Although it may sound like we are in the midst of a cancer crisis, the mortality data tell a very different, positive story: we are experiencing a triumph of modern medicine and there is less reason to start screening women in their 40s now than there ever was before.
I read this back in June when it was first published and it made me mad then, but re-reading it today after seeing it linked again in Adam's recent post on Churnalism, I got mad all over again. I do disagree on the pushback on screening generally but what really pisses me off is the rip on DCIS. Why is it that you docs continue to call it precursor or non-cancer? For many, a lumpectomy at the very least is a no-brainer but for others, radiation and/or tamoxifen (amazing at throwing young women into menopause!) etc are next steps - why on Earth would any of that be recommended for non-cancer? Also, are you honestly suggesting that if a woman is diagnosed with DCIS that she should just wait and watch? Wait for what...exactly? Wait for it to become invasive? Why on Earth would you suggest such a thing? Do you have a crystal ball that tells you when DCIS will be no big deal or when it will turn into something much worse? Are you thinking that "statistics" should be enough for a woman to sleep soundly and take no action with DCIS? Tell me you're not a woman with breast risks without telling me. Good Lord - my mother had a physician who thought like this ... so she waited, and guess what? Not only did her DCIS go invasive (and ultimately kill her) but also she got contralateral DCIS that then ALSO went invasive. Maybe you need to take care of a parent with metastatic disease to get it? Continuing to push the notion that DCIS is no big deal needs to stop, frankly. It can become a very big deal, otherwise I'd still have my mom on this Earth.
And, now the plot twist: I was just diagnosed with DCIS in January - at first the lesion was estimated to be 5-8mm based on U/S and biopsy....but guess what? Upon lumpectomy two months later, it was found to be 4.5cm and that was without clean margins. And no, no one could find it on physical exam - it was deep behind the nipple against my chest wall. Because radiation would do nothing to protect my other breast (and would potentially/likely cause other harms, let alone raise secondary cancer risks) and because I knew I had extensive density and ADH in both breasts (thank you mammography and MRIs), I opted for bilateral Mx. I also needed some nodes taken and am happy to report not only being node negative but more importantly all clean margins and that I am OUT of the cancer "business" matrix. No radiation or chemo needed and no looking over my shoulder every 6 months with screenings ..... but since those screenings saved my damn life, I'm thankful for them. And again, DCIS, call it what you want, but watching and waiting can be deadly for some....and you have no idea for which women that will be the case, and you need to own that.
What you docs could/should be doing is giving Bi-Rads scores as well as the exact Density Category on every mammography report - looking at Tyrer-Cuzick scores would make sense too - with all of those pieces in hand, every woman along with her care team would be able to make an educated and precise decision about her individual screening plan as well as risks if/when something is found ... You know, the thing called "informed consent" we're all entitled to. But, I guess it's easier to just give general recommendations and expect women to blindly follow, eh?
Sorry to rant, but you all can do better than this.
I would just caution you to remain open to new conclusions based on new data. My daughter, 33 years old, is in the midst of chemo treatment for a stage 3 breast cancer of a type normally found in much older (60+, post menopausal). Mastectomy and radiation to follow. Thyroid apparently also needs to be removed. Years of estrogen suppression meds. Horrific.
My son believes it I just 'bad luck' - statistically possible and so you are the 'normal' exception.
I am convinced that its appearance and especially its rapid growth are directly attributable to her aggressive Covid vaccine/booster adoption. Turbo cancer.
If I am right, then the history you cite is not nearly as relevant.
That is horrific and my heart goes out to your daughter and yourself. I can't even imagine. I am also of the belief that turbo cancers are real and need to be discussed. I have read that clinicians have seen a large uptick in childhood cancers during the years of '21-'22. Makes one wonder because we can't put them in the category of not getting annual cancer screenings during the covid years. I wish your daughter the best in fighting this insidious disease.
This article is about risk from CT scans which have 50x or more the radiation exposure of an x-ray. In pediatrics this has already been well-disseminated and we do not use CT's in children anymore without a very good reason. MRIs which have no radiation have become the new standard for almost all imaging in children.
I was glad you mentioned the over diagnosis of a lot of these cases. Happened to a friend of mine and it was traumatic. Now so many are getting tested for the BRCA1 gene. I think if it runs in your family you should have it on your radar. Other than genetics it would be nice to be able to better pinpoint other causes. There is something going on most likely with our environment causing so much cancer. I knew very few ppl with cancer growing up and now I know so many. As the saying goes we seem more concerned with treating the symptom and not the cause. Sabrinalabow.substack.com
I also have a friend over diagnosed with DCIS. It has put her in a tailspin. She was getting an MRI and Mamogram every six months with biopsies from those results. So far, all benign. She was given the advice to go on tamoxifen by a very young aggressive NP which put her in another tailspin. Now she's down to MRI/Mamo once a year but still deals with anxiety over it most of the year.
Daniel, I just used my Evernote app to essentially download the entire text you provided via the link. I will read it with much interest. What is needed, in my opinion, are biological markers of disease such as what I have used over 40 years in the evaluation and treatment of men with prostate cancer. Despite what some articles might say, the PSA blood test, when done properly, and when simple derivates such as PSA doubling time (PSADT), PSAV (PSA velocity) and PSA density (PSAD) are used, is a highly sensitive and reliable tool to discern if a man's prostate gland is abnormal. There are tools available that are improperly used or not used at all. Despite my keen interest in imaging, it is a far less sensitive tool to understand an individual's status and suffers too from the variability in human talent insofar as interpretation as well as the quality of the hardware used. But perhaps if we use artificial intelligence (AI) and machine learning (ML) intelligently, with high quality equipment, and with interval sampling of a radiologist's readings for accuracy, we can better use the tool of imaging.
Thank you. You should keep in mind that my point of view is scientific. I am not trying to go directly to the solution of what is the best attitude for patients, but to determine what data we have regarding the risk of radiological examinations and what are the conclusions. The conclusions are very clear and raise another question: why can't we talk about it? https://danielcorcos.substack.com/p/radiation-the-other-conspiracy-of
A pleasure to read. We physicians have oversold screening. Especially oversold its ability to prolong a happy life. We’re great at diagnosing and labeling based on screening. We’re much less successful at using screening to meaningfully prolonging life and we always ignore the problems we have created by trying to screen, and screen, and screen. The future for populations is not screening, it’s lifestyle, aided by therapeutics.
The Canadian breast cancer screening study shows the limits in screening in a modern population while the marvelous achievements of our oncologist colleagues are the answer.
Likewise no more Pap smears. HPV vaccines +HPV self screening every 5 years or less as we move forward.
