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Originally uploaded by my.third.eye
This was when he was just starting to paint the loft. He was applying sample colors for me to look at...and then lightening or darkening them until we were satisfied. I'm telling you, having a painter for a boyfriend is a gift that I enjoy unwrapping on a fairly regular basis!
Problem: I'm overdue for another MRI, but when I tried to get my health insurance company to authorize it, they called back and said I have to send them a whole shitload of stuff - pathology reports, test records, surgery records, other stuff from doctors, etc. Why are they asking for all of this, when I have already sent all of it to them two or three times over? Why do they need it again? They authorized my first MRI in January of 2006. They authorized it because I gave them the pathology reports, test records, surgery records, other stuff from doctors, etc.
It's not easy to get all this stuff re-sent to them. It could take weeks, even months. And a lot of torment, trying to deal with red tape, telephone calls to doctors and hospitals that won't be able to find/refind the records, being put on hold, having to fill out new forms that I already filled out in the past. Believe me, it's hell'ish. No, it's more than hell'ish. It's insane. After watching Michael Moore's documentary, Sicko, the other night, I realized, as in REALLY realized, just how insane our medical health insurance system is.
No one should have to go through what our health system puts us through. I knew that the system sucked, but when I saw Moore's film, I realized that my frustration and anger goes deeper than just being upset by inconvenience or red tape or financial stress (although that's all bad enough). I am upset because I am trying to manuveur within a world of INSANITY.
For the last two years, I've felt bad about myself because I found it so difficult to deal with all this medical stuff. I got down on myself for not having "good enough" health insurance, for not choosing a "better" health insurance company, for not being able to keep my stress down when dealing with the claim denials and the financial struggle to pay all the bills that health insurance won't cover. Deep down, I felt like a big fat failure for not being able to cope well enough. If everyone else could do it, why couldn't I? What was wrong with me?
Now I know that nothing is wrong with me. If I found it acceptable to be living under this insane "for profit" health insurance system, if I found it possible to NOT be wildly frustrated and upset by it, then I too would be insane.
I am not insane. I am a reasonable person. I don't deserve this shit.
Antidote to Problem: Realize that unless I move to Canada or Great Britain or France, I am stuck in this insane system. Accept that I will have to continue to crawl and claw my way through it, possibly at great cost to my health and overall time of survival. And then, before picking up the phone to call them back and ask them WHY I have to resend everything, I will upload some of my photos to ImageKind, because this is a project that makes me happy and helps me keep from getting too depressed by the ongoing, exhausting battle with the health insurance INSANE ASYLUM.
Here's the link to my ImageKind photo galleries, where you can buy my work and put it on your walls. I've sold three prints so far, all to myself. :-)
Bliss
Originally uploaded by my.third.eye
Oh happy day, Will is home for a visit! We are all blissed out.
Originally uploaded by my.third.eye
Hard to believe there's a city out there, isn't it? I've always maintained that San Francisco fog didn't turn me on, but now that I'm out walking more than I used to, I must admit that it creates magical, mystical moods.
Oh, and appropo of nothing relating to fog, I'm happy to announce that Will is finally coming home for a visit; he'll be arriving tomorrow, staying until Dec. 6th, then going back to perform for the rest of the month in Montreal. My submerged mothering instincts are rising to the surface as I type this.
I do love how the dimensions of life are so mutable. One minute I am the tough-assed businesswoman, the next minute that dimension slips away, and I become Mom.
Another Unknown
Originally uploaded by my.third.eye
Sharp Within Soft
Originally uploaded by my.third.eye
Fog on Bernal Hill
Originally uploaded by my.third.eye
Red Rag in Fog
Originally uploaded by my.third.eye
I think that many people believe that something as seemingly innocuous as taking certain vitamins in order to fight one's cancer is naive and/or kinda like trying to kill an elephant with a pea shooter. But the diet of an average American SUCKS, and does our mainstream medical world focus on the importance of good nutrition to help us stay healthy and strong, with bodies equipped to fight disease? No. They focus on pills. Drugs. Treatments for symptoms rather than for causes.
Maybe cancer wouldn't be AS awful and rampant as it is, if we better understood how to help our bodies work optimally. If our bodies worked optimally, maybe we'd be able to NATURALLY fight off cancer cells before they were able to multiply enough to become tumors. We ALL have cancer cells in our bodies. And our bodies DO know how to kill them off. It's just that our bodies can't do this if they don't have the right foods and exercise (and if they are constantly subjected to overloads of mental, emotional and spiritual stress, in addition to physical stress).
Anyway, I'm not saying that if everyone ate perfectly (assuming anyone could ever agree on the definition of a perfect diet), no one would get cancer. I'm just saying that we might have LESS cancer in our society if we ate better, and if our doctors and researchers paid more attention to "simple" (not really) and relatively inexpensive supplements like Vitamin D and iodine, rather than focusing so intensely on barbarian (and expensive) treatments such as chemo and radiation and hormone blockers (castration causers) such as Tamoxifan and Arimidex.
This short article explains why I take 4,000 IU (not 400) of Vitamin D3 every day:
1: Curr Med Res Opin. 2007 Nov 21; [Epub ahead of print]
Molecular basis of the potential of vitamin D to prevent
cancer. Ingraham BA, Bragdon B, Nohe A.
OBJECTIVE:
To review current research findings in cell biology,
epidemiology, preclinical, and clinical trials on the protective
effects of vitamin D against the development of cancers of the breast,
colon, prostate, lung, and ovary. Current recommendations for optimal
vitamin D status, the movement towards revision of standards, and
reflections on healthy exposure to sunlight are also reviewed.Search
methodology: A literature search was conducted in April and updated in
September 2007. The Medline and Web of Knowledge databases were
searched for primary and review articles published between 1970 and
2007, using the search terms vitamin D, calcitriol, cancer,
chemoprevention, nuclear receptor, vitamin D receptor, apoptosis, cell
cycle, epidemiology, and cell adhesion molecule. Articles that focused
on epidemiological, preclinical, and clinical evidence for vitamin Ds
effects were selected and additional articles were obtained from
reference lists of the retrieved articles.
FINDINGS:
An increasing body of research supports the hypothesis that
the active form of vitamin D has significant, protective effects against
the development of cancer. Epidemiological studies show an inverse association between sun
exposure, serum levels of 25(OH)D, and intakes of vitamin D and risk of
developing and/or surviving cancer. The protective effects of vitamin D
result from its role as a nuclear transcription factor that regulates
cell growth, differentiation, apoptosis and a wide range of cellular
mechanisms central to the development of cancer. A significant number
of individuals have serum vitamin D levels lower than what appears to
protect against cancer, and the research community is currently
revising the guidelines for optimal health. This will lead to improved
public health policies and to reduced risk of cancer.
CONCLUSIONS:
Research strongly supports the view that efforts to improve vitamin D
status would have significant protective effects against the
development of cancer. The clinical research community is currently
revising recommendations for optimal serum levels and for sensible
levels of sun exposure, to levels greater than previously thought.
Currently, most experts in the field believe that intakes of between
1000 and 4000 IU will lead to a more healthy level of serum 25(OH)D, in
the range of 75 nmol/L that will offer significant protect effects
against cancers of the breast, colon, prostate, ovary, lungs, and
pancreas. The first randomized trial has shown significant protection
against breast cancer, and other clinical trials will follow and
ultimately lead to improved public health policies and significantly
fewer cancers.
