No Breast Cancer Screening For Women Aged 40-49

cp418

No Breast Cancer Screening For Women Aged 40-49

cp418

http://www.medicalnewstoday.com/articles/238021.php

No Breast Cancer Screening For Women Aged 40-49, New Canadian Guidelines

LittleMelons

"Women should not carry out clinical breast exams and breast self-examinations if they have no symptoms pointing to breast cancer, the guidelines also recommend.

There should be no routine clinical breast exams by doctors There should be no breast self-exams to screen for breast cancer "

I find these recommendations very disturbing.  Since a lump in many cases in the primary symptom of breast cancer, that first statement doesn't make much sense. 

 I saw Dr. Marla Shapiro in TV this morning saying that she couldn't imagine any family physician NOT doing a clinical breast exam as part of a physical check-up.  She herself was diagnosed with breast cancer in her forties, found by a self-examination.

I'm not sure exactly how useful routine mammograms are between 40-49, but think self and clinical exams are necessary and any symptons whould be followed up with mammos, ultra-sounds, biopsies and MRIs as needed, regardless of age.

 I'm curious how others here see these new guidelines.

crazy4carrots

This is, IMO, another case of using statistics ONLY to make recommendations.  And I guess the only way to discover a palpable lump which could possibly be malignant is "by accident"?

What these recommendations will inevitably lead to is women (with no family history) feeling "oh so confident" because their doc won't be doing a CBE at their annual checkup, and, gee, they don't have to feel petrified once a month before doing a BSE.  Therefore, they don't have to "worry" about breast cancer.

This is so hard for most of us here to understand. 

LittleMelons

These recommendations were made by the "Canadian Task Force on Preventive Health Care".  Here is a link that shows the 14 members of that task force - not a breast cancer specialist among them. http://www.canadiantaskforce.ca/members_eng.html

Interesting that the Canadian Cancer Society supports these new recommendations.  Their director of cancer policy said she thinks they are good because "It is concerning when we scare women into screening no matter what their age."  Huh?  I always thought screening was good. On the other hand, the Canadian Breast Cancer Foundation is against the guidelines saying the data is contrary to their findings and will result in unnecessary deaths from bc.  Dr. Yaffe of Sunnybrook says these guidelines will result in 2000 deaths in the next 10 years. 

 I so agree with lindasa - this is very hard for us here to understand.

alexch

Hi Ladies,

I think this a "numbers game" and I know this is not going to be a popular answer but I think it would cost our health care alot of money to screen women with mammograms when they are not necessary. I think the money saved would be better spent by educating women to understand their breasts and what is "normal" for their breast to feel like. Also, educate younger women ( under 50) to go for their yearly physicals and ensure their family Dr is doing a breast exam as part of their check up. This is on the assumption that younger women have a family Dr.... Otherwise, perhaps the Urgent Care Cente or Walk in clinic would be the only choice to get a physical done. Now, I do think if their is a lump or any issue with the PT's breast then they should be given a mammagram to investigate furthur regardless of what age they are or if they have a strong family history of BC they should be given a mammogram when the PT's feels it is warranted....

I can speak from experience. I found my lump myself at the age of 38 ys old. I had not one thing that put my in a high risk BC category. I went to my FD when I found the lump and I was sent for a mammogram that confirmed it was a suspicious lump for cancer. I was unlucky to be one of the low end stats ( my BC risk was 1 percent at my age to get BC) but I still believe that to give all my friends at my age a mamm. "just because" it is available IMO is unnessecary and costly....

Regards,

Alexch

Diagnosis: Aug, 2009, IDC 7-8 cm, 0/15 nodes, Grade 3, ER/PR + HER+

crazy4carrots

Alex -- The measures I disagree with are the "no clinical breast exams" and the "no breast self exams".  I do not believe that fear of finding a lump which is probably benign is any reason to avoid these exams.

I wish there were a sure-fire screening tool which cost very little but was 100% effective in, not only finding a tumour, but also telling whether it is benign or not.  Alas, there is no such tool on the horizon (that I know of), but surely some precious research dollars should be invested in finding one.

And yes, it is very much a "numbers' game, with a panel depending on studies and statistics -- which is why there are no oncologists on the panel.  Better to keep the human (or anecdotal) element far enough away so that it doesn't influence guideline decisions....... 

Mantra

Below is a link to an article in today's Toronto Star. They are hosting a chat on Monday regarding these new recommendations and the the link to this chat is in the article.

One of the scariest comments in the article is:  They say their research has shown screening programs lead to the over-diagnosis of breast cancer, which means too many women receive unnecessary treatments and suffer needless anxiety. 