HPV vaccines? Have you read the book "The HPV Vaccine On Trial: Seeking Justice For A Generation Betrayed"? This book is an eye-opener, describing the serious and sometimes deadly side affects of HPV vaccine whose health value has apparently never been properly clinically proven.
From the Vaccine Adverse Event Reporting System (VAERS): Since Gardasil came on the USA market in 2006, there has been >450 deaths reported and over 61,000 serious medical conditions from HPV vaccines.
Further, in 2009 HPV vaccines were administered to tribal girls in India, as part of clinical trial without informed consent. This led to major side effects including death.
I find it annoying that medical reporting fixates so much on RR. I get that it’s click-bait-y and you attract eyeballs when you say “breast cancer deaths DOUBLED” or whatever. But double a really small number still gets you a really small number. I need the ARR to know what benefit we are talking about. And this article does that nicely.
If there are subsets that harbor a particularly high risk, such as younger black women, then perhaps the more aggressive recommendations should target that particular subset, rather than a generic change that targets everybody, when not everybody stands to benefit. If you acknowledge the harms of screening, as USPSTF seems to do, then their recommendations should reflect those countervailing concerns.
Imagine if all of the medical organizations we have could establish that reporting relative risk without reporting absolute risk was unethical and all health publications were required to adhere to the principle. Small increment in the road back from poor health publications and misleading journalism. What do you think?
While I agree with what you are saying for the most part I think offering screening to a particular subset of the population can prove problematic. Just like how the vaccine, at least in California, was originally set up that First responders, teachers and the black community would be first in line. There are alot of non black women out there who would feel that they need screening just as much for reasons of their own...family history etc. Again, allowing women to get screened based on race is not a good strategy, IMO. It needs to be offered to every eligible woman and then they can decide if it's right for them.
Can you clarify the graphs showing mortality time trends? Mortality is expressed as Deaths per 100,000, so it clearly (and appropriately) is mortality in the population, NOT mortality among those diagnosed. Therefore, I think the X-axis should just be labeled "Year", not "Year of Diagnosis," as the vast majority of the population will never have been diagnosed.
Mortality by year of diagnosis would be expected to show a downward trend simply because those diagnosed more recently would have had shorter follow-up times!
Thank you for pointing this out, Tom. The x-axis is indeed mislabeled. It should simply be 'Year' and not 'Year of diagnosis'. These labels are added automatically when you generate the graphs on the WHO/IARC web site (see: https://gco.iarc.fr/en) but I should have caught it myself before posting of course. There is a lot of interesting data on there to play around with. You should try it out!
Still not sure I follow. How does figure 1 show greater benefits for younger women? The absolute mortality difference is not smaller in this group. Is this based on RRs? If so how is this justified?
If you look at the decline in breast cancer mortality over time in figure 1, it has been largest in the youngest age group, from about 20 to 12 per 100,000 women, or a 59% reduction) and reductions are getting gradually smaller in older age groups (for example from about 110 to 62 per 100,000 women aged 65 to 69 years, or a 53% reduction). In Canada (data from which the graphs depict), younger women have generally been screened far less than those aged 50 to 74 years. If breast screening was the main cause of declines, we would expect the largest reductions in age groups most likely to benefit. But universally, declines have been largest in younger women, regardless if they have been screened or not. This fits with all age groups having access to improved therapy and younger women benefitting more, not with screening being a major contributor this this incredible success story.
Any risk reduction has to be seen in relation to the base risk. The RR reduction is not meaningful unless you know the base risk, which is what I think you refer to? The base risk is of course much, much lower in younger women. So, even if the relative risk reduction (or percentual risk reduction) is greater in younger women, the absolute risk reduction might be larger. However, when we compare effects between age groups, it is the differences in relative risk reductions we need to look at. Did that answer your question?
I was confused, I apologize. What I’m not clear on is how you relativized the data. If mortality rates aren’t normalized by age group, you cannot meaningfully compare them. From the description of figure 1 I cannot tell whether that has been done. Can you clarify?
The mortality (<0.1%/year) in some age groups is too low to be only breast cancer patients. I think the Y-axis is labeled correctly (i.e., breast cancer deaths per 100K, it's the X-axis that's wrong/inconsistent.
Somewhat related; I’m interested if any studies were done on the health of individuals in general during the time of isolation during COVID. I expect that folks would actually be healthier!
It is hard to find something as dumb as that but here are a couple more that can compete on the absurdity meter. We still stop sporting events when a player gets a drop of blood on his uniform and out comes the trainer, or even worse, the team doctor, of course wearing gloves, to scrub away the offending spot. Tennis fans can probably remember the barbaric practice of having ball boys bring a towel out for the players on hot days. Covid changed that---apparently for good. Players must now walk over to the corner of the court where each player has his designated box for towels. Keeping with the tennis theme, during the early days of covid hysteria we were of course advised not to play at all. Then some thoughtful person came up with idea of each player having his own specially marked ball so that there could be no passage of infection by touching the same ball. Naturally we were also told that changing sides of the court where we might pass within shouting distance of the other player was too risky and we should take care to use opposite sides of the court to complete this movement. I actually witnessed adult tennis players following these dictates (also wearing masks).
It is not screening but using the population of women biological and family history to categorize risk. For example, a woman with a strong family history of breast and/or prostate cancer as well as women with homogeneously dense breast tissue have a greater risk of breast cancer. There also may be additional risk factors such as visceral obesity. The use of artificial intelligence (AI) and other tools like artificial neural nets (ANNs) can help to stratify those at greatest risk.
The next issue is whether mammography really is the best tool to assess such higher risk women. I think we need to look at the results of abbreviated breast MRI and understand the major gains made with multi-parametric MRI (mp-MRI) in the brother-sister disease of prostate-breast cancer. With MRI you not only have no radiation exposure, but also the benefit of DWI (diffusion weighted imaging) and apparent diffusion coefficient (ADC) to better characterize a lesion. I have seen too many women with breast cancer that was missed by mammography, but picked up by MRI. I think the European physicians in the breast MRI field are about 10 years ahead of the American investigators, just as the use of MRI in prostate was led by those in Europe. Here in the US, we have to get over the NIH (not invented here) syndrome and look at the world peer-reviewed literature.
Thank you so much for your complete answer! I had just made a comment about my sister and her struggles to get care, even though she lived in the Greater Cleveland, Ohio area at the time.
You are inspiring me on a rather down day.
As you likely saw, I have worked in many places in the USA and was premed and do have a biology degree. I am also a Certified Case Manager. I constantly read research- especially in immunology. My brother is a researcher at the Smithsonian.
So what I am wanting to do is help patients collaborate with their Drs and I thought no that is the way to achieve better outcomes.
