<p>Yes, I have read the study. I will admit that it’s not crystal clear- there are some things I don’t understand. What I do understand, however, is that in real life, a doctor is not able to tell which cancers will make a difference, and which ones will not. In the study, they could, of course, because they looked at the end point- the end of their life- and could see that it didn’t make a difference in their lifespan. But when a new cancer is detected on a mammogram and biopsied, confirmed, there is no way to know that a cancer will not metastasize. It could stay 2 cm forever, it could grow and never leave the breast, in which case it would make no difference whatsoever to the woman. On the otherhand, it could also make its way into the blood stream and lodge in the bones, liver or lungs.
There is no way to know. No way.</p>
<p>True.</p>
<p>There is no way to know.</p>
<p>But we know that over diagnosing and over treating does not change the outcome. </p>
<p>Which is actually very important to know. </p>
<p>I am over sixty and I go for annual mammograms as well as annual visits to gynecologist and internist which include breast exams. Because I have one breast with dense tissue I always have a sonogram on the same day with the mammogram. While mammogram isn’t something I would want to do every day, it only takes a minimum amount of time and is once a year. I think more people avoid colonoscopy because of the prep for the exam.</p>
<p>I have an acquaintance who is currently undergoing radiation for breast cancer that was detected in her annual mammogram. I have a cousin who had a mastectomy for two tumors in her breast that were not detected in her annual mammogram several months prior to her discovering one lump during BSE. The other lump was detected in the MRI that was a follow-up to her discovery… so who is to say. I have had other friends with lumps requiring follow-up sonos and MRI’s and biopsys all of which turned out to be negative…so I think it is most worth discussing with one’s doctors and if deciding to forego mammograms to be really consistent about BSE. I think that many women, me included can be neglectful to do so. </p>
<p>This debate is very active right now with DCIS in the cancer community. It has been shown that a lot of DCIS never becomes active cancer- in other words, it never leaves the ducts.
With DCIS, “waiting and watching” can make some sense if the lesion is small and isn’t about to leave the duct. Most women would just as soon get the thing out of there with a lumpectomy rather than have to have it
watched every 6 months to a year for changes, but waiting is a reasonable option. For actual BC, which has already left the ducts, waiting isn’t viable because once it’s “out” there is no way to know if it’s in the blood stream. And once it’s in the blood, unless treatment is given, the chance of metastasis is quite high.
It would be great if there were a way to know which cancer will progress and which ones won’t. Right now, we (the collective cancer community) don’t know. The best we can do is to treat all active malignant breast cancers as if they could metastasize. Would you want anything less? </p>
<p>This is an interesting read on DCIS: </p>
<p><a href=“Take Carcinoma Out of DCIS and Ease Off Treatment”>Take Carcinoma Out of DCIS and Ease Off Treatment;
<p>Which is hugely over treated. </p>
<p>Here is what the stats do not show:</p>
<p>A gets mammogram, findings result in an early cancer dx Given growth curve of tumor, it would have been another year before detected, maybe three. Treatment started. Treatment does not exterminate the cancer. However, it remains in check for 4 years before another alternative treatment is started. A lives for 15 years before dying due to infection, or cancer.</p>
<p>B detects cancer 3 years after A, same cell type. From size of cancer it would have been detectable 3 years ago through mammogram but B did not have them At this size, chemo does not reduce tumor to the size that A’s was, so even with aggressive treatment, the tumor load is not reduces as much as A’s which has been reduced and kept steady with chemo. </p>
<p>So we have two people with identical cell type, aggressive, incurable cancer typ, but A has been keeping it in control between time of her detection till B’s detection. A’s stays stable another year and then needs to be changed to another med. B’s is never reduced to where A’s is, and metastisis begins earlier too. </p>
<p>B’s cancer has a more rapid course because it had those 3 years to spread while A’s was held in check. B dies in 8 years after detection. So 11 years after A’s earlier detection with mamogram. A lives another 4 years.</p>
<p>This does not show up in the stats. 4 years. My friend youngest graduated from high school and went off to college. She got to see the prom, help with the apps, knew where he’d be going to school. Oldest graduated and was engaged–didn’t make the wedding, but met the fiancee. Middle one in college. 4 years bought a lot of life happening, especially for the youngest. </p>
<p>In no way am I trying to be disrespectful, but anecdotes do not data make. </p>
<p>The rate of mortality remains unchanged. There are also people who die earlier from complications of treatment. Sometimes treatment induces other illnesses and damage. And others have reduced quality of life. </p>
<p>It is a very difficult situation. And emotions are wrapped up so tightly in this- how can it not be? </p>
<p>But at the end of the day, even when our emotions are so compelling, cancer doesn’t care about our emotions. The final analysis is data driven. And the data shows more harm comes from conventional practices on this issue. And the evidential standard shows we are getting it wrong. </p>
<p>Very well said, ctpofthehouse.
And sometimes, during the four extra years A lives, another treatment comes online which enables her to live another 3-4 years. </p>
<p>
</p>
<pre><code> This is why every woman should be evaluated for her risks and benefits regarding mammograms and other diagnostic procedures.