What does that even mean!! over-diagnosis of breast cancer?

http://www.healthzone.ca/health/newsfeatures/cancer/article/1089956--task-force-to-release-new-guidelines-for-breast-exams

starbeauty

Well, I would be a number that was dead now if I had not been screened in my 40s...

elizadevi

February 11, 2009 8:41 PM

Link Eyed Between Beef And Cancer

By Jaime Holguin

(CBS) In feed lots across the country, beef cattle are given growth hormones to make them fatter faster, to save money.

Now questions are being raised about one of the most widely-used hormones, Zeranol, a synthetic estrogen implanted in cattle. A series of tests done for the Pentagon show a possible link between breast cancer and Zeranol.

In the lab, researchers at Ohio State University mixed beef from Zeranol-treated cows with human breast cancer cells and saw "significant" cancer cell growth -- in some cases at levels 30 times lower than the government says is safe.

Concerned about possible long-term effects, they write: "consumption of food ... derived from ... animals treated with Zeranol poses a potential health risk to consumers."

"We know that Zeranol and some of the synthetic hormones used in cattle production are estrogens, and we know that breast cancer is dependent upon estrogen," says Lou Guillette, a biologist at the University of Florida.

In his own research, Guillette examined the effects of hormones coming off cattle feedlots and getting into the water. The study, funded by the European Union, which bans beef hormones, found serious damage to the reproductive systems of fish downstream from a Nebraska feedlot.

"It certainly raises a red flag for us," says Guillette. "What it suggests is that there are very potent hormones that are coming off of these feedlots that are going into the environment."

Andrea Martin, the founder of the Breast Cancer Fund, says there needs to be more research into what women are exposed to that might be causing breast cancer.

"We feel there are preventable causes of breast cancer," says Martin. "In the last 50 years, it's almost tripled, and there's no reason to think it won't keep increasing."

As a breast cancer survivor, Martin says women in particular need to be aware of the risks.

"It's really a matter of women waking up and demanding to know what is in their products in their food. And what effect it has on their bodies," she says.

But the cattle industry says the minute amount of Zeranol found in beef poses no threat.

"My wife and my four daughters eat beef on a regular basis," says Gary Weber, of the National Cattlemen's Beef Association. "I've reviewed all this science, and I'm confident that beef is safe and wholesome for consumers.

Weber initially said levels of Zeranol found in beef were "57,000 times less, literally, than what the FDA has determined is safe."

However, a day after this CBS report aired, his organization said the figure was wrong. The levels of the drug are 5,700 less than what the FDA has determined is safe -- in effect, 10 times higher than the first estimate.

The manufacturer of Zeranol says the drug is FDA approved as "safe and effective" and adds, "there has been no demonstration that Zeranol affects the development of breast cancer in humans or animals."

The FDA tells CBS News it's waiting for the results of a major follow-up study which will track Zeranol levels in women and in store-bought beef.

Estrogen in chicken and beef may be contributing to hormone-dependent cancers

Posted: May 23, 2010

Breast cancer study

Conference:

American Society of Clinical Oncology Meeting, June 2010

Study name:

Does dietary estrogen intake from meat relate to the incidence of hormone-dependent cancers?

A new study to be presented in early June at the American Society of Clinical Oncology annual meeting in Chicago has reported that U.S. chicken and beef contain relatively high levels of estrogen. Estrogen in oral contraceptive pills has been reported to contribute to the incidence of hormone-dependent cancers in women. However, there appears to be very little discussion concerning dietary estrogen from meat in relation to cancer incidence. In the study, concentrations of estradiol-17β (E2) and estrone (E1) were measured in beef produced in the U.S. and Japan (40 samples each), and chicken produced in the U.S., Japan, and Brazil (25 samples each). Fat and muscle meat were examined separately. For comparison, the authors also analyzed fat tissues of 25 postmenopausal Japanese women.

Estrogen levels were found to be higher in fat than in muscle meat. Median concentrations (picograms per gram (pg/g)) of estrogen in Japanese chicken fat (E2 = 21.1, E1 = 65.7) and in U.S. chicken fat (20.7, 54.6) were the highest of the samples assessed. U.S. beef fat also had a relatively high level (14.0, 7.7). However, Japanese beef red meat (0.0, 0.1) and Brazilian chicken muscle meat (0.2, 0.4) were found to incorporate nearly zero levels of estrogen, and the estrogen levels in their fat were also low. The high E2 levels in Japanese and U.S. chicken exceeded the levels found in the fat of Japanese women (16.3). On the other hand, levels in meat with low estrogen content were a hundred times lower than in human fat.