PMID: 18034918 [PubMed - as supplied by publisher]
Originally uploaded by my.third.eye
So...Jack has finished painting it, and I'm trying to figure out what to put in it. The seating space for classes is small; I must be creative about how to fit everyone in, without spending much money on new furniture. Yes, I am now mortgage-poor (but not complaining).
I've begun to haunt Craig's List again.
Originally uploaded by my.third.eye
Night Flowers
Originally uploaded by my.third.eye
While Jack was busy painting the loft over the last several days, I took up the dog-walking slack. But, still in denial about how early the sun's been going down, I couldn't get it together to leave the house while there was still some light out. So Olivia and I roamed the dark and mysterious 6 p.m. streets, and I tried to figure out how to take night photos without a flash and without knowing how to adjust any of the camera settings that might help me take better night shots.
Tuesday night was foggy and mystical. Isn't it wonderful how the fog transforms the streetlights?
Foggy Night Walk
Originally uploaded by my.third.eye
Foggy Night on Bennington Street
Originally uploaded by my.third.eye
A Foggy Night Near Holly Park
Originally uploaded by my.third.eye
Walking to Holly Park at Night
Originally uploaded by my.third.eye
Written by Ralph Moss (cancerdecisions.com):
AN OPEN LETTER TO FARRAH FAWCETT
On my own behalf, as well as that of my coworkers, and the readers of our weekly online newsletter, I want to wish you success in pursuing innovative cancer treatments in Germany. I applaud your courage in seeking an approach that hopefully will be less toxic and more effective than the treatments you have so far been offered in the US.
With this open letter, I also hope to counter some of the negative comments that have been made in the media about your treatment choices. Some of the derogatory comments about "the murky world of overseas clinics" have come from the tabloids - no surprise there. As your spokesperson told People magazine, "It is now clear that the tabloids are as invasive and malignant as cancer." I wish there were some way to shield you from their abusive attacks.
Far more surprising have been highly critical comments from individuals associated with major US cancer institutions. Isn't it ironic that before your diagnosis you served as a celebrity spokesperson for the American Cancer Society? Now, some people associated with ACS and similar organizations have forgotten this former service and, in effect, have washed their hands of you.
Interviewed by the Associated Press about your case, Barrie Cassileth, PhD, is quoted as saying, "I would [tell a patient considering alternative treatment] that they are signing their own death certificate. I would say they are wasting time they could otherwise spend happier and with their families." Dr. Cassileth is chief of the Integrative Medicine Department at the Memorial Sloan-Kettering Cancer Center, New York and has been prominently associated with your former
organization, the ACS.
I find such statements both highly inappropriate and contradictory. Saying that people are "signing their own death certificate" by pursuing innovative cancer treatments outside the US implies that they would not be signing their death certificate had they only stayed in the US for treatment. While I do not presume to know the details of your case, I assume that you were fully informed by your American oncologists of the treatment options for your cancer, and found them
unacceptable.
I am sure you did not make the decision to seek treatment in Germany on a whim, but after due deliberation of all your options. Dr.Cassileth's melodramatic statement implies that you are wasting your time by doing so and that you could instead spend "happier" time with your family. Not everyone will choose to, as it were, wait out the clock. I thoroughly understand your desire to seek more effective treatments, including those available abroad. This is of course a very personal choice, which is determined in part by one's resources and fighting spirit. But the fact that some people choose to seek out other possibilities abroad rather than give up hope at home is not a sign of irrationality.
Medicine develops unevenly and is still partly determined by national characteristics. (For confirmation, see Lynne Payer's classic Medicine and Culture.) Consequently, there are treatments available in Europe that are not yet available here, and vice versa. Dr. Cassileth seems to think that all German cancer clinics are a monolith and that all their techniques are the same and equally ineffective. But the topic of German innovative medical treatments is a huge one. According to one German Web site (www.klinik.de) there are presently 2,200 private clinics in Germany, containing 500,000 beds and treating 17.5 million patients annually. Many of these are cancer patients. These clinics were not set up to treat Americans, but primarily to serve the interests of the indigenous population. Germans in general (including many of their doctors) have a more positive attitude towards natural medicine than do their counterparts in America. In my experience, the German clinics are generally well run and are in full compliance with both local laws and international standards of ethical patient care.
Germany has long been a world leader in cancer research and treatment. German biologists pioneered almost every step in understanding the nature of this disease. Despite the terrible setbacks of World Wars I and II, German doctors continue to be well trained and well informed on all aspects of cancer care. In the use of complementary medicine they are without peer in the West. German doctors have either pioneered or expanded the use of mistletoe, enzymes, thymic peptides, immunotherapy, hyperthermia, and a host of other innovative techniques. These methods are sometimes employed alongside surgery, radiation and chemotherapy, when these are deemed necessary.
A glance at this year's program of the 41st Medizinische Woche (Medicine Week), held October 27-November 1, in Baden-Baden, reveals a panoply of treatment options that are unknown by most American oncologists. Recently I had the honor of co-editing a medical textbook on the German approach to integrative cancer therapy with Josef Beuth, MD, professor of complementary medicine at the University of Cologne. Our volume, Complementary Oncology (Thieme) gives some idea of the range of these treatments and the depth of their scientific evaluation including, in some instances, through the use of randomized controlled trials.
In conclusion, Ms Fawcett, I hardly think you are wasting your time, much less signing your own death certificate, by going abroad for treatment. You have made a rational decision under extremely difficult circumstances, and that decision deserves the utmost respect, not a flippant dismissal of your survival prospects. All people of good will wish you the best of luck in your search for effective treatments.
Contemplation
Originally uploaded by my.third.eye
I can't write anything today. I must go pay the teachers and issue refunds and create student rosters.
Originally uploaded by my.third.eye
I'm starting to see why I feel drawn to abstract photos. They are so simple and uncomplicated. Thing in itself. Red wheelbarrows in disguise. With so much depending upon them.
Originally uploaded by my.third.eye
Yesterday Jack began the prep work for painting the new loft! The stark white is on its way out. Warm cream, golden green, and rich rust are on their way in. It's always fun to help choose the colors. I love looking at colors. Thinking about colors. Playing with colors.
In fact, I have no more time to write right now, because I must hurry up and walk Olivia, then head over to York Street to help with Phase II of the color-choosing process. Yesterday he did some samples on the walls, and we saw what wasn't gonna work (i.e. the beautiful plum color that just didn't look right next to the bricks). Today, some different hues and shades. A lighter green, a less orangey rust.
After the color play, I'll rush back home and try to catch up on Writing Salon work that has been piling up. For example, the teachers are wondering where their paychecks are. And why there's no tea or half and half for the students. Why? Because I am so BEHIND on everything!
Here's some interesting reading for women who are
serious about wanting to be INFORMED when it comes to assessing how to
prevent and/or detect breast cancer. My opinion for quite some time has
been that mammograms are NOT the
end-all and be-all for breast cancer prevention, and
it's time more women (actually, all women) stop being so damn passive
and ignorant about this important issue.
Jeffrey Dach, M.D. NewsLetter
The Untold Message of Breast Cancer Awareness Month
by Jeffrey Dach MD
Breast Cancer Awareness Month Fails to Disclose Limitations of Mammography
October was Breast Cancer Awareness Month, which is an advertising
campaign for national mammography screening. An eminent radiologist,
Leonard Berlin MD says this message fails to disclose the limitations
of screening mammography, namely that mammography will miss 30-70% of
breast cancers, and leads to over diagnosis and over treatment. He also
says mammography disclosures should be mandated, just like the
cigarette and drug warnings that appear on their ads.
