Comments on: Linking the USPSTF mammogram guidelines to their virtual colonoscopy recommendations

By: jeffrey dach md

jeffrey dach md — Wed, 20 Jan 2010 12:33:00 +0000

Mammogram Guidelines, Fibrocystic Breast Disease, the Iodine Deficiency Connection

Screening the population with mammograms based on guidelines unfortunately did not help a friend who just died from breast cancer. The incidence of breast cancer has increased to 1 in 8 women, with 4,000 new cases weekly. You might ask, could there be a preventive measure which is safe, cheap and widely available that has been overlooked? The answer is YES , and it’s the essential mineral, Iodine, which was added to table salt in 1924 as part of a national program to prevent Goiter. It turns out that this same mineral is the key to breast cancer prevention. Much has been published in the medical literature on this, for example, B.A. Eskin published 80 papers over 30 years researching iodine and breast cancer. In short, iodine deficiency causes breast and thyroid cancer in humans and animals. Iodine deficiency is also known to cause a pre-cancerous condition called fibrocystic breast disease. W.R. Ghent published a paper in 1993 which showed iodine supplementation works quite well to reverse and resolve fibrocystic changes of the breast, and this is again the subject of a current clinical study.(Can J Surg. 1993 Oct;36(5):453-60.)

For more information see: http://jeffreydach.com/2007/05/05/jeffreydachdrdachiodine.aspx

Jeffrey Dach MD

By: DKBerry

DKBerry — Tue, 12 Jan 2010 03:56:09 +0000

As I originally posted when USPSTF breast cancer screening guidelines were released …

… my sister was in her early 40s when through a mamogram she found out she had some lumps. After biopsy … a double mastectomy … and chemo … she has her life back with her family.

I really don’t care now what USPSTF guidelines are … nor any of the hired mafia of posters who think my sister could have waited to be screened and might still have survived and then she would have been ‘in the numbers’.

Wonder if these are the same folks who manipulated the numbers to make a case for global warming?

By: Mattheww Weber

Mattheww Weber — Mon, 11 Jan 2010 17:14:27 +0000

Two comments:
First the writer is in fact a Radiologist, and therefore has a financial interest in the outcome. He also leaves an important unaddressed issue. There is a link between radiation exposure and Cancer. The question becomes how much Xray exposure doesn’t occur because we don’t screen for 10 more years, and how many cancers is that reduced Xray exposure likely to prevent? Let’s face it, there is big money in Cancer detection and treatment.

I also take issue with another statement the author makes.
“Why did the USPSTF refuse to endorse a procedure enthusiastically recommended by numerous professional physician organizations, the American Cancer Society and the national Blue Cross Blue Shield Technology Evaluation Center, a group not anxious to add to the cost of healthcare? Because although they accepted that Virtual Colonoscopy was accurate in diagnosing colon polyps, they feared that the CT-based technique could identify possible abnormalities outside of the colon that might lead to further unnecessary testing and drive up the cost of screening; a theoretical and unsubstantiated risk.”

The risk is neither theoretical or unsubstantiated. The University of Pittsburgh recently abandoned a CT based study to look for early signs of Lung Cancer in smokers. The reason they did so was because the CT screening was finding so many previously undiagnosed anomalies, that investigating them quite literally ran the study out of money! My pulmonologist tells similar horror stories about whole body scans. They often turn up surprises, and once you know about them, cannot be safely ignored.

So the potential costs have been shown to be very real, and have been substantiated in other studies.

By: Diora

Diora — Mon, 11 Jan 2010 03:33:20 +0000

. As for screening mammography, it has absolutely been proven to decrease mortality from breast cancer by 30-35%, which is why I have yet to find a woman who prefers to undergo biennial screening in lieu of annual screening.

This number has not beeing proven, it is actually the number from most optimistic interpretation of the studies. This is not the number cited by Cochrane or USPSTF.

Even if we accept this number it’s not the difference between annual and biennial screening. In fact most of the studies of mammograms done in Europe used biennial screening.

As to what women prefer – if you keep giving them data that vastly overestimates the benefits of mammograms and forgets to mention risks, sure they’ll make the decision to screen.

One more fact to digest: a recent study demonstrated that if a woman develops breast cancer and has had regular mammography screening, her chance of dying from that cancer is 5%. If she has not had regular screening, that risk soars to 56%.

The particular study while interesting failed to look at the access to medical care of the women who failed to get mammograms. Since most insured women do get mammograms and most uninsured women don’t, it’s quite likely the women who didn’t get mammogram didn’t get the same treatment either. Especially considering that their mortality data from unscreened women was closed to that of the 70s. Surely there have been some progress in treatment since then?

Of course every woman should make her own informed decision about screening.

