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I postponed mine for a few months due to COVID, then had it a month ago, complete with n95 mask and face shield. Bit nervous about entering a hospital. I had to take the shield off just during the procedure itself, but kept the mask on. It was the least uncomfortable of any I’ve had, a new machine, it was just slightly uncomfortable. What with that and the new X-ray machine the next day at the dentist, no more dreadful wing bites, I’m pretty happy with the medical system.
Regarding the question of whether to get them at all, I’m aware that there’s some question, but I have an excellent primary care doctor whom I trust, not blindly but implicitly. She still recommends them, and I trust her guidance, so I’ll continue to get them.
Nope. My mother had breast cancer that spread. She survived severe years but besides her, other blood relatives had cancer. The only screening I won’t have a 3rd time is colonoscopy. Both times I was awake during and was in severe pain for days after each one.
You are simply taking the data that the authors are choosing to feature in their article and not the data which would actually be useful to any random woman who is deciding whether or not to get a mammogram (data which can easily be calculated from the data which is featured in the article). What our hypothetical random woman would like to know is the absolute risk of dying from BC for someone who gets screened vs. the absolute risk of the same for someone who is not screened (and not how likely she is to die if she already knows she has advanced cancer (the numbers you cite in your post, the 21,183 women w/ BC and the 2473 who died)). Like I said, this data is not featured in the article. Yes, you have absolute numbers in figure 2 of Table 2. But the authors complicate things by featuring not the incidence of death per person per 10 years, but instead the rate of death over 10 years per 100,000 person-years.
However, these data — the data our random woman is looking for — can be easily approximately calculated from the info in the graph in figure 3 of Table 2 “Cumulative incidence of breast cancer that was fatal within 10 years of diagnosis,” since you have people (100,000 women) on the y-axis. To be as generous to the authors as possible, I chose to look at the data for the last year on the graph when the cumulative effect would be the greatest (2007) and to round up to 800 BC deaths for the nonparticipants (dotted red line) and up to 500 for the participating (solid blue line). If 800 out of 100,000 nonparticipants died of BC, that is the same as 8 out of a 1,000 women. I made a similar calculation with the participants which works out to 5 out of 1,000 women.
It might seem strange that I am talking about featured data vs. non-featured data, but it is really important when you reading medical papers to not let yourself be “seduced” by the authors’ claims. You need to keep in mind that cancer researchers, no matter how idealistic, are also careerists. That is, many sincerely want to help make our lives more cancer-free, but it’s also bit of a jungle out there and they need to do whatever it takes to make their research stand out (so it can be selected for publication, cited, etc.) This does not mean that authors are lying or fabricating data (usually). But it does mean that they are staying up late at night trying to figure out exactly how to manipulate, massage and present their data so as to make the interventions researched and discussed look as absolutely good as possible, even if this means making them seem a bit or, often, a lot better than they actually are. I believe that is what the authors are doing here.
Also, did you notice the paragraph on disclosures of conflicts of interest? One of the principle authors is the president of a certain “Mammography Education, Inc” and is also a breast imaging consultant. It doesn’t take much skepticism to suspect that he just may have a vested interested in making BC screening look as good as possible (instead of simply trying to be as objective as possible).
You say that the data clearly show a benefit to screening. Yes, the data clearly show a very, very small benefit. However, the authors are not discussing most of what screening detects (tiny cancers). And they are not talking about any of the harms that come from false positives, unnecessary biopsies and worst of all unnecessary treatment. So, from the point of view of the woman trying to make up her mind about mammograms, the information in the article is quite partial (in both senses of the term).
You are conflating person years and persons. There were not 100,000 women in the study. "Person years" is used to account for the fact that deaths accumulate over time.
You have also very carefully avoided the fact that an American woman has about one chance in eight of being diagnosed with breast cancer and one in 38 that she will die from it.
From a practical point of view, the only way to say a biopsy was unnecessary is to do it and find out that it was benign. If there were a way to know ahead of time that it was benign without doing a biopsy then no "unnecessary" biopsies would be done. That is like saying a colononoscopy that is completely normal was "unnecessary". For most women the worst "harm" that will come from a biopsy of a benign breast lesion is a scar, and my own scar (I had bleeding from a nipple that was found to be due to fibrocystic disease) is virtually invisible. Yes, there is expense and any risk of anesthesia, too.
Women with benign breast lesions will not have any treatment except the biopsy.
You have still not told us how a physician counselling a woman about a very tiny breast cancer can determine whether her personal very tiny breast cancer will be one that needs no treatment at all - and any treatment will be "over treatment" - or one that will ultimately kill her.
