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Reuters
As many as a third of cancers detected through routine mammograms may not be life threatening, according to a study published on Wednesday that raises fresh questions about the benefits of breast cancer screening.
The study, which looked at three decades of U.S. government data, found more than 1 million women may have been over diagnosed for breast cancer, needlessly exposing them to the anguish of a breast cancer diagnosis and the ordeal of treatment.
"It's a lot of women. It's a very substantial harm," said Dr. Gilbert Welch of The Dartmouth Institute for Health Policy & Clinical Practice in New Hampshire.
But proponents of mammograms have already begun poking holes in the study, by Welch and Dr. Archie Bleyer of St. Charles Health System in Oregon and published in the New England Journal of Medicine. While mammograms are not perfect, the proponents say, their benefits still outweigh the risks.
Welch has made overdiagnosis a major focus of his research. In an earlier study, he concluded that as many as 1 million U.S. men had been over diagnosed with prostate cancer since the introduction in 1986 of the widely used PSA test.
Such studies contradict the deeply ingrained belief that cancer screening is always good because it saves lives, an idea that is being steadily challenged by studies examining the harms of screening.
"We're not the first to suggest this, and it has come at a very huge human cost - the cost of telling a large number of women they have cancer and treating women for cancer with chemotherapy and radiation and surgery," Welch said in a telephone interview.
In 2009, the U.S. Preventive Services Task Force, a government-backed advisory panel, issued new guidelines that suggested women should start routine mammograms at age 50 rather than 40, in part because the tests have such high false positive rates and the benefits in lives saved did not outweigh the worry and anguish caused by the false positive results.
That conclusion, which was based on a review of published studies, contradicted years of messages about the need for routine breast cancer screening starting at age 40 and triggered a backlash from cancer doctors, advocacy groups and lawmakers who said the tests save lives and are worth the risk of a false positive test result every now and then.
An independent panel of advisers in Britain that reviewed data from 11 studies backed up critics of the task force, saying that for every 10,000 50-year-old women invited to have a mammogram over the next 20 years, screening would prevent 43 deaths and result in 129 cases of over diagnosed breast cancers, preventing one breast cancer death for every three over diagnosed cases.
The matter, however, is still far from settled.
Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said the new study was an "interesting conversation starter" but not the final say about the value of mammography in the early detection of breast cancer.
"It points out issues that many if not all experts agree on, but the degree of the number of women have been impacted and the true impact of the negative side of mammography is something that other researchers would disagree with," he said.
In the latest study, Welch and Bleyer looked to see how well mammography was working as a screening tool.
They figured that to reduce the rate of death from cancer, screening needs to not only find more early-stage cancers; it must also reduce the number of cancers that are discovered at a late stage, when treatments are less likely to work.
Using government health and census data, the team compared breast cancer diagnosis between 1976-1978, before mammogram screening was widely used, with data in 2006-2008, when routine mammograms had become well established.
They found that the introduction of screening mammography in the United States has doubled the number of cases of early-stage breast cancer detected each year, but the rate at which women are diagnosed with late-stage cancer has only fallen by 8 percent.
"You see with mammography a dramatic increase in early-stage disease, but you don't see much compensatory decrease in late-stage disease. That means you are finding a whole lot of early cancers that were never destined to become late-stage," Welch said.
Welch said that mammogram screening is likely not doing much to catch cancers at an even earlier stage of the disease, when they are more treatable.
The researchers estimated that breast cancer was over diagnosed in 1.3 million U.S. women in the past 30 years. In 2008 alone, they estimated that breast cancer was over diagnosed in more than 70,000 women, accounting for 31 percent of all breast cancers diagnosed.
Welch said the findings cannot answer the question of whether women should get screened for breast cancer, nor does it suggest that there are no benefits, but the findings do challenge the assumption that mammograms are always a good idea.
"I can't discount that there may be a tiny fraction of women who are helped by screening, but we can say it is very small - much smaller than conventional wisdom," he said.
Others were quick to dismiss the findings, saying the study by Welch and Bleyer was fundamentally flawed because it underestimates the annual rate of breast cancer growth.
Dr. Debra Monticciolo, a spokeswoman for the American College of Radiology and president of Society of Breast Imaging, said the paper was an "extensive analysis based on false assumptions."
For their analysis, the researchers assumed in their "best guess" estimate that breast cancer rates would remain fairly stable over the study period, increasing at a rate of about a quarter of a percent a year.
