Comments on: ACP: Teasing out science, politics, and emotion about the mammography guidelines http://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 By: Diorahttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-121043 Diora Fri, 04 Dec 2009 19:15:40 +0000 http://www.kevinmd.com/blog/?p=41605#comment-121043 A lot of assumption - you still conveniently ignore the issue of overdiagnosis. Also if these things are shown to "do good" - the articles talk about "potential" not what is happening today in general practice; the studies are preliminary. When and if it is actually going to be part of general practice then the issue can be re-visited.And again, why do you keep ignoring the issue of overdiagnosis? Do you even understand it? A lot of assumption – you still conveniently ignore the issue of overdiagnosis. Also if these things are shown to “do good” – the articles talk about “potential” not what is happening today in general practice; the studies are preliminary. When and if it is actually going to be part of general practice then the issue can be re-visited.

And again, why do you keep ignoring the issue of overdiagnosis? Do you even understand it?

]]> By: A lot of assumptionshttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120967 A lot of assumptions Thu, 03 Dec 2009 23:01:01 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120967 Actually it has been shown to "do good". Check out the Medpage links up and to the right for very recent discussions of all of the above. Actually it has been shown to “do good”. Check out the Medpage links up and to the right for very recent discussions of all of the above.

]]> By: Diorahttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120931 Diora Thu, 03 Dec 2009 16:38:55 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120931 <i> What about elastography? The new testing for biomarkers? New protocols for management of lumps with benign characteristics?Catching early breast cancer AND reducing biopsies are not mutually exclusive propositions.</i>None of this has been shown to do any good yet, has it? When and if it is, the question could be revisited. Additionally, "a lot of assumptions", you keep conveniently ignoring overdiagnosis. No testing available today will help you avoid that. In future when and if there are ways to say which cancer would spread, the question can be revisited. Incidentally - if all the money that are used today on scaring women into screening were to be used for research into better treatments and figuring out how to recognize cancers that would spread in woman's lifetime, maybe more progress would've been made.You wanted a radiologist opinion. Here is <a href="http://www.imagingeconomics.com/issues/articles/2004-11_02.asp?SkipInterstitial=TRUE" rel="nofollow">an opinion of a radiologist calling for the truthful information to be given to women</a> written in 2004. Interestingly, the main reason cited for providing more truthful information is malpractice rather than this being the right thing to do. The same radiologist, though, wrote letter to the editor of Chicago Tribute in defense of Elizabeth Edwards at the time of her diagnosis of breast cancer, when every newspaper and every busybody was writing editorials on how irresponsible it was for her to have skipped mammograms. It's long past time for women to be told the full truth. What about elastography? The new testing for biomarkers? New protocols for management of lumps with benign characteristics?

Catching early breast cancer AND reducing biopsies are not mutually exclusive propositions.

None of this has been shown to do any good yet, has it? When and if it is, the question could be revisited. Additionally, “a lot of assumptions”, you keep conveniently ignoring overdiagnosis. No testing available today will help you avoid that. In future when and if there are ways to say which cancer would spread, the question can be revisited. Incidentally – if all the money that are used today on scaring women into screening were to be used for research into better treatments and figuring out how to recognize cancers that would spread in woman’s lifetime, maybe more progress would’ve been made.

You wanted a radiologist opinion. Here is an opinion of a radiologist calling for the truthful information to be given to women written in 2004. Interestingly, the main reason cited for providing more truthful information is malpractice rather than this being the right thing to do. The same radiologist, though, wrote letter to the editor of Chicago Tribute in defense of Elizabeth Edwards at the time of her diagnosis of breast cancer, when every newspaper and every busybody was writing editorials on how irresponsible it was for her to have skipped mammograms. It’s long past time for women to be told the full truth.

