Why the annual mammogram matters-NY Times op-ed

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besa
besa Member Posts: 1,088
edited October 2015 in Clinical Trials, Research News, Podcasts, and Study Results

http://www.nytimes.com/2015/10/29/opinion/why-the-...


By SUSAN R. DROSSMAN, ELISA R. PORT and EMILY B. SONNENBLICKOCT. 28, 2015, New York Times

"LAST week, the American Cancer Society announced changes to its influential guidelines for breast cancer screening. The society no longer recommends that women at average risk between the ages of 40 and 44 have mammograms and advises reducing the frequency of mammograms from every year to every other year for women 55 and older. The group is also recommending ending physical breast examinations by doctors entirely.

We profoundly disagree with these changes. All three of us, two breast radiologists and one breast surgeon, have been named "Mothers of the Year" by the American Cancer Society in recognition of our roles as mothers and physicians who have devoted our professional lives to the fight against breast cancer. One of us, Dr. Drossman, received her award the day before the new guidelines were issued.

Because of our shared goals — early detection of breast cancer, improved treatments and saving lives — we were happy to support the cancer society. Now, we no longer wish to be involved......"

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Comments

  • mittmott
    mittmott Member Posts: 409
    edited October 2015

    Yay..., Dr. Port, my surgeon 8 years ago


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  • lisa-e
    lisa-e Member Posts: 819
    edited October 2015

    I have no idea why being voted Mothers of the Year gives these doctor's comments any more credibility. That said, I have been reading the comments made in reaction to this editorial; I recommend them if you are interested in different view points.


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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2015

    http://www.latimes.com/science/sciencenow/la-sci-s...



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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2015

    http://www.medscape.com/viewarticle/845171


    I think in a few years, most population based image screening will be usurped by liquid biopsies and will make this debate moot.

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  • Italychick
    Italychick Member Posts: 2,343
    edited October 2015

    voracious reader, interesting, especially since I have seen women post a stage 4 diagnosis with no breast tumor. A bio marker test would certainly be a big deal in breast cancer diagnosis. I wonder if there is anything ongoing they are testing

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2015

    lisa...I read the comments as well and they are worthy of reading. What many people fail to appreciate is the data that tells us about all of the population based screening that is occurring, still hasn't curbed the number of Stage IV diagnoses AND the average age of a breast cancer diagnosis is age 63. Diagnostic mammography saves many more lives. What we need is a better population based tool to detect potentially fatal tumors. Hopefully, we will be seeing more blood biomarkers that will hopefully replace imaging for women of average risk!

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2015

    Italy! Yes! The folks at the Rare Breast Cancer lab at Sloan Kettering have identified Stage IV progression using biomarkers before patients became symptomatic AND before imaging spotted it. That will translate into changing treatment more quickly that will hopefully translate into longer life!

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  • Italychick
    Italychick Member Posts: 2,343
    edited October 2015

    voracious reader, wow! Is the testing available to everyone, or is it in the trial stages

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2015

    italy....it is still in the lab! But the news is exciting!

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  • Italychick
    Italychick Member Posts: 2,343
    edited October 2015

    thank you, I will try to look it up

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2015

    http://www.medscape.com/viewarticle/853298


    Great explanation why we need biomarkers!

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  • Italychick
    Italychick Member Posts: 2,343
    edited October 2015

    darn, can't access it. It wants me to log in!

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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2015

    PSA Tests Cut Metastatic Prostate Cancer Rate by 50%

    Alexander M. Castellino, PhD

    October 28, 2015


    "...Why Metastatic Breast Cancer Rates Are Still the Same Despite Mammography

    The authors explain why the metastatic disease trend seen with prostate cancer did not occur with breast cancer. Breast cancer is a systemic disease — conforming to the Fisher paradigm — and screening mammography is unable to detect disease at an earlier stage for cancers destined to become metastatic, they say.

    "Breast cancer has shown no clear declines in the incidence of metastatic breast cancer in the mammography era and is consistent with the Fisher paradigm of advanced disease," Dr Keating concurred.

    Dr Keating agreed with Dr Welch and colleagues that the inherent differences in screening tests for breast and prostate cancer may likely explain the discordance between the paradigms they have chosen to highlight.