The key word here is informed. Your data clearly shows why it’s epidimiologists’ and not radiologists’ or oncologists’ jobs to look at the data. Your citing of studies read the same as that of the media.

By: Mark E. Klein, MD

Mark E. Klein, MD — Fri, 08 Jan 2010 21:32:32 +0000

I first must apologize for inadvertently hitting the submit button before entering my name, which accounts for the anonymous post. To Dr Brayer I would say say the following. When you state that specialty societies will always promote policies that favor their specialties, you imply that they may encourage policies that are not necessarily in the patient’s self interest. Once again this is an example of assuming the worst rather than assuming the best. I know of no leader in radiology that would ever promote any procedure or method that was not supported by hard science to be in the best interest of the public. And I must strongly disagree with her statement that “A specialty society should not be making any recommendations about screening that will benefit their own members.” It is most often the specialty that has the most knowledge of a method or procedure, and they are in fact the best people to make recommendation. The USPSTF might seem unbiased, and while I trust that their intentions are excellent, its members have their own biases based on their personal experiences and frames of reference. They were dead wrong on virtual colonoscopy–as will become evident over time–and they are wrong about mammography screening. Alan Greenspan said, only months before the financial collapse, that derivatives posed no threat to our nation’s economic well-being. Even the best intentioned can miss the mark.

By: Michael Kirsch, M.D.

Michael Kirsch, M.D. — Fri, 08 Jan 2010 20:10:22 +0000

To the anonymous commenter at 12:04 p.m.: With respect, you are overlooking a critical point. I take you at your word that your views are pure, and not contaminated by self-interest. You may, as the rest of us are, be subject to unconscious bias. At the very least, there is an appearance of a conflict of interest, as the author’s views coincide with his specialty’s interest. In addition, those of us in specialties tend to view the medical world through the prisms of our own niches. Surgeons, for example, may favor a surgical solution, not to make money, but this is how the ‘operate’. I am a gastroenterologist. I would not support the American College of Gastroenterology making national policy for colon cancer screening, although I think they should have a seat at the table. Haven’t we all seen how guidelines issued by various specialty societies never seem to go against the specialties’ interests?

By: Toni Brayer, MD

Toni Brayer, MD — Fri, 08 Jan 2010 16:15:33 +0000

And isn’t is curious that the two Radiologic Societies just came out with their own “recommendations” that mammograms start at age 40. A specialty society should not be making any recommendations about screening that will benefit their own members. The conflict of interest is just too glaring. That is why USPSTF is the most unbiased in reviewing literature and recommending “screening” studies for the population at large.

By: Anonymous

Anonymous — Fri, 08 Jan 2010 16:04:32 +0000

I of course can understand why a posting by a radiologist would prompt some to think that promoting screening is self-serving, or all about money. One downside of social networking, and the internet in general, is that although we can freely exchange ideas we really don’t know anything about one another. Unfortunately some choose to use this anonymity to attack rather than discuss. I would prefer if instead of assuming the worst we judged each other a bit more favorably. I will simply state that none of my comments were influenced by economic issues-it’s not about the money-but about my committment as a physician to take the best care of patients as possible. I still beleive that most physicians place their patient’s welfare first.
Virtual colonoscopy is a terrific screening procedure. It is safe, and the radiation dose is quite low, and hardly significant considering the age at which this procedure is recommended. The number of patients in whom I recommend additional testing because of other findings on the CT scan is less than 4%. As for screening mammography, it has absolutely been proven to decrease mortality from breast cancer by 30-35%, which is why I have yet to find a woman who prefers to undergo biennial screening in lieu of annual screening. One more fact to digest: a recent study demonstrated that if a woman develops breast cancer and has had regular mammography screening, her chance of dying from that cancer is 5%. If she has not had regular screening, that risk soars to 56%. Of course every woman should make her own informed decision about screening.

By: Michael Kirsch, M.D.

Michael Kirsch, M.D. — Fri, 08 Jan 2010 15:06:02 +0000

The author is a radiologist, who may have have overt and unconscious bias. I would give him more credibility if he and his colleagues would address the enormous financial and emotional costs that his specialty is responsible for when they report incidental and trivial findings routinely. Indeed, the USPSTF was conscious of this gaping flaw. Clearly, tort reform would be a necessary element of the solution.

By: R Watkins

R Watkins — Fri, 08 Jan 2010 14:11:38 +0000

“I find it more than curious that no cancer specialists were involved in evaluating guidelines for screening for cancer.”

Because cancer specialists specialize in TREATING individuals with cancer. Epidemiologists and public health experts specialize in SCREENING large populations for cancer and other diseases.

Oncologists don’t screen and epidemiologists don’t treat.

It’s discouraging that this has to be explained again and again to members of the medical profession