]]> By: #1 Dinosaurhttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120912 #1 Dinosaur Thu, 03 Dec 2009 11:21:04 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120912 Re: Mammograms for lumpsOnce a woman or her physician finds a breast lump, the mammogram is no longer for "screening" purposes. All third party payers would cover it, as they would any other test to investigate a specific finding. (Although one incredibly irresponsible plan I know refuses to pay for colonoscopy for ANY indication, including rectal bleeding. Mind bending!)Misuse of the word "screening" drives me crazy. Re: Mammograms for lumps

Once a woman or her physician finds a breast lump, the mammogram is no longer for “screening” purposes. All third party payers would cover it, as they would any other test to investigate a specific finding. (Although one incredibly irresponsible plan I know refuses to pay for colonoscopy for ANY indication, including rectal bleeding. Mind bending!)

Misuse of the word “screening” drives me crazy.

]]> By: Elizabethhttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120899 Elizabeth Thu, 03 Dec 2009 04:43:00 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120899 I agree with you, Diora. I really object to the scare campaigns they direct at women for cervical and breast cancer screening. It does not help to scare women. The right approach would be to tell us the truth...benefits and risks and leave us to make the decision. If they're not prepared to do that, if there are bits they have to hide that might put women off screening, then perhaps this test needs a closer look before being released or at the very least, they are the bits we REALLY need to know about.... This attitude that we'll talk about the good stuff and hide away the bad stuff is totally unacceptable and it seems to only happen in screening for women. I've seen lots of articles in the papers and features on the News about the risks of PSA testing. Not a word on cervical screening and even though many have been concerned about mammograms for many years, it's only been the last couple of years that women are starting to hear about it. Isn't it curious that we're always the last ones to be told...when our health is on the line? We're acting on the assurances of people who choose not to release risk information to us - who tell us half the story. Many years later we get the punch line...too late for many women who've already been harmed by the test. Not good enough.... I agree with you, Diora.
I really object to the scare campaigns they direct at women for cervical and breast cancer screening. It does not help to scare women.
The right approach would be to tell us the truth…benefits and risks and leave us to make the decision.
If they’re not prepared to do that, if there are bits they have to hide that might put women off screening, then perhaps this test needs a closer look before being released or at the very least, they are the bits we REALLY need to know about….
This attitude that we’ll talk about the good stuff and hide away the bad stuff is totally unacceptable and it seems to only happen in screening for women. I’ve seen lots of articles in the papers and features on the News about the risks of PSA testing. Not a word on cervical screening and even though many have been concerned about mammograms for many years, it’s only been the last couple of years that women are starting to hear about it.
Isn’t it curious that we’re always the last ones to be told…when our health is on the line? We’re acting on the assurances of people who choose not to release risk information to us – who tell us half the story.
Many years later we get the punch line…too late for many women who’ve already been harmed by the test.
Not good enough….

]]> By: A lot of assumptionshttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120898 A lot of assumptions Thu, 03 Dec 2009 04:38:00 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120898 What about elastography? The new testing for biomarkers? New protocols for management of lumps with benign characteristics?Catching early breast cancer AND reducing biopsies are not mutually exclusive propositions. What about elastography? The new testing for biomarkers? New protocols for management of lumps with benign characteristics?

Catching early breast cancer AND reducing biopsies are not mutually exclusive propositions.

]]> By: A lot of assumptionshttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120897 A lot of assumptions Thu, 03 Dec 2009 04:33:00 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120897 H, again, the guidelines do not apply to women with palpable breast lumps. The guidelines would have no effect on your mammogram coverage even if they were used to set reimbursement for screening (as they would under pending health care legislation). H, again, the guidelines do not apply to women with palpable breast lumps. The guidelines would have no effect on your mammogram coverage even if they were used to set reimbursement for screening (as they would under pending health care legislation).