Yes, I have seen just so much that could be prevented. My next article will be about my husband's prostate issues and reference research.
I just retired from being a cancer doc (medonc) x 60 years. I originally started in hematopathology, transitioned to being focused on HD (Hodgkin’s disease) and then spent 40 years working with thousands of patients and attempting to educate both patients and physicians about prostate cancer. You can find two patient-oriented books I authored or co-authored on Amazon.
What we physician/scientist fail so badly at is translational medicine (TM)-- taking what others have learned and published about and getting it into mainstream (aka real world) medicine. What we can learn from one cancer can be applied to many others. I learned so much about prostate cancer from the breast cancer literature and vice versa. I also learned to always be open to what a lay person can teach us in the medical profession. My involvement in prostate cancer came about as a result of reading a newspaper clipping a patient brought to my office.
What has happened in the US, and perhaps in the world, is a downward trend in the care of the patient and more of a focus on big business involvement in the monetary gains involved in medical care. It is shameful. As a hematologist/oncologist that was diagnosed not long ago with an often rapidly fatal malignancy, I was shocked at what I had to endure and the consequences of poorly thought out treatment "strategy." A quote I heard today sums up so much of what is wrong with today's medicine:
“By failing to prepare, you are preparing to fail.” Ben Franklin
Another quote relates to what seems so often missing in today's "what's in it for me" society:
“You are not required to finish your work, yet neither are you permitted to desist from it.” Pirkei Avos (Ethics of the Fathers)
And yes, meeting you on this forum and knowing I may have made a difference in your experience is a boost to morale.
I hope that we can share some ideas that may serve to help others. I would like to know your thoughts on plastics and ultra processed foods. I have followers on LinkedIn that send me research articles and the first thing I look for is who paid for the study. I have observed that this is not as ethical as it once was.
I just woke up and have not had coffee but I want to offer you to reach out to me.
We live in a world of carcinogens. Much of the food we get is heavily processed and typically fruit and vegetables are picked premarturely before the plant's anti-oxidant system has reached its potential. We would move water in our country via conduits from rivers that flood, and do what the Khmer civilization did and create a new great lakes system and create organic farmlands and also grass-fed or open-range beef or other animal industry. Most people do not know that grass-fed beef contains all omega-3 fatty acids and no harmful omega-6 fatty acids. Most restaurants in the US cook with seed oils that are high in linoleic acid (LA) and this is the prevalent omega-6 fatty acids-- these are the eicosanoids that are pro-inflammatory and that foster malignancy. Inflammation and cancer go hand-in-hand.
We could check the fatty acid status of chidren, adolescents and adults in this country by making the appropriate lab testing affordable and accessible. If this were done with the young female population in the US, we would see very high levels of LA and ratios of critical fatty acids indicative of a biological milieu that is the perfect storm for a tumor microenvironment (TME). For example, AA/EPA is the ratio of the omega-6 fatty acid arachidonic acid to the omega-3 fatty acid called eicosapentaenoic acid (EPA). Optimal AA/EPA is about 1.5-2. Most patients with cancer that I see walk into my office with AA/EPA ratios of 20:1 or 40:1. w-6/w-3 is the ratio of omega-6 fatty acids to omega-3 fatty acids. LA/DHA is the ratio of the omega-6 fatty acid "LA" to the omega-3 fatty acid DHA. Optimally, LA/DHA should be ≤ 10. I often see ratios of 30:1. We can alter the patient's milieu with the use of fish oil, and/or altering the diet to higher intakes of cold water fish like salmon, herring, sardines. The Mayo Medical Labs does a comprehensive fatty acid profile (CFA) but it is costly. See http://bit.ly/1AtZ7 for a link to that Mayo Labs test.
I am not an expert on plasttics and carcinogenesis. Doing a simple PubMed search using "plastics" AND carcinogenesis will bring you to search findings that should lead to additional references. We could do a lot in our world to make it as wonderful as it is by Nature. But after 81 years on this planet, It seems that humanity (human unity) is an endangered characteristic of H. sapiens.
..."not with screening as a cornerstone of modern health care."...modern health, such as it is, basically relies on endless testing as they insist you get tested/screened for everything under the sun, especially as you age. They work overtime to instill the fear factor so as to convince the majority that they will die of some horrible affliction that only "modern" medicine can cure.
This is the very reason I no longer trust the allopathic medicine model.
Allopathic medicine has morphed into a state where it's mostly about profits, drugs, machines, fear of disease; not about healing and health, I'm afraid.
Diet, lifestyle, activity, sunshine, mindfulness: these are the pillars of health.
I’m not a cancer doc. But someone finding a lump would no longer be in a “screening” discussion. Screening is for completely asymptomatic people. Having a lump is a “symptom” (well, technically a “sign”), and that person now needs diagnostic testing rather than merely a screening test.
Exactly. Screening involves taking women without symptoms off the street and running a test to look for a disease they do t know they have, on the theory that intervening early is better than waiting for symptoms to appear.
Someone who has a lump is by definition symptomatic. In that case, it’s not screening, it’s investigation and diagnosis. Totally different thing!
I’m just here to say that mammography does not catch invasive lobular breast cancer, which is something under 1/6 of breast cancer. So if you feel a lump or a mass, get an ultrasound. Do it immediately. ILC tends to make strands that evade detection by mammography until it suddenly forms a mass, which can be large by that point. If this describes you, call your doctor today!
A routine screening using 3D mammography caught my 5mm Stage 2B invasive lobular carcinoma which had spread to 2 lymph nodes in 2021. All the more shocking due to no palpable lump. While I also read all I can regarding ILC as well as the debate on the value of routine screening, I will and do advocate for the continued use of it.
Dear Donna, a 5 cm lump should have been detected by self-breast exam or by the physician's exam. Today's medicine is moving further and further away from patients being actually touched by the physician. In the last six years of seeing many MDs, I have had only one MD examine my ankles for edema without my socks on, or listening to my lungs and not through my shirt. Not one has looked into my mouth, ears or checked my eyes.
There is no question that mammography using good equipment and having an experienced radiologist focused on mammograms is a tool that is of value. There is no question either that breast MRI is also of value. Do we need the sequence of mammorgram ⇢ breast MRI every year or alternating or does one show superiority over the other? These are questions that could be easily answered in a clinical study (ies) if they were conducted (maybe they are).
What I see is every center doing its own thing. Instead of working together to solve problems that affect the health and life of millions, we vie with each other. So much of what we could have learned about COVID-19 to prevent the deaths of millions was negated by such a lack of unity. My mantra has been and always will be: Our humanity lies in our human unity.
