This type of manipulation of numbers is nothing new, it goes on all the time. That is the reason for the old saying "figures don't lie, liars figure." Statisticians are great at manipulating numbers to tell the story they, or their employer, wants to tell. The fact that omen did this should not come as a surprise to anyone. Never trust these types of studies and statistics when they are being put out by an organization with a vested interest, particularly a large financial interest, in the results.

I think that the advent of better imaging along with the increase in life expectancy has resulted in a large increase in the number of women diagnosed with breast cancer as well as increase the number of false positive mammogram results. The imaging technology now shows even the faintest of differences in the tissue that in the past would likely have gone undetected. It is these marginal positive results the cause the most unnecessary procedures. Another thing to consider is what all these additional procedures are doing to health care costs in this country. It would seem to me that in many cases it might make more sense to simply monitor things and do another mammogram in 6 or maybe even as soon as 3 months to see if anything has changed that would warrant further intervention. This would seem to be far cheaper and than doing a biopsy and avoid potentially unnecessary risk to the patient.

For those who do not see over-diagnosis as a big problem, you really need to educate yourself a little on the impacts. First of all every medical procedure has risks, even something as simple as doing a biopsy of suspect tissue. So doing these biopsies on women where the image is not clear that it there is cancer puts them at possibly unnecessary risk. Then add to that the number of women with slow growth cancers who needlessly endure surgery and chemotherapy. The risks from surgery are significant and the side effects of chemotherapy can and often do turn the person into a shell of their former selves. It completely destroys their quality of life in the name of supposedly prolonging it. Some never recover completely from the side effects of chemotherapy. In many cases, particularly in older patients, the best course of action to treat a slow growth cancer is to do nothing and just monitor the status of the tumor in case things change. If a woman lives long enough the odds are very good that she will develop some form of breast cancer in her lifetime. With slow growth cancers the patient would most likely die from some other cause long before the cancer killed them or even had any effect on them at all. Unfortunately, too many doctors are just out to make money and will push women who get frightened by the "C" word into having, if not completely unnecessary, definitely ill advised surgery that there is really no justifiable reason for. Just because something can be treated does not always mean it should. In an older patient who is very likely to die of something else long before the cancer would get them, it makes more sense to simply do nothing than to destroy their quality of life.

Haven't you been keeping up, these anti-test arguments are designed to try to save obamacare by lowering the costs, by eliminating procedures that we are getting at present. You see, if you all eliminate these tests and discontinue treating old people, medical costs will go down, whether we have obamacare or not.

Who can we believe or trust anymore? ............... I'm tired of deception for any reason .... Shouldn't we support "truth?"

Missing from the numbers are how many died who were not detected and how many died because they were tested. They mention risks of taking the test, but what are the risks? Sore boobs? Gee, sore boobs vs. cancer? That's a tough decision. It seems to me that this is just another effort, as government takes over our health care, to reduce their costs.

Essentially, the authors of the study are arguing that "ignorance is bliss!" Sorry, but I don't buy it. Note that Kemen states that the risks depend on various factors, among them the family history of the individual. So...take into consideration family history. Why is it that Komen is essentially touting the line that government did for decades and now that government is looking at more expenses at it takes over health care, they are now arguing: Oh, all that expertise that we told you we had, forget about it, don't worry, you'll be just fine!

Like everything else in life, you have to use your own brain to make a decision for yourself. The real problem comes when government makes decisions for you but does nothing to compensate you when they are wrong. And example: I know several people who have been killed because they were wearing a seat belt and would not have died otherwise. Do you think the State jumped in to compensate relatives because of the death? Heck no! And they'll continue to ticket people who don't wear them. Talk about authority without responsibility. Same thing with the health care. If you die because government decided that you didn't need something, then tough luck to you.

Dear JS In SD, You sound informed but your arguments are not based in the clinical reality. The reality is that Digital imaging has in fact decreased the number of "false positives" and given radiologist more tools to use in their diagnosis of a potential problem. Second Slow growing tumors generally occur in post menopausal patients and if you are not post they grow fast and are usually aggressive ( so FYI start at 40 and come every year please). Third generally full blown surgery is not needed to obtain a biospy . They are now needle biospies with a stereotatic unit or under ultra sound . Neither of these two procedures are very invasive and very few complications arise. As for your assessment of treatment options for the "elderly" How old is elderly to you 60, 70, 80 ? Most Doctors will have a discussion with their patients and give them options for treatment based on their general health. If a doctor doesn't do that it is time to find a new doctor. Sometimes doing nothing means having a cancer growth grow through your skin and and creating a rotting oozing sore that will never heal and only get bigger as it metastasizes to your brain and other organs. That is not good quality to me or any other normal person. The start at 50 and every two years is a crock, it is an Old argument and pretty much is a potential death sentence to any pre-menopausal woman, just like CathyB3 (Fight Like a girl Cathy!)That is why in 1997 when they were revising the recommendations for women they did not recommend that route. Most of these studies are just numbers with no real clinical experience. So many factors are involved there really is no true way to standardize all of the information to get a true picture what happens in every situation. From My experience of 15 years in a clinical setting get your mammogram every year after 40 and sooner if your mother had pre-menopausal breast cancer. If you have Very dense breast tissue and a strong history of breast cancer in your family on your mother's side talk to your doctor about combining it with an MRI. For those of you who are scared to come in, it isn't as bad as you think and is really quick. If you think you feel a lump go see your doctor, try not to panic(the majority of lumps are cysts or fatty tumors) and if you have a new dimple, a change in your skin texture or discharge see your doctor! Mammograms are the best tool we have right now and is one of the only ways to be proactive about your breast health. As for the Komen foundation they need to stay apolitical and fund more research. Their overhead is too high. But at least everyone knows who they are. As for the two yoyos in England well I guess they just do things differently there. Please release how you came to your conclusions what data you are using to support it , the experience level of the Radiologist and tech, the equipment used, if BSE was a factor, patient family and exam history, and patient body habitus. I'd like to know. My heart bleeds every time we find a cancer, but I work hard to give the women who come into my clinic the best chance possible at early detection. Cancers just don't go away by themselves.

