Giuliana Rancic early stage BC

I agree detection methods are flawed, especially if you have very dense breasts! I was vigilant and got yearly mammograms and I was always told my mammogram was "normal".  When I actually read the records after a tumor was found, for every previous year it said  "dense breasts, no calcifications."

  In 2004 my mammogram again showed no tumor but there were micro calcifications.  So they did a magnified view and there it was, a stellate mass that the radiologist was certain was malignant.  I was unaware that dense breasts make it more likely to get cancer AND harder to see. Now I get digital mammograms which are better, but still limited.  So I get MRI's too, used to be yearly, now every two years. 

 I was NEVER told I had dense breasts and what that meant for me.  My cancer was rare: invasive tubulo-lobular, 8mm.  My oncologists did not think chemo would help with that kind of cancer, so I had a lumpectomy and radiation and five years Arimidex.  I now have osteoporosis from the drug, but I'd do it again.

 I had four sentinal nodes, and they surgeon inadvertantly removed 7, altogether, all negative.  I do do believe early detection has saved my life.  Of course, I could get a recurrance or a totally new kind of cancer, but I don't spend time worrying about it. 

 I experienced cliqueish behaviour amongst the women who waited with me to get our radiation.  There were a few women who had had chemo first, and lost their hair.  Others, like me, had their hair.  They ignored me.  I tried to join a conversation or two, and they just looked at my coldly and didn't respond to me.  I'm a friendly, warm person, so I don't think I was being intrusive, just friendly.  I had the feeling they assumed I had DCIS, thus I had no chemo, and therefore wasn't worthy of their time or friendship.  It was very strange. 

 I wish Guiliana the best, and I do think the baby she plans to have probably saved her life by causing her to get her mammogram early.  

From The New York Times:

OCTOBER 24, 2011, 4:01 PM

Mammogram's Role as Savior Is Tested

By TARA PARKER-POPE

Stuart Bradford

Has the power of the mammogram been oversold?

At a time when medical experts are rethinking screening guidelines for prostate and cervical cancer, many doctors say it's also time to set the record straight about mammography screening for breast cancer. While most agree that mammograms have a place in women's health care, many doctors say widespread "Pink Ribbon" campaigns and patient testimonials have imbued the mammogram with a kind of magic it doesn't have. Some patients are so committed to annual screenings they even begin to believe that regular mammograms actually prevent breast cancer, said Dr. Susan Love, a prominent women's health advocate. And women who skip a mammogram often beat themselves up for it.

"You can't expect from mammography what it cannot do," said Dr. Laura Esserman, director of the breast care center at the University of California, San Francisco. "Screening is not prevention. We're not going to screen our way to a cure."

A new analysis published Monday in Archives of Internal Medicine offers a stark reality check about the value of mammography screening. Despite numerous testimonials from women who believe "a mammogram saved my life," the truth is that most women who find breast cancer as a result of regular screening have not had their lives saved by the test, conclude two Dartmouth researchers, Dr. H. Gilbert Welch and Brittney A. Frankel.

Dr. Welch notes that clearly some women are helped by mammography screening, but the numbers are lower than most people think. The Dartmouth researchers conducted a series of calculations estimating a woman's 10-year risk of developing breast cancer and her 20-year risk of death, factoring in the added value of early detection based on data from various mammography screening trials as well as the benefits of improvements in treatment. Among the 60 percent of women with breast cancer who detected the disease by screening, only about 3 percent to 13 percent of them were actually helped by the test, the analysis concluded.

Translated into real numbers, that means screening mammography helps 4,000 to 18,000 women each year. Although those numbers are not inconsequential, they represent just a small portion of the 230,000 women given a breast cancer diagnosis each year, and a fraction of the 39 million women who undergo mammograms each year in the United States.

Dr. Welch says it's important to remember that of the 138,000 women found to have breast cancer each year as a result of mammography screening, 120,000 to 134,000 are not helped by the test.

"The presumption often is that anyone who has had cancer detected has survived because of the test, but that's not true," Dr. Welch said. "In fact, and I hate to have to say this, in screen-detected breast and prostate cancer, survivors are more likely to have been overdiagnosed than actually helped by the test."