Stephen, I appreciate your comment and totally agree with most of what you said, as I’ve experienced much of what you described. My point in commenting was that while I SHOULD have had a palpable lump, I didn’t. And it wasn’t for lack of monthly self exams or neglect of my GYN doing a thorough breast exam. She did, and ordered a routine screening only due to the length of time since my last screening and a family history of breast cancer. I’ve learned through much reading that ILC behaves very differently than IDC and I’m glad more research is being done on this “sneaky” type of breast cancer, which is the word I frequently heard from my oncologist and seen in my reading. Which is why I will continue to advocate for routine screening, whether via mammogram or MRI. Blessings to you and your wife
Correct me if I am mistaken, but breast MRI is a far more sensitive imaging exam than mammography for invasive lobular breast cancer. Having been in cancer medicine x 60 years I have had the experience of seeing the changes in accuracy over decades as we have gone from routine x-ray to whole organ tomography, to CT, Ultrasound, and most recently to MRI with the parameters of DWI (diffusion weighted imaging) and DCE (dynamic contrast enhancement). Far more valuable biologic information is obtained with multi-parametric MRI (mp-MRI) then with other modalities. In my opinion, even PET-CT should be replaced with PET/MRI because more information is very typically helpful to optimize strategies of treatment.
That depends on the insurance company. Because my wife has homogeneously dense breast tissue, I was able to find a center specialized in abbreviated breast MRI. No ultrasound was required. Often insurances require mammography first, or now with my wife's current insurance it allows for every other year mammography alternating with abbreviated breast MRI. Only a clinical trial that addresses this methodoligical issue will provide answers.
Also, if an insurance denies an abbreviated breast MRI, the MD can provide peer-reviewed papers to support its "authorization." Such an appeal process is time-consuming but it does work. I used it to obtain early access to both testing and treatment for men with prostate cancer in Southern California and had Medicare via TransAmerica approve tests and treatments that otherwise would have been denied.
Age 60, just diagnosed with invasive lobular based on a “Fast MRI”. Stage I, would not have shown up on mammogram until Stage III.
As far as the point about “over diagnosis” just ask women how they feel about leaving a breast cancer in their body that “likely” would not have gone anywhere or needed treatment. I bet you don’t get many who say they are fine with that.
Firstly, I hope you crush this cancer quickly! Good luck and best wishes!!!
On the “ask women” part, I disagree on conceptual grounds (I am a man but I think that is irrelevant here). The question is not, “should women who are concerned be allowed to get screened?”. I think we all would agree they should be allowed if they would like to. I think the question here is, “should medicine recommend every woman of a certain age get screened?”.
There should be evidence that shows a net benefit for the women for whom medicine recommends screening.
There is a similar story, perhaps, on prostate screening using a PSA blood test for men. It used to be recommended routinely for men above some fairly young age. Eventually the data showed more harm than good. So the recommendation was dropped. But obviously men are still allowed to get this bloodwork done if they would like.
Anyway, again, I hope you quickly defeat this cancer. Best regards,
Edward, please don't confuse the message with the messenger. Finding prostate cancer vis-à-vis the PSA and its derivatives did not and does not have to equate with over-treatment by an uninformed and often greedy medical doctor or medical center. Often such patients can be "treated" with diet and lifestyle changes that alter the individual's biological milieu. We are just recently also learning the importance of the gut and bladder microbiome on the "establishment" of cancers of the prostate and bladder.
After the decision to stop PSA screening, there has been a surge in advanced prostate cancer and death due to PC. In medicine, we have to follow what we are taught (or tried to be taught) in med school: Primum Non Nocere or First (above all) Do No Harm.
Good medicine is like the popular CSI series on TV. We in the medical field must learn to profile individual patients using the available tools-- from family history, to genetic assessments, to patient input, physical exam, baseline and follow-up labs looking for trends, and also the benefits of artificial intelligence (AI) and machine learning (ML). I was diagnosed very late with.a rare and horrendous B-cell malignancy called light chain amyloidosis (AL). Using my history, and an AI program on the Internet (Symptoma), the diagnosis of AL was the top choice of what I had. An earlier diagnosis would have changed my life immensely.
Insurance often does not cover. When I have insurance through work and was asked if anyone in my family had breast cancer. I answered yes so my mammogram coverage was denied payment due to family history.
If there is any symptom at all, then it is no longer screening. It is diagnostic and no longer free, but goes to the insurance and subject to deductibles and co-pays, etc. even when people are in for their screening mammogram and they find something it often switches to a diagnostic and then people are stuck with bills. It is frustrating.
They are- in past 10 years most breast cancer screenings are performed using 3D mammography which detects more cancers at smaller sizes, results in fewer false positive readings (and fewer call backs for repeat imaging)- it’s become the standard of care- ask your screening center what is being used.
The value of mammography relates to the detection of calcifications associated with malignancy. If we are to be scientific in this discussion we should do a dedicated search using PubMed (see http://www.ncbi.nlm.nih.gov/pubmed) or Google Scholar to see if there is a head-to-head study of 3D mammography vs. abbreviated breast MRI (what Susan referred to as "fast MRI." We should see if such a comparison study was ever done.
You missed one point. The main reason why the screening age has been lowered is that there are more and more rapidly progressing breast cancers in women under 40. This will continue as long as we do not recognize the risk of cancer linked to X-rays, these cancers being probably due to the widespread use of CT scans. You continue to participate in the omerta on this subject.
A suggestion: your comment would be improved if you listed actual data, or references to it, etc. I think you are wrong but I am a moron and an idiot, so likely it is me who is wrong. But still, without data, I (and others) have an easy time disregarding your comment.
I read this back in June when it was first published and it made me mad then, but re-reading it today after seeing it linked again in Adam's recent post on Churnalism, I got mad all over again. I do disagree on the pushback on screening generally but what really pisses me off is the rip on DCIS. Why is it that you docs continue to call it precursor or non-cancer? For many, a lumpectomy at the very least is a no-brainer but for others, radiation and/or tamoxifen (amazing at throwing young women into menopause!) etc are next steps - why on Earth would any of that be recommended for non-cancer? Also, are you honestly suggesting that if a woman is diagnosed with DCIS that she should just wait and watch? Wait for what...exactly? Wait for it to become invasive? Why on Earth would you suggest such a thing? Do you have a crystal ball that tells you when DCIS will be no big deal or when it will turn into something much worse? Are you thinking that "statistics" should be enough for a woman to sleep soundly and take no action with DCIS? Tell me you're not a woman with breast risks without telling me. Good Lord - my mother had a physician who thought like this ... so she waited, and guess what? Not only did her DCIS go invasive (and ultimately kill her) but also she got contralateral DCIS that then ALSO went invasive. Maybe you need to take care of a parent with metastatic disease to get it? Continuing to push the notion that DCIS is no big deal needs to stop, frankly. It can become a very big deal, otherwise I'd still have my mom on this Earth.
