Does Mamography Reduce Mortality From Breast Cancer.

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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby bridgetohealth » Mon Mar 02, 2015 8:47 am

f1jim wrote: the problems with looking at "survival" statistics. They are almost meaningless since they are all simply dictated by the time of diagnosis...
Our best treatments tend to extend the lives of cancer patients measured in months. And that's the best.
It's hard to swallow but for breast cancer it doesn't matter much when we find it. This appears to be counter intuitive, but it's not.
The nice thing about the H. Gilbert Welch book is it's explanation of all the terms we through out in evaluating procedures. 5 year survival, mortality, lead times, and the big elephant in the room, overdiagnosis. His book will unlock much of the world of studies to anyone that is confused by them. It tells you what the important numbers are in evaluating procedures and pills and which ones to ignore. It was eye opening to me.
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There are some cancers that are amenable to early treatment and therefore the time of diagnosis does matter. The problem is that mammography can't distinguish those, and finds cancers that are also equally amenable to late treatment, and cancers that are never amenable to treatment, and ... cancers that don't ever need treatment and would never ever cause a problem anyway. And that last number (the number overdiagnosed) is 50% of all "non-palpable" "cancers" found (ones that we wouldn't find anyway in the shower). Which is why it's not just lead time that changes the numbers -- a full 50% of the additional cancers we're counting in the mammography group have an infinite breast cancer survival rate that is being averaged in -- but those women will never die of breast cancer no matter what. And -- a big chunk of that time they want to be spending with their grandkids is instead spent in chemo and radiation and surgery and worry about the big C. AND ... some of them will die from the "treatment" of a problem they don't actually have. But those are all part of the group of women running around saying mammography "saved" them, and the numbers are so high we're all quite likely to know someone who is part of that group of having had needless breast cancer treatment yet thinking they were part of the group that had a cancer that needed to be treated, needed to be treated early and was found and treated early because of mammography.

Oh, and the study we're referring to here was a 25-year study of 89,000 women -- a huge sample size and extremely long-term (five-year survival rates are less meaningful I think). But there are many many more finding basically the same thing.

Screening mammography (mammography in women without any signs or symptoms of possible breast cancer) has been studied in large randomized trials of nearly a half million women. The theoretic basis for the intervention is sound. It is presumed that therapeutic intervention at a point when cancer is visible on a mammogram but not yet palpable in the breast will, for a small number, result in earlier, ultimately life-saving, therapy. Overall mortality rate, however, was not improved in the groups in these studies assigned to receive regular mammograms. When aggregating data from those trials in which randomization was appropriate (resulting in balanced groups), there was also no identifiable reduction in deaths due to breast cancer.


If screening mammography reduces the rate of one type of death, but the overall rate of death is not affected, it is mathematically implied that there is an increase in some cause of death that is offsetting the reduction in breast cancer deaths. Unfortunately, because most massive trials of mammography are simply too large to reliably track every cause of death, it is often difficult to tell with precisions where this increase occurs.

Harms due to breast cancer screening are discussed at length in the Cochrane review, and in more recent analyses.2,3 These include false positives that result in surgical procedures, and emotional distress due to false positives. In addition, despite the lack of identifiable benefit to screening mammography, women in groups assigned to receive mammograms were 20% more likely to undergo mastectomy and 30% more likely to undergo surgery. Finally, if it is true that breast cancer deaths are reduced it has been estimated that for every one patient who avoids death from breast cancer approximately 10 to 20 women are treated unnecessarily as cancer patients, typically receiving surgery, radiation, and chemotherapy.3,4 This additional estimate of harm is not represented in the NNH statistics listed above.



http://www.thennt.com/nnt/screening-mammography-for-reducing-deaths/
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby cena » Mon Mar 02, 2015 11:52 am

I'm 52 and decided a long time ago not to have routine mammograms. But at age 48 I had some tenderness in one breast. I was told by my doctor that it was fairly common for peri menopausal women to have that and I should get a mammogram. So far, I have not had one. I have had 2 thermographs, 2 years apart. After 18 months eating plant based my thermograph improved quite a bit with no serious hot spots. I like the information and it is not a radioactive procedure. It made me see some benefits in another way from this way of eating. My blood pressure and blood levels, and now this too. I don't tend to go for invasive testing when I am not feeling symptoms. I feel fairly guaranteed not to have a heart attack with cholesterol under 150, but cancer is so different, at least in my mind. Fear of cancer is real and probably in most peoples minds. That fear causes us to do almost anything to ease our minds.
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby Jumpstart » Mon Mar 02, 2015 12:42 pm