"They are off by a factor of 4," said Monticciolo, who said the real figure is closer to 1 percent increase per year.
"If you recognize breast cancer had been increasing for 1 percent per year, there is no overdiagnosis."
Welch dismissed the criticism as a "circling of the wagons" by a specialty group that is "simply not open" to consider that there might be any problems with mammography.
"It's is a lot easier to make a simple (and misleading) case for screening, than it is to try to do better. But it is not in the best interest of our patients," he said.
Dr. Colin Begg of Memorial Sloan-Kettering Cancer Center of New York said he thinks the study makes a pretty good case for overdiagnosis, but he questions the authors' assertion that the benefits of mammography are small.
"We have had umpteen randomized trials out there that show there is a mortality benefit of about 15 percent," he said.\
Begg said the authors are concerned that women are being encouraged to get mammograms when it may not be in their best interest, but he said all screening tests have risks as well as benefits.
Breast cancer is the second-leading cause of cancer death in women, exceeded only by lung cancer, according to the American Cancer Society.
"I'm assuming most women who get mammograms are vastly more concerned about preventing their death from breast cancer than they are about the false positives of mammography," he said.
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They are at the point where they can tell by the mutation what type of cancer it is and what kind of treatment to use. At least that's what I've been told by a specialist in CT. If that is the case, then this is a moot point. Non life threatening cancers will be assessed and treated appropriately.
I think your statement relies too much on physician competency... you're believing that they can 1) properly detect that it's cancer (not misdiagnose), 2) determine what kind of cancer based on a test, and 3) they have the proper facilities and testing abilities on hand to do so.
Being able to test to see what type of treatment to use does not necessarily equate to identifying non life threatening cancers. I am not familiar with this but it would seem plausible that the markers (mutations) that they are detecting for determining the treatment can be present in both life threatening and non life threatening cancers. Cancers often have multiple mutations going on and the mutation that makes the difference between life and death may not be known yet, whereas other mutations that can help determine the appropriate drugs are known.
I believe that they usually discover AFTER the surgery that the tumor was not life threatening.
Doctors too often rely on fancy equipment and end up chasing after every little shadow. No studies are done on how many of these conditions would resolve by themselves if left alone.
Well then I don't consider a biopsy to be life threatening or more harmful than having a tooth pulled.
Another scary aspect is that CT scans aren't always calibrated (right word for it, not sure?) and give off A LOT more radiation than intended. THAT can't be good for you. Actual cancer patients are constantly getting CT scans.
They say to check your breasts monthly for lumps.
In place of a mammogram, I will volunteer my screening services for all the attractive ladies.
Not cool. We are talking about cancer here and for many women, who are all very attractive, this is a serious concern. Your humor is a bit out of line.
You are making my comment out to be much more than it is. Why do you feel the need to make a non-issue grow out of hand uncontrollably?
Ummmm.........because it is insulting to women? I know you don't realize that, but it is, and I am a man. Your locker room attempt at humor has no place here. Now go away.
Funny how people always get offended on behalf of others.
How about you go away and mind your own business? Judging by your other posts here, you're simply here to insult others. Time for you to grow up, yeah? Put on your big boy pants and don't meddle in other people's business?
Didn't your mother even teach you manners? Guess not.
Boom try thinking with your big head you may like it.
The treatement of diagnosed cancers in general seems to do more bodily harm than good. I agree that there are pleny of cases where a person's life is saved after extremely horrendous body mutilation or after the person has to suffer intense exposure to damaging chemicals. But how many more people live full and productive lives with undiagnosed "cancers"? I've known more people that died from cancer after treatment than survived after treatment. At some point, you ask yourself, is treatment really necessary, or is the cancer that much of a threat? Cancer has become the big "C/$" word in the medical and pharmaceutical industry.
Doctors say, we found a group of cells that might be cancer (mole, lump, anamoly on an X-ray or CTScan). Doctors say it must be treated agressively by filling your body with radiation (yeah great idea) or harsh chemicals that you wouldn't wash your car with. If the medical industry didn't have cancer to combat, they would likely be broke.
Try selling your line of crap to people who actually have life-threatening cancer, or to their survivors after they die from it. I have a potentially lethal and incurable cancer, but because it was detected and treated, I am still alive ten years later. Would you have advised that I ignore it and take my chances that it won't kill me?