And, now the plot twist: I was just diagnosed with DCIS in January - at first the lesion was estimated to be 5-8mm based on U/S and biopsy....but guess what? Upon lumpectomy two months later, it was found to be 4.5cm and that was without clean margins. And no, no one could find it on physical exam - it was deep behind the nipple against my chest wall. Because radiation would do nothing to protect my other breast (and would potentially/likely cause other harms, let alone raise secondary cancer risks) and because I knew I had extensive density and ADH in both breasts (thank you mammography and MRIs), I opted for bilateral Mx. I also needed some nodes taken and am happy to report not only being node negative but more importantly all clean margins and that I am OUT of the cancer "business" matrix. No radiation or chemo needed and no looking over my shoulder every 6 months with screenings ..... but since those screenings saved my damn life, I'm thankful for them. And again, DCIS, call it what you want, but watching and waiting can be deadly for some....and you have no idea for which women that will be the case, and you need to own that.
What you docs could/should be doing is giving Bi-Rads scores as well as the exact Density Category on every mammography report - looking at Tyrer-Cuzick scores would make sense too - with all of those pieces in hand, every woman along with her care team would be able to make an educated and precise decision about her individual screening plan as well as risks if/when something is found ... You know, the thing called "informed consent" we're all entitled to. But, I guess it's easier to just give general recommendations and expect women to blindly follow, eh?
Sorry to rant, but you all can do better than this.
Comment isn’t easy on this site
I would just caution you to remain open to new conclusions based on new data. My daughter, 33 years old, is in the midst of chemo treatment for a stage 3 breast cancer of a type normally found in much older (60+, post menopausal). Mastectomy and radiation to follow. Thyroid apparently also needs to be removed. Years of estrogen suppression meds. Horrific.
My son believes it I just 'bad luck' - statistically possible and so you are the 'normal' exception.
I am convinced that its appearance and especially its rapid growth are directly attributable to her aggressive Covid vaccine/booster adoption. Turbo cancer.
If I am right, then the history you cite is not nearly as relevant.
That is horrific and my heart goes out to your daughter and yourself. I can't even imagine. I am also of the belief that turbo cancers are real and need to be discussed. I have read that clinicians have seen a large uptick in childhood cancers during the years of '21-'22. Makes one wonder because we can't put them in the category of not getting annual cancer screenings during the covid years. I wish your daughter the best in fighting this insidious disease.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749234
That is why the silence about the risk of x-rays is a crime.
This article is about risk from CT scans which have 50x or more the radiation exposure of an x-ray. In pediatrics this has already been well-disseminated and we do not use CT's in children anymore without a very good reason. MRIs which have no radiation have become the new standard for almost all imaging in children.
I was glad you mentioned the over diagnosis of a lot of these cases. Happened to a friend of mine and it was traumatic. Now so many are getting tested for the BRCA1 gene. I think if it runs in your family you should have it on your radar. Other than genetics it would be nice to be able to better pinpoint other causes. There is something going on most likely with our environment causing so much cancer. I knew very few ppl with cancer growing up and now I know so many. As the saying goes we seem more concerned with treating the symptom and not the cause. Sabrinalabow.substack.com
I also have a friend over diagnosed with DCIS. It has put her in a tailspin. She was getting an MRI and Mamogram every six months with biopsies from those results. So far, all benign. She was given the advice to go on tamoxifen by a very young aggressive NP which put her in another tailspin. Now she's down to MRI/Mamo once a year but still deals with anxiety over it most of the year.
The BRCA1 gene codes for a protein involved in DNA repair after breakage by X-rays. Its mutation makes you even more sensitive to mammography X-rays.
This was a great article. so well written and understandable. Please keep this stuff coming. Please ignore all non-sensible comments.
Daniel, I just used my Evernote app to essentially download the entire text you provided via the link. I will read it with much interest. What is needed, in my opinion, are biological markers of disease such as what I have used over 40 years in the evaluation and treatment of men with prostate cancer. Despite what some articles might say, the PSA blood test, when done properly, and when simple derivates such as PSA doubling time (PSADT), PSAV (PSA velocity) and PSA density (PSAD) are used, is a highly sensitive and reliable tool to discern if a man's prostate gland is abnormal. There are tools available that are improperly used or not used at all. Despite my keen interest in imaging, it is a far less sensitive tool to understand an individual's status and suffers too from the variability in human talent insofar as interpretation as well as the quality of the hardware used. But perhaps if we use artificial intelligence (AI) and machine learning (ML) intelligently, with high quality equipment, and with interval sampling of a radiologist's readings for accuracy, we can better use the tool of imaging.
Thank you. You should keep in mind that my point of view is scientific. I am not trying to go directly to the solution of what is the best attitude for patients, but to determine what data we have regarding the risk of radiological examinations and what are the conclusions. The conclusions are very clear and raise another question: why can't we talk about it? https://danielcorcos.substack.com/p/radiation-the-other-conspiracy-of
A pleasure to read. We physicians have oversold screening. Especially oversold its ability to prolong a happy life. We’re great at diagnosing and labeling based on screening. We’re much less successful at using screening to meaningfully prolonging life and we always ignore the problems we have created by trying to screen, and screen, and screen. The future for populations is not screening, it’s lifestyle, aided by therapeutics.
The Canadian breast cancer screening study shows the limits in screening in a modern population while the marvelous achievements of our oncologist colleagues are the answer.
Likewise no more Pap smears. HPV vaccines +HPV self screening every 5 years or less as we move forward.
HPV vaccines? Have you read the book "The HPV Vaccine On Trial: Seeking Justice For A Generation Betrayed"? This book is an eye-opener, describing the serious and sometimes deadly side affects of HPV vaccine whose health value has apparently never been properly clinically proven.
From the Vaccine Adverse Event Reporting System (VAERS): Since Gardasil came on the USA market in 2006, there has been >450 deaths reported and over 61,000 serious medical conditions from HPV vaccines.
Further, in 2009 HPV vaccines were administered to tribal girls in India, as part of clinical trial without informed consent. This led to major side effects including death.
Thanks. Good ideas. I put more specifics in but site ate them. Serious AE 2 per 100,000–in range for a cancer vaccine.
I find it annoying that medical reporting fixates so much on RR. I get that it’s click-bait-y and you attract eyeballs when you say “breast cancer deaths DOUBLED” or whatever. But double a really small number still gets you a really small number. I need the ARR to know what benefit we are talking about. And this article does that nicely.
