Re: Mammograms! Hooray!

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1. Really? 1 in 1900? Then how do I know so many women who were diagnosed in their 40s? And not just me, but anecdotally, everybody seems to have lots of these stories.

Maybe some were diagnosed with things that were at a very early stage and would not have been much more of a danger if they were detected five or ten years later?


Posted by: Cryptic ned | Link to this comment | 11-20-09 9:48 AM
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Does needless expense seem less patronizing than needless anxiety? If it really is needless, I think sparing people anxiety is a genuinely good thing and not patronizing to worry about at all. But the expense is real -- 1900 biopsies is going to be a lot of money.

I think I know one breast cancer diagnosed in the 40s -- my mother's cousin Alice died young with it. She might even have been in her 30s - I know she was younger than Mom, but not how much.


Posted by: LizardBreath | Link to this comment | 11-20-09 9:52 AM
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This issue has been around for a little while, hasnt it?

ie: how often mamagrams should be given


Posted by: Will | Link to this comment | 11-20-09 9:53 AM
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1: Did you gloss over countercounterargument 1b? That's the danger with longwinded posts.


Posted by: heebie-geebie | Link to this comment | 11-20-09 9:53 AM
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3: I have never heard anyone challenge the notion that early detection is key, before.


Posted by: heebie-geebie | Link to this comment | 11-20-09 9:54 AM
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Does needless expense seem less patronizing than needless anxiety?

To me, yes. Probably a harder sell to the public, though.


Posted by: heebie-geebie | Link to this comment | 11-20-09 9:54 AM
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There's also an issue of who gets diagnosed literally through mammograms rather than by finding lumps. If the cancers found by mammogram are disproportionately the small, slow, harmless ones, and scary bad cancer grows fast enough that you get a noticeable lump inbetween mammograms, there could be plenty of breast cancer found in the 40s that wasn't diagnosed through mammogram.


Posted by: LizardBreath | Link to this comment | 11-20-09 9:58 AM
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Avoiding needless anxiety doesn't seem patronizing to me. Maybe it's just my tendency to hypchondria talking, but I'm totally fine with taking that into account.


Posted by: Josh | Link to this comment | 11-20-09 9:59 AM
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I think that this entire debate has been around since the mid 90s.


Posted by: Will | Link to this comment | 11-20-09 10:00 AM
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7: The task force also concluded that self-exams did not make any difference in mortality. Which could be consistent with 7, if the prognosis for scary ones is so grim that it doesn't really matter when you find them.


Posted by: heebie-geebie | Link to this comment | 11-20-09 10:02 AM
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9: Are you sure? For these particular reasons? Again, I've never heard anyone challenge the conventional wisdom that early detection is best. The financial tradeoffs, sure. But not that early detection may not matter.


Posted by: heebie-geebie | Link to this comment | 11-20-09 10:03 AM
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8: I'd be furious if someone was making that decision on my behalf. I can avoid mammograms myself to avoid worry, but if the statistics say to get one, that decision is best left up to the woman.


Posted by: heebie-geebie | Link to this comment | 11-20-09 10:04 AM
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I have nothing at all intelligent to add, but my friend starts chemo today and I will be interested to read what everyone has to say. (I'm mid- to late-30s, with a family history, so also becoming a bit more thoughtful about, hey, maybe I should start thinking about this shit.)


Posted by: Di Kotimy | Link to this comment | 11-20-09 10:06 AM
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4: I prefer to think of it as supporting countercounterargument b.


Posted by: Cry | Link to this comment | 11-20-09 10:06 AM
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8 - But the statistics don't say to get one. Isn't that the point?


Posted by: snarkout | Link to this comment | 11-20-09 10:07 AM
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10: Or just that they're fast-growing enough that there's really very little time between 'detectable with a careful self-exam' and 'obviously weird'.


Posted by: LizardBreath | Link to this comment | 11-20-09 10:08 AM
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11: I'm with Will -- this whole conversation seems familiar to me. This is new data, but not raising any issues I haven't heard discussed before.


Posted by: LizardBreath | Link to this comment | 11-20-09 10:10 AM
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15 -- but don't they say it was worth it for 1 in 1900 women? Someone more mathy can calculate that out, but what does the mamogram cost? Multiply by 1900 and is that greater or less than the value of that 1 woman's life?


Posted by: Di Kotimy | Link to this comment | 11-20-09 10:10 AM
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The same debate emerged a while back about early prostate cancer screening, the gist being that in most cases the cancers being detected early would never be life-threatening (and all that stuff about false positives being bad & stressful & requiring needless & not-entirely-riskless biopsies).

That is, of course, a gross over-simplification of the actual recommendations of the experts involved, but that's the gist.

And to 8, remember this is just some government panel's recommendation (that the HHS Sec has said won't be followed anyway) about what the government should recommend to doctors about what *they* should recommend to their patients. This isn't big brother deciding that you can't have a mammogram until your 50th birthday.

Oh, and hi everybody!