My sister died of cancer less than a year ago. She and I went on a 6 month journey of trying to prevent that. The chemo destroyed her as it does most people. She was afraid to give it up. The one thing that made a TREMENDOUS difference was high-dose vitamin C cocktail through an IV. She went from sick as a dog to running around costco (no exaggeration). The tragedy was that she was afraid to totally stop chemo...I respected that as she has a young son and felt she had to continue on the traditional route. There is no part of me that doubts she would still be here if she would have dropped the chemo; yet, I understand her fear in walking away from it.
chris, i am so sorry. my sister died of cancer 2 years ago at age 48. she was the single mom to a then 13 year old. a few years earlier i lost 2 close friends to cancer. after watching them go through the hell of cancer diagnosis and treatment i determined that i will go the alternative route if cancer ever happens to me. which will be hard to discover as i have pretty much lost faith in conventional medicine and will only seek out a conventional practitioner if i suffer an injury. for now i focus on creating optimal health for myself, eliminating the need to feed into the money monster that is modern medicine.
Mymomdidnotraiseafool, I'm not selling anything, just simply stating an opinion based on observation. The cost of treatment is much higher now then it was 10 years ago. There is also more incentive for hospitals to make diagnosis that will require expensive treatments (more $$$). That was one of the points I was making. The board of directors of any corporately owned hospital does not care about individual diagnosis, they care about profit. If the hospital orders unecessary tests or treatments, then more money for the shareholders.
My other point, is that the treatment is often worse than the diagnosed disease. Radiation and chemo is brutal on a body.
There's a LOT of money in over-diagnosis and over-treatment, so obviously the doctors and hospitals are going to want to do what's best for the bottom line. Just as obviously, the insurance companies are going to want their customers to do what's best for their bottom line. I wonder who provided funding for this study.
That tinfoil hat must be getting pretty heavy by now.
This message is for "mymomdidnotraiseafool"...I am sorry for your condition...please open your mind to alternatives...I believe they save lives. My sister went to Sloan and Cancer Centers of America (the latter was far better). It's not that oncologists are evil or not trying their best, but there is so much out there that they don't know. If you can, check out a show (or go online) called "the incurables" on veria (on fios or you can get it at the verizon website). These are real people cured through alternative means. Or read about max gerson or charlotte gerson. This isn't tin hat crazy stuff...it may change your life. My sister was hell-bent on following her oncologist's protocols (including clinical trials)...she died at 48. She had initally bladder cancer that morphed into urothelial cancer and eventually transitional cell carcinoma. When she passed, it was everywhere...lung, abdomen, brain. Also, try to be positive and stress-free -- it DOES matter. If you have any questions, indicate on this thread and I'll email you. Best of luck to you.
There's a LOT of money to be made in over-diagnosis and over-treatment, so obviously the doctors and hospitals are going to want to do what's best for their bottom line. Just as obviously, the insurance companies are going to want their customers to do just the opposite.
I wonder who funded this study.
As a breast cancer survivor of almost 28 years I think every woman should have a mammogram every year. The study says they catch a lot of early stage cancers and about the same number of late stage cancers as they formerly did. Logic tells me that the reason they don't catch more late stage cancers is because they are finding them early - therefore they don't become late stage. This is a good thing - for the patient and the insurance companies. Early detection and treatment is much less expensive than treating late stage cancer after it's spread to other parts of the body. I can only assume this study was done by a bunch of men who 'just don't get it.'
Happy Thanksgiving everyone.
If screening caught only dangerous early stage cancers that would later have become late-stage, you would expect later to see a substantial reduction in late-stage cancers. If you take a dozen eggs and break six of them, you don't expect to come back later and find twelve chickens. One of the oncologists interviewed suggests that this is happening because breast cancer rates are going up so fast and constantly that you'd have seen even more advanced cancers than you could have predicted if all those little ones hadn't earlier been caught and treated. Aside from the fact that his numbers seem intuitively fishy, there are catastrophic problems with his argument. Large studies have compared groups of women who received regular screening to groups who didn't, during the same time period in the same part of the world. Over many years, the former have more total cancers diagnosed. You can't explain this as being caused by everyone's risk growing over time, otherwise the rate of late advanced cancers in the non-screening groups would be much higher. More mammography really does mean more cancer diagnoses. At best that makes his argument circular: if rising mammography rates over time automatically leads to apparently rising breast cancer rates, you can't then use that rising rate as an excuse to hide the relatively meager reduction in death rates. At worst, if he continues to insist that there is no overdiagnosis, and every screen-detected cancer and DCIS would be life-threatening, we would be forced to consider the possibility that the radiation from mammography is enough to substantially increase lifetime breast cancer risks. I would not want to seem to support that hypothesis, if I were him.