If there are subsets that harbor a particularly high risk, such as younger black women, then perhaps the more aggressive recommendations should target that particular subset, rather than a generic change that targets everybody, when not everybody stands to benefit. If you acknowledge the harms of screening, as USPSTF seems to do, then their recommendations should reflect those countervailing concerns.
Imagine if all of the medical organizations we have could establish that reporting relative risk without reporting absolute risk was unethical and all health publications were required to adhere to the principle. Small increment in the road back from poor health publications and misleading journalism. What do you think?
While I agree with what you are saying for the most part I think offering screening to a particular subset of the population can prove problematic. Just like how the vaccine, at least in California, was originally set up that First responders, teachers and the black community would be first in line. There are alot of non black women out there who would feel that they need screening just as much for reasons of their own...family history etc. Again, allowing women to get screened based on race is not a good strategy, IMO. It needs to be offered to every eligible woman and then they can decide if it's right for them.
Thanks for this thoughtful post.
Can you clarify the graphs showing mortality time trends? Mortality is expressed as Deaths per 100,000, so it clearly (and appropriately) is mortality in the population, NOT mortality among those diagnosed. Therefore, I think the X-axis should just be labeled "Year", not "Year of Diagnosis," as the vast majority of the population will never have been diagnosed.
Mortality by year of diagnosis would be expected to show a downward trend simply because those diagnosed more recently would have had shorter follow-up times!
Thank you for pointing this out, Tom. The x-axis is indeed mislabeled. It should simply be 'Year' and not 'Year of diagnosis'. These labels are added automatically when you generate the graphs on the WHO/IARC web site (see: https://gco.iarc.fr/en) but I should have caught it myself before posting of course. There is a lot of interesting data on there to play around with. You should try it out!
Best
Karsten
Still not sure I follow. How does figure 1 show greater benefits for younger women? The absolute mortality difference is not smaller in this group. Is this based on RRs? If so how is this justified?
If you look at the decline in breast cancer mortality over time in figure 1, it has been largest in the youngest age group, from about 20 to 12 per 100,000 women, or a 59% reduction) and reductions are getting gradually smaller in older age groups (for example from about 110 to 62 per 100,000 women aged 65 to 69 years, or a 53% reduction). In Canada (data from which the graphs depict), younger women have generally been screened far less than those aged 50 to 74 years. If breast screening was the main cause of declines, we would expect the largest reductions in age groups most likely to benefit. But universally, declines have been largest in younger women, regardless if they have been screened or not. This fits with all age groups having access to improved therapy and younger women benefitting more, not with screening being a major contributor this this incredible success story.
Thank you. But my question was what justifies using relative risk reduction instead of absolute risk reduction to claim an age-related benefit?
Any risk reduction has to be seen in relation to the base risk. The RR reduction is not meaningful unless you know the base risk, which is what I think you refer to? The base risk is of course much, much lower in younger women. So, even if the relative risk reduction (or percentual risk reduction) is greater in younger women, the absolute risk reduction might be larger. However, when we compare effects between age groups, it is the differences in relative risk reductions we need to look at. Did that answer your question?
I was confused, I apologize. What I’m not clear on is how you relativized the data. If mortality rates aren’t normalized by age group, you cannot meaningfully compare them. From the description of figure 1 I cannot tell whether that has been done. Can you clarify?
The captions say “breast cancer mortality” so it should mean all-cause deaths per 100k diagnosed with breast CA.
I think mortality by “year of diagnosis” gives some flavor of aggressiveness of disease, which you would lose with mortality by “year of death”.
Dear Steve,
The mortality (<0.1%/year) in some age groups is too low to be only breast cancer patients. I think the Y-axis is labeled correctly (i.e., breast cancer deaths per 100K, it's the X-axis that's wrong/inconsistent.
Somewhat related; I’m interested if any studies were done on the health of individuals in general during the time of isolation during COVID. I expect that folks would actually be healthier!
Thank you. Dr. Jørgensen essay was thoughtful treatment of issue.
Humans are not innately equipped to make sense of mortality risks w/ low incidence.
Fig.2 20-24 yro. Imagine urns of beads 2005 (2 red of 10 000 000) & for 2015 (15 red of 10 mil).
How many draws would you need to make to tell difference between urns?
We are still taking our shoes off at airports in US.
It is hard to find something as dumb as that but here are a couple more that can compete on the absurdity meter. We still stop sporting events when a player gets a drop of blood on his uniform and out comes the trainer, or even worse, the team doctor, of course wearing gloves, to scrub away the offending spot. Tennis fans can probably remember the barbaric practice of having ball boys bring a towel out for the players on hot days. Covid changed that---apparently for good. Players must now walk over to the corner of the court where each player has his designated box for towels. Keeping with the tennis theme, during the early days of covid hysteria we were of course advised not to play at all. Then some thoughtful person came up with idea of each player having his own specially marked ball so that there could be no passage of infection by touching the same ball. Naturally we were also told that changing sides of the court where we might pass within shouting distance of the other player was too risky and we should take care to use opposite sides of the court to complete this movement. I actually witnessed adult tennis players following these dictates (also wearing masks).
It is not screening but using the population of women biological and family history to categorize risk. For example, a woman with a strong family history of breast and/or prostate cancer as well as women with homogeneously dense breast tissue have a greater risk of breast cancer. There also may be additional risk factors such as visceral obesity. The use of artificial intelligence (AI) and other tools like artificial neural nets (ANNs) can help to stratify those at greatest risk.
The next issue is whether mammography really is the best tool to assess such higher risk women. I think we need to look at the results of abbreviated breast MRI and understand the major gains made with multi-parametric MRI (mp-MRI) in the brother-sister disease of prostate-breast cancer. With MRI you not only have no radiation exposure, but also the benefit of DWI (diffusion weighted imaging) and apparent diffusion coefficient (ADC) to better characterize a lesion. I have seen too many women with breast cancer that was missed by mammography, but picked up by MRI. I think the European physicians in the breast MRI field are about 10 years ahead of the American investigators, just as the use of MRI in prostate was led by those in Europe. Here in the US, we have to get over the NIH (not invented here) syndrome and look at the world peer-reviewed literature.
Thank you so much for your complete answer! I had just made a comment about my sister and her struggles to get care, even though she lived in the Greater Cleveland, Ohio area at the time.
You are inspiring me on a rather down day.
As you likely saw, I have worked in many places in the USA and was premed and do have a biology degree. I am also a Certified Case Manager. I constantly read research- especially in immunology. My brother is a researcher at the Smithsonian.
So what I am wanting to do is help patients collaborate with their Drs and I thought no that is the way to achieve better outcomes.
Yes, I have seen just so much that could be prevented. My next article will be about my husband's prostate issues and reference research.
I am glad I made my comment and we met that way!
Thank you!