The authors comment that the high estrogen concentrations in Japanese and U.S. chicken, as well as U.S. beef, have been attributed to the residue of external estrogen in the feed given to the livestock. The nearly zero level found in Japanese beef and Brazilian chicken may be considered the natural amount found in meat without estrogen supplementation. The estrogen levels found in U.S. chicken and beef are much lower than those of contraceptive pills. However, estrogen intake from meat consumption cannot be dismissed as a factor governing human health, according to the authors, considering lifetime exposure to such meat. The authors conclude that dietary estrogen intake from meat might promote estrogen accumulation in the human body and could influence the incidence of hormone-dependent cancers.

Fighting for a safer environment at home, in the community, and at work

American Beef: Why is it Banned in Europe?

HORMONES IN MEAT Fact Sheet

Most U. S. beef cattle are implanted with synthetic hormones in feedlots prior to slaughter. On January 1, 1989 the European Economic Community (EEC) placed a ban on hormone-treated U. S. meat, preventing U. S. meat products from being sold in any European nations. The United States Department of Agriculture (USDA) has challenged the ban and accused the EEC of unfair trade practices, but the action of European governments raises some important questions about American meat.

Q. Why did the Europeans (EEC) place a ban on hormone-raised meat?

A. The European Economic Community banned hormone-raised meat because of questions on the dangers of meat that has been treated with synthetic sex hormones. European consumers pressured the EEC to take this action to protect their health.

More than a decade ago, Roy Hertz, then director of endocrinology at the National Cancer Institute and a leading authority on hormonal cancers, warned of the carcinogenic risks of estrogenic additives which can cause imbalances and increases in natural hormone levels. Hertz warned against the uncontrolled use of these potent carcinogens. No dietary levels of hormones are safe and a dime-sized piece of meat contains-billions of millions of molecules.

Breast cancer has been raised as a primary concern in light of associations between breast cancer and oral contraceptives, whose estrogen dosage is known and controlled. The risk of breast and other cancers only increases with the uncontrolled use of hormones in meat.

Q. During the seven years after the EEC ban on hormone-raised meat, the U.S. beef industry has continued to use sex hormones in meat. Why?

A. Hormones can be used to stimulate growth in cattle. Because farmers are paid based on the weight of the animals they sell for slaughter, the use of hormones has been seen as a way to boost profits.

Q. Which hormones are used on feedlots?

A. Diethylstilbestrol (DES) was one of the first hormones used to fatten feedlots. It was banned in 1979 after forty years of evidence that DES was cancer-causing. In its place, sex hormones, such as estradiol and progestins (synthetic forms of the naturally occurring hormone progesterone) have been implanted to virtually all feedlot cattle. The least hazardous way to administer hormones to animals is through an implant near the animals ear. Unfortunately, many farmers inject hormones directly into the muscle tissue that will be later used to make meat products. The only USDA-imposed requirement is that residue levels in meat must be less than one percent of the daily hormone production of children. This requirement is unenforceable because there is no USDA testing for hormone residues in meat. Furthermore, hormonal residues are not practically differentiable from natural hormones created by the cow's body. As a result, the use of hormones to boost meat production is completely unregulated.

Q. What kind of policies should be in place in the U.S. to address this problem?

A. Hormonal and other carcinogenic additives (pesticides from food fed to animals, some antibiotics, etc.) should be banned immediately, as should be all additives that are not proven effective and safe. Additive use and residue levels in animal products, including milk and eggs, should be subject to explicit labeling requirements. Until then, state initiatives that establish hormone-free certification for European shipments, should be applauded and extended domestically.

Q. What can consumers do to protect themselves?

A. Consumers can boycott chemical treated meat in favor of organic meat and insist on the fight to know which additives have been used and what residues might exist. Consumers should speak with their butchers or grocers about hormone-free meat product availability.

Beef Hormones Linked to Premature Onset of Puberty & Breast Cancer

Research links breast cancer, beef hormones

By Dennis Bueckert / The Canadian Press

Ottawa - Consumption of hormone-treated beef may be causing girls to

reach puberty earlier than they used to and making them more susceptible

to breast cancer, say researchers attending a world conference on breast

cancer.

It is "very likely" that hormone residues in North American beef is a

factor in the early onset of puberty among girls in recent decades, said

Carlos Sonnenschein of the Tufts University School of Medicine at

Boston.

"There is no other reason to explain it," Sonnenschein said in an

interview Friday.

Pediatricians say the onset of menstruation has steadily decreased in

recent decades. The average age for a first period is now 12½, up from

age 14 in 1900.

Early onset of puberty with its raging hormones translates into higher

risk of breast cancer, said

Sonnenschein.

"The length and amount of exposure to estrogens (a class of hormones) is

one of the most significant risk factors in breast carcinogenesis.