I am a breast cancer survivor, and for 20 years I had my mammograms. Every once in a while they would say we see something in your breast, please come back. They would say it is Ok. Finally, they said we found something. I had 3 tumors which we fast growing. From the time they saw the 1st one, it grew from 2 cm to 5 cm. in three months. So, yes the cancer was slow growing for 20 years, and then in my 50s it became fast growing. This is an interesting study above, but it does not take in account the issue that most of the breast cancers are diagnosed when women start pre-menopause, menopause and post menopause. Since, genetically women differ when this stage happens - usually from their 40s through their 50s - I would say go get your mammograms. Reread the study above. 2/3 of the women were properly diagnosed and 1/3 had slow growing cancers. I did not know I was pre-menopausal at the time. Slow growing cancers can take off, when your body is going though hormone changes and when being stressed.
I almost lost my life. Go get your mammograms, and catch it early so that you can see your children grow up, get married, and play with your grandchildren. Enjoy life and have a Happy Thanksgiving!
Due to my loss of a wife of 26 years knowing she did everything possible to fight breast cancer and still lost - I am of the belief that there are too many practicing physicians and not enough physicians that know what they are doing. The medical industry in this country needs to heel themselves and quit robbing the public ,,,,
medical practice (hospitals) claim to be non profit but somebody is sure lining their pockets
One topic which has not been addressed in this article is the number of breast cancer cases which are caused by the mammograms. I am not suggesting we don't use them, but the idea that every woman should have one every year is not based on science, but on the bottom line for the medical industry.
What is over diagnosis? If it's cancer, it's cancer. Do you want to roll the dice and hope that it doesn't spread?
In regard to breast cancers caused by mammograms: The radiation dose is tiny, less than the background radiation you get by walking down a city street on a sunny day. Yes, we all get irradiated every day. It bounces off buildings and sidewalks, and people who live in Denver get more than people who live at sea level. And airline pilots and frequent travelers get more than people who don't fly. And people who have horrendous accidents and spend months in the hospital with head to toe x-rays, over and over again to check their progress; they get a whole lot of x-rays. Do they die? Of radiation poisoning? Or cancer? Once a year low dose mammography causes breast cancer??? Give me a break!!!
lesley-2848349, over diagnosis means that many-up to 2/3 of the cancers detected -would have cleared up on their own. yes, cleared up on their own. there are very powerful lobbies in this country who work very, very hard to make sure the C word scares the living hell out of us. with any medical diagnosis or treatment or immunization, etc.., i find it best to look into what canada and europe are doing. in those places wisdom reigns because no one makes an obscene profit from from over doing it.
Actually, according to the World Cancer organization the U.S. breast cancer rate is lower than many of the European countries. The U.S. is actually 19th in the world. Here is the top 20 in order: Belgium, Denmark, France, Netherlands, Israel, Iceland, Uruguay, Switzerland, New Zealand, United Kingdom, Finland, Italy, Australia, Canada, Luxembourg, Germany, Sweden, French Polynesia, and then the U.S.
If even one life is saved then I say he risk is worth taking. My sister is a breast cancer survivor but my aunt is not. Trust me, mamograms are not enjoyable in the least but the alternative can be devastating if you don't have your anual screening. 1 year can make a huge difference!
Frequent screening of low-risk women, such as women in their 40s without a family history, slightly reduces their already small risk of dying of breast cancer within the next 10-15 years. However, it's never been shown to reduce *all-cause* mortality in such women. Cancer treatment does kill some people, immediately or in the long-term. If you die of drug- or radiation-induced heart failure, you are just as dead as if you die of breast cancer. I would not agree that any number of women should be put through hell to save "even one life" - but if screening of a particular group actually costs more days of healthy life than it saves, it's not statistically a good deal for women in that group.
