When first introduced four decades ago, breast cancer screening with mammography was widely regarded as an important tool in the fight against this terrible disease.  It seemed obvious that the earlier it could be diagnosed the more lives could be saved. Aggressive treatment, it was thought, would prevent the cancer from spreading through the body.  A huge amount of research evidence since then has slowly and painfully led to a ...

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Is anyone else frustrated with the business of medicine?  I guess that’s a stupid question.  But really, when you were training to become a physician, what were your goals?  For me, I wanted to have a career that was meaningful, interesting, and at the same time provided a good living for myself and my family.  Growing up, I was always told to strive to become a doctor or a lawyer.  ...

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Sometimes, we play a little politics on this blog.  I am a student of current events and enjoy following the dysfunction and absurdities in American politics.  To paraphrase the legendary former British prime minister, "never has so little been done by so many to benefit so few." Readers know how skeptical I am about medical dogma.  When I was an intern a quarter century ago, I didn’t grasp why routine measurement ...

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The BMJ recently published the latest results from the Canadian National Breast Screening Study (CNBSS). A brief summary of the CNBSS: Women were randomly assigned to annual mammography or breast exams and then the outcomes tracked. The results in the BMJ: mammography did not improve survival. This is a very interesting study and when I first started working on this post I wanted to delve more into the science of ...

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Mammograms: Breast cancer screening as an individual patient decision In a major cancer screening development, a study from the British Medical Journal found that an annual screening mammography didn't result in a mortality benefit:

Women screened annually by mammography for 5 years had had a breast cancer mortality hazard of 1.05 compared with the control group during the screening period. During follow-up for a mean of 22 years, the mammography group ...

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This morning I went for my annual mammogram. It’s not something I generally look forward to. In fact, I mildly dread it. In my personal experience, mammograms have ranged from quite uncomfortable to downright painful. And then there’s the general unpleasantness of standing topless in a cold room. The first time I had this screening imaging study done, the plate pressed so hard into my sternum that I was almost in ...

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In trying to understand my own burnout, "control" (or lack thereof) is a dominant theme. This is nothing new. In fact, I doubt I'm unearthing bones not already thoroughly analyzed. But I can give instructive personal examples. For a while I was on the board of directors of my clinic, which was then and is even more so now one of the most successful doctor-owned and -managed in the US. During ...

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In medicine today diagnostic testing and advanced imaging is readily available and widely utilized in most every clinical setting.  Many physicians have given up the stethoscope and physical exam in favor of an echocardiogram and a CT scan.  Fear of missing something pervades every emergency department and has resulted in hundreds of thousands of unnecessary testing costing billions of dollars in healthcare expenditures. Of course, the driving causes of increased testing ...

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Cardiologists are causing patients to get cancer. It’s true. Cardiologists routinely perform angiograms on patients who have no heart disease whatsoever. As shown in this Harvard newsletter, each angiogram exposes the patients to about 7 mSv of radiation. Add in the myocardial perfusion imaging at another 25 mSv of radiation and you have enough radiation to cause cancer in an otherwise healthy individual. And cardiologists routinely subject patients with normal coronary arteries ...

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Would you tell me, please, which way I ought to go from here? That depends a good deal on where you want to get to. I don't much care where – Then it doesn't matter which way you go. - Lewis Carroll In the new world, payers will increasingly ask before reimbursing medical imaging: why did you bother finding out? This is why we must pay attention to clinical trials. An instructive case is in the ...

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