if you all eliminate these tests and discontinue treating old people, medical costs will go down

Are you saying that the insurance industry doesn't do this already? I'd trust the government before a for-profit corporation. Who knows if the documented CEO is even paying attention, while they are still getting $100,000 a year.

To iwonder - you're penny-wise and pound-foolish. Obama encourages preventative testing. The cost of a mammogram is around $100, so let's allow $200 for the hell of it. Now imagine what one saves by denying 1000 women a test. You think there is a savings of $200,000.00? Nope. At least one in that thousand will have cancer and the treatment will cost far more than $200K. I wonder if you need a brain scan... but that would be a waste of money. There's no brain to scan.

fred evil: You must be very young and haven't heard the phrase "I'm from the government and I'm here to help" and what it means. You've also been duped into believing "the evils of capitalism." Personally, I'll take a private corporation's word over the government any time. Why? Because with government it's dictated and you have no choice. With private corporations, you have the option to go elsewhere. Because of this difference, corporations have much more of an incentive to provide what the customer wants. Do corps make bad decisions? Of course some do. And, when they do that are ultimately held accountable. Does the government make bad decisions? The real answer is of course they do, but they are almost never held accountable.

The issue here is not, as @JSinSD alledges "that statisticians lie." All that does is indicate a profound lack of understanding of statistics. Period. Mark Twain is easy, statistics is hard.

These were numbers "enhanced" by the Komen bunch. They thought they were doing a good thing. But as with so many other issues with this bunch, they were doing the opposite of good.

The issue is "evidence-based medicine." Screening tests and resulting biopsies and treatment are valuable only if the benefit outweighs the risk and either the length of life is substantially improved or quality of life is improved. "Just to be sure" and scary pictures of metastasized cancers are not worthwhile. And a serious confound is that breast cancer is several diseases with potentially scores of causes, a lot of them genetic.

Witchrunner - It was a private corporation that wrote a memo saying if they could stave off for so many months a black-box warning to let patients know that Vioxx caused fatal heart problems, they could make over a billion extra dollars. It was part of our government, the FDA, that told patients the truth about it. So I'm not automatically going to trust for-profit corporations over public institutions. Corporations do have more incentive to provide what the customer wants, but they also have an incentive to increase sales by hiding ways in which their products might lead to outcomes she wouldn't want. They also have an incentive to propagandize us to create new or greater wants for whatever they have to sell, e.g., the deluge a few years ago of commercials telling women that needing to pee in public restrooms was suddenly a disease to be medicated.

Fear-mongering about how you're going to diiieeee horribly of CANCER!!! unless you are constantly screened and tested is part of a want-creating process, and it generates profit. Dr. Otis Brawley, chief science officer of the ACA, noted a couple of egregious examples related to "free" prostate cancer screenings. One was a hospital executive who bragged about how many expensive procedures the free screenings would lead to, and what percentage of those patients would next need treatment for incontinence or impotence. Another was an awareness program sponsored by an adult-diaper company! Certainly the proportion of overdiagnosis is much smaller in breast cancer, and most pro-mammogram propagandists primarily wish to save lives. But those who are radiologists also must have in their subconscious the fact that if we all adopted the European mammography schedule, which does not seem to be significantly inferior to the U.S. schedule in overall outcomes, their income from routine screening mammography would drop by more than half (not even counting the extra income from follow-up testing for the half of all women who will have at least one false positive if they get annual mammograms from 40 to 50).

When it comes to cancer there are always emotional biases. Ms Komen died of cancer. She and her friends intentions were to be sure this happened infrequently. It is easy to be cooly calculating when it comes to someone elses cancer. I do not believe that there is more or less personal gain, financially or otherwise, between foundations like Komen and the U.S. Government appointed experts who are being appointed and paid by the government to recommend less frequent and fewer mammograms. I also do not believe that the European mammography schedule saves as many lives as do the recommended schedules here in the U.S. I think it is very overly critical to say the "Komen bunch" does "the opposite of good" but Chris tends toward hyperbole in a lot of his apparently amature opinions concerning cancer.

Jane, the accepted call-back rate on mammograms in the U.S. is 10%-15%. I see a lot of mammographers who call back more but I hope this happens less and less as certification of mammography centers becomes stricter and requires the better mammographers. 50% false positivity is, I think, quite a large exageration.