Posted by: NCProsecutor | Link to this comment | 11-20-09 10:13 AM
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Oh, whoops, you're right. It's not 1900 biopsies, it's 1900 mammograms. (19,000? Are we talking every year for ten years for every woman? I don't actually know the current recommendation.)


Posted by: LizardBreath | Link to this comment | 11-20-09 10:14 AM
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And radiation is scary and dangerous. Also.


Posted by: NCProsecutor | Link to this comment | 11-20-09 10:15 AM
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18: And the other resulting harms from unnecessary biopsies and radiation exposure.

12: This "decision" is already being made for you, why 40., why not 35?


Posted by: JP Stormcrow | Link to this comment | 11-20-09 10:16 AM
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18: So, by my math, a quick google says full price of a mammogram is between $100 to $200. Figuring that cost times 1900 women times ten years comes to between $1.9 and $3.8 Million, in exchange for saving the life of a woman between 40 and 50 years old. In a wrongful death case involving a woman that age, what would her estate get?


Posted by: Di Kotimy | Link to this comment | 11-20-09 10:19 AM
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This link has the 1 in 1904 number:

http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanup.htm

I assumed that false positives lead to unnecessary medical interventions that can kill or otherwise harm you, but the article does not make that argument. Oddly, the screening efficiency only goes up to 1 in 1339 in women's 50s.


Posted by: Lemmy Caution | Link to this comment | 11-20-09 10:20 AM
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2 gets it right--it's medical rationing. This is probably the result of the House passage of Obama's socialist health care plan. Just wait and see how bad things get once the Senate passes the bill too.


Posted by: Brock Landers | Link to this comment | 11-20-09 10:25 AM
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23: Got to be more than that, no? I'm remembering some EPA number for the value of a life saved by safety precautions being around $6m in terms of cost benefit analysis.


Posted by: LizardBreath | Link to this comment | 11-20-09 10:25 AM
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re: 26

Presumably that includes the cost-savings from otherwise extremely expensive medical treatment?


Posted by: nattarGcM ttaM | Link to this comment | 11-20-09 10:29 AM
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Got to be more than that, no?

The cost of treating the false positives is apparrently what drives a lot of the cost:

"I think the bottom line message is that traditionally, when people have gotten public health messages about screening, it's been oversimplified and presented in a positive light only," said Dr. Jennifer Miller Croswell, of the Office of Medical Applications of Research at the National Institutes of Health, one of the study's lead authors. "What we forget sometimes...is that these are medical interventions and they do have the potential for benefits and harms." In a time when the costs of various treatments are put under the microscope during debate on health care reform, cancer screening presents an uncomfortable challenge, because setting a level of screening invariably leads to an acceptance that certain cases will be missed - thereby putting a dollar value on the lives lost. "The problem with a false positive is that it can trigger this repeated long-term follow-up, and all these things add cost," said Croswell. Ultimately, deciding how many false negatives to accept leaves the realm of medicine. "That's honestly a policy decision that can be made," said Croswell.


Posted by: Lemmy Caution | Link to this comment | 11-20-09 10:29 AM
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26: Yeah, I don't offhand know how to value a human life... Recently read a case where one dead kid, one permanently disabled kid and a seriously injured parent were valued by the jury at $38 million.


Posted by: Di Kotimy | Link to this comment | 11-20-09 10:30 AM
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18: So, by my math, a quick google says full price of a mammogram is between $100 to $200. Figuring that cost times 1900 women times ten years comes to between $1.9 and $3.8 Million, in exchange for saving the life of a woman between 40 and 50 years old. In a wrongful death case involving a woman that age, what would her estate get?

Don't forget incidental costs for the mammograms -- time off work, transport, etc. -- not to mention the follow-up tests.


Posted by: redfoxtailshrub | Link to this comment | 11-20-09 10:31 AM
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You may not be surprised to know that Twisty has rather strong opinions on this subject, especially wrt point 2.

Here.


Posted by: JRoth | Link to this comment | 11-20-09 10:32 AM
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Hi, NCP!

Boy, are you people rude.


Posted by: JRoth | Link to this comment | 11-20-09 10:35 AM
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By "false positive," they don't mean a biopsy that comes back negative for cancer. They mean one that comes back positive for cancer, triggering surgery, chemo, radiation, and lifetime follow-up--yet would never have progressed to become life-threatening.

The new understanding contributing to this is that not every identifiable small pocket of transformed, immortalized cells progresses to become life-threatening. Most of what shows up on mammograms is DCIS with calcifications, and it turns out they just sit there and do nothing if you leave them alone.

This is consistent with your gut reaction: "Really" Then how do I know so many women..?" There are a lot of diagnosed, treated "breast cancer survivors" who would not have died, and indeed would never have known they had it, if they hadn't been screened.

Of course, once your doctor says "you have cancer," then most people want full treatment. Thus, the best way to prevent unnecessary suffering is not to screen.