One out of every 7 women in the U.S. will be diagnosed with breast cancer in the U.S. The mortality rates in the U.S. have been falling due to prevention and treatment according to the World Health Organizations (WHO). The WHO has excellent graphs of how the U.S. breast cancer mortality rate has been dropping over the last 10 years online. According to the WHO, "Breast cancer survival rates vary greatly worldwide, ranging from 80% or over in North America, Sweden and Japan, to around 60% in middle-income countries, and below 40% in low-income countries." The WHO is contributing the large mortality rate drop in the U.S. due to the screenings with mammograms. They state that other countries that do not pay for screening, end up with women being diagnosed with later stage breast cancers.
If you have more screening and therefore more overdiagnosis of harmless cancers, the "survival rate" will be artificially inflated. A better measure is what percentage of the total population actually die of breast cancer, and in that regard the U.S. is not that much better than other wealthy nations.
Actually, the U.S. has dramatically improved that ability of preventing breast cancer deaths in the last 10 years. To state, that "the U.S. is not much better than other wealthy nations" is not true. Right now the U.S. is 61st. which can be confirmed at worldlifeexpectancy.com. These figures are based on population, not against diagnoses.
Cancers deaths per 100,000 are as follows for a few sample of countries:
9th-Denmark->26.7
10th-Ireland->26.1
12th-Netherlands->25.4
14th-Israel->25.1
19th-Belgium->23.1
20th-United Kingdom->23.6
25th-France->22.7
32nd-Germany->21.8
33rd-New Zealand->21.5
46th-Canada->20.2
61st-US->18.8
Our death rate has improved in the past ten years, but mammography's been in wide use since the 1980s, so that's not the sole explanation. There's good reason to believe that treatment of breast cancer has improved significantly. If it hadn't, choosing newer treatments would just add cost and risk of known and unknown side effects. Not all of these advances may be available worldwide. Also, it's hard to directly compare numbers among countries when age distributions may vary (Europeans have more children, which is itself a risk factor for breast cancer) and other risk factors may vary. And further, many European countries actually do have some level of mammographic screening (usually biennial, which does not appear to be inferior to annual screening). Nevertheless, the absolute difference between 18.8 per 100,000 dying in the US and 21.8 per 100,000 in Germany is not large enough to warrant much bragging.
First, according to Komen.org “In general, the more children a woman has given birth to, the lower her risk of breast cancer. After the first child, each childbirth lowers risk.”
Second, the U.S. has a higher birth rate, than any country in Europe. I refer you to chartsbin.com.
Third, the U.S. has less breast cancer deaths per 100,000 than the rest of most of the wealthy European countries. See above discussion.
Lastly, findings from a large study in Sweden of more than 1 million women in their 40s who received screening mammograms showed a decrease in breast cancer deaths by 29 percent.
Remember that most women who get breast cancer have no family history or other known risk factors for the disease. Consequently, since 1 out of 7 our you in the U.S. will be getting breast cancer, with 90% with no former family history, I suggest highly you go get your mammograms and live!
Blast - That's what I was trying to say. I meant to say Europeans have FEWER children, and that not having children is a risk factor. You are, of course, correct. And this means that even if our genetics, diets, lifestyles, and chemical exposures were all equivalent, you would expect more "real" breast cancer among Europeans. Therefore, if they have slightly higher breast cancer death rates that cannot be presumed to have anything to do with their lower frequency of mammographic screening.
A couple of early studies suggested that mammographic screening reduced the death rate by about 25% - which means that 3 of 4 women who would have died will die anyway - but more recent studies come up with numbers closer to 10 or 15%. One reason for this may be that treatment has improved. We cannot reject newer studies and look only at older studies, of women who were given treatments that would now be considered obsolete, just because the latter make mammography look better.
The 1 in 7 number is new and I have not seen evidence for it - but even if it is or becomes true, it applies to lifetime diagnoses assuming we all live to old age, and by no means to deaths. The chance that a woman in her 40s will be saved (from BC-specific death) by annual mammography is about 1 in 2000. Therefore, the chances are great that I will "live!" anyway. I respond to numbers, not fearmongering. I'm not going to be screened in my 40s based on what my risk of getting some disease in my 60s or 70s might be.
Also, the 1 in 7 number would inevitably include a huge number of overdiagnosed cases that were diagnosed only because of screening. According to some studies, annual mammography increases your chance of being diagnosed, long-term, by nearly 50%. That means that you could cut your "risk of breast cancer" by almost a third just by not getting regular mammograms. Of course, you would not thereby reduce your risk of "real" breast cancer, i.e., cancer that actually threatened your life. To make rational decisions about screening on a year-by-year basis, women need to know what that risk is at every age of their lives, and they cannot get any sense of that from a number that includes up to 80 or 100 years of life and a huge proportion of overdiagnoses.
