<p>All I know is that with a strong family history of breast cancer, I will continue getting yearly mammograms as long as I can afford it. Not my favorite annual event but not excruciating. </p>
<p>From a study author: </p>
<p>“It is true that if you find cancer early it could be at a more treatable stage,” study author Prof. Anthony B. Miller told Medical News Today. “But there is no evidence that early detection affects the inherent biology of the cancer. Indeed it is possible that finding the cancer at an earlier stage will result in undertreatment. There is some evidence that is so.”</p>
<p>"The greatest resistance will come from radiologists, who are convinced that finding cancers results in benefit, and who also benefit financially from that belief. We have demonstrated that is not so. Others whose advice resulted in the establishment of breast screening programs will also feel threatened.</p>
<p>It is unfortunate that although we maintain we should practice evidence-based medicine, when that evidence is produced, there will be many who will seek the means to discredit that evidence because it is against their vested interests."</p>
<p><a href=“Annual screening does not reduce risk of death from breast cancer”>http://www.medicalnewstoday.com/articles/272433.php</a></p>
<p>Oh, snap.</p>
<p>Well, since we just spent over 3 years listening to Washington tell us that everyone needs an annual mammogram and it needs to be free of charge because it is so darned essential, I don’t think this recommendation is likely to change anytime soon. Geez, they’ve got enough problems and there’s no way to backtrack without more major embarrassment. Why is health care so expensive again? Sigh.</p>
<p>One of the problems with the concept of practicing “evidenced-based” medicine, is that it is based on broad scale statistics, which potentially can mask benefits (or detriments) which apply to various niche groups. For example, maybe there is no particular benefit in terms of life expectancy for encouraging all women to get annual mammograms, but maybe there IS a benefit for women with certain risk factors, or a family history of breast cancer, or a certain genetic profile – or perhaps a certain body type that might make other forms of screening more or less reliable. For example, perhaps small tumors are more likely to be missed in large-breasted or obese women, more likely to be apparent to small-breasted women.</p>
<p>You would need to have multiple studies to tease out all of these differences – but as a starting point it might make sense for doctors to at least consider known risk factors in the recommendations they make to their patients. </p>
<p>Obviously that approach will lead to some recommendations being made based on hunch or belief, rather than “evidence” – but the problem is that we don’t have all the evidence. </p>
<p>And even the Canadian study is problematic simply because it was a study of … Canadian women. Maybe a long-term study of women who lived in a different part of the world or a different demographic, ethnic profile would have different results. Or what about a part of the world with a less effective healthcare delivery system than Canada? I wouldn’t expect the numbers to be radically different, but the difference doesn’t have to be that huge to cross the threshold into being statistically significant. </p>
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<p>I wouldn’t say that. The Canadian study is devastating. The no-mammogram regime was enormously better than the mammogram regime. The mammogram group went through mammograms, and some of them went through cancer treatment, for no benefit. None.</p>
<p>The researchers are saying we can stop doing screening mammograms for everyone under 60, and we can treat about 83% of the number of women we now treat for breast cancer, and we will get exactly the same results. </p>
<p>Even if the mammogram group had a little better results, which they don’t, we might question the cost-benefit of the results. But here, the cost is huge and the benefit is non-existent. It’s not close; it’s a no-brainer.</p>
<p>Actingmt: The U.S. Preventive Services Task Force has to look at the Canadian study, decide if they accept the results, and drop the recommendation for screening mammograms. The insurers will do the rest; they’re not in the business of paying for useless screening unless they are forced to. It doesn’t look to me like the U.S. Preventive Services Task Force is a political group.</p>
<p>Hello, All,</p>
<p>I glanced at first two pages and a bit at the end here, so not sure what was talked about in between. But I am one of those people that benefited by a mammogram (the only one I ever received) at age 37 when I just happened to get a baseline. I had no real reason to get it…my gyn just gave out scripts every year. And THANK GOD I went because I had cancer! I had no lumps and there is no cancer of any type in my family for generations. Drs point blank told me that had I waited until I felt a lump, I would have been stage 4. Luckily they found it when it was just entering the invasion…I had a microinvasion so stage 1. (no genetic markers either).</p>
<p>And btw…I blasted the *&^%#!! out of it 
. Seriously tho, I was aggressive in treatment. I am so glad my gyn gave me that script. She seriously saved my life.</p>
<p>So thankful to be alive and watching my four kids grow up. For now!</p>
<p>" It doesn’t look to me like the U.S. Preventive Services Task Force is a political group."</p>
<p>They are appointed by HHS. I’m sticking with my prediction. </p>
<p>
The stats give you that information at a group level – but not an individual level.</p>
<p>You can’t say that an individual whose cancer treatment commenced because of tumor mammogram had “no benefit” – you don’t know. You don’t know what would have happened to that one person if she had not had the mammogram. Maybe the cancer wouldn’t have been found until it progressed to a later stage. Maybe it wouldn’t have been found at all.</p>
<p>You can’t say that, on an individual basis, a cancer was treated unnecessarily - that it would never have developed if it had been ignored. You don’t know.</p>
<p>The statistics tell you what happens on a group basis – it gives you a norm or average profile and the larger the study, the less the impact of the outliers on the numbers. But those outliers are human beings.</p>
<p>I’d also point out that there is more to a cancer diagnosis than whether you live or die. I don’t have breast cancer, and I would like to keep my breasts. If I were to get breast cancer, then I believe that the stage of diagnosis might impact the course of treatment. A lumpectomy? or radical mastectomy? So I’d love to see stats that measure outcomes other than who manages to stay alive after X number of years. </p>
<p>It could be very well be that some cancers are more aggressive than others, and some will virtually unstoppable no matter how early they are diagnosed, and some may be essentially curable even when tumor have already grown relatively large before treatment. So maybe early diagnosis is not as significant to survival as we thing. But what about the in-between part? If we are looking at cost-benefit, then how much does it cost to treat a late-diagnosed cancer vs. an early-diagnosed cancer? </p>
<p>I understand that on a broad scale, cost-benefit analysis is important. If the stats don’t support the value of routine mammography, maybe the cost-benefit isn’t there and there should be a change in recommendations as to the number and frequency – or perhaps those recommendations should be informed by other medical factors. </p>
<p>My mom got breast cancer when she was 62, treated with mastectomy and chemo. She is the first person in the family to have BC that we know of. 23 years later, she’s still hanging around wreaking havoc on her daughters. We were told by all the doctors - including highly-respected oncologists - that post-menopausal BC is unlikely to be hereditary, and to go on our merry ways.