It seems that the men think that breast cancer is all the same when in fact there are a number of types. To make blanket statements about survival under these circumstances is just foolish. And you're not going to look for cancer early because some bean brain doctors over diagnose? I guess you men shouldn't see a heart specialist because he might recommend stents or a bypass instead of a change in diet. If you haven't figured it out yet, you as a patent have a choice. In my case I had the lump removed and passed on having nodes from under my arm removed and I also decided not to have radiation or chemo. Yes, those and Tamoxifen were recommended and I said no to all. It's now been eight years and I'm still alive. If I hadn't had early detection via mammogram I'd be dead by now. Whether a lump can be detected by feel depends where the lump is. If it's deep as mine was you won't find it by touch. I've got another problem with the logic of some writer on the subject and those on this board that parrot their nonsense. Let's see, breast cancer patients in general are living longer as a result of better treatment. OK, I'll buy that. But then at the same time when you find the cancer it won't allow you to survive longer? You can't have it both ways. The only way that when you find cancer wouldn't make a difference is if the treatment made no difference. If you've got late stage breast cancer no amount of chemo will make a difference. And if you wait until cancer makes a physical appearance you have late stage cancer and you've got less than a year to live. At that stage forget the chemo which will just make that last year miserable.
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby f1jim » Mon Mar 02, 2015 1:21 pm

This isn't a male/female issue,despite your frequent comments. Improper screening affects both genders as each has their share of issues with survival and over diagnosis.
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby bridgetohealth » Mon Mar 02, 2015 1:52 pm

Jumpstart wrote:It seems that the men think that breast cancer is all the same when in fact there are a number of types. To make blanket statements about survival under these circumstances is just foolish. And you're not going to look for cancer early because some bean brain doctors over diagnose? I guess you men shouldn't see a heart specialist because he might recommend stents or a bypass instead of a change in diet. If you haven't figured it out yet, you as a patent have a choice. In my case I had the lump removed and passed on having nodes from under my arm removed and I also decided not to have radiation or chemo. Yes, those and Tamoxifen were recommended and I said no to all. It's now been eight years and I'm still alive. If I hadn't had early detection via mammogram I'd be dead by now. Whether a lump can be detected by feel depends where the lump is. If it's deep as mine was you won't find it by touch. I've got another problem with the logic of some writer on the subject and those on this board that parrot their nonsense. Let's see, breast cancer patients in general are living longer as a result of better treatment. OK, I'll buy that. But then at the same time when you find the cancer it won't allow you to survive longer? You can't have it both ways. The only way that when you find cancer wouldn't make a difference is if the treatment made no difference. If you've got late stage breast cancer no amount of chemo will make a difference. And if you wait until cancer makes a physical appearance you have late stage cancer and you've got less than a year to live. At that stage forget the chemo which will just make that last year miserable.


Hmm, I'm not sure who this is directed to, but I'm a woman as indicated by my comment that Spiral could never get cervical cancer and I could never get testicular cancer.

If anything, PSA's were stopped much sooner because male researchers and male doctors and male patients and male members of advisory boards were so much faster to put a stop to the practice.

Ok, so now the advice is to go to a doctor who is so much better than the doctors in the cases of the over 500,000 women studied?

You seem to have a basic lack of understanding about screening and overdiagnosis. Overdiagnosis generally isn't because of the decisions or judgment of a particular doctor or radiologist or patient. The issue is that no one can know whether a cancer that is found is a) a cancer that will kill me, and treating it now instead of later will save me; b) a cancer that will kill me and treating me will save me but I could wait several years until it's palpable and still be saved; c) a cancer that will kill me no matter what; d) a cancer that is so slow-growing that it won't ever kill me because I'll die of something else first; e) a cancer that will actually go away and therefore never kill me.

The issue doesn't have to do with bean-brained doctors or patients who don't do their research etc., though it does have to do with the widespread misunderstanding about diagnosis and over diagnosis and whether it's a good thing or not that a screening will detect overall more cancers (hint: despite what you said a few posts back, it's not. That's the number one sign of overdiagnosis), and whether "survival time" is a good measure of a screening's success (hint: despite what you said a few posts back, it's not. It just means a woman is living longer with a diagnosis instead of having more time undiagnosed).
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby bridgetohealth » Mon Mar 02, 2015 5:27 pm

Sorry for the double-post, but I wanted to say that I don't disagree with the notion about scientists and studies lying (though I didn't read the book and have no idea if I agree with the book's premises).

