By Audrey Quinn
Posting in Cancer
The breast cancer cure group used misused data to overstate the benefits of scans.
If you're a woman who truly cares about her health, why not get a mammogram? "Early and often" is the key to successful detection, right?
Not so, say a pair of Dartmouth researchers in a recent article in the British Medical Journal. They write:
Between 20% and 50% of women screened annually for a decade experience at least one false alarm requiring a biopsy. Most importantly, screening results in overdiagnosis. For every life saved by mammography, around two to 10 women are overdiagnosed. Women who are overdiagnosed cannot benefit from unnecessary chemotherapy, radiation, or surgery. All they do experience is harm.
The breast cancer advocacy group Susan G. Komen for the Cure ignores these risks and uses misleading data in mammogram campaigns, the authors say.
Komen's recent ad campaign featured posters that read, "early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%."
Say, for instance, 100 women receive diagnoses of breast cancer at age 67, not through screening but because they detect a breast lump. Assume they all die at age 70; five-year survival for this group would be 0%. Now, say the women were screened and given their cancer diagnosis three years earlier, at age 64, but they still die at age 70. Five-year survival is now 100%, even though no one in the screening group lived any longer.
The article authors say the use of 5-year survival rate stats is "hopelessly biased." It makes sense, for example, that women diagnosed with breast cancer at age 40 would be way more likely to live another five years than a woman diagnosed at 70. That's not good mammograms at work, that's just the statistics of aging.
Early detection can also distort five-year survival rates, Schwartz and Woloshin argue, because it can catch small tumors that would never have caused symptoms or killed patients to begin with; some tumors grow extremely slowly or not at all. By diagnosing these women, you’re including patients who will by definition survive, thereby inflating five-year survival statistics even though the screening itself didn’t actually save lives.
“If there were an Oscar for misleading statistics, using survival statistics to judge the benefit of screening would win a lifetime achievement award hands down,” the authors write.
Why would Komen mislead women about mammograms? I'd guess it's matter of simplifying their message. At this point mammograms are the most accessible method of breast control detection we've got, so to help the most women detect breast cancer in its early stages Komen needs a strong clear agenda. "All women should received mammograms" sounds a lot more digestible and convincing, than, "All women over 50 should get mammograms, but for those under 50 mammograms may do more harm than good, and they might not be that helpful for older women either."
This is the second major controversy for Komen this year, after they temporarily pulled funding for Planned Parenthood screenings.
Photo: Don Kennedy/Flickr
Aug 6, 2012
The link below should remove all doubts about the usefulness of mammograms. The article also includes links to the relevant citations. http://articles.mercola.com/sites/articles/archive/2012/08/15/politics-behind-mammography.aspx?e_cid=20120815_DNL_artNew_1
Time bias has always been a thorn in the side of medical research. Since most major studies are controlled for age, it is not the mere fact that young people live longer that skews results. The major problem is if you find a diseased person at an earlier stage, that person is practically guaranteed to live longer than someone identified with late stage disease. Finding the disease alone does not make people live longer, but rather what can be done to eliminate the disease. Studies involving screening tests should be disease stage controlled as well as age controlled. This time bias is exactly what took the recommendation for PSA screening in all adult males away. In addition the Komen foundation is heavily funded by most parties who heavily profit from mammograms. Be they radiologists (who read the mammograms and do the directed biopsies), oncologists (who use chemotherapy to treat the disease), medical device manufacturers (who build and sell the equipment that is used to find and stage the disease), or integrated medical care systems and universities (who are involved in obtaining government grants to study, evaluate and treat disease as well as write the guidelines for physicians in practice to follow) ; all have a vested interest in promoting mammograms that goes beyond maintaining public health. "Health" insurers, on the other hand usually have an interest in spending as little on medical care as possible and to distribute monies to the shareholders and executives. They may look benign by trying to promote healthy living but this is usually done to cover them in case of a government audit. If screening tests did not drive up premiums and hence profits, the insurers would fight tooth and nail to oppose unnecessary care. As far as mammograms are concerned, they may well indeed save some women years of life. However, false positives cause a large number of women a great deal of unnecessary grief and cost Americans billions of dollars.
