Does Mamography Reduce Mortality From Breast Cancer.

[f1jim]

Yes, that's correct. When it shows up on a scan it's already too late to be before possible metastasis.
Please read H. Gilbert Whelch and view Dr. McDoualls talk on breast cancer and it's progression. You are making the assumption of early detection millions make.
f1jim

[Jumpstart]

It is interesting to hear how women would handle breast cancer before they actually have it. You hear a lot of brave rhetoric. Just wait until the cancer is detected in you breast, I can guarantee you all that brave talk disappears and the fear that you'll have a long, lingering, disfiguring and painful death in less than five years takes hold. Then comes the "I wish I would have done something different.", but at that point it's too late for all that. You've got to live with the decisions you've already made, and NOW how LONG you'll live will depend on the new decisions.

You guys can afford to ignore early detection for breast cancer based on some lame studies. We on the other hand need every chance to get it as early as possible. If someone offers a breast cancer patient another 3 percent to the positive I'll lay you odds most women will take it. Tell a woman she'll get maybe another 6 months to a year of life if she is will to try something new and most will jump on it.

Before you believe any study or series of studies I recommend you read, Lies, Damned Lies, and Medical Science. Dr. Ioannidis has concluded that 90 percent of all studies are wrong, misleading, exaggerated or flat-out wrong. You might want to trust you life to those studies, but I'll take a pass. I spent a fair amount of time on this board noting how most studies are worse than lame and many of those support our way of eating. To me, bad science is bad science no matter who does it.

[bridgetohealth]

Is the study concluding that two years doesn't make a difference in mortality from breast cancer?

Robyn

Bingo.

Except that it's possibly worse -- this is breast cancer mortality. We know from other studies that mortality from other factors is a bit higher in the mammography group. So if mammograms don't help at all for breast cancer, then you're more likely to die if you get a mammogram.

Treatment is part of it, but the detection is, too -- they aren't detecting the cancers that respond to earlier treatments. They're detecting cancers that won't respond no matter what, or will respond anyway later. AND killing women with unneeded and unnecessary treatment at the same time. And lopping off part of their breasts. And giving them chemo and radiation and lifelong fear.

You take 1000 women who get yearly mammograms for 10 years and 50% of them will have a false positive! That's outrageous!

"One of the saddest lessons of history is this: If we’ve been bamboozled long enough, we tend to reject any evidence of the bamboozle. We’re no longer interested in finding out the truth. The bamboozle has captured us. It’s simply too painful to acknowledge, even to ourselves, that we’ve been taken."
-- Carl Sagan

[f1jim]

What is never a lie is how breast cancer cells replicate and grow into tumors that metastesize. We know the process well enough to know a mammogram gives no no early warning. That's an impossibility given the way cancer timelines work. You may think you are buying time but that is an error.
f1jim

[Jumpstart]

So, you don't think it is easier to control cancer when you've got a few thousand cells floating around instead of a few billion? You're saying just wait until they've taken over every organ in your body because it just won't make any difference? Have you ever seen someone who discovers their breast cancer after they get the physical symptoms? They're lucky if they make it past the first year. And that last year is miserably painful. They know they are waking dead. I see it every month from the newbies who find out late stage and join the group. How much chemo will it take to even start to control a cancer that has already taken over every major organ in your body? What's true for breast cancer must be true for all cancer. I guess we shouldn't bother with detection and just let it all happen. As I said, those are brave words for those that don't have cancer yet. Once you get cancer your whole world changes. Let me know how you feel about all this after you wife gets breast cancer. You want to cry now? Go to a breast cancer support group and watch the tears flow with the regrets about the decisions they DIDN'T make, not those they did. The single biggest regret is not catching it early. You catch it early you have a fair chance of 5 years, get it late and it'll be 6 months to a year. I don't need a study; I've seen it every month in my support group for the last eight years.

[f1jim]

I've actually seen both what you call early and late detection breast cancer. Survival in both cases. That's why I talk about the numbers, not anecdotes.
f1jim

[LowCarbIsDeadly]

Probably just best to stick to a Mcdougall diet to lessen your chances of ever getting breast cancer in the first place since we know the Standard American diet puts you a risk for certain cancers like breast.

[LowCarbIsDeadly]

https://www.youtube.com/watch?v=1wG9TI_qvBU

Here's a Mcdougall talk on the fallacy of early detection.