Otherwise, we create unrealistic expectations for mammography which
cannot be met. The public expects every breast cancer to be detected.
They are not. This translates into increased medical malpractice
payouts for the missed cancer, which is now the most prevalent medical
malpractice case against all physicians. (1) (1B) (2) (3) (4)
The fact is that mammograms are difficult to interpret, cancers can be
hidden, and many are missed. This cancer miss is not from lack of
training or competency on the part of the radiologist. It is inherent
in the mammogram technique itself.
The American College of Radiology says that 30-70% of breast cancer are
missed on the initial mammogram, and are seen in retrospect a year
later by going back to the previous mammogram interpreted as normal.
(5) (6) With this legal environment, it is a miracle that mammography
has survived at all.
Screening mammography is not prevention.
Leonard Berlin points out that 57% of the American women believe that
mammograms prevent breast cancer, a misleading message from Breast
Awareness Month. (1B) Mammograms are designed to detect cancer, not
prevent it. Thinking that a mammogram can prevent breast cancer is like
thinking that checking your house annually for broken windows, prevents
robberies.
Secondly. the most likely outcome of a positive mammogram is an
unnecessary biopsy, causing emotional distress, breast deformity and
scarring. 80% of all breast biopsies done for a positive finding on a
mammogram are negative for cancer. (5)
My own experience with mammography
When I began residency training in radiology at Rush Presbyterian
Hospital in Chicago in 1971, the state of the art was Xeromammography.
This was a machine made by the Xerox Company which was prone to
mechanical failure, and always breaking down. It produced a blue photo
on paper with blue toner powder. (27) (29)
In those days, Franklin S Alcorn MD, was the only brave soul willing to
read the Xerox images, and the book was Xeroradiography by John N.
Wolfe. In 1972, the consensus in the department was that mammography
was an orphan procedure and might never become acceptable. Some docs
thought xeromammography was bordering on quackery, and screening
mammogram had not been invented yet. (30)
Useful to the Surgeon
In those early days the surgeons criteria for doing a breast biopsy was
a palpable mass. Many women have palpable lumps and bumps called
fibrocystic breast disease which is quite common, and now known to be
caused by iodine deficiency. (7)
Cyst or Solid Breast Mass?
In those days, the surgeon approached a breast mass with needle
aspiration to differentiate between a fluid containing cyst or a solid
mass. Nowadays, ultrasound determines this easily.
Back to the needle aspiration procedure; if the lesion is a cyst, the
fluid is removed and the mass disappears. If no fluid can be obtained,
then the mass is solid, and surgical removal is the next step. This is
where the surgeons found the xeromammogram useful, occasionally showing
a second occult mass or calcification which alerts the surgeon to
remove additional tissue.
Invention of Needle Localization
Sometimes the surgeon had trouble actually finding the tiny
calcifications at surgery since they couldnt feel them, so needle
localization was invented. The radiologist placed a needle in the
breast tissue near the calcifications which guided the surgeon to the
spot to be removed.
The Switch from Blue Paper to Gray Xray Film
Grey X-Ray film mammograms replaced the blue Xerox paper images around
1982. By that time, I had joined a radiology group in Hollywood,
Florida, but they were still using the xerox machine even though the
whole country had already made the switch to regular x-ray film. This
inevitable switch-over to X-ray film made possible the large scale
national breast screening programs, since the mammogram could be done
at any hospital x-ray department. (27)
Finally, We All Learn Mammography
My radiology group made the plunge into film mammography. None of us
had prior training or experience reading mammograms, so we traveled to
expensive meetings and teaching courses on mammography from leaders in
the field, such as Marc Homer MD and Laszlo Tabar MD (Sweden), and then
we started reading on our own. (8)
From Breast Needle Biopsy to the Creation of a New Department
Soon we were doing the needle localizations (using the Marc Homer
needle) and needle biopsies in the radiology department. Initially,
biopsies were done with simple supplies, a standard 20 gauge needle and
10 cc disposable syringes. A few years later, the radiology industry
came out with spring loaded and vacuum assisted biopsy guns, and later
invented dedicated biopsy tables using stereo tactic guidance. This
machine allows the operator to take two x-rays at different angles, and
uses a computer to calculate the exact position for the biopsy needle.
By 2005, the cranky unreliable blue toner xeromammogram had been
replaced with a shiny new department on the third floor with all the
new modalities: hi-resolution digital mammography, stereotactic biopsy,
breast ultrasound, and breast MRI. There is no question that the
combination of these modalities makes a powerful and useful tool for
diagnosis, treatment and follow up of breast cancer cases. However,
this is quite different from screening mammography which is discussed
below.
Victimization of Women?, No, Merely Good Medical Care.
When we started the screening mammogram program, many of the suspicious
findings were false positive meaning they looked like something, but
were in fact nothing. The radiologist would send a report of suspicious
requires biopsy to the doctor who would tell the patient it might be
cancer and the terrorized woman would then not only submit to surgical
biopsy under anesthesia, she would become hysterical and insist on the
biopsy immediately. The negative biopsy would be a relief to the
patient making the surgeon a hero. Feminists call this victimization of
women, and healthcare professionals would call this good medical care.
Occasionally, about 10-20% of the time, a real cancer would be found at
surgery. These were typically spiculated masses or branching tell-tale
calcification patterns. In the early days, the punctate calcifications
and the milk-of calcium (teacup) were called benign and did not require
biopsy, and the branching calcifications indicated malignancy requiring
biopsy and further treatment, However, nowadays, even the benign
calcifications are routinely sent for biopsy, sometimes showing a
controversial non-aggressive cancer called DCIS. (9) (10)
What's Your Track Record ?
At first, we had no idea how many of our mammogram readings of
suspicious for cancer were actually found to be cancer by surgical
biopsy and pathology evaluation. So, we started compiling the pathology
data and attended monthly conferences to review the data and our track
record. The average is one cancer every 5 biopsies, but each
radiologist and hospital may have more or less. Optimally, this
information should be posted on the wall of the waiting room.
Unfortunately, this type of data is rarely available to the patient.
Questioning Screening Mammography
In the 1980s I believed, along with every one else in the health care
industry, that mammography was capable of early detection of breast
cancer, and that mass screening programs were capable of reducing
breast cancer mortality. I even wrote a short editorial that appeared
in the Miami Herald to this point which won the praise of my associates
at the hospital.
Starting around 1995, however, I began to question the idea of
screening mammography. Even from the beginning, there was a debate
between proponents and critics of mammogram screening. They argued that
the studies either did, or did not show reduction in breast cancer
mortality. The critic, Samuel Epstein says mammograms cause harm from
overtreatment with unnecessary breast biopsies, and the radiation
increases breast cancer risk.
Luck of the Draw - Mammography Malpractice
One of radiologists in my group had the misfortune of being sued for
malpractice. He missed a cancer on a mammogram that was visible in
retrospect a year later. Remember, this happens 30-70% of the time,
routinely.
