Mammograms and breast cancer

Mammos and dense breasts

http://bc.ctvnews.ca/mi-jung-lee-why-my-mammogram-...

Other problems with Mammos

http://www.montrealgazette.com/health/mammograms+s...

"while it may push back the time when a diagnosis is made, it may not actually push back the time of death.Therefore, detecting cancer earlier means that an individual will live
longer with the diagnosis, but it doesn’t mean that they will
necessarily live longer."

"Overdiagnosis occurs when a cancer
is detected and treated even though it would not have caused any
problems if it were left alone. A common mantra in urology is that most
men die with prostate cancer, not of prostate cancer. In recent years, a
process of watchful waiting has been established in prostate cancers.
Small, non-aggressive prostate tumours are often not treated because of
the recognition that they may not actually ever cause clinical disease."

 I am glad the Canadian study was done. It examines the problems that have been present all along but not openly and honestly acknowledged in the medical profession. My breasts are gone, but I still question the safety of mammograms. It seems obvious to me that smashing our bodily tissue to the point of severe pain, especially areas as sensitive and delicate as the breast does damage to that tissue, possibly smashing and spreading carcinogenic tumors if they are there, and along with the x-ray imaging, which is already known to be damaging...it just does not feel okay to me. Yes, to each his own, but I am glad to see this imaging procedure exposed for at least some of it's shortcomings, and hope that we have more effective imaging practices for all women in the future.

Thanks, Light.

That's part of what Dr. Nancy Synderman said on an NBC.

She also said she's getting death threats from her reports on mammograms' lack of benefits. Frantic women, emailing her with all sorts of explanations. She said it was a very "sensitive" subject and women didn't want to hear the only thing that would save them was pretty useless. I feel so sorry for Dr. Snyderman. She really studies the data and hates to be ther bearer of bad news.

BTW, I never found out if the nipple aspiration was going to be used for Br Ca testing. The Project Lead scientists were pretty sure that was going to lead to something.

We all know there are two sides to a story and somewhere in the middle is the truth.  Like the landmark Atlas study published last year regarding ER Positive tumors and 10 years of Tamoxifen, sisters like me were left to wonder, what does this data mean to me?  At the end of the day, it boils down to our individual risks and benefits and ultimately, CHOICES. Many studies are broad and trying to tailor our individual risks and benefits is difficult at best.  However, what I think makes this debate regarding mammography so damning, is because it builds on so many prior studies, whether it be breast, prostate or other diseases, that are questioning population based screening. Going forward I think we will move away from generalized population based screening and I think we will be moving closer to genetic based screening which will better analyze our own personal risks for diseases and then help us evaluate what screening is correct for each individual.

voracious, I totally agree with your view about individualized medicine. Hopefully it will be a reality soon.

Nancy, I am completely with you on that one. I am also 3B, and I am also completely sick of people telling me that at least they caught it early and I am now cured/fine/whatever. But even with an early cancer, there really are no guarantees. The early detection propaganda probably has saved many lives, but I think it has had the unfortunate side effects of making people think that BC is no big deal and also of marginalizing all the women with stage 4 BC.

Nancy & Momine, 

I am sorry there is so much naivety out there! People have said the same to my mother...who despite screening only had her cancer "found" when it was a 6+ cm ILC....19 out of 20 positive nodes. If that is their concept of "early" I will remember to always tell them a party starts a week earlier than it does I guess so they might show up on time!

Of course, as my mother is still here 8 years later with NED, many of these same people think she is "cured" too....they have no idea we are just hoping the chemo and AIs were enough and that we won't know if it is enough....until we do or don't.

The pink propaganda machine worked well. Problem is it worked well to pass along the wrong information (and failed to pass along the right stuff). I watched Pink Ribbon Blues, Inc again last week with my husband, and I believe it was the amazing Barbara Brenner (who sadly passed away last year from ALS) who emphasized this, and also hit on the fact many seem to still believe that getting mammograms also prevents cancer. I have seen this too....when people ask a newly diagnosed woman if she was "getting her mammograms".  So yup, wrong message.