The statement " women diagnosed with breast cancer at age 40 would be way more likely to live another five years than a woman diagnosed at 70" ignores the fact that women diagnosed at a younger age are significantly more likely to succumb to their disease. This is a fact because they are more likely to have a more virulent and harder to treat variant of the disease. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894028/ Anyway, the average life expectancy for a 70 year old women is still over 16 years. http://www.ssa.gov/oact/STATS/table4c6.html This article may make some good points, or it may just be out to knock the Komen fund because of their (since retracted) statements about abortion rights. At any rate it is not really scientifically accurate given the oversimplification of a complex topic
Thank you for this blog post. I have printed it as a useful reference. Facing death is emotional, there's no way of getting around that, and it is often extremely difficult to think rationally when in that position. We may use "statistics" to rationalize what may actually be choices made from fear and panic. So, it is wise to keep demanding that studies and the statistics they produce be held to true mathematical and scientific standards. I want this information, I want to be able to make these evaluations, and I don't want to be manipulated emotionally. For the record, I have survived ovarian cancer (so far), my sister has survived breast cancer (so far), but I certainly have many friends who have died of cancer of one kind or another. A mammagram may indeed be part of what saves a person's life -- it also may be part of a series of steps that unintentionally kills another person. I just want straight information on mammograms -- no hyperbole, no browbeating.
It's not government sponsored, it's good old poor management, chasing targets, bean-counters and spouting management mumbo-junbo - favored by management and business consultants, and business schools the world over - instead of letting professionally qualified medical professionals get on and run their hospitals. North Stafford shire NHS trust was a scandal, and there are a good many others where bad management and endemic government tinkering drove the NHS trust into the ground - however your are presenting this as symptomatic of the NHS where you are only spouting ill-advised rhetoric to support your 'NHS is socialism gone bad' which it isn't. In general it's a cost effective and reasonably efficient *Free at the point of use* healthcare system for all the UK population. It's not perfect, but it probably gives better overall outcomes than the US money/profit driven Healthcare System that is bankrupting the country, with an estimated 30m US citizen's left to be sick with no healthcare insurance. If I want to see my UK Family Doctor tomorrow - It's free to me. No charge. Your rhetoric almost implies no doctor or healthcare provider in the US has ever made a mistake. I'm sure with 10 minutes on Google, i could find a vast list of issues where people died or were mis-diagnosed.
You are all arguing about the use of Mammograms. What I see as the problem is what happens after the mammograms have been completed. Wizoddg had it right. Cancer is real big business and those that run them do not want it to stop. There have been many low cost discoveries for cures that have been bypassed simply because there was not enough money in it. Do you really think these people are going to shut down a 100 billion dollar business! I too have many friends that have had cancer but they used the internet to find better ways to cure themselves. The cancer society hides their true statistics on survival rates because if you really new you might not be so scared when they told you that you must go through hell to get cured. You need to sit up and take notice. THE DOCTORS DO NOT KNOW EVERYTHING! You need to research every aspect of what they are going to do to you before they do it. This is what my attorney told me after loosing my legs.
What do you expect from a socialized medicine system that is struggling to contain costs. We have already seen similar cost cutting reports come out during the last 2 years from the Obamacare rationing boards. The reality is the government has been playing budget games with peoples lives for years. Medicare cut off my mothers PAP smears at age 65. At 72 she was diagnosed with aggressive stage 3 cervical cancer. Something the PAP smears would have caught before she started showing symptoms. The numbers have been proven for decades that the occasional false alarm biopsy is far less expensive than finding cancer at stage 3 or 4 when it is harder to treat and far more fatal. Of course dead people cost less to care for. It is cheaper to tell a stage 4 patient, take these pain pills there is nothing we can do. That is what they do in the UK. They also hide their true cancer fatality rates by playing games with the listed cause of death. A person will be officially listed as dying of pneumonia when in fact they died of complications from stage 4 lung cancer. But their cancer fatality rates look low and they saved money. Who cares?