On the other hand, there is a big difference in being very cautious that you have missed a breast cancer versus fear mongering. 25 years ago I saw 2 patients, one young and one older, who died from breast cancer that in retrospect should have been caught earlier. They had aggressive cancers but to this day it makes me wish we had better equipment back then. It's easy to say too many of these tests are being done if you are just considering numbers but when you put a name with the number and have to look them in the eye it is very hard.

Jack - Yes, a low-end false-positive rate may be as little as 10% at some centers. But that is for a single mammogram. In the second year, some of the women who were not called back in the first year will get a call-back; in the third year, some who escaped it in the first two years will get a call-back; and so forth. A large study has report that if women in their 40s, who have higher false-positive rates than older women, get every-year mammograms, about half will end up with a false-positive. Mammograms every other year may reduce the number of false positives.

Mammogram advocates often speak as if the emotional stress and financial burden of these call-backs were the worst downside of mammography, so they can sneer at the contrast between "anxiety" and death from cancer. But it is not. Mammographic screening causes a lasting increase in cancer diagnoses, mostly from overdiagnosis (though it's possibe that the radiation of several decades of mammograms causes some cancers). The worst burden falls on those who had harmless cancers, who may end up severely disabled by needless treatment.

"The piece by Woloshin and Schwartz is part of a multipronged, outrageous effort to use pseudoscience to reduce or eliminate access for women to mammography screening. This is a major scandal that is being allowed to proceed. The public needs to know what is going on."

Daniel R. Kopans M.D.

Professor of Radiology at Harvard Medical School

Senior Radiologist Breast Imaging Division

Massachusetts General Hospital "The editor of the British Medical Journal is on the Board of the so called "Nordic Cochrane Center", a group that is trying to eliminate access to mammography screening..."

"What it far more egregious than what the author writes is the amount of unsupportable material from their group that has been published and given credence as a result."

Jane, I suspect you are affiliated with the Cochrane Center in some way or are some other form of shill. You are playing games with women's lives by spreading false information and Newsvine's Editors should be ashamed for allowing this topic to even be posted in this fashion.

As a man I can empathize "why" a woman may not want to under go a mammogram, but I CANNOT UNDERSTAND THEIR REFUSAL TO SUBMIT TO ONE. I cannot see ANY reason why a woman should not do what is in her best interest. the Koman foundation IS a political organization and has had some really nasty partisan members of their board that was NOT looking out for the well being of women, but I think that has been eliminated by the uproar caused by an denier of facts. The minuscule amount of radiation incurred during a mammogram is nothing compared to other procedures and should not even be a considered factor in the reasoning to have this procedure. To some the "fact of knowing" is a terrible thing, BUT NOTHING IS MORE TERRIBLE AS FINDING OUT IT IS TO LATE TO SAVE THE LIFE OF A LOVED ONE BECAUSE THEY DID NOT WANT TO KNOW THE THE TRUTH EARLY ENOUGH TO STOP IT. That is just stupid. So there can be study after study that tells you this or that about someone else, nothing will stop the pain of losing your wife, mother, or friend knowing you had the chance to save her AND YOU DIDN'T USE THAT CHANCE! GET THE MAMMOGRAM, IT WILL NOT HURT YOU, IT MAY SAVE YOUR LIFE!

Good gravy. Jack, the "You disagree, you must be a Shill" argument is one of the tackier fallacies favored by both American scientism and its anti-scientific opposite. (Mammography is one of those weird subjects where I can't tell from your outrage which of those camps you fall into.) I doubt you even believe your attempted ad hominem, but let me assure you that I have no connection to the Cochrane Center. Though I would be honored to be associated with their rigorous reviews and meta-analyses, my own scientific training is in a field they have nothing to do with. Want to tell me where you work?

Ray, given the history of mistreatment of women by American medicine (and the gross malpractice that three of my loved ones have suffered), I bristle when any male tells me that I will be "stupid" if I do not "SUBMIT" to whatever American medicine currently thinks is "in my best interest." But I suppose that your fervor is because you have lost a loved one to breast cancer, and you think more screening might have saved her. The problem is this: Screening saves the lives of only a small fraction of women in whom cancers are found; many who have aggressive cancers will already be doomed by the time the cancer is even detectable, whereas most of those who have indolent cancers would not have died if they had waited to find it later - or never. Those who never would even have found it before they died of something else are termed overdiagnoses, and two to ten women are overdiagnosed by intensive mammography screening for every woman whose life is saved. So if you go in for screening and are converted from healthy person to cancer patient, it's much more likely that you have been severely harmed for no benefit whatsoever than that you have been saved from eventual death from breast cancer.

Mammography advocates try to make all of us imagine that we would be in the latter, smaller group. Even if I was, though, I would still have an ethical question about screening that, in my age category, has been reasonably suggested to do more harm than good. Let's say that I am the one woman in 2000 whose life would be saved by annual screening from 40 to 50. But let's say that the price of my being diagnosed at 45 and saved through early treatment from death at 60 is that six other 45-year-old women who never would have gotten sick are also diagnosed and treated, and that they suffer physical and/or cognitive damage during what should be their happiest and most productive years, a lifetime of stress, fear, and labeling, and possible financial ruin for their families. Would it be fair of me to expect them to suffer all that for my benefit? Is their loss not perhaps greater than my gain? I might gain 20 or so quality-adjusted life years, if I was lucky, but if those six women each lost four QALYs, the harm would exceed the benefit. No, we can't just screen me and not them, or pressure me and not them into aggressive treatment when something is found; since all of us are healthy and without complaints, the only way to catch the few desired fish is to drag the net through the whole school.