[bridgetohealth]

So, you don't think it is easier to control cancer when you've got a few thousand cells floating around instead of a few billion? You're saying just wait until they've taken over every organ in your body because it just won't make any difference? Have you ever seen someone who discovers their breast cancer after they get the physical symptoms? They're lucky if they make it past the first year. And that last year is miserably painful. They know they are waking dead. I see it every month from the newbies who find out late stage and join the group. How much chemo will it take to even start to control a cancer that has already taken over every major organ in your body? What's true for breast cancer must be true for all cancer. I guess we shouldn't bother with detection and just let it all happen. As I said, those are brave words for those that don't have cancer yet. Once you get cancer your whole world changes. Let me know how you feel about all this after you wife gets breast cancer. You want to cry now? Go to a breast cancer support group and watch the tears flow with the regrets about the decisions they DIDN'T make, not those they did. The single biggest regret is not catching it early. You catch it early you have a fair chance of 5 years, get it late and it'll be 6 months to a year. I don't need a study; I've seen it every month in my support group for the last eight years.

I know the idea is shocking, but yes,I personally am recommending against looking for illness in well people in almost all cases. IF you start from the premise that "all science is bad science," then of course you are already defending against any sort of argument,but then again it's "science" that brought us mammograms and cancer treatment, so it seems you aren't actually against all science. We all want to think we're special, so anytime we are diagnosed "early" with cancer we want to believe that we represent one of those those cases where early treatment actually prevents death. However, we are not all part of that group. Period. You do acknowledge that some people aren't helped by early detection, right? And sometimes mammograms don't detect soon enough (and as a matter of fact, the fastest-moving cancers are the ones mammograms are least likely to catch, unless we're going to have a mammogram every day or something). You do acknowledge that some people are treated unnecessarily because of either false positives, or they have cancers that don't need treatment, or will never respond to treatment, right? Part of this widespread false idea that medicine is so great at treating cancer gives women guilt for not getting mammograms sooner. Maybe providing education about the truth (mammograms don't prevent deaths) would ease at least that part of the pain that women feel when they're dying of breast cancer, but it seems that the people in your group are so blindly following science (what is medicine if not science?) that they won't even face the truth to help ease a dying woman's conscience. That is horrifying to contemplate -- increasing a woman's suffering to protect our own misconceptions about the infallibility of medicine, and it sounds like all the women in the group you go to partake in this.

I could give you all the statistics about the uselessness (or harms) of other kinds of screening (colonoscopies for example), but again since you started out saying that no type of study would persuade you, I'm not sure it's worth the effort. But even in the one area where I haven't seen evidence that the test shouldn't be done -- pap smears for cervical cancer screening -- they've drastically reduced the recommended frequency of those tests. Because again, it turns out that screening actually is more likely to help with slower-moving cancers rather than fast-moving ones.

[Spiral]

I could give you all the statistics about the uselessness (or harms) of other kinds of screening (colonoscopies for example), but again since you started out saying that no type of study would persuade you, I'm not sure it's worth the effort. But even in the one area where I haven't seen evidence that the test shouldn't be done -- pap smears for cervical cancer screening -- they've drastically reduced the recommended frequency of those tests. Because again, it turns out that screening actually is more likely to help with slower-moving cancers rather than fast-moving ones.

bridgetohealth,

Two questions (if you'd like I can start a new thread):

[1] What's your opinion on treatments for breast cancer once someone has been diagnosed? Surgery. Chemotherapy. Radiation. I'm guessing that your opinion would depend on the stage of the cancer and other factors.

[2] Care to elaborate on your opinion of colonoscopies? Many of us McDougallers might be tempted to skip the whole colonoscopy and perhaps even skip other screenings because we consume a high fiber diet and a healthy diet generally. On the other hand, we do have a participant in this discussion forum who was diagnosed with colon cancer despite being a McDougaller for many years prior to diagnosis.

[bridgetohealth]

I could give you all the statistics about the uselessness (or harms) of other kinds of screening (colonoscopies for example), but again since you started out saying that no type of study would persuade you, I'm not sure it's worth the effort. But even in the one area where I haven't seen evidence that the test shouldn't be done -- pap smears for cervical cancer screening -- they've drastically reduced the recommended frequency of those tests. Because again, it turns out that screening actually is more likely to help with slower-moving cancers rather than fast-moving ones.

bridgetohealth,

Two questions (if you'd like I can start a new thread):

[1] What's your opinion on treatments for breast cancer once someone has been diagnosed? Surgery. Chemotherapy. Radiation. I'm guessing that your opinion would depend on the stage of the cancer and other factors.

[2] Care to elaborate on your opinion of colonoscopies? Many of us McDougallers might be tempted to skip the whole colonoscopy and perhaps even skip other screenings because we consume a high fiber diet and a healthy diet generally. On the other hand, we do have a participant in this discussion forum who was diagnosed with colon cancer despite being a McDougaller for many years prior to diagnosis.

