No one wrote letters to her!  We wrote orgs!

Anything larger than 5% btw, in the medical community is considered statistically significant.

I always thought one of the reasons younger women tend to be diagnosed with later stage cancer was that they tended to present with tumors big enough to palpate because they weren't getting mammograms? Not to suggest that they should be getting them, mind you. Just saying that it's hard to find tiny specks in the breast visually or by palpation, and by the time those specks grow, it's generally a lot more serious, isn't it. Also, before the advent of digital mammography, were there any diagnoses of DCIS prior to pathology reports? Of course women over 40 are the ones getting mammograms and therefore being diagnosed in larger and larger numbers with DCIS, not  women under 40. So DCIS probably skews the statistics for older women down to earlier stages. All of that is above and beyond the more aggressive characteristics of cancer in younger women. I I'm one of those women with very dense breasts, so I asked my MO for an MRI next time I have to get a mammogram, and he said he would still also recommend mammo and US, because apparently calcifications don't show up well on MRI? I might be throwing too many different things into this post but I don't have time to edit and write properly because of course I'm also at work!

L to the K you are right. When you meet women in their 20's and early 30's they are often at stage 2b or 3...since they do not get mammos, their tumors are not found until they are big enough to feel.

A few high risk young women may get MRI's, but often they are told young women have lumpy breasts, it's nothing.

Of course it is often nothing, but I have heard this story from several young women who were 4 from the get go.

I think it's just a crap shoot. No one in my family has had breast cancer. I had a "normal" baseline mammo at 41 and at 43 I was diagnosed with stage 4 breast cancer. No in between for me.



Enough with awareness, it's time for a cure!

 This study was published on October 18, 2011 in The Annals of Internal Medicine. This is EXACLTY the kind of research that we need to find new modalities for effective SCREENING:

Comparative Effectiveness of Digital Versus Film-Screen Mammography in Community Practice in the United StatesA Cohort StudyKarla Kerlikowske, MD; Rebecca A. Hubbard, PhD; Diana L. Miglioretti, PhD; Berta M. Geller, EdD; Bonnie C. Yankaskas, PhD; Constance D. Lehman, MD, PhD; Stephen H. Taplin, MD, MPH; andEdward A. Sickles, MD, for the Breast Cancer Surveillance Consortium          From University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, California; Group Health Research Institute, Group Health Cooperative, University of Washington School of Public Health and Community Medicine, and University of Washington School of Medicine, Seattle, Washington; Health Promotion Research, University of Vermont, College of Medicine, Burlington, Vermont; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and Applied Research Program, National Cancer Institute, Rockville, Maryland.        AbstractBackground: Few studies have examined the comparative effectiveness of digital versus film-screen mammography in U.S. community practice.Objective: To determine whether the interpretive performance of digital and film-screen mammography differs.Design: Prospective cohort study.Setting: Mammography facilities in the Breast Cancer Surveillance Consortium.Participants: 329 261 women aged 40 to 79 years underwent 869 286 mammograms (231 034 digital; 638 252 film-screen).Measurements: Invasive cancer or ductal carcinoma in situ diagnosed within 12 months of a digital or film-screen examination and calculation of mammography sensitivity, specificity, cancer detection rates, and tumor outcomes.Results: Overall, cancer detection rates and tumor characteristics were similar for digital and film-screen mammography, but the sensitivity and specificity of each modality varied by age, tumor characteristics, breast density, and menopausal status. Compared with film-screen mammography, the sensitivity of digital mammography was significantly higher for women aged 60 to 69 years (89.9% vs. 83.0%; P = 0.014) and those with estrogen receptor-negative cancer (78.5% vs. 65.8%; P = 0.016); borderline significantly higher for women aged 40 to 49 years (82.4% vs. 75.6%; P = 0.071), those with extremely dense breasts (83.6% vs. 68.1%; P = 0.051), and pre- or perimenopausal women (87.1% vs. 81.7%; P = 0.057); and borderline significantly lower for women aged 50 to 59 years (80.5% vs. 85.1%; P = 0.097). The specificity of digital and film-screen mammography was similar by decade of age, except for women aged 40 to 49 years (88.0% vs. 89.7%; P < 0.001).Limitation: Statistical power for subgroup analyses was limited.Conclusion: Overall, cancer detection with digital or film-screen mammography is similar in U.S. women aged 50 to 79 years undergoing screening mammography. Women aged 40 to 49 years are more likely to have extremely dense breasts and estrogen receptor-negative tumors; if they are offered mammography screening, they may choose to undergo digital mammography to optimize cancer detection.Primary Funding Source: National Cancer Institute