Sounds altruistic on the surface but you don't have breast cancer and I hope you never do. That takes away a lot of your credibility. I stated a suspicion, that is not a ad hominem attack. There are frequently "plants" in these discussions, and you at least verified my suspicion that you "would be honored" to participate in the work of tha Cochrane Center, the agenda of which is to preach against a disease that is cured if caught early but devistating if found late. Now I'll tell you about my practice. I am in an oncology clinic that is in the top 5% for both disease free survivals and overall survivals in the management of breast cancer. I participated in breast cancer research at a major referral center for 6 years. Now...your turn to avoid ad hominem attacks, but I will flatly state that the avoidance of mammograms that you espouse is dangerous and you over-exagerate the risks of having one. Have you ever been involved in the treatment of breast cancer in any way, other than railing against the scientific pursuit of it?!

Now, where is your field of expertise? Do you have any personal experience in radiation or radiation poisoning, for example?

Jack - No, I do not make my living treating breast cancer;a lack of financial interest is hardly a source of bias. Nor does not having had breast cancer make me incapable of reading and thinking about clinical trials. Once a person gets diagnosed with something, even DCIS labeled as cancer, and is being pushed from all sides into aggressive treatment, it would be emotionally very difficult to walk away. That is why I, as a 40-50-year-old woman, chose to give advance thought to the relative likelihood of benefit and harm associated with intensive screening mammography, based on my own risk and tolerance for various outcomes, and decided rationally that the European practice would be better for me. I think it will maximize my statistically expected QALYs (with "quality" of life as defined by me - YMMV). What is immoral or dangerous about that?

I don't think I am exaggerating the risks of having mammograms; I am only saying that there is a risk. One of my relatives is a radiation physicist who is concerned enough about the risks of medical radiation that he encourages his family to avoid excessive dental x-rays. However, the prevailing opinion, which I am happy to accept, is that mammograms cause more cancer diagnoses primarily through overdiagnosis rather than carcinogenesis. When you start a mammography program, cancer diagnoses shoot up, and they don't later drop to compensate. If it were true that mammography was almost entirely catching cancers that would later become deadly, and also that it caused no cancers, then the overall number of cancers in a population over a lifetime would not change; more would be caught earlier, then you'd see fewer in later years. Since that's not what happens, we know that some women are overdiagnosed. So if your clinic is in the top 5% for disease-free survival, is that solely because you use better treatments than 95% of the clinics in the country? Or is it perhaps in part because an above-average percentage of your patients have screen-detected DCIS that would never have killed them no matter what? You have powerful emotional reasons to believe the former, but that doesn't necessarily make it true.

1. The stages of breast cancer that we diagnose are approximately the same as the national average, from stage 0 to IV. Was that a personal attack? The part about us diagnosing too many stage 0's? You are being very presumptuous.

2. We do NOT give chemotherapy to stage 0 breast cancer nor to most invasive tumors less than 1 cm. We do not push to treat theses stages. Even with stage II - IV we give the patient choices and the final decision is theirs to make. (Another personal attack implied by your "aggressive treatment" comment as was the one about financial interest.)

3. I agree that in the past too many dental x-rays have been performed. My dentist asks me before doing them and if I say no, he does not do them...another personal choice.

4. Your logic about catching all the cancers in early life is flawed. Cancer can occur any time in a person's life and just because one is not detected at age 30 does not mean there will not be one there 3 years later. Also there are new patients coming into the risk group all the time. A 15 year old is not likely to develop breast cancer but by 30 her risk has risen.That is why the number of diagnoses remain static.

5. Of course the number of people diagnosed with breast cancer shoots up when mammography is first available. That is called "early detection" which we hope means early treatment of stage 0 and stage I & II disease rather than stage III and IV. That also means fewer patients having to take chemotherapy or other more aggressive forms of radiation or surgery.

6. Over diagnosing cancer?! NO. Many of the patients I see are treated with wide excision of DCIS and/or radiation, again their choice. They are not given chemotherapy. If a person chooses not to have anything done for DCIS that is their prerogative and we simply follow them with check-ups if they allow us to do that.

I don't think I'm the one that has emotional issues. Your experience in dealing with cancer of any type appears to come from reading. Your decisions about treatment are yours to make. I hope they stay fictional and never become real.

Jack - No need to be so touchy. I didn't presume that your clinic diagnosed everyone you treat; for all I knew, a sizeable fraction of your patients might have been sent to you after they were diagnosed elsewhere. I'm just observing that survival estimates are inflated when you include people who would have had essentially no risk of dying of cancer within 5 years even if they were not treated.

Yes, early detection means that the number of "stage 0" and stage 1 and 2 shoots up when you start. If those tumors otherwise would have been diagnosed ten years later, say, as stage 3 or 4, then ten years from now, the number of cancers detected IN THAT GROUP should drop below baseline. This has nothing to do with other women aging into the screening group, as you suggest. You removed growths from a bunch of 50-year-old women, therefore they will not still be there to be found when the women are 60. But that's not what happens; in fact, you have about as many diagnoses in the 60-year-olds as you would have had had they not been screened at 50. The total, lifetime number of cancers diagnosed in a single age cohort is increased. How do you explain this if not as overdiagnosis?

