<p>In a european country that I am very familiar with, if your mammogram detects something, you are automatically send over for an USG. Why not start with USG?</p>
<p>sunnyflorida - you make some excellent points. Especially this one:</p>
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<p>When I was 40 getting a mammogram was a rite of passage. I did it and never thought about it much. About 2 years ago, I was told the mammogram I had gotten for the past 8 years was no good. I needed a digital mammogram. My gyn insisted and I had to wait. Since the machines were so new, only two places in the county had them. The wait was 4 months for my annual mammogram. I got suspicious and did some research. The digital mammogram was supposed to be much better at picking up tumors in younger women with more dense breasts.
Finally, I had my digital mammogram. The radiologist came down and saw me. Explained that she “saw somethiing”. I needed a diagnostic mammogram. I was crushed, of course. I had to wait 3 more weeks for my diagnostic mammogram. All that time, 3 weeks of wating I thought - my gosh, I am going to die. I thought I should have insisted on the non-digital mammogram that waiting had surely done me in. I had all kinds of irrational thoughts, and I consider myself a rational woman (tho some on her may disagree!).
Finally, I went in for my diagnostic mammogram. The radiologist came down again. All was well. There were some ‘suspicious’ markings that proved to be false.
So then I learned the story about mammograms. How they provide false securtiy. They they don’t do what we trust them to do really well. They might not pick up a cancer or they will see one that doesn’t exist.
I am 50 now so I am still supposed to get one, though I am considering one every two years. For my own sanity.</p>
<p>Agree with you, Kelowna. It is done here as well. I have to have an ultrasound followup for every mammo because my breast tissue has a tendency to develop cysts. Since they are just benign saks with fluid and do not bother me, I opted out of draining them (why do it when by the next mammo a new one will appear?). </p>
<p>I have read that MRI, another non-Xray technique, is better at detecting breast cancer than mammography, but the equipment and its mantenance are expensive.</p>
<p>What we need is a sensitive, minimally or non-invasive test detecting cancer markers in fluids (blood, plasma, urine, saliva, etc.). I do not believe that there aren’t such markers. MicroRNA, maybe?</p>
<p>"Sorry, but we really do not know. This is all anecdotal. It is not first hand evidence.
Actually, 15-20 years ago mastectomies and double mastectomies were much more popular then they are now. "</p>
<p>The cancerous lumps they removed right after they did the mastectomies was first hand evidence. Nuff said! The cancerous lumps never would have been removed if they hadn’t had those mammograms. </p>
<p>The bottom line is they had no clue they had cancer(cancer does not always cause pain) and they both are alive now and they both had lumps that were found not through self examination, but through those mammograms and the lumps were found to be cancerous and they were removed solely due to the fact that they had those mammograms.</p>
<p>Again in this day and age, I would recommend ultra sound which is far superior and many times helps to alleviate unnecessary radiation and can detect many times if something is just a cyst or a tumor.</p>
<p>This new recommendation has nothing to do with the healthcare debate. Several studies have shown that routine mammograms for women between ages 40 and 50 did not change death rates from breast cancer. Aside from the cumulative exposure to radiation and the issue of false positives, the most important point is that most of those early cancers caught by routine screening would have never killed these women anyway. It is simply not true that most women’s lives were saved when they had cancer removed at an early stage. The evidence is that it made no difference in rate of survival. And unfortunately, those women who had an aggressive cancer removed at an early stage also had no better outcomes than if it had been discovered later. </p>
<p>The reasons that screening did not improve outcomes are not completely clear, but there was a recent series of articles in the NY Times about research showing some cancers can and do disappear on their own. Other research has shown that many women have breast cancer and never know it; it’s simply slow-growing or non-invasive and causes no harm. Unfortunately, there is presently no way to distinguish between the deadly and benign tumors.</p>