As far as treatment is concerned there are now genetic tests that can be done on tissue from an actual breast cancer that can help guide decisions concerning adjuvant therapy, especially whether chemo should be considered.
You still have not proved your thesis that mammography is more dangerous than breast cancer.
Quote:
Originally Posted by guidoLaMoto
I haven't read thru this thread, but here's a few thoughts on screening mammography:
It's difficult to evaluate the benefits of mammography because treatments continue to improve over the last 40 yrs since it was first started-- Is improved survival due to the screening or to the improved treatment?
Secondly, breast cancer can never be considered "cured." Studies show recurrence rates continue steadily and indefinitely over time https://www.nejm.org/doi/full/10.1056/NEJMoa1701830 Studies usually are of short duration (like 5 or 10 yrs). Just because a women lives for 5 yrs after early detection and treatment, doesn't mean she won't still die of breast cancer after 20 yrs.
"Early detection" may only make it appear that women are living longer--It may be that we just know about their cancer for longer, and they're still dying at the same point they would have had it not been detected early.
In short, we can support arguments on either side of the question. One should do what she feels comfortable with. There's no definitive scientific answer.
The study I cited earlier accounted for the effect of improved treatment by comparing screened and unscreened women who were diagnosed contemporaneously and would be offered the same state of the art treatment. By studying those with advanced disease they skipped the lead time bias issue.
I have to feel that late "recurrences" are not so much a recurrence of the original cancer as they are new cancers in women predisposed to have such a cancer.
I haven't read thru this thread, but here's a few thoughts on screening mammography:
It's difficult to evaluate the benefits of mammography because treatments continue to improve over the last 40 yrs since it was first started-- Is improved survival due to the screening or to the improved treatment?
Secondly, breast cancer can never be considered "cured." Studies show recurrence rates continue steadily and indefinitely over time https://www.nejm.org/doi/full/10.1056/NEJMoa1701830 Studies usually are of short duration (like 5 or 10 yrs). Just because a women lives for 5 yrs after early detection and treatment, doesn't mean she won't still die of breast cancer after 20 yrs.
"Early detection" may only make it appear that women are living longer--It may be that we just know about their cancer for longer, and they're still dying at the same point they would have had it not been detected early.
In short, we can support arguments on either side of the question. One should do what she feels comfortable with. There's no definitive scientific answer.
Thanks, Guido. Always helpful to hear from a medical practitioner.
I have to feel that late "recurrences" are not so much a recurrence of the original cancer as they are new cancers in women predisposed to have such a cancer.
In my case, it was obvious that my second breast tumor was a new primary because it was a totally different type of breast cancer. And doctors can usually tell through analysis of the tumor whether it is a new primary or a recurrence of an old one. Breast cancer, say, that recurs in some other part of the body is still identifiable as breast cancer and not bone cancer or liver cancer or whatever. At least, it is now. I'm sure it was more difficult to make that judgment in the past, and you are probably right that some late "recurrences" were really not recurrences, but just another cancer popping up.
In my case, it was obvious that my second breast tumor was a new primary because it was a totally different type of breast cancer. I'm sure it was more difficult to make that judgment in the past, and you are probably right that some late "recurrences" were really not recurrences, but just another cancer popping up.
I had what might have been a recurrence or might have been a new primary...it was the exact same type, grade, hormone sensitivity, etc. as the first, just separated by 25 years. IMHO which it was doesn't really matter...more importantly, a mammogram, which is annoying but relatively non-invasive, found both and found the second one early enough to avoid extensive treatment.
I had what might have been a recurrence or might have been a new primary...it was the exact same type, grade, hormone sensitivity, etc. as the first, just separated by 25 years. IMHO which it was doesn't really matter...more importantly, a mammogram, which is annoying but relatively non-invasive, found both and found the second one early enough to avoid extensive treatment.
I completely agree. To be honest, my second tumor was found by MRI rather than mammogram, because as someone who had already had cancer I had a more stringent screening routine than the average person. But it would have been found on a mammogram, if I'd had one instead.
You have still not told us how a physician counselling a woman about a very tiny breast cancer can determine whether her personal very tiny breast cancer will be one that needs no treatment at all - and any treatment will be "over treatment" - or one that will ultimately kill her.
I haven’t told you because I am advocating against mammograms for the average woman. If you don’t get a mammogram, your doctor doesn’t find himself in the situation you describe. So, it is a non-question.
I haven’t told you because I am advocating against mammograms for the average woman. If you don’t get a mammogram, your doctor doesn’t find himself in the situation you describe. So, it is a non-question.
I thought that was obvious from my remarks.
So you will throw every woman whose life will be saved by mammography under the bus.
Gotcha!
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