I do not have cancer, but while people have been overwhelmingly supportive when they hear I am getting a prophylactic mastectomy, a couple have also told me I should just get mammos so I can catch it early. I give them the eyebrow raise...if it only it were that easy!

..

I don't like Orac .

Srh242, why don't you like Orac? I sometimes disagree with him on certain things, but he knows breast cancer like few people. 

Ah, we agree! At least on some of the points.

There
are many other studies that have shown that mammograms are not very
effective on women who have very dense breast tissue. So I agree with
you completely on that. I also agree with you anecdotally, as someone who is post-menopausal and yet still has extremely dense breast tissue, and who has been getting mammos and MRIs every year since my diagnosis.

I would also agree with you that speaking
generally, mammograms (and particularly film mammograms) are not
as effective as we have been lead to believe that they are. This study and many others have shown this to be the case, at least with regards to films mammograms.

But there is a difference between what can be concluded from other studies or from a compilation of study results vs. what can be concluded from this single study.  That's the point I've been trying to make through all my posts in this thread. 

This particular study didn't include a measure of breast density and didn't evaluate the effectiveness of mammograms based on breast density levels.  So this study does not tell us that mammograms are not as
effective as we've been lead to believe regardless of density level.
No study has been done to specifically look at whether having regular
mammograms reduces the BC mortality rate of women who have lower levels of breast
density. It might be found that this is one area where
mammograms are very effective. Or maybe not. We don't know because it appears to have never been studied. 

And what this study also
doesn't tell us (to my earlier posts in this thread and other comments
made) is that mammograms don't save any lives. Digital mammograms may save lives.  3D mammograms may save lives.  That wasn't part of this study.  Even film mammograms may save lives, but just not enough to cause a significant change in the numbers. For example, a 10th
of a percent difference in mortality rates would not be considered significant and the conclusion would be that there is "no difference" in mortality rates, but a 10th of a percent difference, when measured across all women diagnosed with invasive breast cancer each year in North America, is 300 women.  To researchers and to the medical community, that's a rounding error.  But if you are one of those 300 women.... 

And that's why this is such a difficult and contentious issue.

Yes, and that's a really important point because breast density is categorized and we tend to think of ourselves as being within a particular category or level of density, without considering where we are within that category.

There are several different methods of categorization but the most common is:

Category 1:  Extremely Fat     0% to 25% density

Category 2:  Scattered Fibroglandular Densities     >25% to 50% density

Category 3:  Heterogeneously Dense    >50% to 75% density

Category 4:  Extremely Dense   >75% density

Radiologists use a grading system to describe the density of breast
tissue based on the proportion of fat to connective tissue. The four
levels of density are shown in these mammogram images. From left to
right: level 1 (a very fatty breast), level 2 (fatty tissue makes up
more than 50 percent of breast), level 3 (dense tissue makes up more
than 50 percent of the breast) and level 4 (a very dense breast with
very little fat).  http://www.mayoclinic.org/procedure/mammogram/multimedia/breast-density-mdash-the-four-levels/IMG-20008862

The majority of women who are pre-menopausal fall into Category 3, having heterogeneously dense breasts.  But there is potentially a significant difference in the effectiveness of a mammogram for someone who has 53% density (at the low end of the category, closer to Category 2 ) vs. someone who has 73% density (at the high end of the category, closer to Category 4).  That's actually why, in my previous few posts, I consciously used the term "very dense breasts", which isn't an official category. To me that covers those who have breasts that are dense enough that it affects the ability of radiologist to be able to effectively read their mammograms, whether they are in Category 4, with extremely dense breasts, or at the high end of Category 3. From everything I've read, my understanding is that those who fall at the lower end of Category 3 probably don't have much of an issue with screening, not much different than those in Category 2.