How is it possible that finding cancer early isn't always better? One way to look at it is to think of four different categories of breast cancer found during screening tests. First, there are slow-growing cancers that would be found and successfully treated with or without screening. Then there are aggressive cancers, so-called bad cancers, that are deadly whether they are found early by screening, or late because of a lump or other symptoms. Women with cancers in either of these groups are not helped by screening.

Then there are innocuous cancers that would never have amounted to anything, but they still are treated once they show up as dots on a mammogram. Women with these cancers are subject to overdiagnosis - meaning they are treated unnecessarily and harmed by screening.

Finally, there is a fraction of cancers that are deadly but, when found at just the right moment, can have their courses changed by treatment. Women with these cancers are helped by mammograms. Clinical trial data suggests that 1 woman per 1,000 healthy women screened over 10 years falls into this category, although experts say that number is probably even smaller today because of advances in breast cancer treatments.

Colin Begg, head of the department of epidemiology and biostatistics at Memorial Sloan-Kettering Cancer Center in New York, said that he supports mammography screening and believes that it does save lives. But he agrees that many women wrongly attribute their survival after cancer to early detection as a result of mammography.

"Of all the women who have a screening test who have breast cancer detected, and eventually survive the cancer, the vast majority would have survived anyway," Dr. Begg said. "It only saved the lives of a very small fraction of them."

The notion that screening mammograms aren't helping large numbers of women can be hard for many women and breast cancer advocates to accept. It also raises questions about whether there are better uses for the hundreds of millions of dollars spent on awareness campaigns and the $5 billion spent annually on mammography screening.

One of the reasons screening doesn't make much difference is that advances in breast cancer treatment make it possible to save even many women with more advanced cancers.

"Screening is but one of the tools that we have to reduce the chance of dying of breast cancer," Dr. Esserman said. "The treatments that we have actually make up for a good deal of the benefits of screening."

The Dartmouth analysis comes two years after a government advisory panel's recommendations to scale back mammography screening angered many women and advocacy groups. The panel, the United States Preventive Services Task Force, advised women to delay regular screening until age 50, instead of 40, and to be tested every other year, instead of annually, until age 74. The recommendations mean a woman would undergo just 13 mammograms in her lifetime, rather than the 35 she would experience if she began annual testing at age 40.

But the new recommendations have scared many women who believe skipping an annual mammogram puts them at risk of finding breast cancer too late. But Donald Berry, a biostatistician at M.D. Anderson Cancer Center in Houston, said adding more screening is not going to help more women.

"Most breast cancers are not lethal, however found," Dr. Berry said. "Screening mammograms preferentially find cancers that are slowly growing, and those are the ones that are seldom deadly. Getting something noxious out of the body as soon as possible leads women to think screening saved their lives. That is most unlikely."

Dr. Love, a clinical professor of surgery at the David Geffen School of Medicine at the University of California, Los Angeles, says the scientific understanding of cancer has changed in the years since mammography screening was adopted. As a result, she would like to see less emphasis on screening and more focus on cancer prevention and treatment for the most aggressive cancers, particularly those that affect younger women. Roughly 15 percent to 20 percent of breast cancers are deadly.

"There are still 40,000 women dying every year," Dr. Love said. "Even with screening, the bad cancers are still bad."

Thats-life....I hope your questions are rhetorical ones and not directed at me, because I don't have an answer.

Check out the thread "NY times slamming mammograms."

Also, if you read the article on the website, check out the comments.  There are some pearls.

the last bit was rhetoric

Here's one of the comments that I posted on the other thread that I copied and pasted from a comment from Tara Parker-Pope's thread....

4 hours agovoraciousreader wrote:

BTW...Regarding the article, there are over two hundred comments on Tara Parker Pope's site at The New York Times.   Many of the comments are well worth reading. Tara also made the following comment:

If annual mammography costs $5 billion and saves 4,000 women, imagine if women and doctors followed the guidelines, reducing mammography screening to every other year, saving about the same number of women and saving $2.5 billion that could be spent on prevention research or treatment for aggressive cancers. How many grandmother, mothers, sisters and daughters could be saved with that money?

Annettek Ditto, my second mammo at age 41 found the tumor close to the chest wall at 1.2 cm. Due to the location I would not have found it myself. It was Her2+/aggressive so I'm very grateful that the mammo caught it at stage 1 to give me my best possible chance.