Sandra
I just retired from being a cancer doc (medonc) x 60 years. I originally started in hematopathology, transitioned to being focused on HD (Hodgkin’s disease) and then spent 40 years working with thousands of patients and attempting to educate both patients and physicians about prostate cancer. You can find two patient-oriented books I authored or co-authored on Amazon.
What we physician/scientist fail so badly at is translational medicine (TM)-- taking what others have learned and published about and getting it into mainstream (aka real world) medicine. What we can learn from one cancer can be applied to many others. I learned so much about prostate cancer from the breast cancer literature and vice versa. I also learned to always be open to what a lay person can teach us in the medical profession. My involvement in prostate cancer came about as a result of reading a newspaper clipping a patient brought to my office.
What has happened in the US, and perhaps in the world, is a downward trend in the care of the patient and more of a focus on big business involvement in the monetary gains involved in medical care. It is shameful. As a hematologist/oncologist that was diagnosed not long ago with an often rapidly fatal malignancy, I was shocked at what I had to endure and the consequences of poorly thought out treatment "strategy." A quote I heard today sums up so much of what is wrong with today's medicine:
“By failing to prepare, you are preparing to fail.” Ben Franklin
Another quote relates to what seems so often missing in today's "what's in it for me" society:
“You are not required to finish your work, yet neither are you permitted to desist from it.” Pirkei Avos (Ethics of the Fathers)
And yes, meeting you on this forum and knowing I may have made a difference in your experience is a boost to morale.
Thank you for sharing!
I hope that we can share some ideas that may serve to help others. I would like to know your thoughts on plastics and ultra processed foods. I have followers on LinkedIn that send me research articles and the first thing I look for is who paid for the study. I have observed that this is not as ethical as it once was.
I just woke up and have not had coffee but I want to offer you to reach out to me.
Thank you,
Sandra Dingler
We live in a world of carcinogens. Much of the food we get is heavily processed and typically fruit and vegetables are picked premarturely before the plant's anti-oxidant system has reached its potential. We would move water in our country via conduits from rivers that flood, and do what the Khmer civilization did and create a new great lakes system and create organic farmlands and also grass-fed or open-range beef or other animal industry. Most people do not know that grass-fed beef contains all omega-3 fatty acids and no harmful omega-6 fatty acids. Most restaurants in the US cook with seed oils that are high in linoleic acid (LA) and this is the prevalent omega-6 fatty acids-- these are the eicosanoids that are pro-inflammatory and that foster malignancy. Inflammation and cancer go hand-in-hand.
We could check the fatty acid status of chidren, adolescents and adults in this country by making the appropriate lab testing affordable and accessible. If this were done with the young female population in the US, we would see very high levels of LA and ratios of critical fatty acids indicative of a biological milieu that is the perfect storm for a tumor microenvironment (TME). For example, AA/EPA is the ratio of the omega-6 fatty acid arachidonic acid to the omega-3 fatty acid called eicosapentaenoic acid (EPA). Optimal AA/EPA is about 1.5-2. Most patients with cancer that I see walk into my office with AA/EPA ratios of 20:1 or 40:1. w-6/w-3 is the ratio of omega-6 fatty acids to omega-3 fatty acids. LA/DHA is the ratio of the omega-6 fatty acid "LA" to the omega-3 fatty acid DHA. Optimally, LA/DHA should be ≤ 10. I often see ratios of 30:1. We can alter the patient's milieu with the use of fish oil, and/or altering the diet to higher intakes of cold water fish like salmon, herring, sardines. The Mayo Medical Labs does a comprehensive fatty acid profile (CFA) but it is costly. See http://bit.ly/1AtZ7 for a link to that Mayo Labs test.
I am not an expert on plasttics and carcinogenesis. Doing a simple PubMed search using "plastics" AND carcinogenesis will bring you to search findings that should lead to additional references. We could do a lot in our world to make it as wonderful as it is by Nature. But after 81 years on this planet, It seems that humanity (human unity) is an endangered characteristic of H. sapiens.
..."not with screening as a cornerstone of modern health care."...modern health, such as it is, basically relies on endless testing as they insist you get tested/screened for everything under the sun, especially as you age. They work overtime to instill the fear factor so as to convince the majority that they will die of some horrible affliction that only "modern" medicine can cure.
This is the very reason I no longer trust the allopathic medicine model.
Allopathic medicine has morphed into a state where it's mostly about profits, drugs, machines, fear of disease; not about healing and health, I'm afraid.
Diet, lifestyle, activity, sunshine, mindfulness: these are the pillars of health.
In her case, there was no family history. She found a lump and insisted on treatment. The first Dr said she was too young to be screened.
I’m not a cancer doc. But someone finding a lump would no longer be in a “screening” discussion. Screening is for completely asymptomatic people. Having a lump is a “symptom” (well, technically a “sign”), and that person now needs diagnostic testing rather than merely a screening test.
Exactly. Screening involves taking women without symptoms off the street and running a test to look for a disease they do t know they have, on the theory that intervening early is better than waiting for symptoms to appear.
Someone who has a lump is by definition symptomatic. In that case, it’s not screening, it’s investigation and diagnosis. Totally different thing!
I’m just here to say that mammography does not catch invasive lobular breast cancer, which is something under 1/6 of breast cancer. So if you feel a lump or a mass, get an ultrasound. Do it immediately. ILC tends to make strands that evade detection by mammography until it suddenly forms a mass, which can be large by that point. If this describes you, call your doctor today!
A routine screening using 3D mammography caught my 5mm Stage 2B invasive lobular carcinoma which had spread to 2 lymph nodes in 2021. All the more shocking due to no palpable lump. While I also read all I can regarding ILC as well as the debate on the value of routine screening, I will and do advocate for the continued use of it.
Correction…5cm lump
Dear Donna, a 5 cm lump should have been detected by self-breast exam or by the physician's exam. Today's medicine is moving further and further away from patients being actually touched by the physician. In the last six years of seeing many MDs, I have had only one MD examine my ankles for edema without my socks on, or listening to my lungs and not through my shirt. Not one has looked into my mouth, ears or checked my eyes.
There is no question that mammography using good equipment and having an experienced radiologist focused on mammograms is a tool that is of value. There is no question either that breast MRI is also of value. Do we need the sequence of mammorgram ⇢ breast MRI every year or alternating or does one show superiority over the other? These are questions that could be easily answered in a clinical study (ies) if they were conducted (maybe they are).
What I see is every center doing its own thing. Instead of working together to solve problems that affect the health and life of millions, we vie with each other. So much of what we could have learned about COVID-19 to prevent the deaths of millions was negated by such a lack of unity. My mantra has been and always will be: Our humanity lies in our human unity.