In the U.S. for 2011, the breast cancer rates from the American Cancer Society are as follows:
(Population figures are from the U.S. Census Bureau 2012)
Age: In-situ cases---Invasive cases---Deaths
30-40: 1,780---11,330---1,160
40-50: 14,240--50,530---5,240
50-64: 23,360---81,970---11,620
65-80: 20,050---98,080---22,660
All ages 57,650---230,480---39,520
(30-80)
Age: Population---Diagnose Rate
30-40: 21,576,587---0.61% (1 out of 170)
40-50: 21,515,659---3.01% (1 out of 30)
50-64: 21,607,152---6.82% (1 out of 15)
65-80: 14,459,069---12.25% (1 out of 8)
All ages 79,158,467---14.20% (1 out of 7)
(30-80)
Age: Population---Breast Cancer Cases---Death Rate (based on cases)
30-40: 21,576,587---13,110---8.85%
40-50: 21,515,659---64,770---8.09%
50-64: 21,607,152---105,330---11.03%
65-80: 14,459,069---118,130---19.18%
All ages 79,158,467---228,130---13.72%
(30-80)
In summary, the older a woman gets the more chance she has to develop breast cancer. When you wish to start your exams is your choice, but please realize that statistics don’t mean much when they say to you the words, “I’m sorry, you have cancer”. I had to face the reality that I had not had a mammogram in 2.5 years, and now I had to fight for my life. I was told this was a slow growing cancer, and I had made the wrong choice not to make the mammograms a priority. I had no one to blame but myself, and then I had to tell my family. I learned a lesson that we all need to choose wisely in our health decisions.
The incidence figures have to be "per decade of life," not "per year". It's not possible that 1 in 30 women between 40 and 50 is diagnosed every year, even with mammography. And the only death rates that would help you decide when and how often to be screened are population-based absolute death rates with and without mammography. Both the chance of dying if you are diagnosed and the chance of being diagnosed are affected by how much screening is done.
I wish you the best of luck in your own cancer treatment. However, if you don't mind my saying so, you have suffered outrageous emotional abuse at the hands of whatever doctor gave you the "wrong-choice" line. Really slow-growing cancers can sit for well over two years before becoming dangerous (or going away altogether!). Really aggressive cancers can become dangerous in less than 12 months, sometimes even before they are detectable, which is why even annual mammography only slightly reduces the breast cancer death rate. Your doctor cannot know exactly how your cancer developed, nor can he know that your eventual outcome would have been better had you gotten a screen on any specified date. If you should eventually die of breast cancer, there would be perhaps an 85% chance that that would have been your fate even with screening. Even if you survive cancer-free, telling you that you will be directly to blame for everything that happens could cause you lasting psychological harm. I'd ask myself what he hopes to accomplish by saying such things. Perhaps he thinks you will not question damaging treatment choices if you believe you deserve to suffer.
Yes, the figures are presented by an age range. So, for the 40 to 50 years old, in that decade those are the figures. This is the way the cancer.org presents the data, so I'm following their way of presenting the data. Right now there are 2,600,000 women who are living cancer survivors, that turns out to be 3% of the total women's population from ages 30 to 80.
According to the World Health Organization 80% of all tumors are found by the women themselves. The in-situ early stage cancer cases are typically found only by mammograms. In countries that don’t have regular access to mammograms and the newer cancer treatments, the average mortality rate of a woman is currently 40%.
U.S. Breast Cancer Diagnostic Time-line
(Mortality rate is based against breast cancer diagnoses in that age group)
.
Breast Surgery
1950-1959 ages 50 to 64 mortality rate – 33.05%
.
(HRT drugs become a standard for women – late 1960s)
Standard Diagnostic Mammogram - after 1967
1970 to 1979 ages 50 to 64 mortality rate - 38.19%
.
CTs – 1970s
MRIs – 1970s
Ultrasound – late 1970s
1980-1989 ages 50 to 64 mortality rate – 38.35%
.
PETs – 1980s
1990-2000 ages 50 to 64% mortality rate – 32.53%
.