From what I can see, for young patients with my profile (young, dense breasts, BC survivor), the best screening is mammography, ultrasound, and MRI.  My doctors described they actually catch different things. I have calcium deposits the mammography is tracking.  The ultrasound actually found my tumor, but they called it "probably benign" for two years while they biopsied everything else.  The MRI will show tiny tumors, but the calcium deposit changes can detect things prior to detectable tumors, from what I understand.

The issue is, for dense breasted patients, mammography is probably not enough.  And what I resent in my treatment is this is so bloody obvious based on the literature, and yet no one ever even mentioned I had dense breasts and that is clearly an additional risk factor.  If I'd had an MRI early in the game, as I've mentioned around the boards, my survival might have been up to five percent better over then years (based on cancermath).  That haunts me.

StephN, yes!  That is an extremely important point.  If I knew then what I know now, I would never have gotten my mammography at anything other than the best.  I went to a second-rate hospital because they had better wait times.

 NEW YORK TIMES, OCTOBER 30:

Considering When It Might Be Best Not to Know About Cancer

By GINA KOLATA

After decades in which cancer screening was promoted as an unmitigated good, as the best - perhaps only - way for people to protect themselves from the ravages of a frightening disease, a pronounced shift is under way.       

Now expert groups are proposing less screening for prostate, breast and cervical cancer and have emphasized that screening comes with harms as well as benefits.       

Two years ago, the influential United States Preventive Services Task Force, which evaluates evidence and publishes screening guidelines, said that women in their 40s do not appear to benefit from mammograms and that women ages 50 to 74 should consider having them every two years instead of every year.       

This year the group said the widely used P.S.A. screening test for prostate cancer does not save lives and causes enormous harm. It also concluded that most women should have Pap tests for cervical cancer every three years instead of every year.       

What changed?       

The answer, for the most part, is that more information became available. New clinical trials were completed, as were analyses of other sorts of medical data. Researchers studied the risks and costs of screening more rigorously than ever before.       

Two recent clinical trials of prostate cancer screening cast doubt on whether many lives - or any - are saved. And it said that screening often leads to what can be disabling treatments for men whose cancer otherwise would never have harmed them.

A new analysis of mammography concluded that while mammograms find cancer in 138,000 women each year, as many as 120,000 to 134,000 of those women either have cancers that are already lethal or have cancers that grow so slowly they do not need to be treated.       

Cancer experts say they cannot ignore a snowballing body of evidence over the past 10 years showing over and over that while early detection through widespread screening can help in some cases, those cases are small in number for most cancers. At the same time, the studies are more clearly defining screening's harms.       

"Screening is always a double-edged sword," said Dr. Otis Brawley, the chief medical officer of the American Cancer Society. "We need to be more cautious in our advocacy of these screening tests."       

But these concepts are difficult for many to swallow. Specialists like urologists, radiologists and oncologists, who see patients who are sick and dying from cancer, often resist the idea of doing less screening. General practitioners, who may agree with the new guidelines, worry about getting involved in long conversations with patients trying to explain why they might reconsider having a mammogram every year or a P.S.A. test at all.       

Some doctors fear lawsuits if they do not screen and a patient develops a fatal cancer. Patients often say they will take their chances with screening's harms if a test can save their lives.       

And comments like Dr. Brawley's give rise to other questions as well. Is all this happening now because of worries over costs? And in any case, is all this simply an academic argument, since most doctors, faced with real patients, still suggest frequent screening and their patients agree?       

The answer, cancer experts say, is, to a certain extent, all of the above. But, they say, there does seem to be a change in the air. Researchers used to be afraid to even broach the subject of screening's harms.       

"It was the third rail," said Dr. H. Gilbert Welch of Dartmouth Medical School. "We were afraid to say exactly what we thought for fear of seeming too crazy." It was easy to get financing to study the benefits of screening, he added, but a study that looked at harms was "too far out of the culture."       

Not now, he said.       

And with that change has come a new look at screening.       

"No longer is it just, Can you find the cancer?" Dr. Brawley said. "Now it is, Can you find the cancer, and does finding the cancer lead to a decrease in the mortality rate?"       

Then there is the new emphasis on cost.       

The current issue of The New England Journal of Medicine, for example, has an article by two prostate cancer specialists who note that one recent study concludes that $5.2 million must be spent on screening to prevent one prostate cancer death. And, add the authors, Dr. Allan S. Brett of the University of South Carolina School of Medicine and Richard J. Ablin of the University of Arizona, that figure is not inclusive. The true cost is undoubtedly even greater.       