"Unless you are exposed to estrogens you don't get breast cancer. The

longer the exposure is, the higher the incidence. Therefore if you

decrease the age of menarche (first menstruation) . . . you

are at higher risk."

Hormones are used by cattle farmers in Canada and the United States to

increase the weight of cattle prior to slaughter. They are currently the

focus of a major trade dispute between North American and the European

Union.

Annie Sasco, of the International Agency for Research on Cancer at

Lyons, France, said more study is needed but it makes sense that

hormone-treated beef could affect the onset of puberty.

"Any exposure to a high level of hormones is associated with earlier

onset of puberty. It needs to be

studied more but it makes sense."

She said the risk of breast cancer associated with hormone residues in

meat is not proven, and is probably small.

"We all have estrogens and we need estrogens," she told the mainly

female audience. "They are needed for life, for being what we are. We

cannot say, 'Ban estrogens.'

"We all have to try, through our diet and physical exercise, to keep our

levels down. But there is a

need to keep things in perspective . . . without getting into a complete

panic."

Even if the risk is small, she said it would be prudent to stop the use

of hormones in the cattle industry there's no offsetting health benefit

for consumers.

The European Union has banned the use of hormones for fear they pose a

health risk, and has banned imports of hormone-treated Canadian and U.S.

meat.

The two North American countries have taken the dispute to the World

Trade Organization and have won the right to retaliate by placing

tariffs on European goods. Canada announced retaliatory tariffs on a

range of goods this week.

The federal government maintains the hormones are safe, despite strong

misgivings on the part of its own scientists at the Health Protection

Branch.

Four scientists with concerns have been placed under orders not to

discuss the issue in public.

The incidence of breast cancer has been rising steadily, most quickly in

rich countries. In 1997, around the world, close to 400,000 women died

of the disease.

The number of new cases reported annually approached 900,000 in 1997,

up from 572,000 in 1980.

Date: Sat, 31 Jul 1999 22:36:56 -0700

From: Andrew Gach <UncleWolf@WORLDNET.ATT.NET>

Posted to: Health and Environment Resource Center

<HEALTHE@HOME.EASE.LSOFT.COM>

LittleMelons

elizadevi - Hormones in our meat is relevant topic, but did you mean to post it on this thread?  Maybe you should start another thread for it.

voraciousreader

http://www.amazon.com/Overdiagnosed-Making-People-Pursuit-Health/dp/0807022004

The author of the above mentioned book, Dr. Welch is leading the crusade denouncing many screenings...including pre-natal and prostate.  The book is EXCELLENT and I recommend that EVERYONE read his book.  After reading his book, I highly recommend reading, Dr. Abramson's book, Overdosed America:

 http://www.amazon.com/s/ref=nb_sb_noss/178-6814674-6059942?url=search-alias%3Dstripbooks&field-keywords=overdosed+america

Once you've read BOTH books, you will understand first hand the controversy of OVER screening and OVER diagnosing....

Enlightening.....

She

I suggest they are trying to 'lessen' the impact of this guideline by specifying 'women at medium risk' .

I was 42 the first time I got BC, 46 the second time.  I'd be dead twice over before I even made it to my third different BC. 

They tried the same thing in 2001.  They cited a study in China as their basis to stop teaching BSE.  Unfortunately the link to the abstract below no longer works.  I suggest Canadian women submit their thoughts on the new guidelines to the Canadian Medical Association Journal.

2001 Study:

Baxter N, with the Canadian Task Force on Preventive Health Care. Preventive health care, 2001 update: Should women be routinely taught breast self-examination to screen for breast cancer? CMAJ 2001;164(13):1837-46.[Abstract/Free Full Text]

voraciousreader

According to the National Cancer Institute:

