"The Promise" movie - Dangers of Routine Breast Cancer Screening

It may be that some patients opt for mastectomy despite doctors' recomendations of less invasive surgery.

check out the discussion on the thermography thread. Mammography is not perfect, but is still a very useful tool. Standard of care does not mean the same tax for everyone, it means following guidelines based on how a patient presents.

I couldn't watch the whole thing. It is incredibly twisted. Also, I find this horror at mastectomies, coming from men, annoying. There is a fat, little bald man in the trailer who exclaims how "cruel" it is to tell a woman she needs a mastectomy. How incredibly patronizing. I had a mastectomy. It wasn't fun and I would certainly prefer still to have all my parts, but I am fine. Really.

My doc ted-talking about some of all this: http://www.youtube.com/watch?v=jWPRD52H5F4

Momine, I am glad to know oncotype testing is becoming more readily available to women in countries other than the US. That is a good thing.

Still, the central problem raised by this film is that some women are harmed by screening for breast cancer. Wide scale screening of younger women (under 50) is finding many cases of DCIS. But we don't know what needs to be treated and what doesn't need to be treated and until that can be determined many women are being faced with the same treatment for a non-invasive cancer that they would if they had an invasive cancer. That is a real harm to women. Breast surgery, lumpectomies and mastectomy, are not without side effects. It is one thing to have to deal with the side effects if you have a disease that may kill you. It is quite another thing to have such surgery for something that will not harm you.

Blessings, in my time on this board, I have seen a couple of people come through who believed that the squeezing and pressure from a mammogram could cause cancer to spread. Honestly, there's not much you can say to someone who believes that. It's not like there are any studies that refute it because no researcher is going to waste limited and valuable research dollars studying this.

The doctor quoted as saying this in the film, Dr. Sarah Myhill, has a bit of a history: Private Powys GP banned from prescribing drugs by GMC and more recently INVESTIGATION COMMITTEE ORAL HEARING 2-4 OCTOBER 2012 "The Committee considers that the relevant statements in relation to breast cancer screening and contraception are neither factually correct nor clinically substantiated and they contravene national guidelines. The Committee is concerned that the way in which these statements had been written could mislead patients and place them at significant risk.In your oral evidence you accepted that some of statements were both slapdash and contrary to national guidelines.....The Committee considers that you expressed your personal beliefs in a way which has exploited patients’ lack of medical knowledge and vulnerability by arousing ill founded fears for their health."

Blessings, to your question, "is DCIS harmless?" the answer is "yes", DCIS, as DCIS, is harmless. DCIS that remains DCIS can stay in the breast forever and will never cause harm, even if it spreads within the breast. The problem of course is that DCIS doesn't always remain DCIS; a significant (but unknown) portion of DCIS eventually will evolve to become invasive cancer. So DCIS is removed and treated in order to avoid the development of invasive cancer. The other reason that DCIS is removed is because where there is DCIS, there might already be some invasive cancer. In about 20% of cases where DCIS is found by a needle biopsy, the final diagnosis, once the surgery is done and all the cancerous tissue is examined, is IDC. But does DCIS, as DCIS, really need to be treated? No. It is treated because of the potential future risk, not because of any current existing risk.

A couple of comments about the video:

• At the start they make reference to women being treated for "Cancers they don't have". Here they obviously are referring to DCIS, and they have taken the position that DCIS is a pre-cancer and not a cancer. That would therefore mean that any woman who has treatment for DCIS is being treated for "a cancer she doesn't have". The fact is that there is a lot of discussion and debate about whether DCIS is a cancer or pre-cancer, and there are valid arguments on both sides. Eventually I believe that the medical community will reclassify some DCIS as being a pre-cancer. Personally I hope that a distinction is made between low risk cases of DCIS (which I believe can be reclassified with little risk to patients) and high risk cases of DCIS (where I believe that a reclassification will result in under-treatment and the development of many more cases of invasive cancer). And I further hope that no reclassification is made until we have better information about the biology of DCIS and which cases are in fact low risk and which are high risk.

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• At the end, one of the doctors says "We don't know what's best for women. Women know what's best for women if they are given a choice". Sometimes yes, but unfortunately sometimes no. I've spent too much time on this board to think that all women, when faced with a diagnosis of cancer, will always make rational decisions, or always make the decision that is ultimately the best for their health. I've seen women opt to have chemo (sometimes requiring a change in MO in order to find an oncologist who will prescribe chemo to them) even though all indications are that chemo will provide little to no benefit and put their health at greater risk. I've seen women who've had a BMX for DCIS or LCIS choose to take Tamoxifen even though the risks from the drug are greater than their remaining risks from the disease. I've seen the reverse too, women who have chosen to pass on treatments that would give them a signficantly greater chance at survival. On the DCIS side, as Lisa pointed out, I've seen many cases where "women opt to have bilateral mastectomies even though they have small tumors and it is not medically necessary". It's one thing if someone is high risk, or has a pre-cancer in the other breast, or has a family history of breast cancer, or has other health issues that suggest that a BMX is the best option, or is large-breasted and planning to not reconstruct (and therefore is better off being flat on both sides) - those aren't the situations that I'm thinking about. I'm thinking about women who have small (<1cm) or tiny (3 or 4mm) areas of DCIS (particularly low grade DCIS), and no other risk factors, and yet they choose to have a BMX. If a BMX came without risks, that would be one thing. But I've seen too many of these women suffer the consequences, with reconstruction problems that go on for years, ongoing pain, impacts to their sexual relationships, etc..

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So if that is one of the problems that they are trying to get at with this video, I understand it. However I don't agree that the answer to the problem of over-treatment of DCIS (whether it's the doctor's recommendation or the patient's choice) is to simply not diagnose DCIS. To me, that's absurd. Some cases of DCIS are very aggressive, with a high risk that they will develop into IDC within a short time frame. These cases need to be diagnosed, and fully treated. What's needed is better information and better communications by doctors to their patients, not just about DCIS but for invasive cancer as well. But even then, even with the best information and communication, some women will choose to over-treat, and some women will choose to under-treat (just as men will in similar situations related to their health).

Lastly, one area where I do agree with the film is that we certainly need to find better methods of screening. From what I've read, it doesn't appear to me that thermography is it.

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Beesie, as always your explanation was very helpful. It could be that the diagnosis of a disease entity called DCIS is the problem if there are in fact two (or maybe more) varieties of DCIS. We know that breast cancer is a multidimensional disease. My breast ca is not the same as your breast ca, so it stands to reason that one person's DCIS would not be the same as another person's DCIS. Now if researchers can differentiate the different varieties and then find a way to name them so that we, the great unwashed, can understand, I think THEY will be doing a great service. This might help to reduce the whole problem of over diagnosis and over treatment.

This kind of thing makes me want to spit - to spit acid fire into the eyes of every narcissistic arrogant a-hole (sorry mods) that had any part of this production. Anybody can take a string of things that are 'factual', tie them together with 'some people think' and make a BS story out of it. Yes, there is consideration of making DCIS and LCIS into 'precancerous' classifications & maybe that would be a good thing (and maybe it wouldn't). But this kind of $H!T is going to kill people. Yeah - I liked my 'beautiful nurturing breasts' until one of the WAS going to kill me and having it removed is no great shakes because I love my beautiful BRAIN a lot better.

Mammogram found my cancer. I chose to have a double mastectomy. My youngest at the time was seven. The breast that had no cancer was full of cysts and atypical cells, so I did the right thing for me.