This event happened early in his career, just out of training, before I
joined the group. His insurance company quickly settled the case by
paying the woman a settlement of a million dollars, with no attempt at
defending the case. As you can imagine, this was a major event which
changed how he interpreted mammograms. After that, he was gun shy,
almost always did a callback for additional views, and always
recommended biopsy for any vague density. The problem is that almost
every mammogram has vague densities. Almost all of these biopsies were
unnecessary for the patient, but they were quite necessary for the
radiologist, considering the medico-legal climate.
The x-ray techs quickly learned to bring the mammograms over to my
reading area for a quick negative, rather than to the other reading
room, where they usually end up doing more views and send the patient
for biopsy of a questionable area. This went on for years, and I was
never sued for malpractice on a mammogram reading during my entire
career. I consider this "the luck of the draw".
Realizing the high rate of false positive biopsies and the emotional
impact on women, I did my best to call the negative mammograms negative
realizing there could be a cancer hiding somewhere, and the visible
cancers were sent to biopsy.
Biopsy Everything and Anything
The reality of a hostile medico-legal malpractice climate and financial
pressure dictates the practice of mammography in most community
hospitals. Current practice is to basically biopsy anything and
everything that shows up on the mammogram, as long as the patient is
compliant. Its not difficult getting compliance by telling patient that
it might be cancer, we cant be sure. That usually is enough to make the
woman hysterical and submit to biopsy. The radiologist is happy because
he thinks he is reducing his chances of being sued for malpractice. His
partners and the hospital administrators are happy because the
procedures bring in more income. If cancer is found, the surgeons are
happy because they have more lumpectomies and cancer operations to keep
them busy.
DCIS, the Controversial Non-Aggressive Cancer
Over half of the cancers detected with mammography are DCIS (ductal
carcinoma in situ). This is a non-aggressive form of cancer which has a
98% survival after 5 years even with no treatment, although when found,
they are treated with surgery as any other cancer. Some consider this
detection and treatment of DCIS a form of overtreatment, others
consider it good medical care.
Some critics have said that increased mammographic detection of DCIS
has skewed the statistics, falsely reducing breast cancer mortality.
This makes it look like we are reducing breast cancer mortality, and we
are not.
Without mammography, most of these DCIS cases would go undetected, and
probably never cause a problem. Autopsy studies of women dying from car
accidents have shown occult DCIS in up to 15% of the population. The
actual incidence of cancer mortality is 0.4 per cent, not 15 per cent,
suggesting that 96% of DCIS cases never go on to clinical disease. Yet,
when DCIS is detected on the mammogram, these cases are treated with
the same mastectomy or lumpectomy.
A third of the time, pathologists will disagree on the diagnosis of DCIS while looking at the same case. (11) (12)
Lung Cancer Screening
Screening tests in radiology have been tried before. For example chest
x-ray screening for lung cancer was tried, studied and abandoned. It
was found that when you do a chest X-ray on smokers every 6 months,
find the cancers and send the patient to surgery for treatment, there
is no change in mortality figures. No lives are saved. In addition to
make matters worse, when you go back to the earlier films 6 months
before, on the film that was read as negative or normal in retrospect
the lesion is visible 90% of the time. (13) (14)
We thought these problems would be solved by moving up to CAT scans, a
more advanced imaging technique. However, now we have a problem with
seeing too many "suspicious" lesions and the false positive diagnosis.
The net result is that lung cancer screening even with CAT scanning has
not caught on. (15)
Mammogram screening in the under 50 age group NOT recommended by all other countries.
Current guidelines recommend a screening mammogram every 2 years for
the 40-50 year age group. No other western country does this, as these
women have dense breast tissue difficult to image and are most prone to
a false positive reading, or a diagnosis of DCIS, the controversial
less aggressive form of cancer. Most European countries restrict
screening to post-menopausal women, after 50, when breast tissue
involutes to fat and the cancers become more conspicuous.
Efficacy of Breast Cancer Screening - Does It Reduce Mortality?
The public perception is that breast cancer screening reduces breast
cancer mortality. The reality is that this is a fiercely debated
question in the medical literature with no clear winner. Leonard
Berlin's articles summarize this debate in the medical literature. (3)
The debate is best exemplified by one example cited by Dr. Berlin in
the Annals of Internal Medicine (2002), in which two conflicting
articles appeared in the same issue, one stating that mammography has
no mortality benefit, and the other saying it does.
Here are the two articles:
(1) Canadian researchers concluded that mammography screening did not reduce breast cancer mortality (16) (17)
(2) United States Preventive Services Task Force concluded mammography
reduces breast cancer mortality among women 40-74 years old. (18) (19)
Another listing and review of Mammography Screening Studies is found of the National Breast Cancer Coalition (web site). (44)
Bottom line, the debate rages on with no clear winner.
One observation which might clarify the debate is this: in two
countries with socialized medicine, Canada and Sweden, careful studies
of mammography screening were found to have NO Mortality Benefit
compared to breast clinical exam.
Here in the US, however, with a 4 billion dollar fee-for-service
screening mammogram industry, the mammography studies are interpreted
to show that Yes, there is a Mortality Benefit of about 15-20% .
The influence of money and politics over medical science is pervasive,
and mammography is certainly not immune. A few MD PHD's from Canada or
Sweden are not about to derail a 4 billion dollar industry in the US.
Conflict of Interest in Sponsoring Breast Cancer Awareness Month?
Screening mammography critic, Samuel Epstein MD, irritates the
establishment every time he points out that in 1984, the American
Cancer Society created the October National Breast Cancer Awareness
Month sponsored by money from the Astra-Zeneca Company, the maker of
Tamoxiphen, the best selling breast cancer drug. In addition,
Astra-Zeneca also manufactures industrial chemicals that cause breast
cancer. Some consider this a conflict of interest.
Epstein also points out that past ACS advertisement promised early
detection results in a cure nearly 100% of the time. Even more
seriously, the Awareness Month advertisements avoid any reference to
information on avoidable causes and prevention of breast cancer. (20)
(21)
What is breast cancer prevention?
A previous newsletter discusses Iodine supplementation as the most
effective way to prevent breast cancer. Iodine tablets are safe,
inexpensive and readily available. This is true prevention.(7)
Samuel Epsteins landmark book, "The Politics of Cancer" discusses
carcinogenic chemicals in our food supply, home and workplace. Removing
them can reduce breast cancer. This is true prevention. (22) (23)
The Untold Message of Breast Cancer Awareness Month:
To summarize, here is the untold message of Breast Cancer Awareness Month:
1) mammography screening is detection, not prevention and has several
limitations, namely 30-70% missed cancers, and a tendency towards over
diagnosis and over treatment. (5)
2) Many different carcinogenic chemicals cause breast cancer, and
removing these chemicals from the workplace or home can reduce breast
cancer rates. (22) (23)
3) Iodine deficiency causes fibrocystic disease, and Iodine supplementation prevents breast cancer.(7)
4) Synthetic hormones like Provera increase breast cancer risk. (WHI Study)(24)
5) Bio-Identical Hormone programs are safe, and do not increase risk of breast cancer. (French Cohort Study) (25)
Will mainstream medicine ever endorse Dr. Leonard Berlin's
Truth-in-Mammography disclaimers ? No, this will never happen. The
public's unrealistic expectation that a breast cancer nodule will be
detected 100% of the time will continue, and the high cost of medical
malpractice will simply be absorbed into "the cost of doing business".
The screening mammogram is here to stay.
Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood Fl 33021
954 983 1443
Jeffrey Dach, M.D. BLOG TrueMedMD disclaimer
References
(1) American Cancer Society Breast Cancer Prevention Page: Yearly
mammograms are recommended starting at age 40 and continuing for as
long as a woman is in good health.