Omg, if I didn't have access digital mammos, I would have frequently put them off. The non-digital were painful.

LtotheK...Pubmed.org.  I also know which are the best respected journals because I used to do public relations for a medical organization.  Studied statistics in college.   The most important class I ever took.....

My oncologist tried to block my MRI by saying the diagnostic digital mammography used by my hospital would be "read more carefully".  What a bunch of malarky, especially since my BS said with my oncologist present that my tumor would probably not have been found for years with my dense breasts.  I knew these things because of my reading on this board.

What will be interesting is to see the long-term studies on MRI detection.  Part of the many reasons my NCI-ranked hospital blocks them (including read time, and insurance hoo ha) is there are no long-term studies on precisely what VoraciousReader just posted.

Edited to add:  in order to get MRI screening, I went to another hospital that wrote a letter to my oncologist suggesting it would be a real shame for me to have to move my treatment to them over the MRI issue.  That, and my husband called one day irate telling my oncologist if anything happened to me because mammography missed my tumor, he didn't know what he would do.  Sadly, my rationalizing with her based on studies didn't do the trick initially.

Got a long way to go even on the prevention, screening, and awareness issue, long before cure.

I got an MRI scheduled the same day I got my biopsy results- but of course it was never suggested to me before, despite extremely dense and lumpy breasts since the age of about 18. I think I am going to push for an MRI as often as I can get one, from now on.

Even though this thread is about Giuliana Rancic (I do wish her well, she seems like a nice young woman and I hope her wish to have a baby comes true) I went to see my PCP yesterday and with young women in mind (I am older) I asked her what she was doing for her younger patients and she said that she is vigorously screening them for bc and any doubts she sends for an MRI and I asked her if that was a problem getting insurance approvals and she said "not going to happen I insist on the MRI" especially because she says a lot of her patients have dense breasts (as do I) my onc has US screening done on me every six months now and prior to this it was every three - because I have a dense breast mammo is no longer the screening mechanism of choice - so I continue to encourage anyone in their 30s to go get screened and ask for at least an ultra sound this waiting till you're 40 is just not doing it.

Here are the type of celebrity false statments that I believe are unhelpful, and add to the mistaken idea the "early detection = cure" (BTW it doesn't.  Done properly, it can help extend a person quality and quantity of life.  But it isn't a cure.)

http://content.usatoday.com/communities/entertainment/post/2011/10/giuliana-rancic-reveals-shes-battling-breast-cancer/1

Rancic, 36, said that when they went to do the third round of IVF, a doctor said she needed a mammogram. She wasn't going to get one until she was 40, but he urged her. When she found out the mammogram revealed breast cancer, she said, "I couldn't believe it."

She adds, "I will be OK, because I found it early."

She'll have surgery this week, then radiation for six weeks. "I'm not going to give up" on trying to have a baby. "Now I truly believe God was looking out for me. Had I gotten pregnant, a few years down the line I could have gotten sicker. So the baby saved my life."

 http://ihatebreastcancer.wordpress.com/2011/09/08/dear-andrea-mitchell-early-detection-is-not-a-breast-cancer-cure/

EW.com reports:

Luckily, the news isn't that bad. Mitchell's cancer was discovered at a very early stage, and the cancer has not spread. "I'm looking at this as another of life's lessons," she said on the show. "For you women out there and for the men who love you, screening matters. Do it. This disease can be completely curable if you find it at the right time."