"We believe that the current P.S.A.-based screening paradigm does not compare favorably with competing health care priorities," they wrote.       

The cost of screening, said Dr. Russell P. Harris, a screening researcher at the University of North Carolina, "is one of the factors that is pushing toward a tipping point."       

But, medical experts note, many people, including doctors, are confused by the changing message, which is understandable.       

"You don't turn decades of thought around immediately," said Dr. Timothy J. Wilt, a task force member from the University of Minnesota.       

In part, doctors and patients are stuck in a sort of cancer time warp. The disease was defined in 1845 by a German doctor, Rudolf Virchow, who looked at tumors taken at autopsy and said cancer is an uncontrolled growth that spreads and kills. But, of course, he was looking only at cancers that killed. He never saw the others.       

"Now we are backing away from that," Dr. Brawley said. In recent years, researchers have found that many, if not most, cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not need to be treated - they are harmless.       

"We are going from an 1845 definition of cancer to a 21st-century definition of cancer," Dr. Brawley said.       

Dr. Brawley, too, noticed that more people are starting to understand the limitations of screening, and its risks.       

Change, though, has been slow in the face of intense promotion of screening by medical practices, hospitals and advocacy groups and years of misunderstandings about screening's benefits and risks.       

"You've got all this positive stuff" about screening, Dr. Brawley said. "And you have been taught since you were on your mother's knee that the way to deal with cancer is to find it early and to cut it out."       

Yet he is optimistic.       

"I think people are actually starting to understand that we need to be a little more rigorous in what we accept about screening," Dr. Brawley said. "I do sense there is some movement there."       

Again, from a personal level, which is the only one we can really be expert at, I am certainly grateful to have had mammograms beginning in my 40s and shudder to think what would have happened if I had to have skipped two years. Since this disease is as varied as the women who develop it, I surely would not want to have bet on my early stage slow growing cancer not needing treatment. I have no taste for russian roulette. Early, in almost every disease, is always better than later. Is it the do all end all...no. But the last thing needed is to convince women who are already leery of getting a mammogram not to do it. Are those who benefit from it to be discarded to the vagaries on the part of the talking heads? I think not. So much is expert one day and total bunk the next. I think we all agree more diagnostics are needed that better serve more but I fear one woman reading all of this and what is in the news who might forgo the very mammo that might have saved or extended her life. And in light of the fact that for all of the varied types of breast cancer nobody really knows what direction it will take, only averages. I will continue to hit the streets imploring women to have a mammo. If it helps only one, then that cannot be a bad thing.

VR, could I copy and paste that NYT article from your post, to another thread? Its a pretty full on admission of the need for change!

LtotheK...The new study does NOT contridict the other study.  The other study refers to women with "average" risk.  This study is regarding SURVIVORS who are naturally at a higher risk.

 From The NY Times... I couldn't have said it better!

Mammogram Message (1 Letter)

To the Editor:       

Re "Mammograms' Role as Savior Is Tested" (Well, Oct. 25): Tara Parker-Pope clearly describes the questions many of us have raised through the years about the efficacy of mammography screening for breast cancer for all women over the age of 40. As patient advocates, we have been trained to recognize that it is only through evidence-based medicine that we can hope to achieve quality health care. Together with the medical and research communities, we have an obligation to educate and empower the general public to incorporate changes in scientific thinking into changes in health behaviors.       

This is not easy, and it is made more difficult by those who feed into people's fear of change and perceived need for easy sound bites. The public today will be better informed, supported and empowered than it was in the past. And we can all focus our attention where it needs to be: on preventing this disease and, for those who already have a diagnosis, preventing metastasis and death from breast cancer.       

Alice Yaker       

New York       

The writer is executive director, Share: Self-Help for Women with Breast or Ovarian Cancer.

First off...remember... the study regarding screening is for women with "average risk."  For women who are at "high risk" of getting breast cancer...screening matters.  So women have to discuss with their doctors, when they are young, their risk level and then have an articulation of what kind of screening they need. 

With breast cancer survivors, they are automatically "high risk" so the data is not that controversial.  Screening helps once you've been diagnosed.

Ltothe K..I think your logic is correct!

Don't let anything haunt you!  Halloween has passed for this year!  Time to enjoy life!