(1B) Leonard Berlin, MD Mammography Screening Can Survive Malpractice .
. . If Radiologists Take Center Stage and Assume the Role of Educator
(2) Berlin L. The missed breast cancer redux: time for educating the
public about the limitations of mammography? AJR Am J Roentgenol 2001;
176:1131â€"1134.
(3) Malpractice Issues in Radiology, Breast Cancer, Mammography, and
Malpractice Litigation: The Controversies Continue Leonard
Berlin,Excellent discussion of controversy of screening mammography and
impact on mortality figures.
(4) Perspective Dot Size, Lead Time, Fallibility, and Impact on
Survival Continuing Controversies in Mammography Leonard Berlin MD
(5) STATEMENT of Leonard Berlin, M.D. To the U.S. Senate Committee on
Health, Education Labor and Pensions Re: Mammography Quality Standards
Act Reauthorization April 8, 2003. Leonard Berlin: Suffice it to say
that research studies performed at some of the most prestigious medical
institutions in the United States reveal that as many as 90% of lung
cancers, and 70% of breast cancers, can at least partially be observed
on previous studies read as normal.
(6) A Manifesto for Truth-in-Mammography Advertising by Leonard Berlin
MD Imaging Economics, November 2004 From cigarettes to pharmaceuticals
to financial services, all advertisements feature a disclaimer: Why not
those for mammography? Of all medical malpractice lawsuits filed in the
United States that allege a delay in the diagnosis of breast cancer,
radiologists are the most frequently sued specialists. Of all medical
malpractice lawsuits lodged against radiologists, the most frequent
cause is the allegation of a missed breast cancer on mammography. Why
has "missed breast cancer" risen to first place in the medical
malpractice standings? I suggest that it is because we have oversold
mammography. We have marketed mammography without informing the
American public all that we know about not only the benefits, but more
important the limitations and potential harms of mammography.
(7) Iodine Prevents Breast Cancer by Jeffrey Dach MD
(8) Screening mammogram studies Swedish Study by Dr. Laszlo Tabar
(1977- 1984) Population-based randomized controlled study 31% reduction
in breast cancer mortality in women 50 plus
(9) INTERACTIVE MAMMOGRAPHY ANALYSIS WEB TUTORIAL Images of benign calcifications, secretory disease, milk of calcium, etc.
(10) Tutorial 2 : CALCIFICATIONS ASSOCIATED WITH A HIGH PROBABILITY OF MALIGNANCY
(11) Ductal Carcinoma In Situ of the Breast Elisabeth L. Dupont, MD; Ni
Ni K. Ku, MD; Christa McCann, BA; and Charles E. Cox, MD, FACS DCIS,
60% of DCIS cases are discovered solely by mammography Seven major
autopsy studies of women not known to have had breast cancer have
provided insight. Six studies found an incidence of 4% to 18%.7 The
seventh and largest study showed a 0.2% incidence (1 in 519 cases).8
However, this study included a significant proportion of groups known
to have a smaller than usual risk of breast cancer. Of the more than
1,000 cases comprising these seven studies, only one case of invasive
cancer was detected. Further analysis with fixed criteria is needed.
(DCIS) this type of cancer now accounts for nearly half of
mammographically detected cases of cancer.
(12) Using Autopsy Series To Estimate the Disease "Reservoir" for
Ductal Carcinoma in Situ of the Breast: How Much More Breast Cancer Can
We Find? H. Gilbert Welch, MD, MPH, and William C. Black, MD Annals of
Internal Medicine December 1997 Volume 127 Issue 11 Pages 1023
(13) DOES LUNG CANCER SCREENING SAVE LIVES?
(14) Lung cancer screening
(15) Corporate Medical Policy Lung Cancer Screening, CT Scanning or
Chest Radiographs BC BS doesn’t cover Lung cancer screening with
chest CAT or Xrays.
(16) Miller AB, To T, Baines CJ, Wall C. The Canadian national breast
screening study. 1. Breast cancer mortality after 11 to 16 years of
follow-up. Ann Intern Med 2002;137:305 312 After 11 to 16 years of
follow-up, four or five annual screenings with mammography, breast
physical examination, and breast self-examination had not reduced
breast cancer mortality compared with usual community care after a
single breast physical examination and instruction on breast
self-examination. The study data show that true effects of 20% or
greater are unlikely. Controversy will persist because other studies
suggest that screening causes small reductions in breast cancer
mortality.The Editors
(17) Journal of the National Cancer Institute, Vol. 92, No. 18,
1490-1499, September 20, 2000 Canadian National Breast Screening
Study-2: 13-Year Results of a Randomized Trial in Women Aged 50â€"59
Years Anthony B. Miller, Teresa To, Cornelia J. Baines, Claus Wall, For
the Canadian National Breast Screening Study-2 Results: Randomization
achieved virtually equal distribution of demographic and breast cancer
risk variables. At the first annual screen, 21% of the cancers found by
mammography alone (in the mammography plus physical examination group)
were 20 mm or more in size compared with 46% of those found by physical
examination in the mammography plus physical examination group and 56%
in the physical examination-only group. The corresponding percentages
for screens were 10%, 42%, and 50%, respectively. Screening detected
267 invasive breast cancers in the mammography plus physical
examination group compared with 148 in the physical examination-only
group. By December 31, 1993, 622 invasive and 71 in situ breast
carcinomas were ascertained in the mammography plus physical
examination group, and 610 and 16 were ascertained in the physical
examination-only group. At 13-year follow-up, with 107 and 105 deaths
from breast cancer in the respective groups, the cumulative rate ratio
was 1.02 (95% confidence interval = 0.78 ). Conclusion: In women aged
50 - 59 years, the addition of annual mammography screening to physical
examination has no impact on breast cancer mortality.
(18) Humphrey LL, Helfand M, Chan BKS, Woolf SH. Breast cancer
screening: a summary of the evidence for the U. S. Preventive Services
Task Force. Ann Intern Med 2002;137:347 -360 The U.S. Preventive
Services Task Force recommends screening mammography, with or without
clinical breast examination, every 1 to 2 years for women aged 40 and
older.
(19) United States Preventive Services Task Force concluded mammography
reduces breast cancer mortality among women 40-74 years old.
(20) Dangers and Unreliability of Mammography: Breast Examination is a
Safe, Effective, and Practical Alternative Samuel S. Epstein, Rosalie
Bertell, and Barbara Seaman International Journal of Health Services,
31(3):605-615, 2001.
(21) Cancer, Inc - National Breast Cancer - Awareness Month Sierra,
Sept, 1999 by Sharon Batt, Liza Gross THEY MAKE THE CHEMICALS, THEY RUN
THE TREATMENT CENTERS, AND THEY'RE STILL LOOKING FOR "THE CURE"--NO
WONDER THEY WON'T TELL YOU ABOUT BREAST CANCER PREVENTION Astra Zeneca
Sam Epstein
(22) Cancer Prevention Coalition
(23) The Politics of Cancer, Revisited 1998 By Samuel S. Epstein, M.D.