Clinical Breast Examination

No randomized trials of clinical breast examination (CBE) as a sole screening modality have been done. The Canadian National Breast Screening Study compared CBE plus mammography to CBE alone in women aged 50 to 59 years (refer to the Effect of Screening on Breast Cancer Mortality section of this summary for more information). CBE was conducted by trained health professionals with periodic evaluations of performance quality. The frequency of cancer diagnosis, stage, interval cancers, and breast cancer mortality were similar in the two groups and compared favorably with other trials of mammography alone. One explanation for this finding was the careful training and supervision of the health professionals performing CBE.[56] Breast cancer mortality with follow-up 11 to 16 years after entry (mean = 13 years) was similar in the two screening arms (mortality rate ratio, 1.02 [95% CI, 0.78-1.33]).[57] The investigators estimated the operating characteristics for CBE alone. For 19,965 women aged 50 to 59 years, sensitivity was 83%, 71%, 57%, 83%, and 77% for years 1, 2, 3, 4, and 5 of the trial, respectively, and specificity ranged between 88% and 96%. PPV, which is the proportion of cancers detected per abnormal examination was estimated to be 3% to 4%. For 25,620 women aged 40 to 49 years, who were examined only at entry, the estimated sensitivity was 71%, specificity 84%, and PPV 1.5%.[58] Among community clinicians, screening CBE has higher specificity (97%-99%) [59] and lower sensitivity (22%-36%) compared with examiners in clinical trials of breast cancer screening.[60-63] A study of screening in women with a positive family history of breast cancer showed that, after a normal initial evaluation, the patient or CBE identified more cancers than did mammography.[64] Another study examined the usefulness of adding CBE to screening mammography. Among 61,688 women older than 40 years and screened by mammography and CBE, sensitivity and specificity for mammography and for combined mammography-CBE were calculated. Specificity for mammography was 78% and for both modalities 82%. The increased sensitivity was greatest for women aged 60 to 69 years with dense breasts (6.8%), compared with women aged 60 to 69 years with fatty breasts (1.8%). Specificity was lower for women undergoing both screening modalities compared with mammography alone (97% vs. 99%).[65] The duration of examination in the trials was 5 to 10 minutes per breast.

Breast Self-Examination

Monthly breast self-examination (BSE) is frequently advocated, but evidence for its effectiveness is weak.[66,67] The only large, well-conducted, randomized clinical trial of BSE that has been completed, randomly assigned 266,064 women according to workplace in Shanghai to receive either BSE instruction, reinforcement and encouragement, or instruction on the prevention of lower back pain. Neither group received breast cancer screening through other modalities. After 10 to 11 years of follow-up, 135 breast cancer deaths occurred in the instruction group and 131 in the control group (relative risk [RR] = 1.04; 95% CI, 0.82-1.33). Although the number of invasive breast cancers diagnosed in the two groups was about the same, women in the instruction group had more breast biopsies and more benign lesions diagnosed than did women in the control group.[68]

Case-control studies, nonrandomized trials, and cohort evidence about the effectiveness of BSE is mixed; results are difficult to interpret because of selection and recall biases. For example, a small case-control study in Seattle, Washington, compared self-reported practice of BSE in women with advanced breast cancer with that in age-matched controls.[69] The frequency of practicing BSE did not differ in these groups, and there was no decrease in the risk of advanced-stage breast cancer associated with BSE (RR = 1.15; 95% CI, 0.73-1.81). BSE proficiency was low in both groups of women.

In the U.K. Trial of Early Detection of Breast Cancer, two districts invited more than 63,500 women aged 45 to 64 years to educational sessions about BSE. After 10 years of follow-up, there was no difference in mortality rates in these two districts compared with four centers without organized BSE education (RR = 1.07; 95% CI, 0.93-1.22).[70]

A case-control study nested within the Canadian NBSS suggests that well-performed BSE may be effective. This study compared self-reported BSE frequency before enrollment in the trial with breast cancer mortality. Women who examined their breasts visually, used their finger pads for palpation, and used their three middle fingers had a lower breast cancer mortality.[71]

A device called the Sensor Pad was designed to improve the accuracy of BSE and has been approved by the FDA; however, there is no evidence on its efficacy to decrease breast cancer mortality.

MaxineO

This makes me mad. I was diagnosed at 38, from a CT scan for another issue; no risk factors, no one ever felt my lump. If I had waited until 50 for a mammogram? It would have been everywhere. My DH got the same business recently about prostate screening...raising the age.

So who funded the study? The insurance agencies??

lindasa: I agree with you, a doctor 'not worrying' goes a long way in a patient's mind. "If the doc says no test needed, by golly, I must be okay!"

Luah

This is a very complicated issue, and I can see valid arguments on both sides. One thing that's disturbing though is that the recommendations are said to be based on older screening technologies.

The no-CBE guideline has me baffled too. I'm not sure too many cancers are caught this way (though some are), but if you're at your GP for a physical, why not do a CBE? As for BSE, I think semantics come into play here. I'm not sure anyone is saying women shouldn't be breast aware - feel and visually inspect their breasts on a regular basis (many women find their own symptoms this way), but the argument is over the formal BSE (which always seemed a bit mysterious to me) and whether that really has an impact on outcome, maybe not.

As for mammos, they are not now indicated for women 40-49 at average risk in Ontario, so the only change would be that women over 50 wouldn't be getting them so often (every 2-3 years instead of every 1-2 if you're average risk). I think the province is trying to direct its dollars to where they can have maximum impact, so for example, now in Ontario, young women at high risk are entitled to screening by MRI - which is known to be better for dense breast tissue. That's a good thing imo... as is regular screening for anyone at high risk, and good surveillance for those with a personal history.  