</code></pre>
<p>It will be interesting to see what other scientists and cancer experts say after they look at the study. I’m sure there will not be agreement within the community. In the end, each woman needs to talk to her doctor and evaluate her own risks and make her own decisions. And do her monthly self- exams. ;)</p>
<p>Of course- it is up to each woman and her doctor.</p>
<p>My hope is that more women and their doctors make their decisions from the evidence, and not from a place of fear and false information. ;)</p>
<p>Mammograms are beneficial. My stage 1 cancer was found with a mammogram in June (no lumps) and I decided to get a mastectomy due to DCIS, small breasts that already had a lumpectomy, etc. I now take Tamoxifen and never had to have chemo or radiation. I think it is a quality of life issue and I feel blessed that my cancer was found so early and treated. With a family history of breast cancer I will get a mammogram yearly.</p>
<ol>
<li>The stats do not show what cptofthehouse describes, because apparently it does not exist. Seriously. That is the narrative that screening advocates sell, but it is not something that can be demonstrated by actual outcomes and actual data. If a meaningful number of women were getting four extra years, or even four extra months, because of early detection and treatment, it would show up in the age-related mortality curves. But it doesn’t. The curves sit right on top of one another.</li>
</ol>
<p>There is a scary implication here, and that is that lots of the treatments used are simply ineffective. We believe that the treatments given to cpt’s “A” are delaying the metastasis of her cancer, but maybe they aren’t. Or, if they are, they will delay the metastasis of B’s cancer as well.</p>
<p>It is important to recognize that this study does not discredit screening; it discredits screening for tumors that are too small to be palpable. All of the women in the study were checked annually.</p>
<ol>
<li>moonchild, I believe the reason the tumor sizes in the two groups were so close is that a large number of tumors were identified at the initial screening with both groups. If I remember correctly, the average size of tumors identified in the mammography group after the initial screening was 1.4 cm, i.e., meaningfully smaller. Also, remember, that the design of the article does not count DCIS identifications as tumors. So there was an additional set of much smaller growths identified, and often treated, but not counted for these purposes.</li>
</ol>
<p>Well you all got me nervous and curious. At my last mammogram, which I got the new 3d imaging, I was called back for another look. I was a nervous, anxious mess over it. It showed calcifications and I have to go back in 6 months for a recheck. To show how dumb I am, I just googled, do calcifications turn into breast cancer, and for the first I learned benign calcifications never turn into cancer. However, I got the probably benign - which means they’re 98% sure it’s benign.<br>
It’s an awful lot of heartache and worry for me to wonder between now and June if something else is going to show up.<br>
My regular doctor said he just wished they didn’t even have me get a mammo - I’m under 50. But what if it is cancer, and we find out super duper early in June? I would sure rather have it caught early than to find out 5 years from now. I have to believe my outcome will be better to know sooner rather than later. How is my thinking wrong here? </p>
<p>
<br>
We actually can tell if treatments are working, using scans and sometimes tumor markers.</p>
<p>I don’t find the difference in sizes of the cancer found in the two groups to be all that significant, even if you look at the beginning average and not the mean during the study. More importantly, imo, there is no information about the types of treatments that were given once those who died of the disease were diagnosed with mets and what their side effects were, or how long after their original cancer they progressed (good years vs not so good), or what the quality of their lives were before or after, or anything else other than their actual death rate.
As I said in my first post, there is more to life with cancer than death. Many of these women lived a good long time. Quality of life is everything. It might be interesting to know if those whose cancers were discovered "earlier had better quality of life. But honestly, it seems that most of the women in this study had their cancers discovered “early”, imo. Even 2.1 is pretty early.</p>
<p>Another point to make: The study was started 25 years ago and the women were followed until 2005. As far as treatments go, there have been significant improvements in hormonal and chemo treatments in the last 10 years. Why does this matter? Because now, if you catch an Her2+ cancer early enough, there are drugs that can keep it asleep, but when this study was done, that was not the case. That doesn’t convince me that mammos are so great, I will admit, but it does make another case for early detection, some way or another.</p>
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</p>
<p>Yes!! This is the most important take away from the article. </p>
<p><em>1. The stats do not show what cptofthehouse describes, because apparently it does not exist. Seriously. That is the narrative that screening advocates sell, but it is not something that can be demonstrated by actual outcomes and actual data. If a meaningful number of women were getting four extra years, or even four extra months, because of early detection and treatment, it would show up in the age-related mortality curves. But it doesn’t. The curves sit right on top of one another.</em></p>
<p>Quoting this because it needs to be repeated. It is very important, and gets lost in the call for early detection advocates. </p>
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</p>
<p>This ^^^</p>
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</p>
<p>That’s a tough case to make: we told you all this expensive diagnosis and treatment would work, and now it turns out we were wrong. But this time we’re telling the truth!</p>
<p>Sorry, this time they have to demonstrate the expensive screening and treatment protocol works BEFORE I undergo it. Fool me once…</p>
<p>And I don’t think anyone has argued that diagnostic mammography for palpable tumors is unnecessary. </p>
<p>It’s the broad based screening that is the issue. </p>
<p>I read more carefully and found this:</p>
<p>
</p>
<p>Wow! Fully half of non-palpable cancers were over-diagnosis. In other words, if you have a breast cancer found by mammogram, and you can’t feel it (or, at least, if your doctor can’t feel it), don’t do any treatment. Wait. When you can feel it, treat. You have a 50% likelihood of never being able to feel it, even when you are 90 and hale and hearty.</p>
<p>
</p>
<p>The science has improved over the last 25 years. And Heceptin is a pretty easy case to make. (why I chose it…lol)</p>
<p>I do agree about mammo screening- unnecessary for broad screening. I won’t give you the “earlier doesn’t matter” argument though. It matters. If not for life (and I think in many cases, it matter for life) for quality of life. I’m a living example of that, so even though I’m an anecdote of one, it matters. </p>