<p>This is all contrary to decades of advice and seems hard to accept. But the simple fact is that all this screening was just not as helpful as advertised. Medical advice can be wrong and should be re-evaluated when necessary. Not long ago doctors were routinely recommending HRT for menopausal woman, though I always felt there was plenty of evidence that this was questionable, at best. Breast cancer rates in the U.S. have fallen significantly since 2002, when routine use of HRT was ended. So, there’s a case of a common medical “therapy” that was, until recently, actually causing breast cancer:
[Hormone</a> Therapy-Breast Cancer Tie Grows - CBS News](<a href=“http://www.cbsnews.com/stories/2008/12/13/health/main4667464.shtml]Hormone”>http://www.cbsnews.com/stories/2008/12/13/health/main4667464.shtml)</p>
<p>“it’s simply slow-growing or non-invasive and causes no harm. Unfortunately, there is presently no way to distinguish between the deadly and benign tumors.”</p>
<p>That’s exactly why both my aunts were so happy that they had mastectomy’s performed when they found these very suspicious lumps. The lumps turned out to be cancerous and were getting into their lymph nodes. I guess we will not know in their case if they would have died if they had done nothing or had not gotten those mammograms, but we do know they are alive today so to them it was so worth it!</p>
<p>I am going to use this occasion to plug a really thoughtful book I read that has a lot of background about this issue:</p>
<p>[Amazon.com:</a> Unnatural History: Breast Cancer and American Society (Cambridge Studies in the History of Medicine) (9780521822497): Robert A. Aronowitz: Books](<a href=“http://www.amazon.com/Unnatural-History-American-Cambridge-Medicine/dp/0521822491/ref=sr_1_1?ie=UTF8&s=books&qid=1258574182&sr=1-1]Amazon.com:”>http://www.amazon.com/Unnatural-History-American-Cambridge-Medicine/dp/0521822491/ref=sr_1_1?ie=UTF8&s=books&qid=1258574182&sr=1-1)</p>
<p>It’s written by an MD history of medicine professor at Penn, and it combines very sharp-focus individual case studies of breast cancer treatment at various points over the past 200 years (using historical medical records, physician journals and correspondence, and patient/family journals and correspondence) with a big-picture history of the debates at the top level of the medical profession about breast cancer therapies. It is very nuanced. The author isn’t an advocate and doesn’t have an axe to grind, and he’s fairly sympathetic to everyone, although in the never-ending struggle between surgeons and internists he’s professionally and constitutionally in the internist camp.</p>
<p>The most sobering thing in it is the chart in the introductory chapter showing age-adjusted mortality from breast cancer 1830-2000. From 1830-1990, it is essentially a straight horizontal line. That period showed a huge increase in breast cancer diagnoses, in part because of the increased technological ability to find cancers, in part because more conditions were defined as cancers, and in part because the other conditions that tended to kill women before they got breast cancer WERE being addressed successfully. But, despite exponential growth in breast cancer treatment, and claims of a constantly increasing cure rate, women continued to die at almost a constant rate (with a very slight reduction in the 90s corresponding to the introduction of tamoxifen).</p>
<p>As my wife (a 7 year breast cancer survivor) commented to me this morning, “If I had been required to follow this suggested guideline, I’d be dead”.</p>
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<p>I disagree. Again, you do not know if they would be dead by now if it was not for mastectomies or not. </p>
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Yes, it has been proven, though as a society we are making that research quite difficult if not impossible. But our bodies are designed to heal itself. One of the arguments being made on this thread is that we are living in such a poluted world, eating poluted food - no wonder there is more cancer. Remember though, how much chemistry we are putting in our bodies willingly, just to get rid of some bothersome symptoms. Headache or muscle ache - let’s pop and Advil, fever - how about some Tylenol? And fever is a natural reaction of the body, research shows that low grade fever should be allowed to run it’s course (actually there is a recommendation to treat only fever higher than 38.5 C which is 101.3 F and only if it is bothersome).