I am glad to hear you don't give chemo for DCIS, but that is irrelevant to the question of whether it is overdiagnosed. Overdiagnosis only means that a woman who would not have gotten sick from breast cancer in her lifetime is labeled as having cancer. In fact, she is almost always treated for it, which has consequences. For example, as you know, radiation can lead to disabling or fatal heart failure. Early diagnosis of a dangerous cancer spares women some treatment-related harm, but the flip side is that some who needed no treatment are caused harm. The total number of mastectomies is increased over the long-term by screening. Therefore, it appears that the number of women who are spared mastectomies may be smaller than the number of women who get mastectomies they wouldn't have needed. And that is part of why I am not convinced that the benefit exceeds the harm.

You don't treat prostate cancer patients as part of your business, but you are a male with (AFAIK) a prostate and have undoubtedly pondered the enormous overdiagnosis of prostate cancer resulting from PSA screening. It's questionable whether screening and treating actually improves all-cause mortality in average men of certain age groups, i.e., the excess treatment just might kill as many as it saves. At best, 40 or 50 get treated for every one who is saved from PC-specific death, and most of those will wind up with some level of disability. Do you think it's beyond question that you should line up for annual PSA tests throughout your life? If so, you plainly use a value judgement that says "avoiding death from cancer" is the ultimate goal to be pursued at all costs, and I have an equal right to hold different values. If not, then you should be able to agree that women equally can and should rationally weigh the net benefits of female-specific screening based on scientific literature ("reading," as you contemptuously put it). Either way, there is no reason to get angry because I do not make the decisions that you would have me make.

We treat prostate cancers that have failed hormone therapy, but chemotherapy is very often the next choice. Prostate cancer behaves differently from breast cancer and certainly is often less devastating and frequently not even fatal. I personally think it is prudent to have a PSA checked every 2 or 3 years, but more often if your family history is positive for prostate cancer.

The choice of having a mastectomy or not is an individual choice and I am surprised that a lot of women choose mastectomy instead of less surgery.

All DCIS does not become invasive. I can take years in some patients and we follow those closely. Often with estrogen blocking hormone therapy. Some elect to have radiation. Others choose to have lumpectomies. Some patients have such small areas of DCIS that they are literally removed by coring out a small area and leaving a barely visible needle mark.

I'm not angry but I do not approve of the Cochrane Center's negative and unscientific approach to mammograms because I see every day what invasive and metastatic breast cancer do to lives. I also see the lack of evidence first hand and in peer review journals concerning breast cancer from mammograms, especially with the new state of the art machines. There are no laws about what you must do to your own body if you get breast cancer and there never should be, although if the government has its way there may be in only a few years.

The risk of a second breast cancer in someone who has had one previously is about 0.5% a year. The risk of an early stage breast cancer coming back (not DCIS) varies with a lot of different characteristics of the tumor.

Excess treatment kills some people with breast cancer or at least shortens their lives. It happens most often in people with very advanced cancers with a short life expectancy and almost always the patient has stated that they want the aggressive therapy but I don't think a lot of them truly understand the consequences not just because it has not been explained to them but also because they are in denial or grasping at straws.

I don't understand your point in paragraph 2. If you wait for breast cancer to reach stage IV it is metastatic and very unlikely to be cured. Stage III breast cancer likewise tends to recur even with aggressive treatment. However even in those stages, treatment with hormone therapy and even with properly adjusted chemotherapy often allows for some additional months and even year of quality life. I don't give chemotherapy just to see how long a patient will live. If their suffering is made worse I have violated my oath to first do no harm.

Jack - Some of our disagreement seems to be due to a difference in fundamental personal values. If I were a man at less than high risk for prostate cancer, I would consider it prudent to make darn sure my doctor never ran a PSA test on me. That means that we could never reach agreement on this subject by reading the same literature, because the meaning of data always depends upon value judgements. For example, you express surprise that a woman might choose mastectomy over lesser surgery; I would do so without hesitation (refusing excessive lymph node removal!) if I were told that I'd be expected to accept radiation or chemo along with a lumpectomy. I value my brain and heart infinitely more than my breasts. Others no doubt differ.

I don't understand your point in your last paragraph. Yes, certainly, those cancers that would have been fatal if untreated are more likely (though not guaranteed) to be cured if they are treated early. But this is irrelevant to the issue of overdiagnosis. Let's say you take a group of women who would, without routine screening, have been diagnosed with 100 breast cancers during their lives. You screen them all every year, and during their lives they are diagnosed with 125 breast cancers. We can be sure that 25 of those cancers would never have become stage III/IV cancers and the sad prognosis of people with such cancers is utterly irrelevant to those women. Of course, the trouble is that you don't know which women those are. It's possible to make a case for identifying and treating everyone, but first you have to admit that the problem exists or your argument will be plainly "unscientific."