    Mammography looks for structural abnormalities, whereas PSA is a biochemical assay that detects a tumor marker, Dr Welch and colleagues indicate.

    "Were a similar breast-cancer assay discovered — and a similar organ-wide sampling strategy used (the typical prostate biopsy now involves at least 12 needle cores throughout the organ) — then perhaps fewer women would present with metastatic breast cancer," Dr Welch and colleagues write.

    When asked whether the new guidelines for screening mammography will have an impact on the future incidence of metastatic breast cancer, Dr Keating said: "I don't expect the new recommendations to change the incidence of metastatic breast cancer; the incidence has remained steady despite no mammography, increasing use of mammography (including periods where mammography was recommended yearly starting at age 40), and in recent years."

    Dr Welch has financial ties with Beacon Press, which publishes his books, including one on overdiagnosis of disease. Dr D'Amico and Dr Keating report no relevant financial relationships.

    N Engl J Med. Published online October 28, 2015."

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  • floaton
    floaton Member Posts: 181
    edited October 2015

    Italychick, this one should work...

    http://www.atmjournal.org/article/download/2930/40...

    I've been doing some reading on this lately, and this is a reasonable explanation of why circulating tumor cell DNA testing, while better than what we have now, is not yet clinically available. It is very interesting and exciting, though, and I'm guessing will eventually replace standard staging, which as far as I can figure is basically just a proxy for how likely you are after treatment to have stem cells waiting outside of the breast to cause obvious metastatic disease later. It would be awesome if this can translate into better determining who needs long term drug therapy, and also allow for quicker changes in meds once small tumors become resistant. I'm really hoping it's available by the time I have to make my 5 vs 10 year tamoxifen decision, but I'm not holding my breath!

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  • floaton
    floaton Member Posts: 181
    edited October 2015

    Also interesting...

    http://www.medscape.com/viewarticle/839398


    Measurement of circulating cell free DNA levels by a simple fluorescent test in patients with breast cancer. Agassi, R... Am J Clin Pathol. 2015;143(1):18-24.

    Abstract

    Objectives To evaluate circulating cell-free DNA (CFD) measured by a simple fluorescent assay as a biomarker of breast cancer.

    Methods We enrolled 38 patients with breast cancer before surgery, two patients with noncancerous breast lesions, nine patients after surgery, 16 healthy participants, and 29 control women admitted to the hospital emergency ward and released without hospitalization. CFD levels were measured by a direct fluorescence assay.

    Results Presurgery patients with cancer had elevated CFD levels (1,010 ± 642 ng/mL), which were higher than those measured in the healthy control group (395 ± 248 ng/mL, P < .001), the noncancer breast lesion group (386 ± 40 ng/mL), the nonhospitalized control group (492 ± 193 ng/mL, P < .001), and the postsurgery cancer group (398 ± 162 ng/mL, P < .01). The area under the receiver operating characteristic curve of the presurgery vs healthy patient group was 0.83. CFD levels correlated with tumor size (P = .03, ρ = 0.36), nodal involvement (P = .0003, ρ = 0.56), and TNM stage (P = .0002, ρ= 0.56). All patients with axillary node involvement had a CFD value greater than 600 ng/mL.

    Conclusions CFD measured using a simple fluorometric assay has shown good correlation to stage and enhanced sensitivity to locally advanced disease. A large prospective study is warranted to evaluate if inclusion of this method as a decisive marker before mammography is advantageous.

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  • floaton
    floaton Member Posts: 181
    edited October 2015
    Ok last link :),

    http://www.sciencedaily.com/releases/2015/05/150518081720.htm

    Also, to be mildly on topic ;), I think the recommendation for no more clinical breast exams is odd. Really, just ignore a body part entirely so you can avoid finding something you need to work up? It's weird and not reasonable medicine, in my opinion.
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  • voraciousreader
    voraciousreader Member Posts: 7,496
    edited October 2015

    http://www.cbsnews.com/news/medical-community-divi...


    Interesting....and on a side bar....Dr. Agus comes from a family of esteemed physicians! One of his family members has been treating the DH and another, truly saved a friend's son's life! Really! I think what Dr.Agus said was really, really smart! What we need to understand is that for many women in the 40-45 age category, screening mammography is NOT optimal. The take away from the important issue is that more ( mammography) is not better.....and that we need to find better!

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