BS: New Breast Cancer Guidelines

Subject: BS: New Breast Cancer Guidelines
From: wysiwyg
Date: 18 Nov 09 - 08:45 AM

CHECK THIS OUT

===

Couldn't believe there was not already a thread on this, but apparently MudThought on this has not yet begun. And I do have a few comments I want to make, but I think I'll wait for cooler heads, until the Mudcat outrage/hysteria die down. Hot clue: it's not the younger women who are supposed to pay the price for this emerging set of guidelines. Nope-- it'll be older women.

~S~

Subject: RE: BS: New Breast Cancer Guidelines
From: wysiwyg
Date: 18 Nov 09 - 08:47 AM

NEW TASK FORCE "GUIDELINES" STORY

Subject: RE: BS: New Breast Cancer Guidelines
From: Stilly River Sage
Date: 18 Nov 09 - 10:42 AM

They're discussing this in the first hour of the Diane Rehm show on NPR today. You can get it as a podcast a few hours after the program is finished. (It's on right now).

SRS

Subject: RE: BS: New Breast Cancer Guidelines
From: Catherine Jayne
Date: 18 Nov 09 - 10:52 AM

In the UK women aged 50 are invited for a mamogram but there isn't any recommendation for women younger to have one unless they have found a lump. I had a mamogram January last year but I have a family history. I think better breast awareness and teaching women what to look for would be a good start as well as earlier examinations.

Subject: RE: BS: New Breast Cancer Guidelines
From: wysiwyg
Date: 18 Nov 09 - 11:23 AM

Thanks SRS.

~S~

Subject: RE: BS: New Breast Cancer Guidelines
From: pdq
Date: 18 Nov 09 - 01:44 PM

This is from a "federal task force" which has no power to enforce such standards.

Once we have federal control of health care, they will have the power of law.

ObamaCare stands at about 41% public support according to recent polls.

We may get it anyway. {er, Clinton only got 41% of the vote in 1992}

Subject: RE: BS: New Breast Cancer Guidelines
From: Q (Frank Staplin)
Date: 18 Nov 09 - 02:58 PM

A physician with Harvard Medical Services last night took strong exception to the recommendation that mammograms were not necessary for the under 50 age bracket. He also recommended that regular consultation with one's physician is necessary.

No oncologists were on the task force (see guidelines story linked by WYSIWYG).

Self-examination also discussed, the doctor's opinion was that without the imaging, many tumors are missed.

Subject: RE: BS: New Breast Cancer Guidelines
From: wysiwyg
Date: 18 Nov 09 - 08:16 PM

At least 1 ins co group sez they will put the guidelines into their HMO plan.

~S~

Subject: RE: BS: New Breast Cancer Guidelines
From: Q (Frank Staplin)
Date: 18 Nov 09 - 08:37 PM

Insurance companies will grab onto suggestions like this as they seem to save money, but if the insured gets the cancer, they would be liable. A matter of statistics which way they jump.

I hope our Alberta Health Plan doesn't put age limits on coverage
(Yes, every province has a health plan, but there is no uniform Canada health plan).

Subject: RE: BS: New Breast Cancer Guidelines
From: pdq
Date: 18 Nov 09 - 08:56 PM

"...in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives." ~ Barack Obama Sept.9, 2009

Subject: RE: BS: New Breast Cancer Guidelines
From: Q (Frank Staplin)
Date: 18 Nov 09 - 09:02 PM

A nice statement, but what will happen to the bill in the Senate is unknown, and then the bureaus will start writing the specifics.

Subject: RE: BS: New Breast Cancer Guidelines
From: Janie
Date: 18 Nov 09 - 10:52 PM

I'm not sure what to think. I'm well over 50 now, but would still be in a high risk group were I 40 or younger , as my sister died from breast cancer age 41 that was diagnosed when she was 36.

I haven't been able to make much sense of the medical reasons behind the revision from what I have heard from MD's interviewed on NPR, don't have time right now to read much of the news and "news" coming out through the various media outlets, so I think I will hold off for a bit and let the dust settle before I make a deliberate effort to learn enough to have an opinion.

Having said that, here are my very initial concerns:

I understand that when a screening tool is used, the number of false positives has to be considered in determining the over-all benefit of the broad use of the screening tool to the potential screening population. But the arguement I heard from an MD interview on NPR did not make much sense to me, and it was not clear to me that the potential harm to a women from a false positive outweighed the benefit to the number of women who get what turns out to be a true positive. What the MD mainly emphasized was the worry and anxiety women with false positives experience, some concern about women going through biopsies that end up being negative, and then went on to talk about women with false positives undergoing surgery, chemo, radiation, etc.