As a precaution, my doc had me get a baseline mammogram at age 35 (6 years after her dx). I had them annually beginning at age 40. When I was 46, I was dx with DCIS. Yes, stage 0. Yes, in-situ. (blah blah blah, Susan Love can go fly a kite.) However, because of the pathology of the cells, it was recommended that I get radiation. I did. The next year I was dx with more issues which are considered non-obligate pre-cursors to cancers. My risk will not decline with age. As a result of my dx, I take Tamoxifen and get annual mammograms and MRIs. My sisters also get them. </p>
<p>One sister was diagnosed Stage IIIc BC at age 48. Double mastectomy, chemo, radiation. Another sister was dx this year with Stage II BC.
there are 2 more sisters as yet cancer-free.</p>
<p>Maybe their lives haven’t been extended. Maybe the mammograms didn’t save their lives, but it did detect the cancer and allowed them treatment. The only reason they had increased screening was because I had the dx of DCIS. Maybe my mammogram and “overtreatment” saved their lives. If I’d waited until 50, it is entirely possible that my cancer would have gone invasive. The signs were there. My sisters probably wouldn’t have been screened either because we didn’t think there was a risk and they were younger than 50. Given what we know about my sister’s cancer, she would have either not made it to 50 or be dealing with stage IV. </p>
<p>If you don’t want a mammogram, nothing is forcing you to have one. If you don’t want treatment, no one will force you to get treatment. You get more radiation in a window seat on an airplane. I’m not an idiot and not an over-consumer of health care. If someone could figure out which cancers would get worse and which ones wouldn’t, they’d be heroes. There is still too much we don’t know. </p>
<p>Isn’t the study telling us that non-mammogram screening works just as well and provides the same outcomes? It is not telling us not to get screened or treated; just that mammograms don’t add any value to the process, right?</p>
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<p>“Everyone in Washington”? The USPSTF in 2009 reduced the recommendations for mammogram screening for breast cancer. It was every 1-2 years for women age 40 and over, changed to every 2 years for women age 50-74 and based on individual factors for women age 40-49. That ignited a political firestorm about health care rationing and death panels, ironically with the supposed “conservatives” arguing against the (incidentally cost-saving) reduction in mammogram screening.</p>
<p>The PPACA is still politically “hot” enough, and Americans culturally seem to have the “more is always better” attitude toward medical care, that if the USPSTF changes its recommendation again in response to this study, it needs to carefully manage the message to avoid the recommendation being completely ignored for political reasons.</p>
<p>That said, there may be specific high risk groups that could benefit from mammogram screening even though the general population may not – perhaps another study focusing on the high risk groups may be needed to answer that question.</p>
<p>Calmom, You’re right that one can’t tell if an individual was helped by a mammogram diagnosis and subsequent treatment. But on the population level, if you do a whole lot more treatment and you get zero more population benefit, it doesn’t matter whether some treatment was useless and the rest helpful, or whether some treatment was harmful and the rest very helpful.</p>
<p>If an individual has treatment as a result of a mammogram diagnosis, she might be better off. But if she is, then another woman who gets treatment has been harmed by it, because on net, if no one gets treatment based on mammogram results (because no one has mammograms) then the population does just as well.</p>
<p>So it’s logically possible that some women are helped by treatment and others are harmed. But it does us no good to know that-- if we already knew WHICH women would be helped and which harmed, we would already not be treating the ones who would be harmed. </p>
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<p>That’s true-- if you happen to be taking a 133 hour flight. Otherwise, not.</p>
<p>But the only way we can know WHICH women will be helped is through more targeted studies. You can’t take the broad scale study and use it to support an assumption that NO women will be helped. </p>
<p>You can take the study and say it’s time to stop population-wide mammogram screening for women under 60, though. I</p>
<p>There are some cancer specialists who say this is a flawed study due to the methods and equipment used. I had heard this, but this is the first formal written objection I’ve seen. </p>
<p><a href=“http://www.acr.org/News-Publications/News/News-Articles/2014/ACR/BMJ-Article-on-Breast-Cancer-Screening-Effectiveness-Incredibly-Flawed-and-Misleading”>Error | American College of Radiology;
<p>I know, radiologists have a financial interest. If their objections are true, however, it still casts doubt on the results.</p>
<p>The radiologists object that the study was not correctly randomized; that objection is refuted directly in the text of the paper.</p>
<p>But the main objection of the radiologists is that the mammograms should have found more cancers. Perhaps so, but that doesn’t disprove the conclusion of the study: since it didn’t do any good to treat the cancers they did find, why would it do any more good to find and treat more cancers? If treating isn’t any good, you want less of it, not more of it.</p>
<p>Sounds to me like the radiologists are flailing around trying to protect their income. </p>
<p>The objections may not be valid. I don’t feel I’m in a position to judge, not having any access to any of the actual primary sources of data.</p>
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<p>Your view seems cynical, and doesn’t really reflect the reality of cancer treatment today, cardinal fang.