Foreword by Congressman David Obey,Introduction by Congressman John
Conyers In this book, world-cancer expert Dr. Samuel Epstein indicts
the National Cancer Institute and the American Cancer Society for
responsibility in losing the cancer war-
(24) Postmenopausal Hormone Replacement Therapy Scientific Review Heidi
D. Nelson, MD, MPH; Linda L. Humphrey, MD, MPH; Peggy Nygren, MA;
Steven M. Teutsch, MD, MPH; Janet D. Allan, PhD, RN JAMA.
2002;288:872-881.
(25) French Cohort Study
(26) Leonard Berlin MD biography
(27) Breast Imaging: From 1965 to the Present Edward A. Sickles, MD,
Radiology. 2000;215:1-16.) Examples of xeromammograms and film
mammograms, speculated lesion, needle localization.
(28) Case 41: Ductal Carcinoma in Situ, Alanna T. Harris, MD The
detection of ductal carcinoma in situ has increased markedly in recent
years secondary to the widespread use of screening mammography, and it
now accounts for 25 to 40% of mammographically detected breast cancers
(29) History of Breast Cancer WILLIAM L. DONEGAN
(30) History: Narratives Radiology in Illinois By Franklin Alcorn, M.D.
Dr. Alcorn's history appeared in the program of the Chicago
Radiological Society at the Centennial of Radiology in 1995.
(31) Miller AB, To T, Baines CJ, Wall C. The Canadian national breast
screening study. 1. Breast cancer mortality after 11 to 16 years of
follow-up. Ann Intern Med 2002;137:305 â€"312 After 11 to 16 years
of follow-up, four or five annual screenings with mammography, breast
physical examination, and breast self-examination had not reduced
breast cancer mortality compared with usual community care after a
single breast physical examination and instruction on breast
self-examination. The study data show that true effects of 20% or
greater are unlikely. Controversy will persist because other studies
suggest that screening causes small reductions in breast cancer
mortality.The Editors
(32) Journal of the National Cancer Institute, Vol. 94, No. 20, 1546-1554, October 16, 2002
Detection of Ductal Carcinoma In Situ in Women Undergoing Screening Mammography Virginia L. Ernster
Results: A total of 3266 cases of breast cancer were identified, 591
DCIS and 2675 invasive breast cancer. The percentage of screen-detected
breast cancers that were DCIS decreased with age (from 28.2% [95%
confidence interval (CI) = 23.9% to 32.5%] for women aged 40 to 49
years to 16.0% [95% CI = 13.3% to 18.7%] for women aged 70 to 84
years). However, the rate of screen-detected DCIS cases per 1000
mammograms increased with age (from 0.56 [95% CI = 0.41 to 0.70] for
women aged 40 to 49 years to 1.07 [95% CI = 0.87 to 1.27] for women
aged 70 to 84 years). Sensitivity of screening mammography in all age
groups combined was higher for detecting DCIS (86.0% [95% CI = 83.2% to
88.8%]) than it was for detecting invasive breast cancer (75.1% [95% CI
= 73.5% to 76.8%]).
Conclusions: Overall, approximately 1 in every 1300 screening
mammography examinations leads to a diagnosis of DCIS. Given
uncertainty about the natural history of DCIS, the clinical
significance of screen-detected DCIS needs further investigation.
(33) Ductal Carcinoma In Situ of the Breast Elisabeth L. Dupont, MD; Ni
Ni K. Ku, MD; Christa McCann, BA; and Charles E. Cox, MD, FACS
DCIS, 60% of DCIS cases are discovered solely by mammography Seven
major autopsy studies of women not known to have had breast cancer have
provided insight. Six studies found an incidence of 4% to 18%.7 The
seventh and largest study showed a 0.2% incidence (1 in 519 cases).
However, this study included a significant proportion of groups known
to have a smaller than usual risk of breast cancer. Of the more than
1,000 cases comprising these seven studies, only one case of invasive
cancer was detected. Further analysis with fixed criteria is needed.
(DCIS) this type of cancer now accounts for nearly half of
mammographically detected cases of cancer.
(34) STATEMENT of Leonard Berlin, M.D. To the U.S. Senate Committee on
Health, Education Labor and Pensions Re: Mammography Quality Standards
Act Reauthorization April 8, 2003.
Leonard Berlin: Suffice it to say that research studies performed at
some of the most prestigious medical institutions in the United States
reveal that as many as 90% of lung cancers, and 70% of breast cancers,
can at least partially be observed on previous studies read as normal.
(35) A Manifesto for Truth-in-Mammography Advertising by Leonard Berlin MD Imaging Economics, November 2004
From cigarettes to pharmaceuticals to financial services, all
advertisements feature a disclaimer: Why not those for mammography?
Of all medical malpractice lawsuits filed in the United States that
allege a delay in the diagnosis of breast cancer, radiologists are the
most frequently sued specialists. Of all medical malpractice lawsuits
lodged against radiologists, the most frequent cause is the allegation
of a missed breast cancer on mammography. Why has "missed breast
cancer" risen to first place in the medical malpractice standings? I
suggest that it is because we have oversold mammography. We have
marketed mammography without informing the American public all that we
know about not only the benefits, but more important the limitations
and potential harms of mammography.
(36) Mammography Books
(37) AJR 2001; 176:1123-1130
Perspective Dot Size, Lead Time, Fallibility, and Impact on Survival Continuing Controversies in Mammography Leonard Berlin
mammography had become the most prevalent procedure involved in
malpractice lawsuits filed against radiologists, and that the
allegation of an error in the diagnosis of breast cancer had become the
most prevalent condition precipitating medical malpractice lawsuits
against all physicians.
An article published in the ACR (American College of Radiology)
Bulletin pointed out that 30-70% of breast cancers detected at followup
mammography are visible in retrospect on initial mammograms that had
been interpreted as showing normal findings
The debate as to whether screening mammography saves lives and
lengthens survival rages on and will certainly not be resolved in the
foreseeable future .
This article is not intended to be a comprehensive review of all
available data on the subject of mammographic efficacy. Even if it
were, no definitive answer to the question of whether mammography does
indeed reduce mortality from breast cancer would be found.
(38) Journal of the National Cancer Institute, Vol. 92, No. 18,
1490-1499, September 20, 2000 Canadian National Breast Screening
Study-2: 13-Year Results of a Randomized Trial in Women Aged 50 to 59
Years Anthony B. Miller, Teresa To, Cornelia J. Baines, Claus Wall, For
the Canadian National Breast Screening Study-2
Results: Randomization achieved virtually equal distribution of
demographic and breast cancer risk variables. At the first annual
screen, 21% of the cancers found by mammography alone (in the
mammography plus physical examination group) were 20 mm or more in size
compared with 46% of those found by physical examination in the
mammography plus physical examination group and 56% in the physical
examination-only group. The corresponding percentages for screens were
10%, 42%, and 50%, respectively.
Screening detected 267 invasive breast cancers in the mammography plus
physical examination group compared with 148 in the physical
examination-only group. By December 31, 1993, 622 invasive and 71 in
situ breast carcinomas were ascertained in the mammography plus
physical examination group, and 610 and 16 were ascertained in the
physical examination-only group. At 13-year follow-up, with 107 and 105
deaths from breast cancer in the respective groups
Conclusion: In women aged 50 to 59 years, the addition of annual
mammography screening to physical examination has no impact on breast
cancer mortality.
(39) Pink Ribbon Madness: Say No to Breast Cancer Exploitation for Corporate Profit
(40) article critical of mammographhy
(41) Dangers and Unreliability of Mammography: Breast Examination is a
Safe, Effective, and Practical Alternative Samuel S. Epstein, Rosalie
Bertell, and Barbara Seaman International Journal of Health Services,
31(3):605-615, 2001.