Digital Diagnostic Mammography – early 1990s
BRCA1 and BRCA2 gene testing – patent 1998
(HRT drugs stopped for most women)
MRIs for high-risk patients - 2007
2000 to 2004 ages 50 to 64 mortality rate – 25.67%
.
Three-Dimensional Mammography – 2010
2010 to 2012 ages 50 to 64 mortality rate – 11.03%
(Information taken from National Cancer Institute & U.S. Census Bureau)
With earlier detection, detailed maps of where the cancer is located and more sophisticated cancer treatments, which can be pinpointed to the exact areas of cancer, plus new drugs to help prevent cancer from coming back, we have gone from 1/3 of women dying to approximately 10% dying. I'm sure the mortality rate will even get lower in the next decade with the new nano technologies being tested now - nano machines placed in the body that destroy only the specific cancer cells and leave the normal tissue alone.
I just turned 40 this summer and have an appointment with my doctor to schedule my mammogram. They are not the most comfortable things in the world ( had one a couple of years ago due to feeling a lump in one breast, thankfully it is just a cyst that isn't anything to worry about) but I'd rather spend 5 minutes uncomfortable then many months going through cancer treatments. Every woman 40 or older- please get your mammogram asap and every year, it could save your life.
People develop cancers all the time that their bodies take care of on their own. There are numerous reports of people dying of old age or earlier due to accidents who have cancers in their bodies but no signs of illness.
There are also cases where cancers stay dormant in peoples bodies until injuries cause them to grow and spread.
I had a nasty mole on my chest develop after getting a severe sunburn. Doctors told me to watch it and if it changed to come back. Well, over 5 years it did change...it slowly shrunk and disappeared. That was 20 years ago. Moles just don't disappear on their own unless there's something wrong with them and your body handles them on its own.
I believe that a large numbers of cancers found during screenings will never actually progress. They'll either be eliminated by a persons body or just stay dormant. When doctors start cutting into people is when the cancers gain a good blood supply and are triggered to grow and spread. It they'd just leave things along, most people would be fine and never know they are these small cancers.
For women with dense breasts, it is not just one mammogram per year.
They had me going in every 6 months from age 37 for several years. When I got there, they kept doing repeat images because they could not "see" what they wanted to see well enough. Then, I got (no radiation) ultrasounds after each mammogram.
I was lucky in having three fibroadenonas. However, I cannot believe all those repeat mammograms from a young age, in some cases at urban hospitals, with apparently unskilled technicians, did no harm to me at all.
I am glad I did not (so far) have cancer. My Mom had it twice so I will keep going back. But there are better, unfortunately more expensive methods now that do not involve radiation- 3D ultrasound is one possible example.
But a 3D ultrasound cost me $300 for one set of images. But no radiation- go figure. Maybe one day insurance companies will cover better techniques, involving no radiation.
Leading causes of death:
As far as the heart and stroke, we as a nation are lacking in research knowledge of how the body systems really work, but we have make great progress the last five years. Ultimately, in the end most of us die from heart disease or a stroke. The body ages and the last thing to go is usually the heart. Most women, go to their gynecologists to have their yearly female exams, which includes a pap smear, and depending on their age and family risks a mammogram. Some women chose sonograms instead of the standard mammogram. A sonogram costs about twice the money, but no radiation. Most men go in and get their yearly exam, which includes a prostate exam. If you don't wear a seatbelt and you get hit hard in a car accident, you have an excellent chance of dying from head injuries. There are flu shots every year and there is a pneumonia vaccine. Last year 132 million took the vaccine to prevent dying from the flu. Notice you have a greater chance of dying from the flu than a car accident. I have held the hand of someone on chemo. I have held the hand of someone dying from a stroke. I have helped save people from car accidents - bad ones - like wrapped around a tree, overturned vehicles, etc. Ultimately, we can up our odds of living a long life. The choice is ours of how we take care of ourselves, and the choices we make affect our families, our friends, our neighbors and our communities.
Like clockwork, another inflammatory, non-useful study is done on mammogram efficacy. And again, the researchers, obviously (presumably) trying to help, end up hindering.
There is no perfect breast cancer detection method. There is no perfect science in ALL of science. With breast cancer, which is not one disease, it is MANY different diseases, detecting becomes tricky, especially at the earliest stages when the potential cancer is most curable. But the methods we have are the most state-of-the art for RIGHT NOW. There is no other, better way to try and find early breast cancer.