Well, first of all, no one's risk of any cancer is zero (well, your risk of cervical cancer is zero and my risk of testicular cancer is zero!) it's just that the higher risk you are then the more the benefits outweigh the risks of screening. So someone could be a strict McDougaller for 30 years and still get colon cancer, he or she would just be less likely to get it. I should point out that when giving my personal opinion on the matter I'm talking about people at normal risk. If I had a genetic disposition towards breast cancer then maybe I'd get a screening mammogram. Or at least I wouldn't think that in general it's not a good thing (whether I'd personally get the screening mammogram sort of depends on my answer to number one -- if all I'd do is try to eat better and include more garlic and onions -- http://nutritionfacts.org/video/1-anticancer-vegetable/ --maybe I should just do that anyway).

1) This is where I do agree with Jumpstart -- it's much easier to talk about this in the abstract, and most people when faced with the diagnosis will go the more conservative route. However, I know that Thrasymachus posted something awhile back about cancer treatment killing a large percentage of people that go through it (who otherwise wouldn't have died) and I know I've read a lot of surveys of oncologists who wouldn't personally choose the treatments they offer their patients, etc. So I would lean towards non-medical intervention, but like you say it depends on several factors of size prognosis etc. One thing is true that Dr McD. points out which is that usually when the surgeon or oncologist says "OMG you need surgery immediately!" that's not true, so I would carefully weigh my options and not race to the hospital. The percentage of women who spontaneously recover from breast cancer is quite large -- I think it's 20%. Then like I said there are those the treatment won't help anyway, either because it will kill them anyway, or because it's so slow-growing they'll die of something else in the meantime. Since I would have no way of knowing if I'm in the over diagnosis group or not, I probably wouldn't treat -- I'd rather that no one lop off part or all of my breast if it's not necessary. But I do agree that people change their minds when faced with the decision for real.

2)

Based on solid evidence, screening for colorectal cancer (CRC) reduces CRC mortality, but there is little evidence that it reduces all-cause mortality, possibly because of an observed increase in other causes of death.

That's from cancer.gov -- not some "radical" vegan guru! And that is referring to different kinds of screening, even fecal occult blood test!! How many doctors are aware of this?

So the question isn't whether we can get colon cancer (we can, just like I could get breast cancer despite being somewhat lower risk based on family history [though never having had a baby and thus never breastfeeding has also increased my risk]), it's whether screening does anything to save us: evidence is good enough that it doesn't that I'm not going to take any chances. Because for all of these, when we die from over diagnosis that is of course hastening our natural death.

The chart also shows that there is absolutely no mortality difference between sigmoidoscopy and colonoscopy, so if I were to get tested I would follow what Dr McD recommends and just get the sigmoidosopy.

The new DNA test real hadn't been used enough before a lot of these studies were done, so I'd be curious to see what studies show about that. I'm currently 50, and personally won't get screening until I'm 55, if then -- maybe I'd do the DNA if studies seem to suggest a benefit.The problem is that even the fecal occult blood test doesn't save lives because of the follow-up colonoscopies, so I'm not sure the DNA test will be much better, though it is more effective in finding cancers.

http://www.cancer.gov/cancertopics/pdq/screening/colorectal/HealthProfessional/page1

(BTW, I have a genetic disposition for glaucoma, which has been in 3 immediate family members -- a lot -- and I make sure to be screened for that. But that's because I'm 100% sure I would take the treatment if I were tested positive, which are just eyedrops, and the test is totally non-evasive. It's practically a perfect screening test. We can't ask for all screening tests to be that good, but they should be better than they are before they are as popular as they are. And the cervical cancer screening I mentioned is also non-invasive, and test 2 if you have an abnormal result is relatively non-invasive [a punch biopsy of cervix which hurts like hell for a few seconds to minutes, but if it has possible complications I'm sure the chances of them are minuscule]. Basically with a lot of these it's because of the next steps in the process, which are dangerous to do if unnecessary, that the benefits stop outweighing the risks. So I think that should be something to take into consideration. I'm assuming that that's also why Dr McD has occasional checks for skin cancer on his list of "Do's" for screening -- non-evasive and the next test is also not terribly evasive, even if it hurts temporarily)

[Jumpstart]

Sadly you have men on this board who read abstracts without understanding exactly what the study is NOT saying.

"A long-running Canadian study contending that annual screening in women aged 40 to 59 does not lower breast cancer death rates. For 25 years, the researchers followed nearly 90,000 women who were randomly assigned either to get screening mammograms or not."