Here's an example of those widespread lies. I'm not sure if this article was brought up here:

Reading the FDA’s inspection files feels almost like watching a highlights reel from a Scientists Gone Wild video. It’s a seemingly endless stream of lurid vignettes—each of which catches a medical researcher in an unguarded moment, succumbing to the temptation to do things he knows he really shouldn’t be doing. Faked X-ray reports. Forged retinal scans. Phony lab tests. Secretly amputated limbs. All done in the name of science when researchers thought that nobody was watching.

That misconduct happens isn’t shocking. What is: When the FDA finds scientific fraud or misconduct, the agency doesn’t notify the public, the medical establishment, or even the scientific community that the results of a medical experiment are not to be trusted. On the contrary. For more than a decade, the FDA has shown a pattern of burying the details of misconduct.


http://www.slate.com/articles/health_and_science/science/2015/02/fda_inspections_fraud_fabrication_and_scientific_misconduct_are_hidden_from.single.html

But for me that's all the more reason that we should a) try to inform ourselves about how they "lie" with statistics or a study's relevance even when they truthfully present the data; and b) think about why they would lie, who would want them to lie, and if there is a widespread belief or widespread suggestions, who might benefit if it's not true; and c) generally always err on the side of no intervention if we're not sure.

The ones who have the big dollars to spend to perpetuate untruths, and the ones who have the most to gain from widespread use of a procedure or drug are the corporations that manufacture those drugs and those machines, and also the doctors and hospitals who use them/prescribe them. This is why I advocate for c) above. The weight is heavily on the side of intervening, so to balance it out, I begin with non-intervention as a default and go from there.

This is where there is a trio (or really a quartet) of speakers that have been at ASW's that have a really important message. They are informative about how overdiagnosis and over-treatment work, and eye-opening about the extent of the control that pharmaceuticals and other corporations have in the medical industry.

This trio (plus) is:

1) H. Gilbert Welch, speaking again this month. (main book is Overdiagnosed)
2) John Abramson, whose main book is Overdosed.
3) Robert Whitaker, whose book Anatonmy of an Epidemic is about psychiatric drugs.

Special mention goes to 4) Marc Gosselin, who I don't think has a book ( :eek: ) and is actually a radiologist; he gives a good explanation of a lot of these issues -- our perception of the world and medicine vs. reality. He got a lot of his info and ideas from Welch, but he gives his own touch and is a great speaker. He spoke at the last ASW. Buy access to that one, and it will expire soon, March 30, but still worth the price IMO (also Neal Barnard and others, and Doug Lisle's talks are always great). Then if you get the next one, you'd have Welch. Their books are all good in addition to watching them speak.

You can watch the short version of Robert Whittaker here :
https://www.youtube.com/watch?v=5VBXWdhabuQ

Here's an interview with Abramson, I haven't watched the whole thing. His talked at ASW a few years ago were great.https://www.youtube.com/watch?v=OYBrXcsDzhI
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby Spiral » Mon Mar 02, 2015 5:42 pm

bridgetohealth wrote:The ones who have the big dollars to spend to perpetuate untruths, and the ones who have the most to gain from widespread use of a procedure or drug are the corporations that manufacture those drugs and those machines, and also the doctors and hospitals who use them/prescribe them.


I find this situation similar to how I feel when I take my car to be serviced. I am not an auto-mechanic. If the auto-shop says, "You need a new battery." Or "You need new brakes." I am tempted to go along with them.

I am at a knowledge disadvantage. Same in health care.

Even if I study up a lot on these issues, I don't have decades of specialized experience. So, it's very difficult to say "no" to a doctor who appears to have my best interests at heart. He or she might even be sincere and not just trying to pay for his vacation home or his daughter's post-graduate education.

A little over a year ago, an ear nose and throat doctor told me that I needed nasal surgery. I initially turned him down. But he called me back after finding out that I cancelled one of my appointments. He talked to me and convinced me to go ahead with the surgery.