Stephen, I appreciate your comment and totally agree with most of what you said, as I’ve experienced much of what you described. My point in commenting was that while I SHOULD have had a palpable lump, I didn’t. And it wasn’t for lack of monthly self exams or neglect of my GYN doing a thorough breast exam. She did, and ordered a routine screening only due to the length of time since my last screening and a family history of breast cancer. I’ve learned through much reading that ILC behaves very differently than IDC and I’m glad more research is being done on this “sneaky” type of breast cancer, which is the word I frequently heard from my oncologist and seen in my reading. Which is why I will continue to advocate for routine screening, whether via mammogram or MRI. Blessings to you and your wife
Correct me if I am mistaken, but breast MRI is a far more sensitive imaging exam than mammography for invasive lobular breast cancer. Having been in cancer medicine x 60 years I have had the experience of seeing the changes in accuracy over decades as we have gone from routine x-ray to whole organ tomography, to CT, Ultrasound, and most recently to MRI with the parameters of DWI (diffusion weighted imaging) and DCE (dynamic contrast enhancement). Far more valuable biologic information is obtained with multi-parametric MRI (mp-MRI) then with other modalities. In my opinion, even PET-CT should be replaced with PET/MRI because more information is very typically helpful to optimize strategies of treatment.
Stephen B. Strum, MD, FACP
Medical Oncologist
Stephen, you are absolutely correct, BUT insurance often won’t cover the MRI without a cheap ultrasound to first identify suspicions.
That depends on the insurance company. Because my wife has homogeneously dense breast tissue, I was able to find a center specialized in abbreviated breast MRI. No ultrasound was required. Often insurances require mammography first, or now with my wife's current insurance it allows for every other year mammography alternating with abbreviated breast MRI. Only a clinical trial that addresses this methodoligical issue will provide answers.
Also, if an insurance denies an abbreviated breast MRI, the MD can provide peer-reviewed papers to support its "authorization." Such an appeal process is time-consuming but it does work. I used it to obtain early access to both testing and treatment for men with prostate cancer in Southern California and had Medicare via TransAmerica approve tests and treatments that otherwise would have been denied.
Age 60, just diagnosed with invasive lobular based on a “Fast MRI”. Stage I, would not have shown up on mammogram until Stage III.
As far as the point about “over diagnosis” just ask women how they feel about leaving a breast cancer in their body that “likely” would not have gone anywhere or needed treatment. I bet you don’t get many who say they are fine with that.
Firstly, I hope you crush this cancer quickly! Good luck and best wishes!!!
On the “ask women” part, I disagree on conceptual grounds (I am a man but I think that is irrelevant here). The question is not, “should women who are concerned be allowed to get screened?”. I think we all would agree they should be allowed if they would like to. I think the question here is, “should medicine recommend every woman of a certain age get screened?”.
There should be evidence that shows a net benefit for the women for whom medicine recommends screening.
There is a similar story, perhaps, on prostate screening using a PSA blood test for men. It used to be recommended routinely for men above some fairly young age. Eventually the data showed more harm than good. So the recommendation was dropped. But obviously men are still allowed to get this bloodwork done if they would like.
Anyway, again, I hope you quickly defeat this cancer. Best regards,
Edward, please don't confuse the message with the messenger. Finding prostate cancer vis-à-vis the PSA and its derivatives did not and does not have to equate with over-treatment by an uninformed and often greedy medical doctor or medical center. Often such patients can be "treated" with diet and lifestyle changes that alter the individual's biological milieu. We are just recently also learning the importance of the gut and bladder microbiome on the "establishment" of cancers of the prostate and bladder.
After the decision to stop PSA screening, there has been a surge in advanced prostate cancer and death due to PC. In medicine, we have to follow what we are taught (or tried to be taught) in med school: Primum Non Nocere or First (above all) Do No Harm.
Good medicine is like the popular CSI series on TV. We in the medical field must learn to profile individual patients using the available tools-- from family history, to genetic assessments, to patient input, physical exam, baseline and follow-up labs looking for trends, and also the benefits of artificial intelligence (AI) and machine learning (ML). I was diagnosed very late with.a rare and horrendous B-cell malignancy called light chain amyloidosis (AL). Using my history, and an AI program on the Internet (Symptoma), the diagnosis of AL was the top choice of what I had. An earlier diagnosis would have changed my life immensely.
Insurance often does not cover. When I have insurance through work and was asked if anyone in my family had breast cancer. I answered yes so my mammogram coverage was denied payment due to family history.
I thought insurance had to cover under the affordable care act. Preventive screening is supposed to be free.
If there is any symptom at all, then it is no longer screening. It is diagnostic and no longer free, but goes to the insurance and subject to deductibles and co-pays, etc. even when people are in for their screening mammogram and they find something it often switches to a diagnostic and then people are stuck with bills. It is frustrating.
There are many exclusions. Just take a look at statistics and you will find that Medicare Advantage plans have huge profits.
I guess I am lucky that we have really good insurance.
No.
My opinion is the mammogram machines need to be updated.
They are- in past 10 years most breast cancer screenings are performed using 3D mammography which detects more cancers at smaller sizes, results in fewer false positive readings (and fewer call backs for repeat imaging)- it’s become the standard of care- ask your screening center what is being used.
The value of mammography relates to the detection of calcifications associated with malignancy. If we are to be scientific in this discussion we should do a dedicated search using PubMed (see http://www.ncbi.nlm.nih.gov/pubmed) or Google Scholar to see if there is a head-to-head study of 3D mammography vs. abbreviated breast MRI (what Susan referred to as "fast MRI." We should see if such a comparison study was ever done.
Yes, if they have had mRNA injections since 2020
You missed one point. The main reason why the screening age has been lowered is that there are more and more rapidly progressing breast cancers in women under 40. This will continue as long as we do not recognize the risk of cancer linked to X-rays, these cancers being probably due to the widespread use of CT scans. You continue to participate in the omerta on this subject.
A suggestion: your comment would be improved if you listed actual data, or references to it, etc. I think you are wrong but I am a moron and an idiot, so likely it is me who is wrong. But still, without data, I (and others) have an easy time disregarding your comment.
The increase in cancer incidence among young individuals has made headlines.
https://www.nature.com/articles/d41586-024-00720-6
https://edition.cnn.com/2024/04/18/health/cancer-colon-breast-screening-young-wellness/index.html
Regarding breast cancer, I have seen the figures from Rebecca Johnson and Archie Bleyer (not yet published), and they are very impressive.
Concerning CT scans as a cause of cancer, the figures are also striking. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2749234
The reason it is difficult to connect the facts is explained here:
https://danielcorcos.substack.com/p/radiation-the-other-conspiracy-of