In past years, Mitchell has participated in the Susan G. Komen Race for the Cure.

 A prophylactic mastectomy isn't actually a breast cancer cure. It does significantly reduces breast cancer risk, but it doesn't guarantee that you'll never develop the disease.

"Prophylactic mastectomy is highly effective," reports Karen Kaplan in the LA Times Booster Shots blog. "Studies show it reduces the risk of developing breast cancer by 90 percent in moderate- and high-risk women."

Comedian Wanda Sykes recently revealed she had a double mastectomy after a DCIS diagnosis in her left breast. Noting that her family has a history of breast cancer, Sykes said: "I had both breasts removed ... because now I have zero chance of having breast cancer."

In 2008, actress Christina Applegate declared herself cured after her prophylactic BMX.

A a 90% percent risk reduction is nothing to sneeze at but it isn't exactly the same as an iron-clad guarantee. That's because some breast tissue remains behind even when the breasts are removed.

"Bilateral mastectomies as a treatment for breast cancer are not a cure," Dr. Len Lichtenfeld wrote in 2008. "They are the best strategy we have to reduce the risk of another breast cancer in the opposite breast, but they don't remove risk completely."

Okay sisters...I'm presently in the library... ahhh...my home away from home reading the September 15, 2011 hardcopy of the New England Journal of Medicine.  Under the title "Clinical Practice" feature which "...begins with a case vignette highlighting a common clinical problem" Ellen Warner, MD presents the author's "clinical recommendations after presenting "evidence supporting various strategies, followed by a review of formal guidelines when they exist. 

Here is the case:

"A healthy, 42 year-old white woman wants to discuss breast cancer screening.  She has no breast symptoms, has menarche at the age of 14 years, gave birth to her first child at the age of 26 years, is moderately overweight, drinks two glasses of wine most evenings, and has no family history of breast or ovarian cancer.  She has never undergone mammography.  She notes that a friend who maintained the 'healthiest lifestyle possible' is now being treated for metastatic breast cancer, and she wants to avoid the same fate.  What would you advise?"

 ....."Since 1990, mortality from breast cancer in the United States and other industrialized countries has been decreasing at the rate of approximately 2.2% per year.  In the United States, this decline has been attributed both to advances in adjuvant therapy and to increasing use of screening mammography, in approximately equal measure.  Nevertheless, in contrast to its 2002 guidlines, the more recent recommendations of the U>S> Preventive Services Task Force, published in November 2009, support a REDUCTION in the use of screening mammography.   This revisioin resulted in considerable confusion and controversy.  The two most disputed changes were the reclassification of screening for women between the ages of 40 and 49 from the B recommendatioin (based on moderately strong evidence) to a C recommendation ("the decision...should be an individual one and take into account patient context, including the patiein'ts values regarding specific benefits and harms") and the recommendation that the frequency of screening be reduced from every 1 to 2 years to every 2 years....."

"this article focuses on the updated evidence and recommendations for screening women who are at average risk for breast cancer that have been published since this topic was last reviewed in the Journal in 2003."  It does not address breast-cancer screening for women at high risk --- that is, women with a lifetime risk of breast cancer that is greater than 20 to 25% on the basis of genetic testing, a strong family history or early therapeutic chest irradiation--which has been reviewed previously.

She then has a table of all of the guidelines issued by the major organizations and the years they were issued.    Nine 0rganizations are listed.  Regarding the guidelines she states, "Although all medical professional organizations in industrialized countries recommend screening mammography for women between 50 and 69 years of age, recommendations differ SUBSTANTIALLY with respect to other age groups, screening intervals and breast examinations in the clinic or by the patient herself."

Her conclusions and recommendations follow in the next post from me.......

yes, I like this thread as a library and review of the literature and the emotions don't change anything.  Its a long crooked path to get as close to the truth as possible. 

Voracious, I don't think anyone here is dissing the value of screening mammos, even in their current form, for women in the age groups 50-69.  The current controversies, as highlighted in your last couple of posts, are in the 40-49 age group.  Is that what you are referring to?