(42) AJR 2001; 176:1131-1134 Malpractice Issues in Radiology The Missed
Breast Cancer Redux Time for Educating the Public About the Limitations
of Mammography? Leonard Berlin
(43) Cancer, Inc - National Breast Cancer - Awareness Month Sierra, Sept, 1999 by Sharon Batt, Liza Gross
THEY MAKE THE CHEMICALS, THEY RUN THE TREATMENT CENTERS, AND THEY'RE
STILL LOOKING FOR "THE CURE"--NO WONDER THEY WON'T TELL YOU ABOUT
BREAST CANCER PREVENTION Astra Zeneca Sam Epstein
(44) National Breast cancer Coalition, Position Statement on Screening Mammography Updated May 2007
Excellent review of all studies up to May 2007. Overall, mammography
screening has a modest effect on breast cancer mortality. When analyzed
in absolute terms, the death rate is reduced by just 0.05%.
(45) Dr. Nortin Hadler is professor of medicine and
microbiology/immunology at the University of North Carolina at Chapel
Hill, and an attending rheumatologist at University of North Carolina
Hospitals.
Does Screening Mammography Save Lives? Numbers May Not Justify Practice for Routine Mammograms
OPINION By NORTIN HADLER. M.D. In the United States, radiologists are
so hesitant to read a mammogram as "normal" that false positive rates
can reach 80 percent. This hedging on the readings is driven by the
fact that "missing a breast cancer" on mammography is the most frequent
reason for malpractice litigation in the United States.
But screening mammography is so terribly blunt that it approaches
useless: It finds very few cancers that are truly treatable, it misses
many of these and it is awash in false positives. Norway, Sweden,
Australia and the United Kingdom are re-examining their national
experience with screening mammography because of appraisals similar to
mine.
If a woman's life was saved because of early detection of an evil
breast cancer, she should thank her lucky stars rather than her
mammographer. I would relegate mammograms to the archives of false
starts, next to radical mastectomy
(46) After 40 Years, Mammography Remains as Much Emotion as Science Judith Randal
Journal of the National Cancer Institute, Vol. 92, No. 20, 1630-1632, October 18, 2000
For the better part of a century, it would have been unthinkable to
treat primary breast cancer with anything but the operation pioneered
in the 1890s by William Halsted, M.D., one of the most prominent
surgeons of his day. Beginning in the 1970s, the Halsted era drew
gradually to a close when randomized controlled trials found that the
operation generally known as radical mastectomy was no more effective
than less drastic surgery (sometimes in combination with radiation).
Could a similar fate await the current gold-standard status of
screening mammography? Will a time come when its popularity dwindles,
too?
mammography now a $4 billion a year industry in the United States alone
Absent unforeseen developments, it is probably safe to predict that
mammography for screening will continue to be as much about strongly
held opinions and political pressures as about science.
(47) Good News and Bad News About Breast Cancer by David Plotkin M.D. The Atlantic Monthly
Breast cancer is a major public-health concern; it kills 0.04 percent of all American women yearly.
Most of the time the news is reassuring; two thirds to four fifths of
all biopsies reveal that the abnormality is not malignant. (Women in
their forties are more likely than older women to have negative
biopsies, because mammograms of their naturally lumpier breasts are
harder to interpret.)
An official nationwide mammography program would be a huge commitment:
51.5 million American women are aged forty or above. And one must bear
in mind the cost of needless medical procedures generated by the huge
number of false-positive mammogramsâ€"two to four false positives
for every true positive, according to some measures.
On balance, then, I reluctantly support the status quo. When my
patients come in for their mammograms, I do not try to dissuade them.
But I tell them that the most optimistic interpretation of the
available evidence suggests that routine mammography has only a
marginal effect on a woman's chances of surviving breast
cancerâ€"and that it may have no effect at all.
(48) Journal of Clinical Oncology, Vol 21, Issue 1 (January), 2003: 41-45
High Prevalence of Premalignant Lesions in Prophylactically Removed Breasts From Women at Hereditary Risk for Breast Cancer
N. Hoogerbrugge, P. Bult, L.M. de Widt-Levert, L.V. Beex, L.A.
Kiemeney, M.J.L. Ligtenberg, L.F. Massuger, C. Boetes, P. Manders, H.G.
Brunner Full text
The fact that an occult carcinoma was present in only one of 67
patients in our study might indicate that surveillance is as effective
as prophylactic mastectomy. However, in our study, all 10 DCIS cases
were missed by surveillance, and it was recently shown by
Meijers-Heijboer that surveillance is less effective than prophylactic
mastectomy in preventing breast cancer deaths.
(49) Mammographic Screening for Breast Cancer Suzanne W. Fletcher,
M.D., and Joann G. Elmore, M.D., M.P.H. NEJM Volume 348:1672-1680 April
24, 2003 Number 17
(50) POINT COUNTERPOINT On the efficacy of screening for breast cancer
David A Freedman,1 Diana B Petitti,2 and James M Robins International
Journal of Epidemiology 2004;33:4355
(51) International Journal of Epidemiology 2004;33:6973 Rejoinder David A Freedman, Diana B Petitti and James M Robins REJOINDER
(52) Screening for Breast Cancer. Joann G. Elmore, MD, MPH; Katrina
Armstrong, MD; Constance D. Lehman, MD, PhD; Suzanne W. Fletcher, MD,
MSc JAMA. 2005;293:1245-1256.
All major US medical organizations recommend screening mammography for
women aged 40 years and older. Screening mammography reduces breast
cancer mortality by about 20% to 35% in women aged 50 to 69 years and
slightly less in women aged 40 to 49 years at 14 years of follow-up.
Approximately 95% of women with abnormalities on screening mammograms
do not have breast cancer with variability based on such factors as age
of the woman and assessment category assigned by the radiologist.
Studies comparing full-field digital mammography to screen film have
not shown statistically significant differences in cancer detection
while the impact on recall rates (percentage of screening mammograms
considered to have positive results) was unclear.
(53) Cancer Epidemiology Biomarkers & Prevention Vol. 13, 501-510, April 2004
Fear, Anxiety, Worry, and Breast Cancer Screening Behavior: A Critical
Review Nathan S. Consedine, Carol Magai, Yulia S. Krivoshekova, Lynn
Ryzewicz and Alfred . Neugut3
Women's fears surrounding breast cancer seem to encompass nearly
"everything" but certainly include fear of a breast cancer diagnosis,
fear of pain/discomfort, and more complicating, fear of embarrassment.
To this list, we can add fear of the medical establishment, radiation,
nonspecific "cancer worry" general anxiety, or phobia .
(54) Cancer: When it isn’t a killer DCIS: Precancer, benign
cancer or what? What Doctors Don't Tell You (Volume 13, Issue 10)
The cancer establishment was recently rocked to its core when Professor
Michael Baum, an eminent and well-respected breast surgeon and
researcher, claimed that screening for breast cancer should be scrapped
because it caused hundreds of healthy women to undergo risky,
mutilating and unnecessary treatments even when they may never develop
the disease. His comments, made at a meeting of the Royal Society of
Medicine, cut even more deeply because Baum was one of the physicians
who helped set up the 50-million-a-year breast-screening service (Frith
M, Scrap Breast Cancer Screening, Evening Standard, 10 December 2002, p
1).