As always I'm assuming that GPs can refer their patients for screening if they feel so inclined. I know my GP sent me for a mammo in my early 40s - it's just that it wasn't part of the provincial screening program. Still covered by OHIP though. I guess we will have to see whether these recommendations are adopted by the provinces or not -- and what the funding implications are.

crazy4carrots

I'm quite confident that, whether or not the guidelines are adoped, a decision made by patient and physician will continue to allow the patient to be tested regardless of age.  I just wish that mammos were appropriate for everyone, and we see so clearly that they are not, especially for younger women with dense breasts.

I'd like to see some serious research dollars go towards developing the safest, and the most accurate, testing equipment -- for everyone.

mumito

I could not believe this when I heard it on the news.Do you think alot of it has to do with our health Insurance plan?To me it makes no sense.

voraciousreader

  

  Editorial in the Journal of The National Cancer Institute 11/22/2011:

  

Cancer Screening Reform NeededSince the National Cancer Institute developed the first guidelines on mammography screening over thirty years ago, advocacy                  and professional groups have developed guidelines focused on who should be screened, instead of communicating clearly the                  risks and benefits of screening, according to a commentary by Michael Edward Stefanek, Ph.D., the associate vice president                  of collaborative research in the office of the vice president at Indiana University, published online Nov. 21 in the Journal of the National Cancer Institute. Stefanek writes that too much time has been spent debating guidelines, instead of ongoing debates about who should be screened.                  He advocates educating people about the potential harms and benefits of screening.               The U.S. Preventative Task Force (USPTS) recommendations against routine mammography for women aged 40-49 sparked controversy                  followed by more studies on screening, notably a Norwegian study comparing cancer-specific mortality in screened and unscreened                  women, which found a small and statistically insignificant breast cancer mortality reduction in the screened group. Stefanek                  writes that "similar ambiguity" exists for prostate cancer screening, noting that the two largest and high quality studies                  gave conflicting results, with the USPTS recently issuing recommendations against PSA testing in healthy men. The National                  Lung Cancer Screening Trial reported a 20% relative decrease in lung cancer deaths among subjects undergoing CT scans compared                  with those receiving chest x-rays, but with the majority of positive results being false positives. Overall this situation                  leads Stefanek to the conclusion that despite all the analyses to date, we are on unsteady ground when we attempt to dictate                  who should and shouldn't undergo screening.               Stefanek poses the question of what we have taught the public about cancer screening, since the public invariably seems to                  feel that screening is almost always a good idea and that finding cancer early is the key to saving lives. He cautions that                  the public may persist in holding a biased view of screening if we continue to engage in guideline debates. Furthermore, new                  technologies, despite the potential for combating cancer, will likely result in false positives, false negatives, overtreatment,                  and under treatment, and incur important patient harms.               Stefanek writes that we have failed to truly educate the public about cancer screening, and that our approach to screening                  needs to be reformed. He says engaging patients in shared decision making, tracking the number of patients provided with information                  related to the harms and benefits of screening instead of just those who are screened, and uniting scientific and advocacy                  organizations with primary care provider organizations in this effort to inform about costs and benefits is needed. "If we                  agree on the premise that individuals are supposed to be informed before making medical decisions, including decisions about                  cancer screening, then the time and talent of such groups could be much better spent educating the public on the harms and                  benefits of cancer screening," Stefanek writes. "Screening can be very beneficial (or not), and screening messages should                  reflect the complexity of this decision."              

Sugar77

My breast cancer was discovered on my very first mammogram at 45 years old.  My GP wanted a baseline "for the file." My tumour was fast growing and triple negative. Don't even want to think of the outcome had I not had that mammogram. These guidelines are scary.  

LittleMelons

When anti-screening proponents are asked what is wrong with screening they say unnecessary procedures and anxiety for the women who receive false positives.  Aren't the risks of some unnecessary mammograms, ultra-sounds and biopsies worth it to save the lives of women whose cancers would otherwise become incurable.

In the British medical journal, The Lancet, a group of doctors and scientists just published an article which disputes the anti-screening movement. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61766-2/fulltext?rss=yes

" Although the wider scientific community has long embraced the benefits of population-based breast screening, there seems to be an active anti-screening campaign orchestrated in part by members of the Nordic Cochrane Centre. These contrary views are based on erroneous interpretation of data from cancer registries and peer-reviewed articles. Their specific aim seems to be to support a pre-existing opposition to all forms of screening.1 These individuals, making claims of poor methods, selectively discount overwhelming scientific evidence from numerous randomised trials in different countries that organised screening reduces breast cancer mortality.