We don’t know how these women were treated, as the study didn’t consider it as part of their data. The women’s treatment protocols weren’t part of the study.
Whatever you may think of the usefulness of mammograms or your conviction that this study is the best and definitive word on the subject, this study really tells us nothing about the value of cancer treatments- especially current treatments. It also doesn’t say that detecting cancer early makes no difference, as some have tried to infer from the results. All it states is that statistically, women who were diagnosed with early stage breast cancer through mammography did not live longer than those who were diagnosed by a yearly thorough manual breast exam.</p>
<p>What I find interesting, is that we never found evidence that mammograms do save lives. We have all gone under the assumption that mammograms detect early cancer that can more easily treated and therefore saves lives. But this has always been an assumption, fiercely protected by well meaning people who treat, and have been treated for breast cancer. The most fierce protectors of yearly mammograms is the American Cancer Society. I was also a bit shocked that 3 months ago an announcement from the CDC showed up on my Facebook feed stating: “Mammograms save lives.” </p>
<p>For those who had breast cancer caught early through mammogram screening, I am so happy you were treated and are doing well. Personally, I had a positive mammogram and a subsequent lumpectomy showing normal breast tissue. I don’t feel “harmed” by the procedure. I might feel harmed if they found atypical cells, not breast cancer, and had to be on hormonal treatments my whole life. But, I wouldn’t know, and still wouldn’t, if those treatments would be necessary or not. That was 3 years ago, and after yearly mammogram screening, I made a decision not to get a mammogram next year. </p>
<p>But if you want one, I don’t think insurance/government should be obligated to pay for it. There is a fairly large public health infrastructure around getting low income women yearly mammograms. It is time for us to rethink this. </p>
<p>The stats do NOT show what I am saying, and what MAY be happening in actuality. It isn’t measured. Maybe it isn’t even there. How to measure it is a problem, and I have no answer as to how it could be measured. BUt it is something that is an issue in terms of early detection in a lot of other situations, though until measured for BC, we do not know. A high tumor load in any series is a bad prognostic sign. Buy catching a cancer earlier, you do have that to work with. Clearly in terms of ultimate mortality, according to the study that is the subject of this thread, it makes little or no difference. Whether the tumor is found early by mammogram or months, even years later by exam makes no difference as to whether you are going to die from it or not. But what is not measured, and may not be measurable is how many year more you can get when it’s detected early, and that is taking into account the years before it would have been detected digitally vs via mammogram.</p>
<p>A lot of the breast cancers that are not chemo sensitive, and metastatic BC specifically are being treated as chronic health issues once stability is achieves. As I said before, I know many women who HAVE breast cancer, And they will have it for the rest of their lives, most likely unless something new comes up that can eradicate it. In my earlier days, those with BC were undergoing acute treatment–then they either HAD it or died. No more in terms of women my age. Some have been around for a long time with BC, and many credit early screening and discovery to still being alive. They have a cancer type that is not curable and it tends to spread very early. But keeping a small amount at bay is easier than larger tumor loads. THey know many with similar cell types and are very active in keeping up with treatment options as their very lives depend on it. It’s only a matter of time before whatever is keeping them stable will lose its effectiveness and they will have to go to another option. So they know, how quickly they can go, once the disease gets past a certain point, and no chemo or drug options can contain it. They’ve seen it with their peers. </p>
<p>Many in that group have had BMT (now stem cell replacements ) with high dose chemo, something now pretty much discontinued, as it makes no difference in mortality, but many credit the BMT for stopping the runaway train’s acceleration and giving it a slower course for awhile, and again, buying them some more time. </p>
<p>So no, there is no measure of how much time early and aggressive treatments can buy a person. Most research go by mortality, and if they use a long enough period, nothing works since we all die in the end anyways. I’ve lost some friends in the time period that these women who have terminal BC and were being treated for it.</p>