Is this true? I have no doubt that it is, but that shouldn’t be the takeaway from this study. The reality is that for most women the best that current science can do is hold cancer at bay for a time. It can’t cure it…yet. What should the takeaway be? Based on this very study:

"Mammography detected many more invasive breast cancers,"

AND more importantly:

"Survival time was longer in women getting mammography."

Yes, 25 years later there was no difference in the number of dead, but those that were caught early lived longer than those who didn’t have testing to caught the cancer early. That additional time was precious to them, their husbands and children, but more importantly new drugs were being developed all the time. The only way of being around for those new drugs to used on you is to live longer.

I'm 52 years old and I really am not concerned if I'll be dead in 25 years. I do care about making it for another five, ten or even 15 years. I'd like to see my grandkids for a few more years and watch my children have more of them. I might see them graduate from grade school, high school maybe college. How about watching them get married. And in the interim science might come up with new stuff to give me another 5 or 10 years. I'm more than happy to take the extra years that testing has been proven to give me.

[f1jim]

What was the difference in survival times? That might be good to know. If it's 10 years that certainly is an important factor. If it's just a few weeks that is meaningless.
f1jim

[bridgetohealth]

Ok, first you say this:

90 percent of all studies are wrong, misleading, exaggerated or flat-out wrong. You might want to trust you life to those studies, but I'll take a pass. .

Then you say this, from the study that you said you wouldn't pay attention to:

"Survival time was longer in women getting mammography."

And it turns out of course, that your take-away is in fact the "bad science."

I just can't recommend enough Welch's book along with paying the $150 for access to March's ASW just to hear him talk. Along with Abramson's book. Because the idea of over diagnosis is so misunderstood even by doctors.

Umm, yes of course "survival time" is longer in the mammography group. 1) No one is denying that any "cancer" is going to be detected earlier in the mammography group. So if woman A and woman B both have the same cancer that is going to kill them no matter what on Jan 1 2025, and woman A is diagnosed on Jan 1 2001, and woman B is diagnosed on Jan 1 2015, then woman A survived longer !!! yay!! whoopee!! Yes, she had 14 additional years of the big C diagnosis with no benefit to her dying or not dying. Wow, thank God for modern medicine and thank God for all these decades of women's health being decided by men in white coats.

2) In the mammography group there were significantly more cancers being diagnosed. And these included cancers that weren't going to kill them anyway. So in the mammography group, you have additional women who are never going to die from breast cancer anyway. So you average in their 25 year "survival rate" (yippee, modern medicine again! Now we have 25 years of the big C diagnosis) with the others, and yes, those "with" cancer live longer on average, because they are averaging in the 25-year "survivors" of a cancer that will never kill them anyway.

"Mammography detected many more invasive breast cancers,"

Ha, ha ha. Can we all agree that if a woman dies of breast cancer, that she will (99.99% of the time) eventually be diagnosed with breast cancer? Our question is when she is diagnosed. If many more women are diagnosed with breast cancer than women who don't have mammography, it's because they are detecting "invasive" cancers that won't EVER kill them anyway. We want to know what "causes" cancer? The biggest "cause" of breast cancer is actually mammography! And then we can say it "saves lives" because more of these women (who have gotten unneeded radiation and chemo and had part or all of one or more breasts removed!) "survive" the cancer that was never an issue to begin with!

Sadly you have men on this board who read abstracts without understanding exactly what the study is NOT saying. ...

" I'd like to see my grandkids for a few more years and watch my children have more of them. I might see them graduate from grade school, high school maybe college. How about watching them get married. And in the interim science might come up with new stuff to give me another 5 or 10 years. I'm more than happy to take the extra years that testing has been proven to give me.

Sadly you have women who are so fooled by the medical industry. And while claiming that they're anti-science, won't believe the big scam and believe that science will actually save them!

From the study:

Although the difference in survival after a diagnosis of breast cancer was significant between those cancers diagnosed by mammography alone and those diagnosed by physical examination screening, this is due to lead time, length time bias, and over-diagnosis. At the end of the screening period, an excess of 142 breast cancers occurred in the mammography arm compared with the control arm, and at 15 years the excess remained at 106 cancers. This implies that 22% (106/484) of the screen detected invasive cancers in the mammography arm were over-diagnosed. This represents one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial. Assuming that nearly all over-diagnosed cancers in the Canadian National Breast Screening Study were non-palpable, 50% (106/212) of mammogram detected, non-palpable cancers were over-diagnosed.

(lead time and length time bias is number 1 of my example above and over diagnosis is number 2)

[f1jim]

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