 They claim that the significant decrease in breast cancer mortality achieved by screening is due to improvements in treatment alone, discounting the benefits of early detection. If true, this would imply that breast cancer is an exception among adenocarcinomas in that early detection does not improve prognosis-a claim contrary to the evidence.

For women with breast cancer, early detection also results in improved quality of life from less extensive surgical treatment. Women with screen-detected breast cancer in the UK have half the mastectomy rate of women with symptomatic cancers-ie, 27% versus 53%.2 Organised, high-quality breast screening is an important public health initiative by numerous governments worldwide. These policies are based on robust and extensive analysis of individualised patient data from scientific trials, with particular attention paid to the balance of potential benefits and harms.3 To imply that such an international action is mass misrepresentation, or that screening is done for the benefit of self-interested professionals, is as perverse as it is unjustified. Comprehensive guidelines deal with the entire screening process.4 Organisations responsible for screening programmes regularly review published evidence on the effects of mammographic screening, and also contradictory interpretations. We consider the interpretation by Jørgensen, Keen, and Gøtzsche,5 of the balance of benefits and harms to be scientifically unsound. Women would be better served by focusing efforts on how best, and not whether, to provide breast screening. The signatories below, charged with provision and implementation of breast screening in many different countries, remain convinced that the scientific foundation for population-based, quality-assured, organised breast screening is one of the major accomplishments of the translation of clinical cancer research into public health practice. Early detection, in combination with appropriate treatment, significantly lowers breast cancer mortality and improves the life quality of patients with the disease." 

voraciousreader

The editorial in the Journal of The National Institute of Cancer speaks to the Lancet letter. I read the Lancet letter today as well. A few weeks ago, the Lancet's sister publication, The British Medical Journal published data and reports on the screening controversy which led to the British health czar deciding to convene a committee to study the data once and for all and bring forth a cohesive recommendation. We won't know for months what that recommendation will be. In the meantime women have to know that this controversy exists and need to enlighten themselves as to how they should proceed with the current evidence. I maintain, we owe our younger sisters an answer sooner, rather than later.

oliviafinnegan

The findings of this task force strike me as a step backward. Considering that 80% of women diagnosed with bc have no family history or other high risk factors, not providing mammograms for women over the age of 35 or 40 just seems wrong. I have no experience with ultrasound or MRIs -- is dense breast tissue easier to deal with in those tests?

voraciousreader

Penn Medicine Physicians Receive Five-Year, $7.5 Million Grant
for Breast Cancer Screening Research from the National Cancer Institute
(PHILADELPHIA) - University of Pennsylvania researchers have received a
five-year, $7.5 million grant from the National Cancer Institute (NCI) to create
the Penn Center for Innovation in Personalized Breast Cancer Screening (PCIPS),
dedicated to studying emerging methods of breast cancer detection. The NCI
funding will allow the team, led by Perelman School of
Medicine faculty Katrina
Armstrong, MD, MSCE, chief of the
division of Internal Medicine and associate director of
Outcomes and Delivery in the Abramson Cancer Center,
and Mitchell
Schnall, MD, PhD, Matthew J. Wilson Professor of Radiology, to use
clinical, genomic and imaging information to guide the use of novel,
personalized breast cancer screening strategies that will reduce false positive
rates to improve outcomes." The research, which also involves researchers from
medical oncology, psychiatry, and colleagues in the Annenberg School for
Communication and the Wharton School, will be conducted through August 2016.
PCIPS research is three-fold. First, they will aim to improve breast cancer
screening by creating a new "breast complexity index" to predict individual
screening outcomes. Second, the team will also compare the effectiveness of new
imaging technology, including digital breast tomosynthesis compared to
conventional mammography. Third, they will create new strategies for
communicating individual estimates of benefit and risk of
alternative screening methods to better inform patients and health care
providers.
  
Along with these three projects, the Center will study
outcome data of a diverse group of 74,000 women who undergo breast cancer
screening at six sites in Penn Medicine's integrated health network. The center
will use resources in breast imaging, primary care, communication, computer
science, biostatistics, health services research, bioinformatics, medical
oncology, cancer genetics and clinical leadership to advance the breast cancer
screening process and encourage collaboration through NCI's Population-based
Research Optimizing Screening through Personalized Regimens (PROSPR)
network.

mumito

It will be interesting to hear what our Onc's have to say about this.

LittleMelons

The guidelines contradict the premise that early detection is better than late detection.  The whole idea is to get the cancer before it becomes metastatic.  As voraciousreader cited above "Women who examined their breasts visually, used their finger pads for palpation, and used their three middle fingers had a lower breast cancer mortality."