One of our neighbors, 50+, gets regular mammograms. 4 years ago her GP made a comment about dropping back to every 2 years. She decided that maybe wasn't the best thing to do and asked for the requisition. No problem. Imagine her surprise that a 0.9 mm elliptical spot was found that had spiculated.. A followup magnified digital mammogram was required to confirm. The reason that such a small tumor was found? Regular mammograms allowed the radiologist to compare changes over the years and zero in on the change. Without that history no one knows how much larger it would have grown. I don't recall the grade of the tumor but that is they key to how quickly it may have grown. The diagnosis was LCI but was upgraded ILC after the biopsy.
My yearly mammogram detected a star-shaped mass of tissue. This was followed by a sonogram and a biopsy. It was a tubular carcenoma. After a lumpectomy and lymph node excision I underwent 12 weeks of radiation. Due to the early detection, I was not subjected to chemo. I credit my yearly mammogram with saving my life. I am so tired of all this drama about mammograms. So what if you get a false positive? Isn't that better than not getting diagnosed until you are stage 4 and have no chance at survival? A sonogram and a biopsy have to be much less expensive for the insurance companies than radiation and chemo - and much easier on the patient.
Keep your tech stuff out of women's breast health, and stick to what you know. As a breast cancer survivor, going on eight years; I feel fully confident that the mammograms I get every year are a benefit in early detection of any recurrence. While mammograms may not always detect breast cancer (in fact - after 3 years of not having a mammogram - I found a lump myself, which was verified to be malignant by mammogram, sonagram and biopsy), the chances of survival at early detection and a stage 1 diagnosis vs. late detection and a stage 4 diagnosis increases survival rate by almost 100%. A yearly mammogram gives me peace of mind; and the knowledge that detecting a recurrence within one year will almost guarantee a successful treatment. Mammograms do, in fact, save lives.
X-ray mammograms are at best, inefficient, as they can and do miss a fair percentage of cancer. Better tests exist. Check out this new tech: http://www.ted.com/talks/lang/en/deborah_rhodes.html Of course, we don't USE it... Worst, is that we finance medical research based upon emotional appeal rather than actual threat (well, we do THAT with everything.) Breast cancer kills. Yes. Heart disease kills far more women...#1 killer of people in America. Terrorists & maniacs with guns kill. Yes. But far more people die because of tailgating the car ahead. In fact, more people are crushed by their furniture, than killed by terrorists. We spend billions to fight terrorists. We spend NOTHING to fight falling furniture or tailgating. Killing an embryonic human is killing. True. So is sending young men and women into war zones for ambiguous goals mostly related to consuming weaponry and making corporate profits. God, like Santa Claus, exists if you believe. If you believe, why do you destroy what He's created? If you don't believe, remember that killing the environment includes killing yourself, and your loved ones. When someone says something that scares you, stop. Think. Calm down. What is it they're trying to sell you? Why do they want you to act emotionally instead of with careful thought? Democracy does not equal capitalism. Nor is it necessarily the best form of government, as it requires and educated, informed and thoughtful public. This is why America was designed as a representative democracy.... Tyranny comes in many forms, including popular rule. Politicians are elected to serve you. So why are they exempt from the law you must follow? Some animals are better than others 'Animal Farm' George Orwell. If a politician is running for office (i.e trying to get reelected,) from the day he is installed--when is he working for YOU? Instead, he works ON convincing you to reelect. Did you know that Congress, the Supreme Court and the President and all of their minions are exempt from drug testing? Doe it make sense that a minimum wage clerk is tested, but the people who spend trillions of dollars more than we have, authorize killing on a mass level (war) and write the rules by which you live are not only not tested, but are free to do their jobs regardless of competency. Drunk or sober. Stoned or straight. Jacked on heroin or just up too late. Along complex law is like a net, the bigger it is, the more holes it has. The US Constitution is a few hundred words long. The new Iraqi constitution is over 900 pages long. Laws are written longer to create loopholes and to confuse people--many times they actually mean nothing, more often,they mean the opposite of their name. The purpose of government is to provide a referee for individual disputes, and a means of dealing with other countries. It does not exist to force others to live the way you believe they should...nor for others to force you. The first rule of government is: Do no harm to the country, the land, or the People. Are there people you hate? Did you bother to get to know them first? There are far more than two sides to any conflict. And there may be not a single one which is 'right.' Do unto others as they would have you do unto them. (Everyone is NOT the same, what pleases you may disgust someone else.)