And as a final point, I object to you using such a word for the Cochrane Group, which publishes rigorous data-based meta-analyses. It is pure scientism to declare that a statistical analysis that does not support one's own opinions is thereby un-Scientific. You also hint at a partisan bias in suggesting that the evil Democrats want to pass laws regulating what kind of care people can/must have. It may well be true that if we ever had a government health care system, as opposed to the corporate-welfare abomination we are now facing, the government would not pay for expensive practices that had not been shown to save more QALYs than they cost. I would call that wise use of tax dollars. Many American insurance companies were pressured into paying for the horror that was bone marrow transplant; I'm sure some European national health services were wise and frugal enough to recognize that it hadn't been proven to be anything but a wallet-filler, and draw a line.

There is no partisan bias. I do not care for either party. If anything, the Democrats support health care more than the Republicans, who want to wage war and not help the poor and elderly when it comes to health care. My point is that both parties have become not only incompetent but blind to the specific needs of people needing health care. They have all put too much paper work on nurses and doctors thinking they are going to find a lot of thievery where it does not exist to that great a degree. They can find the crooks without encumbering the entire health care field.

As far as not getting tested for cancer, I look upon your idea of that in the same way I think of a person crossing a busy street without looking both ways first. Just because you don't look for a cement truck coming does not mean it will not be there to crush you flat.

I'm not surprised at a woman choosing mastectomy over lumpectomy and radiation. I understand why they do it. It is a personal choice.

I still am confused about why you think any cancer should just be left to grow without at least following it once you have made the diagnosis. To just ignore the possibility that a person has cancer is like ignoring the possibility of AIDS, TB or a lot of other potentially catastrophic diseases. Why would you stick your head in the sand and just think that early breast cancers should be allowed to go undetected?

Medicare and the FDA have already limited which drugs can be used in certain settings by appointing panels consisting of doctors, nurses and other so called experts who determine that certain drugs cannot be used in certain cancers. The panel that decided not to include Avastin as an acceptable treatment across the board in breast cancer did not contain a single expert in the field of breast cancer. They WERE experts in other types of cancers but not in breast cancer and that made their decision biased. If I were a lymphoma expert and wanted more federal funding I would not want those dollars to go to breast cancer studies.

The suspicion I have that the current Affordable Care Act is flawed is due to the fact that it was written by the private insurance companies, the pharmaceutical consortium (PHARMA) and a few U.S. Senators. It does not matter to me that they were Democrats. What does matter to me was there was no testimony from anyone in the medical field when that committee met.

Data based on meta analysis often compares apples to oranges and the data is easily skewed. There are numerous experts in the U.S. that disagree with the Cochrane group. The likelihood of dying of breast cancer IS HIGHER in northern Europe and England than it is in the U.S.

You keep trying to put spin on what I am saying. I do not send patients for allogeneic bone marrow transplants, especially not breast cancer patients, but actually no one goes for those from my practice. I rarely send patients for autologous marrow transplants and I question the benefit of those as well.

I am not saying that everything is better in the U.S. than Europe when it comes to healthcare. There are treatments available in Europe that I wish we had over here. I am specifically saying that in some European countries you either have to be rich and go outside the healthcare system for treatment of breast cancer, or you are under diagnosed and under treated. That is not wise and frugal, that is stingy and uncaring.

One other thing you keep mentioning is monetary gain. Everyone expects to be reimbursed for their work and their expertise. If I were working as an electrician and put in as many hours in that avocation as I do in medicine, I would be making as much or more than I make with my medical degree. The big money makers in health care are the private insurance companies and the pharmaceutical industry. I cannot control them in many ways. When I prescribe a hormone therapy to a breast cancer patient I am reimbursed at the same rate as an internist treating a patient with complicated hypertension.

Okay, sorry for presuming you were a Republican. You're still too touchy :-) - I never implied that YOU performed bone marrow transplants on breast cancer patients, only referred to the fact that some American MDs did.

The reason I don't think it's a no-brainer to diagnose every cancer is that diagnosing cancer does harm. Usually it leads to enormous pressure to treat right away (complete with rhetoric about how horrible it will be to die of cancer if you delay). Refusal is socially challenging. Even with prostate cancer, which is far more likely to be ultimately harmless than breast cancer, few men are brave enough to choose watchful waiting and, as the word "watchful" implies, this leaves them with a lifetime of anxiety, which itself has health costs and reduces quality of life, plus the costs and risks of follow-up procedures. Diagnosis has made it impossible to get affordable health insurance, and may lead to job discrimination. It's said that ALL of us beyond a certain age have a few cancer cells of some type in our bodies, and if we were to find them all, we would all be cancer patients. (The rate of thyroid cancer in America has skyrocketed like that of prostate cancer, thanks to overdiagnosis of harmless nodules.) I don't believe that such thorough screening would reduce all-cause mortality - but even if it did, I am convinced that it would reduce quality of life even more. Even greatly exaggerating the life expectancy benefit of screening, I'd rather have 20 good years than 25 years of fear, disability, constant medical care and possible bankruptcy. (Yes, I keep mentioning money. I don't mind doctors making a good salary for what they do - you deserve to - but you have to realize that I DON'T, and there are many things I can't afford that would be higher on my priority list than "medical attention not proven to do more good than harm".)