Mammograms, I have always understood, do not detect breast cancer. I assume(d) they detect suspicious lumps or changes in breast tissue that could prove cancerous upon further exploration, and can detect these lumps or changes that might be cancerous while they are still so small that a physical breast exam would not detect them. I have never heard of or known any one who was told they have breast cancer based on a mammogram.   I have also never heard of anyone having chemo, radiation or a lumpectomy or mastectomy based on a mammogram. I think, (perhaps incorrectly), that a biopsy is necessary to determine if tissue is cancerous, and assume that a woman would undergo any of those further significant procedures only if a biopsy confirmed cancer.

Any person told they may have cancer is going to experience worry and anxiety. That is part of life. I had a lesion a number of years ago that turned out to be squamous cell carcinoma, and I well remember the intense anxiety I experienced waiting to find out if it was in situ or had spread, and what the prognosis and treatment regimen was going to be. I had the lesion for a number of years, and several MD's said it was nothing to be concerned about. Then a PA, not so certain of herself, decided to remove it and it send off for biopsy.    Blessing on her forever. Since then, and because of that history, I have had MD's decide to biopsy other lesions because they "might be suspicious." I'm very anxious every time, and so grateful to endure that anxiety for the sake of an accurate evaluation. So far, no more cancerous lesions after 20 years.

Based on all the above, the cost/benefit analysis he presented didn't seem to make much sense to me, and I found myself wondering if the medical cost/benefit analysis was an attempt at spin to obscure the main cost/benefit analysis is really related to dollars spent by insurance companies, Medicare and Medicaid.

I do understand that the dollar cost does have to be factored in when considering a widely used medical screening procedure.

I would like to know more specifically what they mean when they say there is no drop in mortality for women who discover suspicious lumps through self breast exam. 1 year mortality? 5 year mortality? Over-all mortality from breast cancer? I didn't hear enough information for it to have any meaning. (Maybe news media have reported that and I just haven't come across it.) My sister's breast cancer was diagnosed after she felt a small lump while showering one morning and had a thorough medical evaluation of the lump. She had a radical mastectomy and then radiation and chemotherapy. After a 3 year remission, she went to the doctor because of back and hip pain, and tests indicated the cancer had metastatized (sp). She underwent more chemo, more radiation, and finally, an experimental bone marrow transplant (since that time, proven ineffective for the treatment of metastic breast cancer.) The hope was that better treatments or even a cure for metastic breast cancer might be found, the longer she lived. She lived 5 1/2 years after the original diagnosis. The last year of her life was pretty brutal, a combination of the pain from the metastic disease, and the brutality of the treatments.   If the statistics indicate that she would have likely died at 5 years, most of them with a pretty decent quality of life, even if the cancer had not been detected when it was and she had not gone through all of that torturous treatment, then there may be a good argument for not bothering with breast self-exams. If, however, her life would have been significantly extended, and that quality of life would have been pretty good, had she conducted breast exams and noticed that lump when it was smaller, even if she ultimately died from metastic breast cancer 7, 10 or 12 years after diagnosis, it seems to me the breast self-exam would be well worth the effort.

Since she was 36 when she detected the lump, she had never had a mammogram prior to detecting that little pea-sized knot.   I think it is pretty well established whether one is looking at medical or fiscal issues, that routine mammography screening is not warranted before age 40.

I know I'm wordy and redundant, and that my posts are way too long. Knowing that, and mastering the art of pithiness are separate skills. I am better at awareness than I am at change. Sorry.

Subject: RE: BS: New Breast Cancer Guidelines
From: Janie
Date: 18 Nov 09 - 10:58 PM

I also don't catch my spelling errors very well. I will write on the board 50 times "metastatic"....

Subject: RE: BS: New Breast Cancer Guidelines
From: Desert Dancer
Date: 19 Nov 09 - 04:33 PM

Quoting from someone in the recent "breast brouhaha" (that's from Gail Collins in the NY Times), "the plural of 'anecdote' is not 'data'".

Our Bodies Ourselves blog on the topic -- with good links to other reports.

~ Becky in Long Beach

Subject: RE: BS: New Breast Cancer Guidelines
From: Desert Dancer
Date: 19 Nov 09 - 04:35 PM

I also meant to say that it really pisses me off that the GOP has twisted this to their own ends.

Subject: RE: BS: New Breast Cancer Guidelines
From: Janie
Date: 19 Nov 09 - 04:54 PM

Becky,

Thanks so much for that link!