While I feel for every loss that people have experienced due to cancer - it is becoming increasingly apparent that cancer (tumours of various kinds) are much more commonplace than science once realized. There have been several cases of groups of people who have died from non-cancer means and been autopsied, where it has been discovered that several of them have had tumours of varying sizes that had never been diagnosed. The numbers are far higher than was previously thought in terms of occurrence per thousand or million. This suggests that many people in the general population have or will have some tumour or other within their lives. These tumours may come and stay, come and go, or occasionally grow and kill us. What this therefore suggests, is that not every lump will kill us - but unfortunately, it seems we have no quick way of determining which is which. Also unfortunate is the fact that surgery carries risks (and can be very traumatic), and chemotherapy has very adverse side effects. Perhaps cancer is actually pretty common - even normal, and that perhaps our bodies can normally deal with it in a way that we don't even notice it. Then there are (fortunately uncommon) cases where our bodies do not protect us - and these cases lead to severe malignancies that could kill us. However, if this is the case - and we successfully treat the cancer on the first go around - what does this say about our long term survival? If we lacked that which could defeat the cancer initially - we would probably be further weakened by the treatment, and more vulnerable to a future malignancy. There are some mechanisms involved here that we do not fully understand. This is where more research and effort needs to be spent so that fewer men and women need to go through unnecessary suffering that cannot be shown to prolong life. We need actual effective treatment. One day, the methods we use to treat cancer today will be recognized as crude an ineffective as bleeding used to be.
This article is total BS... Mammograms save lives... You expect me to buy into some stupidly ridiculous idea that not screening is better for women? It doesn't matter how you skew the numbers, claims, or any of it, mammograms save lives... Detecting it early and treating it has helped far more women than the moronic idea of ignorant neglect. I have lost a few friends to breast cancer. Seeing a vibrant person who is full of energy and life wither and die within 6 weeks of finding a lump is a very scary thing to witness.
But I just wouldn't be surprised to see certain corporations (machine makers, HMOs, etc.) that would benefit from an overuse of the technology at the top of Komen's donor list. Just more "pinkwashing", if you ask me.
I feel bad for the Komen Foundation. They can't seem to win no matter what they do. The problem is they're trying to please all of the people all of the time and that just ain't gonna happen. They've done a wonderful job of bringing breast cancer awareness to women of all ages, and probably the most important thing they've done is inspired women to be proactive about their health. Before the Komen Foundation, women rarely spoke about their breasts. Now it is a topic that is approached without embarrassment or shame. Kudos to the Komen Foundation for a job well done!
If it is run by the government, with policies approved by and dictated by the government, ITS GOVERNMENT SPONSORED. Everyone knows that honestly punishing government employees for gross negligence is almost impossible in such a system. For all of the complaints and the chronic, systemic problems identified there is still no one going to jail in the UK for the massive health care problems seen there. The government protects them because in many cases they were doing desperate or just plain stupid things to meet ill conceived government goals, mandates and budgets. When government policies forbid a doctor from getting second opinions you cannot blame them for a blown diagnosis that ends up with a person needlessly dying in a death hospice.
You say "There have been many low cost discoveries for cures that have been bypassed simply because there was not enough money in it. Do you really think these people are going to shut down a 100 billion dollar business!" Do you have some actual evidence for this statement or just a healthy dislike of anything that smacks of big business and special interests? Certainly there are many nutritional supplements that can help improve the odds and stretch survival, but evidence for any "miracle cure" is wholly lacking. My wife is an eight year survivor of stage IV breast cancer. I am scientifically literate and a proficient researcher. In our long journey with this disease we have exhaustively researched every claim for natural and nutritional treatments. While you can get some benefits with a select group of these options, none comes near the efficacy of standard treatments with chemo and radiation therapy. If it weren't for Herceptin (think $40-50 K an year) she would not be here now since she was progressing until this expensive main-stream treatment put her into remission. If you'd spent some time actually talking to oncologists and living with cancer while doing intense research into treatment options you would not repeat such ignorant statements.