I was going to leave off there, but I thought of a potentially helpful analogy. Analogize health and money, and screening is like a state lottery. A tiny fraction of participants win something very substantial indeed (money to solve all one's financial problems; prevention of genuinely premature death), and the cost to each individual non-winning participant (money for tickets, hours of healthy/happy life for screening) is small enough that the pursuit of such a win might be entirely rational even if the total expenditure well exceeded the total payout. (I don't play lotteries, but it may be more defensible behavior than I was raised to believe.) But to add overdiagnosis to this analogy, let's imagine that when you played the lottery, there were not just a set of "winning numbers" but several sets of "losing numbers" that, if you hit them, would cause the state to confiscate some of your existing financial assets. Suddenly it would become a lot less clear that going for the win made sense; such a decision would at the least be highly dependent on individual values.

Well, the decision to have a mammogram is an individual decision. The insurance company establishes the cost of a lottery ticket in this case. Even so, I certainly would have thought that the cost of a mammogram would have dropped below what they cost nowadays.

Studies have already been done that have to some degree established how long it takes DCIS to become invasive, but they could be repeated now that mammograms are more sensitive and detect more DCIS, but then that would cause even more mammograms to be performed.

I understand your concerns and the reason you choose to have certain tests and not to have others. It is a personal thing and if you can live with your decisions, then good for you.

What bothers me is when politics and rumors, or bad advice come into play. I concede that this happens from all interested parties. People should be able to make this a personal and informed decision and not be influenced by pseudoscience.

By the way, bone marrow transplants for breast cancer patients went away over 10 years ago.

Cathy B3

It is great your outcome was successful and will remain so in the future. I agree with your post also. False positives occur in many tests (ie, bloodwork, CT, MRI, ultrasound) so frequent follow up is always the next step.

A big concern is always the "false negative" results (disease is present but testing discloses no evidence). This is always the worst outcome. Going forward it would be prudent that when researchers publish their results and are then disseminated to the public by any news organization this should also be discussed. There are also statistics that can be reported called "predictive value" of a positive or negative test results that should also be discussed. Maybe then we all can have a better understanding of the validity of a given editorial or study.

@AW-1027,

It would also be good if the media also always cited the name of the paper(s) in which information is published, the name of the journal in which it is published and the names of the principal investigators. The media should also insure that the paper is available to the public before making it a public issue.

Physicians, especially those from medical schools, are currently seeing a promotional opportunity in going to the media with articles instead of going through the peer review process. You have to bear in mind that physicians have absolutely zero training or skillset in conducting research. They only have a vocational degree that is the rough equivalent of a partial master's degree (sans thesis and any critical thinking training.) These "direct to the press" articles often cponfuse correlation with causation, use inappropriate statistical methodologies and draw unwarranted conclusions, often self-serving for a certain drug or procedure.

Chris

Your comments are very true--I am familiar with lack of research training (nor interest) many physicians have in academic medicine during their residencies or fellowship and basically want to get through it and move to private practice. The possibility of submission of research studies to "on line" journals is growing and whether there is critical peer review is a concern. I agree also that correlations do not necessarily imply causation--they are more often aptly to be "associations".

Chris, not true, at least not in Oncology. Fellows in training are routinely expected to assist in clinical research and the publication of papers in peer review journals. "Vocational degree"? That is not just untrue but insulting.

If they've raised nearly 2 billion dollars, yes, someone is listening.

yes someone is listening, all the people who rush thinking they are doing a good thing, when in reality, the money just goes into other people's pockets, not reasearch. I belive it was like for every dollar you give only one cent actually goes to reserach if that. most of the money goes to the CEOs, advertising (ever notice everything has a pink ribbon on it). but the research gets the peons. way to keep "promoting a cure". they will NEVER cure cancer. look at how much money it brings into corporations. I am sure there is a cure out there, but then nobody would go to the doctor anymore. the idea is to keep people sick.

Not sure what you are talking about. The cost to participate in the walk is around $35 for a non-survivor). What you raise is irrelevant to whether or not you can participate. You don't have to raise a dime.

You just showed your ignorance. They are Democrat because they take money donated for breast cancer research and funneled it to Planned Parenthood.

yakmik: What are you talking about? Koman is not a republican organization, it's a women's health organization.

Koman is not a republican organization, it's a women's health organization.

Oh seriously. Do a scrap of research, because you only embarrass yourself when you post something like this. Komen is only about women's health anymore on the surface. They are rolling around in bed with Republicans. Everything about President Nancy Brinker screams Republican, from her huge donations, her Bush-era government appointments, and even her hairstyle. She is DEEPLY in cahoots with the Republican Party. SGK may not ostensibly be a Republican organization, but it's folly to suggest that they're not one under the facade.

Just more pathetic liberal lies. Too bad it's all you have left.

@Valhalla,

You really should do some checking before you speak, especially about the connections between the Komen bunch and the attacks on Planned Parenthood. There was plenty of documentation to go around on this one. The GOP engineered the anti-Planned Parenthood, got its own people in at the top of the Komen organization and then let Komen absorb the damage.

Komen had already called a great deal of attention to itself by spending so much money suing other cancer charities for using the color pink or "for the cure" or "for a cure" in their advertising. Hundreds of individual women who tried to raise cancer research funds with bake sales and such found themselves on the receiving end of huge lawsuits. Sound like a charity to you?

And calling them "patheric liberal lies" is really stupid. That's not an argument, but simply an attack on people about whom you know nothing.