]]> By: Deborahhttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120895 Deborah Thu, 03 Dec 2009 02:39:27 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120895 I found the Nordic Cochrane Institute's information sheet on "Mammograms: the risks and benefits" very helpful. I was confused by all the conflicting opinions. I'm pleased though I had access to someone like Professor Michael Baum, who first alerted me to a potential problem with breast screening. He was a sole outspoken voice for quite a few years. Prof Baum is a senior breast cancer surgeon who helped set up the first UK breast screen clinic. He now believes we need to reconsider screening and the clear evidence of harm and limited benefits. His articles and interviews are available on-line. The NCI were highly critical of the brochures porduced by BreastScreen in the UK, Australia and many other countries. They thought they gave women inadequate and misleading information. They called for an immediate re-draft, which has largely fallen on deaf and arrogant ears. They decided the issue was so important they should draft their own brochure. I'd recommend it to any woman considering mammograms. http://www.cochrane.dk/ They also found insufficient evidence to recommend CBE's for women of any age...they did not reduce the death rate from cancer, but added considerably to the number of breast biopsies. Self-examination is no longer recommended by our doctors or by most medical associations. Once again, it doesn't help, but causes lots of biopsies for benign things. Where does that leave us? Well, that will be different for every woman, but I've chosen to be breast aware - just being observant and I'll report any changes to my Dr. IMO, if these things can't help us or end up hurting us, it's best to avoid them. I found the Nordic Cochrane Institute’s information sheet on “Mammograms: the risks and benefits” very helpful.
I was confused by all the conflicting opinions. I’m pleased though I had access to someone like Professor Michael Baum, who first alerted me to a potential problem with breast screening. He was a sole outspoken voice for quite a few years.
Prof Baum is a senior breast cancer surgeon who helped set up the first UK breast screen clinic. He now believes we need to reconsider screening and the clear evidence of harm and limited benefits. His articles and interviews are available on-line.
The NCI were highly critical of the brochures porduced by BreastScreen in the UK, Australia and many other countries. They thought they gave women inadequate and misleading information. They called for an immediate re-draft, which has largely fallen on deaf and arrogant ears.
They decided the issue was so important they should draft their own brochure.
I’d recommend it to any woman considering mammograms.
http://www.cochrane.dk/
They also found insufficient evidence to recommend CBE’s for women of any age…they did not reduce the death rate from cancer, but added considerably to the number of breast biopsies.
Self-examination is no longer recommended by our doctors or by most medical associations. Once again, it doesn’t help, but causes lots of biopsies for benign things.
Where does that leave us? Well, that will be different for every woman, but I’ve chosen to be breast aware – just being observant and I’ll report any changes to my Dr.
IMO, if these things can’t help us or end up hurting us, it’s best to avoid them.

]]> By: Hhttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120889 H Thu, 03 Dec 2009 01:05:47 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120889 "H, the lump in your breast would take you out of the average risk patient the screening guidelines apply to."And my insurance company covered the mammogram even though I wasn't 40 years old. This fear tactic that women at higher risk or those that have a lump are going to be denied a mammogram is just fear mongering..."...THEIR interest." Their financial interest-not my health. “H, the lump in your breast would take you out of the average risk patient the screening guidelines apply to.”

And my insurance company covered the mammogram even though I wasn’t 40 years old. This fear tactic that women at higher risk or those that have a lump are going to be denied a mammogram is just fear mongering…

“…THEIR interest.” Their financial interest-not my health.

]]> By: A lot of assumptionshttp://www.kevinmd.com/blog/2009/12/acp-teasing-science-politics-emotion-mammography-guidelines.html#comment-120884 A lot of assumptions Thu, 03 Dec 2009 00:10:02 +0000 http://www.kevinmd.com/blog/?p=41605#comment-120884 I take the American College of Radiology's , et al's statements with the financial interest in mind. But I also consider that of all interested parties, they will be the ones that look most critically at the science and the conclusions and the assumptions contained in the report. They will be the ones most motivated to point out what others might be tempted to overlook because of THEIR interest.The mission of the American Cancer Society and the Breast Cancer Research foundation also varies from that of radiologists, so their criticisms can be compared.MSA'S encourage wise use of screening. I take the American College of Radiology’s , et al’s statements with the financial interest in mind.
But I also consider that of all interested parties, they will be the ones that look most critically at the science and the conclusions and the assumptions contained in the report. They will be the ones most motivated to point out what others might be tempted to overlook because of THEIR interest.

The mission of the American Cancer Society and the Breast Cancer Research foundation also varies from that of radiologists, so their criticisms can be compared.

MSA’S encourage wise use of screening.

]]>