The study drags up that old, tired concept that mammography and our current methods find too many cancers that probably wouldn't kill you. Sit back for a moment and be a fly on the wall in that consultation. "Ma'am, we have found a tiny cancer. We don't think it will kill you. We'd like to leave it there." Who in their right mind is going to agree to that course of action? No woman I know and I have been doing breast health education and imaging for 26 years.
Only in America could science be angry that we find too many cancers, but they are the "right" kind to matter. You never, ever know what that abberant cell or tumor is going to do, or when it is going to do it. There are too many factors that contribute to growing cancers and turning them deadly, most of which we haven't discovered yet.
We do have work to do, but we can only work with what we have NOW. Scaring women away, confusing them about the need for imaging and constantly trying to change the ages that they should beging screening is irresponsible and could potentially kill many women.
Only in America do people with no health problems spend so much time in doctors' offices getting tested, screened and scanned for an ever-expanding list of diseases that they are afraid they might someday get. And yet our life expectancy is dropping to near 50th in the world and our age-adjusted rates of death from cancer and heart disease are higher than in many nations that don't spend so much time screening and treating asymptomatic diseases and risk factors. Maybe we should stop looking for techno-fixes for the predicament of mortality and ask what other cultures do better than ours.
Early and continual mamogram may end up causing the cancer, Thermography is a safer way to do it when starting checking at younger age. Taking beta-glicans and medicinal mushrooms are some of the ways to protect the body from radiation damage.
I understand the argument as to early screening and treatment for breast cancer. I am also intelligent enough to know that screening is important. However, I do wonder if the instrument used to clamp a woman's breast in a vice grip and mashing it is adequate enough to do any good. It would be very rewarding to me to know that this device was first tested on the creator's private parts (I would be hard pressed to believe this instrument was created by another female. My last exam was no picnic and my doctor knows that I am looking for alternative screening because the way I was tested was BARBARIC!!!.
Zeely: I'm with you! The last time I had a mammogram, the technician ruptured the skin under one breast. I started mammograms early as my sister had early onset breast cancer, but I've been told my breast tissue is not dense and not the type that is suspect for growing cancers.
Kaiser keeps urging me to come back, but their cut-off age is 65 and I'm 62. I think the farther away from Kaiser I am, the healthier I'll be! (The last time I was catheterized, instead of threading the urethra they just stabbed my bladder--when my urine was filled with fresh blood, the doctor accused me of having some horrible illness I wasn't telling her about--but she never noticed how I'd been "cathed.")
Kaiser. Awful
The only studies that clearly answer a proposed question are double blinded, prospective studies that study patients in a control versus a study group that are randomized and are evaluated by the same equipment, the same researchers, over the same period of time. Looking at old data through computers where there are many variables may raise interesting questions, but should never be used to make conclusions.
Being a breast cancer "survivor" for 6 years (since diagnosis; mutilating surgery; debilitating, intensive, on-going chemo, and a rather bleak prognosis), I have become a reluctant authority on all things which are supposed to be "good" for you. To test, or not? I have friends who live in absolute fear of suffering my fate. I was not one of them. I had no family history, a healthy life style. Mammogram normal. I found the lump, which as it turned out, there were actually 3 - all different "stages", fast growing, generally lethal, commonly found in "older" women I was told. I was 46 at the time. After weeks of x-rays, biopsies, more x-rays, consultations; everything started to happen so fast. I would have done anything.
I hate statistics. I am not a statistic. I am a wife, mother, grandmother, daughter, aunt and friend. I hate that people have made the entire month of October into a "celebration" of pink. Like women need to be made aware of breast cancer. Really. All I want is to get on with living my life, without being continually reminded of the hell I went through. Can't even enjoy a football game. Pink everywhere. Ugggh.
Having an x-ray does not save you from this terrible disease. It is merely diagnostic tool that should be used at the discretion of your doctor. Routine Mammogram - people are unique - what works for some does not work for all. My normal, routine mammogram nearly cost me my life.
I would like to see research efforts focused on finding the cause & preventing people from getting cancer in the first place. In as much as some progress has been made, the diagnostic tools and treatments currently in use are still a crap shoot.
If the mammogram is suspicious, they inform you and you go in for a biopsy. The biopsy determines whether the tumor/cells are malignant or not, not the mammogram. Mine were, and I'm glad I had that mammogram. Dr. Welch doesn't have to encourage his wife, mother, daughter or sister to have one however.