Even to this day I am not sure that I made the right decision. I think that when you do nasal surgery for a living, you have an unconscious bias towards the benefits of that surgery, even if you are a very honest person. People want to believe in the work that they do everyday. Who wants to believe that they do lots of marginally beneficial surgeries? Who wants to believe that they do lots of unnecessary surgeries?
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby Annitenth » Mon Mar 02, 2015 5:58 pm

bridgetohealth wrote: The issue is that no one can know whether a cancer that is found is a) a cancer that will kill me, and treating it now instead of later will save me; b) a cancer that will kill me and treating me will save me but I could wait several years until it's palpable and still be saved; c) a cancer that will kill me no matter what; d) a cancer that is so slow-growing that it won't ever kill me because I'll die of something else first; e) a cancer that will actually go away and therefore never kill me.


I shouldn't jump into the fray here, because I am not at all knowledgeable about breast cancer. But my understanding is that the cancer described in (a) above simply doesn't exist. Cancer cannot be found, by any means currently available, until it has already been growing 10 years. However, if it is the kind that is going to spread, it has already started spreading by the sixth year. And once it has spread, if it's the killing kind, you're pretty doomed.

If you have a cancer diagnosis at year 10, and then get treatment, and survive, then you would have survived anyway without treatment (other than lumpectomy).

How many patients with lymph node involvement survive long term?

I hope someone can speak to this, because I'm basing my refusal to have more mammograms on this understanding.
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby Spiral » Mon Mar 02, 2015 6:53 pm

Annitenth wrote:How many patients with lymph node involvement survive long term?

I hope someone can speak to this, because I'm basing my refusal to have more mammograms on this understanding.


My wife had three of her lymph nodes removed last year. She also had surgery, chemo and radiation.

She was trained as a nurse, but is retired. She feels reasonably optimistic about her future.

I think the statistics for stage 2 breast cancer, even when the cancer has spread to some of the lymph nodes, show a pretty high survival rate.

I might not be in favor of mammograms (and I didn't tell my wife to get them or not get them).

But as for treatment, when my wife had to make a decision as to whether to go ahead with chemotherapy, her oncologist gave her a sheet of summarized statistics showing survival rates and recurrence rates with and without chemotherapy.

If I remember correctly, if 20 women do chemotherapy, one woman lives that would not live without chemotherapy. My wife chose the chemotherapy. She hated it. Her hair fell out. But she got through it and her hair is all grown back now.

I think she is glad that she did the treatment. She told me that she would not want to go forward thinking that she left a powerful weapon against breast cancer unused.
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby bridgetohealth » Mon Mar 02, 2015 9:36 pm

Annitenth wrote:[

I shouldn't jump into the fray here, because I am not at all knowledgeable about breast cancer. But my understanding is that the cancer described in (a) above simply doesn't exist. Cancer cannot be found, by any means currently available, until it has already been growing 10 years. However, if it is the kind that is going to spread, it has already started spreading by the sixth year. And once it has spread, if it's the killing kind, you're pretty doomed.

If you have a cancer diagnosis at year 10, and then get treatment, and survive, then you would have survived anyway without treatment (other than lumpectomy).

How many patients with lymph node involvement survive long term?

I hope someone can speak to this, because I'm basing my refusal to have more mammograms on this understanding.


As far as I understand it, if you have a faster-growing cancer, then you would be helped by earlier treatment. However, these very fast growing cancers are often not found in time even by mammography -- it all depends on the timing. I do think there's an advantage to treatment for a lot of cancers, I just can't find any good statistics on breast cancer mortality rates at the moment, and especially for different kinds of breast cancers. We know that breast cancer "incidence" when way up when mammography started being general practice (because mammograms found cancers that were never going to be a problem thus never diagnosed), and even now continues to go up slightly each year despite fact that late-stage cases don't decline (this again is the telltale sign of over-diagnosis). Also when HRT stopped being used much, breast cancer deaths went down significantly. But I'm not sure about the numbers of deaths now. If the number of deaths are decreasing like press releases make it seem, then it's because of the treatments available (since we know from the studies mentioned it's not because of screening).

To me the best stats to use to decide about getting a mammogram are the stats about mammograms. But of course they are generally for the typical woman, and each of us has to decide if we're typical, and whether we'd be more worried not getting a mammogram, etc.