Baum has stated publicly that the most dramatic consequence of the rise
in the numbers of routine mammographies has been a huge increase in the
incidence of small, well-contained, relatively benign breast cancers
known as ductal carcinoma in situ (DCIS) (BMJ Rapid Responses at
bmj.com/cgi/eletters/325/ 7361/418#24945, 24 August 2002).
(55) Michael Baum, Emeritus Prof. of Surgery University College London
The Portland Hospital, 212-214 Great Portland Street, London W1W 5QN
Re: Screening and Mastectomy rates
(56) 'Scrap breast cancer screening' By Maxine Frith, Health Correspondent, Evening Standard 10.12.02
The man who helped to set up the NHS breast screening programme claims today that it does more harm than good.
Professor Michael Baum, a leading expert in the field, said that
screening for the disease causes hundreds of healthy women to have
risky, mutilating and unnecessary treatments even when they may never
develop the disease.
Fifteen years after he established one of the first screening centres
in the UK, Professor Baum has now called for the £50million a year
service to be shut. He believes the techniques used for screening are
not accurate enough and lead to too many false alarms.
Professor Baum, who is to address the Royal Society of Medicine in
London today, has been a long-standing critic of screening but has
never before gone so far as to say it should be scrapped entirely,
He is one of the most eminent breast surgeons in the country and a
respected researcher into the disease. His comments have sparked a
furious row among experts over the benefits of the NHS breast screening
programme
(57) Breast screen 'wrong care' fears, Breast screening may produce
false positives. Concerns have been raised that breast cancer screening
might lead to some women undergoing unnecessary treatment. Researchers
looked at international studies on half a million women. They found
that for every 2,000 women screened over a decade, one will have her
life prolonged, but 10 will have to undergo unnecessary treatment. UK
experts said women over 50 should go for their breast checks, but a
screening pioneer raised doubts about the NHS programme's future. The
report, published in the Cochrane Library, involved a review of breast
cancer research papers from around the world.
(58) Doubts raised by the pioneer of screening By Nic Fleming, Medical Correspondent 18/10/2006
(59) Screening for breast cancer with mammography. Gotzsche PC, Nielsen M Cochrane Reviews
Main results: Seven completed and eligible trials involving half a
million women were identified. We excluded a biased trial from analysis.
Two (Canada and Malmo)trials with adequate randomisation did not show a
significant reduction in breast cancer mortality, relative risk (RR)
0.93 (95% confidence interval 0.80 to 1.09) at 13 years; four trials
with suboptimal randomisation showed a significant reduction in breast
cancer mortality, RR 0.75 (0.67 to 0.83) (P = 0.02 for difference
between the two estimates). RR for all six trials combined was 0.80
(0.73 to 0.88).
The two trials with adequate randomisation did not find an effect of
screening on cancer mortality, including breast cancer, RR 1.02 (0.95
to 1.10) after 10 years, or on all-cause mortality, RR 1.00 (0.96 to
1.04) after 13 years. We found that breast cancer mortality was an
unreliable outcome that was biased in favour of screening, mainly
because of differential misclassification of cause of death.
Numbers of lumpectomies and mastectomies were significantly larger in
the screened groups, RR 1.31 (1.22 to 1.42) for the two adequately
randomised trials; the use of radiotherapy was similarly increased.
Authors' conclusions: Screening likely reduces breast cancer mortality.
Based on all trials, the reduction is 20%, but as the effect is lower
in the highest quality trials, a more reasonable estimate is a 15%
relative risk reduction. Based on the risk level of women in these
trials, the absolute risk reduction was 0.05%. Screening also leads to
overdiagnosis and overtreatment, with an estimated 30% increase, or an
absolute risk increase of 0.5%.
This means that for every 2000 women invited for screening throughout
10 years, one will have her life prolonged. In addition, 10 healthy
women, who would not have been diagnosed if there had not been
screening, will be diagnosed as breast cancer patients and will be
treated unnecessarily. It is thus not clear whether screening does more
good than harm. Women invited to screening should be fully informed of
both benefits and harms.
(60) Should We Offer Routine Breast Cancer Screening with Mammography?
SEAN P. DAVID, M.D., S.M., Brown Medical School, Pawtucket, Rhode
Island July 15 2003
(61) Screening for breast cancer with mammography Gøtzsche PC, Nielsen M cochrane collaboration 2006 full text pdf
(62) BMJ 2001;323:956 (27 October)
Row over breast cancer screening shows that scientists bring "some subjectivity into their work Susan Mayor, London
The review claimed that there was no reliable evidence to support the
value of mammo-graphy screening in reducing deaths from breast cancer
and alleged an association with increased rates of breast surgery.
Ole Olson and Peter Gotsche from the Nordic Cochrane Centre,
Righospitalet, Copenhagen, Denmark, reassessed as part of a Cochrane
review a meta-analysis of seven randomised trials of screening
mammography which they had previously carried out. This confirmed their
original conclusion, they said, that there was no evidence of a
reduction in either total or breast cancer mortality in two of the
trials that they considered to be of sufficient quality to analyse.
They added: "We have also confirmed that screening leads to more
aggressive treatment, increasing the number of mastectomies by about
20% and the number of mastectomies and tumourectomies by about 30%"
(Lancet 2001;358:1340-2 ).
(63) BMJ 2002;324:677 ( 16 March ) Hazel Thornton, independent advocate
for quality in research and healthcare. Letters Breast screening seems
driven by belief rather than evidence.
(64) BMJ 2001;323:1131 ( 10 November ) Letters. Office of NHS cancer
screening programme misrepresents Nordic work in breast screening row
Peter C Gotzsche, director. Nordic Cochrane Centre, Rigshospitalet,
DK-2100 Copenhagen ø,
(65) List of articles in Lancet on Screening Mammography
(66) Professor of Radiology Course Director LÃzlo³ TabÃr, M.D.
Professor of Radiology Course Director 2007 BREAST SEMINAR SERIES
Covering the world of breast diagnosis
(67) Screening mammogram studies Swedish Study by Dr. Laszlo Tabar
(1977- 1984) Population-based randomized controlled study 31% reduction
in breast cancer mortality in women 50 plus
(68) National Breast Cancer Coalition (NBCC) The Mammography Screening Controversy:Questions and Answers February 8, 2002
(69) www.stopbreastcancer.org National Breast Cancer Coalition 1707 L
Street, NW, Suite 1060 Washington, D.C. 20036 (202) 296-7477 voice
(202) 265-6854 fax
Position Statement on Screening Mammography Updated May 2007
Xeromammography is not quackery done by quacks says John Wolfe MD,
author of Xeromamogram interpretation. Film screen mammography replaced
it shortly there-after.
Womens perception of the benefits of mammography screening: population
based survey in four countries. Domenighetti G, DAvanzo B, Egger M, et
al.Int J Epidemiol 2003; 32:816 821.
Enthusiasm for cancer screening in the United States. JAMA 2004; 291: 7178. Schwartz LM, Woloshin S, Fowler FJ Jr, Welch HG
Bartow SA, Pathak DR, Black WC, et al. Prevalence of benign atypical,
and malignant breast lesions in populations at different risk for
breast cancer: a forensic autopsy study. Cancer. 1987;60:2751-2760.
Ringberg A, Palmer B, Linell F, et al: Bilateral and multifocal breast
carcinoma: A clinical and autopsy study with special emphasis on
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