The British NHS may have it's issues, but at least it doesn't do anything like toss an estimated 30m citizen's to the no health-insurance wastelands, regardless of age or employment status/cover. http://www.msnbc.msn.com/id/47876329/ns/health-health_care/t/millions-americans-may-still-go-without-health-insurance/#.UCE4PaN6r8N Also if you want to see your family doctor, it is a fixed price of 0GBP, again regardless of age or your employment status/employer health plan. I'd rather have the certainty of a socialized Healthcare system, than one that costs 2-3x as much as any other system in the world by everyone skimming their profit margin out of it - and you berate the UK NHS for being unable to contain costs - that's laughable. Even the Canadian;'s agree with state funded free at the point of use health provision, though is mostly privately provisioned - an in between stance. In the UK, if you want Private Health Cover, it;'s freely available, for a monthly fee. The NHS is not compulsory. Never understood American rabid objection to State funded universal healthcare or gun control, yet the State Education systems are used without any anti-statist provision rhetoric.
Men get breast cancer too. The number of men who get breast cancer is small compared to the number of women who get breast cancer, but it does happen.
It should be verboten for males with a technical background to comment on mammograms and breasts. You could then sprout your own limited insights. As a matter of fact mammograms are more likely to cause breast cancer as well as aggravate existing tumours. But then what would a male engineer, who always averts his eyes in the presence of female breasts, know.
Yes cancer is common. Sometimes they are very slow growing and may not become dangerous for many years. But, many are dangerous and early detection is critical. All you have shown is that some people die of other causes before the cancer kills them. Better to know that you have a tumour and then decide what to do than to just be ignorant.
There are no non-obvious breast cancer lumps that kill in 6 weeks without treatment, however radiation and chemotherapy are quite capable of killing within 6 weeks. I suggest you read up on the differences and the risks, damage done, and differences between over-diagnosis and misdiagnosis. It's not just breast cancer, but prostate and a number of other cancers where unnecessary diagnosis and treatment is causing pain and early deaths. Our medical/insurance industries are "farming" us and they need to be reigned in.
I don't feel sorry for them. They have an agenda, and they're pushing it. The incidence of prostate cancer in men is about the same as that of breast cancer in women, yet breast cancer receives the lion's share of attention and funding. Why? Everyone likes boobies and people are afraid to speak ill of any cancer research for women. The real question is why are North American women many many times more likely to get breast cancer than women in the rest of the world?
Pure rhetoric. In most healthcare systems there will be instances of bad practice, cover-up, management horrors. - esp. one driven by profit ? Your are trying to say State Bad, Private Good, whereas the reality, as ever, is in the middle. At least with a 'free at the point of use' state funded/ran system paid for out of general taxation, you do not have to worry about having to pay for healthcare when you have a need, or go without treatment because you do not have the money - a very poor reflection on the society you live in.
Government sponsored lying on death certificates to cover up poor treatment of patients. http://en.wikipedia.org/wiki/Stafford_Hospital_scandal http://www.nenp.org.uk/patients-and-carers/my-story/living-experiences/misdiagnosis-of-stroke.aspx After decades of misclassification of the causes of deaths, a shift to honest classifications has caused headlines like these to become all too common. http://www.webmd.boots.com/cancer/news/20101112/cancer-death-rates-for-uk-women-among-worst-in-europe http://news.bbc.co.uk/2/hi/health/8117561.stm (15,000 people aged over 75 may be dying unnecessarily) http://www.medicalnewstoday.com/articles/243811.php (UK Womb Cancer Deaths Rise 20%) Frequent misdiagnoses that leads to people being dumped into death hospices. There is at least 1 new incident revealed monthly. http://www.dailymail.co.uk/news/article-1219853/My-husband-beaten-cancer-doctors-wrongly-told-returned-let-die.html http://www.lindermyers.co.uk/case-report-misdiagnosis-of-terminal-illness-for-mental-patient_1038.html http://www.jmw.co.uk/blog/widow-wins-compensation-claim-after-misdiagnosis-left-husband-to-die http://www.firstthings.com/blogs/secondhandsmoke/2009/10/12/liverpool-care-pathway-man-misdiagnosed-with-cancer-dehydrated-to-death/ It is that bad. You can keep this kind of system.
