what it says. It says that over one in five women whose cancer is detected by mammogram will not have any clinical signs of cancer in their entire life. They don’t need to be treated, because even though there is a cancer inside them, it doesn’t make any difference. What is the possible argument to subjecting so many women to needless cancer treatment? </p>
<p>You say that women are not treated for cancer if they don’t have cancer. Yes, but women are treated for cancer when they don’t have a cancer that will ever make a difference. Why would that possibly be good? If you don’t detect these irrelevant cancers in the first place, then you won’t have to worry about whether to treat them.</p>