I guess I am missing the point or maybe just have another point to make. I do not care whether  mammograms vs waiting until I can see that lump in the mirror gets me more survival. What I want is survival with a good quality of life.

If a mammogram will allow me to know I have a cancer before I can see or feel it and that means it has less time to grow and get to my lymph nodes and that means a choice of a lumpectomy and avoidance of a full N dissection, I'll take it. I have more issues with the fact that the available treatments are all awful and barbaric and cause a lot of chronic health and emotional issues all in themselves. I want more effective research on prevention, and treatments with quality of life in mind not just survival.

Why can't Beesie add reality-based information? Surely reality is not in some sort of mortal opposition to anything alternative.

"Believe what you will, but having 'Alternate' beliefs is no excuse for misinterpreting a research study and misusing the results for your own purposes. "

Beesie, I am in total support of this.  There has been no challenge to alternative beliefs here, simply a challenge to the gross misinterpretation of the data in the media and by others.  If one chooses to not have regular mammograms, then - of course - that is your choice.  You are free to persue the screening method that you prefer.  But when you twist the data into something that it is not nor ever was intended to be?  That's not doing anyone any good and merely perpetuates misinformation.  We are, already (as pointed out above), painfully aware of other breast cancer myths perpetuated by the media and others (i.e., "catching it early means you're cured") - even when all the data points to the fact that this is patently untrue - and, yet, there are those who continue to spread this myth regardless.  Which - as we all know on the boards - is frustrating and doing a disservice to women everywhere.  The same is true of the results of the Canadian study; people continue to twist it into something it is not.  Do what you will regarding mammography screening, but don't pretend that this "data" supports your decision that mammograms are "moronic" or useless.

"The data does not support screening film mammograms for improving survival reducing breast cancer mortality rates across the population of women as a whole. It is not known if digital or 3D mammograms reduce mortality rates, nor it is known if even film mammograms might reduce mortality rates within specific populations of women. Period."

Sorry. That's just the researcher in me coming out, clarifying the conclusions of this study (and all studies, I believe, since I don't think that any long-term mortality studies have been done yet on digital or 3D mammos, nor have any studies been done on the effectiveness of mammos on particular subsets of women).  And remember, this study did in fact find significant improvements in survival.  What the study did not find was a reduction in the mortality rate from breast cancer.

"If only there were a blood test or nipple aspirate out there. But we
have to question whether any early diagnosis option improves survival for certain populations who have the most aggressive breast cancers"  That's just my own thought, not the research. I agree generally with the statement, but I think there may be 3 situations here:  1) Women who have a breast cancer that will never become life threatening... and these women will survive anyway, whether they have effective screening or not;  2) Women who have a breast cancer that is very aggressive and will lead to their death... and it's likely that effective screening won't save these women because even finding the cancer at the earliest stage won't make a difference; and 3) Women who have a breast cancer that is slow growing but will eventually become life threatening... and these are the women who might benefit from effective screening.  Just my thought on this.

Well, both times my breast cancer was no where near palpable, it was found by mammogram.  So I personally am grateful for them as I would have ended up in much more dire straights had my cancer grown until I or a doctor could feel it.

That said, yes the medical community has lead us to believe that mammograms are the be all, end all.  Leading women to breath a huge sigh of relief if their mammo is clear.  As we know, that isn't always the case.  And granted lots of women go through a big scare, and then find out it is b9. 

Radiation is used to diagnose tooth decay, broken bones etc.  It is an integral part of modern medical treatment.  Yes, overexposure can be harmful, but walking around on a broken foot or letting tooth decay go untreated, can have negative consequences as well.  If you want to avoid medical radiation, that is a personal choice.

And as far as alternative vs conventional medical practices, I am like a lot of people, I use a combination of both.  I make as informed a decision as possible, knowing my personality and my personal health, so for some alternative practices don't always mean you rule out all conventional methods of medicine.