Male breast cancer Educational Information video clip (1 minute .wmv 4.3Mb) Breast cancer, I thought that was only for women http://www.ssrichardmontgomery.com/download/malebreastcancer.wmv
Seriously, you would rather bury your head in the sand than know if you have a lump? There are lumps that are huge that can only be detected by mamogram. Don't confuse early detection with medical malpractice... Early detection is EVERYTHING... It gives you the time you need to get a good second opinion before making a life altering decision. It also gives you time to monitor the lump... I have 2 in my thyroid that I have been monitoring for the past 4 years. If they get any larger, I will have a biopsy, if not I will continue to monitor them via ultrasound. I could have them removed, I could have a biopsy, I could do a lot of things, but I am not about to let anyone do anything to my thyroid unless it is very necessary. With early detection, we have time to make less costly rational decisions, and some of us want that. If there are stupid people out there doing anything a stupid doctor tells them to do it is not the fault of early detection. Mamograms save lives... Period.
There are dozens of things I need before I need health care; Food & shelter being two obvious ones. These are certainly not free, and cost far more than "health care" does. Why shouldn't they be "free at the point of use" too?
It's the expected refuge of the individual with an ideology but no argument to back it up against the facts. It's also amusing to note that it's the vast majority here who seem to overwhelmingly favor large statists solutions to problems like health care, and yet it's just Hates Idiots and I who are accused of sharing only a single brain.
...as when you say I [i]"seem very judgmental over a government you do not live under." "Why are you happy with government ran Tax, Military, Education, Transport system, but seem to balk at a Healthcare one."[/i] Where did I ever say that I was? I am not at all happy with any of those things here in America. The tax system is complex, corrupt and unfair. Our military is highly inefficient and only effective at destruction because of its largesse. If you've spent any time on this site at all, you'd know that our education system is a joke, and our highways are behind and in a perpetual state of disrepair. This is not "rhetoric". It's fact. So yes, it really does scare me that the incompetent people responsible for all of the above wish to take total responsibility for my health care as well. Any expectation that they will do better running it than they have with anything else is simply insane.
You seem very judgmental over a government you do not live under. Why are you happy with government ran Tax, Military, Education, Transport system, but seem to balk at a Healthcare one. You are happy to damn on principle a state run one with only rhetoric to back you up, and champion a profit driven Healthcare system that costs hugely more than any other comparable country in the world, yet the US is far behind these same countries in overall Life Expectancy. US Healthcare system delivers poor value - Bang for the Buck - compared to most other Healthcare systems in comparable Westernized Countries. https://en.wikipedia.org/wiki/List_of_countries_by_life_expectancy http://www.reuters.com/article/2009/06/01/us-healthcare-costs-sb-idUSTRE5504Z320090601
BS, BS, BS... Mamograms do not give false positives. That's like saying an xray gives false positives of broken bones... Do you even know what a mamogram is CrispinChapman??? Mamograms are a low energy x-ray and they don't give anything but an x-ray image of a squished breast... No positive, no negative, nothing to get false... It's a friggin picture and you can't get any better or do less harm as far as a detection method goes. It also can't get any less expensive. Hopefully we can get better technology eventually, but for now, this is the best we have, it's widely available, and it works. There is no early detection method that causes less harm than a mamogram brainiac? The next step from a mamogram is a biopsy. The biopsy could give a false positive, but that is very unlikely (then again, Kaiser has been known to operate on the wrong limb or patent). But the notion that a x-ray can give a false positive is total BS... It's just an x-ray. After a biopsy there is cancer treatment... But I don't see how you could jump to cancer treatments without an image of the cancer, blood work to confirm, and a biopsy of some of the tissue. And I don't see how you could get false positives on all of those.
Mammograms save lives. Mammograms also kill people by subjecting them to unnecessary cancer treatments due to false positives. This makes mammograms a poor choice IMHO. I agree that early detection is important, but let's get a detection method that causes less harm.