BC is more prevalent in older women, but tends to be more aggressive in younger women, so all the more need for early detection in younger women. 

 Are they going to chastise young women and family doctors for finding and wanting to check out lumps with mammos and biopsies, saying they were told not to do self or clinical breast examinations?

As several of you have mentioned, we need more accurate tests for bc.

voraciousreader

Littlemelons...

Yes.  These guidelines DO contradict the idea that early detection leads to a cure.  Here's the bottom line about the statistics and screening.  The researchers know that some women, mostly younger women, are going to have VERY aggressive tumors that NO screening is going to improve their mortality.  Likewise, they know that some women, most likely older women, are going to have VERY slow growing tumors and they will die from old age before they would die from their tumors.  So the question is how effective is screening for EVERYONE else.  Without a doubt, they know that SCREENING mammograms will save lives for women in the 50-69 age category.  They also know now that those women do not need annual screening mammograms to save lives.  The question is, how effective is SCREENING mammograms (unlike diagnostic mammograms) for everyone else.  According to the anti-screening researchers, not very.

With studies like the one now announced yesterday by University of Pennsylvania, maybe we can get to the bottom of WHAT modality works BEST for each age category.  Furthermore, perhaps the money saved by not requiring tests that DO NOT EXTEND MORTALITY, can be directed towards research that will find a cure.

cp418

Breast cancer screening won't change despite guidelines

http://www.cbc.ca/news/canada/prince-edward-island/story/2011/11/22/pei-breast-cancer-screening-584.html

LittleMelons

voraciousreader - Yes, I think the University of Pennsylvania study you cited is an excellent idea and will hopefully clarify the efficacy of the various techniques available.  I am not a  medical person and intuitively have doubts about the use of routine screening for young women since exposure to even small amounts of radiation may be harmful in the long term and do not seem to lead to better outcomes anyway.  It's just that the guidelines against either clinical or self breast exams seem to leave younger women out in the cold.  And we can see from these boards that lives have been saved in this age group by the use of breast exams and mammos. 

I know it's about the use of resources.  It's interesting what lindasa said - that they intentionally didn't seek input from cancer specialists in order to keep it a "number crunching exercise", no anecdotal evidence, less emotional connection.  The Lancet article points out that there are a significant number of medical professionals who question their interpretation of data.

alexch

Hi Ladies,

I agree with many points made by above posters in regards to younger women getting more aggressive cancer when they are younger and yes perhaps a mammagram may find the tumour earlier but many younger women have "dense" tissue and would require an MRI to see if their was actually a cancerous tumour there at all. I can understand what the recommendations are saying if we give every women under 50 a mamm. then "something" is found we have now scared them, put them through more tests and maybe a biopsy to find hopefully a b9 finding.... That is costly and IMO not warranted. Take the emotion out of this and look at it from a percentage of women who are getting BC under 50 and how we can afford OHIP to cover furthur testing that may or may not change really anything. My BC was found at 38  on my own. I felt the lump... So should a surveillance mammo be given to me in my 30's... In other words when do we draw the line as to an age that we give surveillance mammos. for.

To the ladies that did have their mammos in the 40's b/c their FD's felt that it is part of "their" PT care and they did get their BC found early that is wonderful. I had LABC and a huge tumour I was an unlucky stat but I still feel that it is like anything in life. Everything happens for a reason. I beat my cancer and I do my best to support others who are dealing with it....Would a surveillance mammo or MRI in my 30's changed the fact I had BC, NO but yes, maybe it would have been caught early and I would have still been given the same treatment (chemo and rads) b/c of my young age whether it was stage 1 or stage 3.

I also think some oncologist would agree with the "new recommendation" b/c many of them do not do tests, scans or bloodwork routinely after we are done treatment b/c it will not change anything at the end of the day. If a chest xray shows cancer in your lungs than you are Stage 4. Therefore, many oncologists ask you to discuss your symptoms and then they will get the tests reqiured to rule out METS.

Bottom Line- We as women need to advocate and ask for tests when WE ourselves know that something is not right with our body. Whether it be a lump in your breast or a cough after BC treatment. We need to know our bodies and it is our job to know what tests should be ordered if we are not comfortable with what our Dr's are saying. Sad to say but the only one looking out for your very best care for you is YOU!

Take Care,

Alexch (lost my password I was Chalex): IDC, 7-8cm, 0/15 nodes, Grade 3, ER/PR+, HER+

208sandy

just a note here - older women have dense tissue too - I am one of them and have been told I will not have any further mamos just US or MRI as necessary.