We are afraid of sickness, we are looking for an instant cure.</p>
<p>Brava, anneroku!</p>
<p>JHS: Thank you for the book rec. Interesting.</p>
<p>Anneroku:</p>
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<p>I’ve read about this elsewhere in the popular press. This suggestion is such a big deal–if it proves to be true–that I think confirmation of these suspicions would be truly explosive. I wouldn’t want to be on the panel that tells tens of thousands of women they might have gone through surgery, chemo and radiation for nothing.</p>
<p>BunsenBurner and others: switching away from mammograms is going to be very very tough. What does one DO with a million old mammogram torture devices? Until a few years ago I had to go over to the cancer hospital in town for my mammograms; now my little clinic has its own, and that is true all over town. I suspect they aren’t even paid for yet. The bosses are not going to be happy to ditch them in favor of new technology.</p>
<p>The real world (of economics) just keeps getting in the way.</p>
<p>“I wouldn’t want to be on the panel that tells tens of thousands of women they might have gone through surgery, chemo and radiation for nothing.”</p>
<p>We already know that some of them went through it for nothing, if “something” is defined as additional years of life.</p>
<p>I think it is very difficult for many to understand the complexities of medical research and literature. I do not mean to sound condescending; it can be difficult for me and my fellow physicians as well. Added to this is the sometimes subtle effects of the interests of some researchers, and various industries.That is why a trusting relationship is so important. I personally feel like that trust is fostered when everyone is clear on who the “customer” is.</p>
<p>midmo, I agree. I bet that GE, Hologic and the like are gearing up their lobbying efforts and their sales forces are descending on hospitals and clinics like the Mongol Empire army.</p>
<p>Sis just finished a year of treatment for two kinds of breast cancer. Non-aggressive–treated with surgery and radiation, and then aggressive form with more surgery and chemo. After finishing chemo a couple weeks ago she had more tests–which showed three spots in the OTHER breast. She had more biopsies, and got the word last Friday that it was, indeed, more cancer. She was starting to give up hope that she would be cured.</p>
<p>(Everything has gone wrong for this formerly healthy fit woman–every complication in the book–punctured lung, blood clots, nerve damage, etc. And errors such as the aggressive cancer being present at the same time as the non-aggressive form–but the lab messed up and that cancer wasn’t “found again” until after she had finished surgery and radiation for the non-aggressive cancer–the aggressive cancer was in her lymph nodes by then–so she went on to more surgery and months of chemo. (Her doc said he’d only seen one other case with these two kinds of cancer on top of each other.) We couldn’t believe that she could have even MORE fast growing cancer–growing while she was on chemo?</p>
<p>Well, yesterday she got a call. The same lab screwed up again! They mixed up her results with another patient’s. Of course she is relieved to find out that she doesn’t have more cancer–after spending the whole weekend in tears, and most of the last year out of work and in treatment-- but she feels sorry for the other patient (who originally got good news, and now will be told she has cancer. . .)</p>
<p>Sis had several risk factors–including never having kids, so she got the routine yearly mammograms starting at 40. She was diagnosed at age 47. We were talking about the new screening recommendations yesterday. Yes, there is only one life saved for every couple thousand women that go through screening, so the huge cost/hassle isn’t worth the benefit. Unless that one life is yours, of course. She really does believe that the screening saved her life–or at least saved her from much more extreme and difficult treatment (which was bad enough as it was).</p>
<p>I am now 47 myself, and have never had a mammogram. (Even when Sis got cancer, I didn’t feel compelled to get one–am I crazy?) I sort of felt guilty about it, but now I am relieved of that. I’m not so crazy. I think my risk is low since, among other things, I spent more than 15 years pregnant and breastfeeding. There is no other breast cancer on either side of my (big) family among other sisters, mom, grandmas, aunts and female cousins. . .we’ve definitely beat the odds.</p>
<p>^Yes, you are crazy…just denial though; pretty mild as craziness goes!(…joking… ?).</p>
<p>SR–Crazy?—Do you mean the “not getting a mammogram” or the “15 years pregnant and breastfeeding”? ;)</p>
<p>"I disagree. Again, you do not know if they would be dead by now if it was not for mastectomies or not. "</p>
<p>You are correct, I don’t know for sure if they are alive because they had mastectomies, but I can tell you that the tumors they did biopsy’s on which in turn were taken out because they had mammograms were in fact malignant and getting into their lymph nodes so…I would rather in that case ere on the side of caution and remove the lumps, then to have possibly had to bury my aunts 15/13 years ago.</p>
<p>^^oh, I understand and I would do the same, trust me.
All I am saying is that cancer is such a scary disease to us that we want it out now and forever, thus limiting other treatment options by just not looking for them.</p>
<p>Anneroku brough up an excellent point about hormon replacement. There are other things that we might not be aware of yet. It is best to stay away from drugs if you can at all avoid it.</p>
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<p>Unfortunately, we now know for women ages 40-50 there are zero lives saved for every couple thousand women that go through routine screening. This is not an evil plot by Obama, or by evil insurance companies, or by the evil government, or by the evil Bush administration that appointed the leaders on that panel. It’s just a sad fact.</p>
<p>Speaking of evil, though, some radiation facilities will try to exploit our fears by urging women to continue to get this mammogram screening, even though we now know it’s worthless as a routine screen for younger women. Judging by the posters on this thread, those arguably-evil radiation facilities will succeed.</p>