Here are some stats re. zero lymph nodes involved or 4+ lymph nodes involved for a few different sized tumors. (more size tumors in the chart I'll link to, plus a column for 1-3 lymph nodes for each size tumor). The problem is, the stats are for 5-year survival rates which for the reasons we've given are not a good measure of much of anything. We don't know if women with smaller tumors and fewer lymph nodes survived 5 years because they were just caught earlier and they're going to die at same rate later, or whether treatment is helping. But what we do know is that even with a 100-mm tumor and 4+ nodes involved, the women are nearly 50% as likely to live 5 years as a woman with no breast cancer at all.

Tumor size o nodes 4+ nodes

1-4 mmm 100 76.6

10-19 mm 100 80.1

20-29 mm 95.4 72.7

100+ 83 46.6

More info on that and lots of other charts here, but again it's all based on 5-year survival rates which are very limited in use.

http://seer.cancer.gov/archive/publications/survival/seer_survival_mono_lowres.pdf

By the time a tumor is 20mm, a vast majority are palpable.

when a tumour was between 11 and 15 mm in size, 48% of the lesions were palpable, and with tumours greater than 20 mm in size, 84% were palpable.


http://www.ncbi.nlm.nih.gov/pubmed/8252194
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby dynodan62 » Mon Apr 13, 2015 8:45 am

f1jim wrote:It is very hard to grasp some of these concepts without thinking them through. But when you do the pieces fall into place.
Bridgetohealth clearly states the problems with looking at "survival" statistics. They are almost meaningless since they are all simply dictated by the time of diagnosis.
Our best treatments tend to extend the lives of cancer patients measured in months. And that's the best.
It's hard to swallow but for breast cancer it doesn't matter much when we find it. This appears to be counter intuitive, but it's not.
The nice thing about the H. Gilbert Welch book is it's explanation of all the terms we through out in evaluating procedures. 5 year survival, mortality, lead times, and the big elephant in the room, overdiagnosis. His book will unlock much of the world of studies to anyone that is confused by them. It tells you what the important numbers are in evaluating procedures and pills and which ones to ignore. It was eye opening to me.
f1jim


PBS radio report today had dualing 'expert' opinions re: early detection screening. A radiologist touting routine mammography claimed it reduced the 'death rate' 25%. Sounds like another case of 'spin', with #s dependent upon statistical semantics (?).
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby f1jim » Mon Apr 13, 2015 8:48 am

Gee, I wonder what a radiologists take is going to be regarding mammograms?(sic)
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby Skip » Mon Apr 13, 2015 11:35 am

Valter Longo is doing some interesting work with regards to treating cancer. By preceding chemotherapy with fasting, the normal cells of the body are more protected against the ravages of chemotherapy and the cancerous cells become less protected so the chemotherapy can destroy the cancer cells (in conjunction with the environment caused by fasting, lower IGF-1 and glucose levels)

https://www.youtube.com/watch?v=RjABM8UmBzI

https://www.youtube.com/watch?v=LGafhm1cuSI

Maybe this should be the start of a new thread as it is slightly off the topic but very much related to the issue of cancer.....
Last edited by Skip on Mon Apr 13, 2015 11:51 am, edited 2 times in total.
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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby hazelrah » Mon Apr 13, 2015 11:41 am

This related link came into my work email:

http://www.npr.org/blogs/health/2015/04 ... rtreatment

I work for an insurer, so take it with whatever grains of salt you choose, but it seemed relevent to this thread so there it is.


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Re: Does Mamography Reduce Mortality From Breast Cancer.

Postby Jumpstart » Mon Apr 13, 2015 12:22 pm

After reading and listening to Dr. McDougall, Jim and others on this board here is the conclusions you should draw if you're a woman.

Detection of breast cancer early doesn't give you a survival advantage so stop wasting time and money trying to track your cancer early. Wait until it makes its usual late stage physical appearance.

Forget about chemo or other drug treatment. It will do more damage than good and will shorten what time your have left. Surgery of any kind does nothing for survival and simply disfigures you.

If a change in diet doesn't cure your cancer nothing else will. Just get your life and order, sit back and wait to die.

Of course since early detection makes no difference to survival you can start that plant based diet once cancer becomes obvious at late stage. You'll still have the same survival as if you changed your way of eating five years earlier as a result of early detection, simply because early detection gives you no survival advantage. Use Ruth Heidrich as your example. Here is a woman with late stage cancer that had already spread. She made the mistake of having surgery, but saved herself even though late stage with a simple change of diet.
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