This whole Tea Party thing is destroying the Republican brand and every election will become more and more impossible for a Republican to win except in states with no Latinos, noi Afriocan-Americans and in the lower half of the country in education. The current odds of Obama winning on Nov 6th are 70.2% to Romney's 29.8% --- almost 3 to 1 against the GOP. But of course if Romney releases his tax returns ...... LOL

Elizabeth Taylor's Law-WTF? Was this a law you passed in your head? Was Liz your local state representative or what? What kind of whacko quotes Liz's Law? The only thing "charitable" about SGK is the amount they pay their leaders!

And more pathetic liberal lies. How boring.

You could get a thermogram instead of a mammogram.

Thermograms are crap. They are a poor man's version of a doppler ultrasound operating under the premise that there will always be increased blood flow to a cancer. If there is enough blood flow to a cancer to show up on it then it is probably something you could already feel.

GetAMammo, do yourself some real good and stop wearing a bra. Best way in the world to decrease the risk of ever getting breast cancer. Funny how Komen never mentions that, but then they don't want to admit that preventing it in the first place beats 'finding a cure'.

Yes. They wouldn't want to encourage women to go braless, can't have that. I've noticed they NEVER talk about genuine ways to prevent breast cancer such as nursing your babies for at least one year. I have yet to hear them once mention that and there are numerous studies proving that breastfeeding reduces your risk - significantly, like quitting smoking. But somehow that's not important enough or politically correct to mention.

New digital imaging uses only 1% the radiation of past methods. You could have one digital mammogram every year for life and get more radiation from a plane ride.

You could have one digital mammogram every year for life and get more radiation from a plane ride.

[citation needed]

I really hate to see people assume that statistics can be manipulated to show anything that a statistician desires. This is simply NOT true and shows only a lack of statistical knowledge. Statistics can be abused. But there is a system in science called the peer-review process that helps stop most of it before anyone hears of it and the rest falls automatically by the wayside.

In the peer-review process, experts in various fields review all grant applications. These applications must state clearly the methodologies, and especialy the statistical methodologies that will be used before the data is even collected. If the methodologies are not sound, no funding. And publications are reviewed the same way before journal articles are accepted for publication. There are weaknesses but they tend to be with non-scientists such as physicians who try to shortcut the process and occasionally there is someone who falsifies results, but in both cases it is usually statisticians who find the mischief.

The idea that statisticians can be wrong is correct. All humans can err. The idea that they can willfully make statistical results paint incorrect pictures is also correct. All humans fabricate at some time. But the idea that a syayistician can be wrong or incorreect and not immediately be pounced on by other statisticians is absolutely wrong. And, for a statistician to be caught manipulating data is the end of a career. There is no way back from that slippery slope.

The numbers Komen was using were simply made up and based on anecdotal evidence and "common sense" (which is seldom common and often makes no sense.) This is not statistics --- it is advertising.

The only story a good statistician can make data tell is the truth.

Have you any idea how lame that crap is? If there were really such a cure Cuba would adapt it then charge millions. The shear stupidity of people who believe these idiotic conspiracy theories is appalling.

Cancer survivor rates have been improving year after year and progress is being made, particularly since the human genome was codified. There are some fantastic cures that work in the laboratories so it's only a matter of time before we see a revolution in cancer treatment.

I know that doesn't fit your conspiracy wet dream, but reality never does.

There is an excellent book "The Emperor of all Maladies" out there which is a history of cancer, its detection and treatments. When a friend recently was diagnosed with cancer and was feeling hopeless, I recommended it to her. It does not sugar coat the complexity of the problems in treating these diseases but it does provide real information, and real information can make a huge difference in how people respond to their diagnosis.

@Brian Watson,

The problem with a supposed cure for cancer from 1952 is that cancer is not a disease ---- it is literally hundreds of different diseases. And a "cure" would actually require at least hundreds, if not thousands of cures.

The lunitic fringe always makes such claims when there is a problem so big or complex that they simply cannot get their mind around it. They can't even understand the problem and that is what makes a conspiracy theory necessary.

And losing the bras.

And nursing their babies

Obama played politics with your life over Obamacare, does that mean you will not support him either?

Just sayin'

Obama is a POLITICIAN, it would be stupid to expect him (and all the others) NOT to play politics with any and every issue. The Komen organization is not a political body. Big difference.

I would expect a professional medical doctor to attempt to perform surgery on me if I needed it; but I would be outraged if my barber tried the same thing. Big difference.

No, becuase chemo unfortunatley is just a way for more money to be made at the expense of hte patient. chemo kills your body. like one doctor said, nobody dies from cancer, they die from the treatment (fried organs from radiation, fried liver), but they always put cancer on the death certificate becuase if they actually todl the truth everyone would see that their "cures" are actually killing people, not the cancer itself. Look up Dr. Farley.

Paranoid nonsense without a shred of truth. Cite your sources, besides "I know a nut case who..."

No, because defending women's health in one context does not make up for harming it in another, and there is good reason to suspect that the extreme mammography schedule promoted in the US does more harm than good. Also, because an organization that genuinely respected women's autonomy and intelligence would not attempt to control their behavior by lying to them. Komen's "statistics" are not just biased, but outright fabrications, and what that says to me is that they do not want me as a woman to hear the real numbers lest I use them to make a choice other than the one that they think I should make. Instead, they want to manipulate me through fear as if I were an irrational animal. Feminism FAIL.

Amen ShoeDiva.