A couple of analogies: We know that about 2/3 of cesarean sections in the US are unnecessary, but how many individual women spontaneously describe their c/sec that way? We also have allowed men with biopsied, confirmed prostate cancer to choose "watchful waiting" because we believe the side effects of treatment are severe enough to justify that choice, and the cancer doesn't progress fast enough to bother them.

Shall we talk about why it's a bad idea to have a Pap smear before age 21?


Posted by: Shamhat | Link to this comment | 11-20-09 10:36 AM
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There's going to be a strong tendency for people never to want to back down from established practices on this stuff -- that is, it's really hard to get people to agree to step back and be less vigilant, across the board. And in general I think that's unfortunate. I don't like the trajectory towards implementing ever more neurotic preventative measures without recognizing their costs when it shows up in the TSA or increasing cultural biases against letting your kids walk places alone. I don't yet have a clear notion of the wisdom of this recommended shift with respect to mammograms in particular, but I'm strongly disinclined to write it off prematurely, or to view it as condescending, given my feelings about similar issues in other domains.


Posted by: redfoxtailshrub | Link to this comment | 11-20-09 10:39 AM
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Again, I've never heard anyone challenge the conventional wisdom that early detection is best.

NCP mentioned prostate screenings above, where this same debate arose. The expert consensus for both seems to be that the unnecessary pain, cost, and anxiety that result from false positives outweigh any potential benefits.

Man, I just typed a whole bunch of other stuff that I'm now deleting. Just read 19 and 28 again.


Posted by: emdash | Link to this comment | 11-20-09 10:40 AM
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.... and 33 and 34.


Posted by: emdash | Link to this comment | 11-20-09 10:41 AM
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To further NCP's point: the last time I was following this argument, there was a discussion about the number of times a mammogram will actual induce a tumor. For some reason that statistic isn't coming up in the current debate.

But that clearly is the kind of downside to screening that can balance lives saved. Now we are comparing lives with lives.


Posted by: rob helpy-chalk | Link to this comment | 11-20-09 10:42 AM
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||

OK, I can't tell if this was a dream, or if my brain is fucked up, or what, but:

At some point before fully awakening this morning, I was visualizing a graph showing the growth of Unfogged - similar to those rock band family trees that were all the rage ~20 years ago. It would start with Unf and Ogged, tracing how long they were active, and show how commenters showed up - personal friends with Unf or Ogged or other commenters, links, search engine, etc.

I was not suffering from insomnia last night, and I really don't think I was wasting sleep time by thinking about this. But my thinking about how to lay it all out was completely logical and normal, with none of the wacked-out dream logic that would suggest it was only a dream. So I can't figure out in what mental state I was thinking about this. Regardless, it would be really cool, in a "lamest thing in human history" sense.

|>


Posted by: JRoth | Link to this comment | 11-20-09 10:43 AM
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a mammogram will actual induce a tumor

Say what?


Posted by: JRoth | Link to this comment | 11-20-09 10:44 AM
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Radiation exposure can give you cancer. I don't think that's a big risk, but not zero.


Posted by: LizardBreath | Link to this comment | 11-20-09 10:49 AM
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starting in 1993, the use of mammograms was beng questioned.

A better topic should be why isnt there a better way, instead of clinging to the old, very ineffective method, that gives false hope.

But, most importantly, no insurance company should be able to receive government money and also cover abortions. Bc abortions have nothing to do with women's health.


Posted by: Will | Link to this comment | 11-20-09 10:52 AM
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I'm trying to find a reliable source for mammogram induced tumors. Most of what comes up are alarmist alternative medicine sites. This page from Cornell talks about radiation induced breast cancer, but then goes on to say that you shouldn't worry about mammograms, at least if you are over 50.


Posted by: rob helpy-chalk | Link to this comment | 11-20-09 10:54 AM
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Wikipedia to the rescue. The risk of inducing breast cancer with radiation is taken into account by the organizations who set guidelines, and thus may have been taken into account in considering the new guidelines. The radiation risk was also important in deciding that women under 35 should not receive mammograms.


Posted by: rob helpy-chalk | Link to this comment | 11-20-09 10:58 AM
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38: Of course, we'd have to set it up as a wiki.


Posted by: LizardBreath | Link to this comment | 11-20-09 11:00 AM
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40: But surely it's teeny tiny - wouldn't even show up compared to 1/1900.


Posted by: JRoth | Link to this comment | 11-20-09 11:02 AM
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25: 2 gets it right--it's medical rationing.

I realize this was a joke, but -- it's evidence-based medicine, is it not? Which is looked on with favor generally.

Radiology is a trip, I must say. I recently had a CT scan of my adrenal glands (something funky maybe going on there), and in the course of conversation with the endocrinologist, learned that pretty much everyone has small masses, growths, on her or his adrenal glands, and it's generally of no concern.

We're all walking small-mass carriers. Who knew. This has, however, brought home to me the value of medical specialists and the extent to which we laypeople are often lacking in understanding.

I'm not sure of my point. Perhaps it's that (a) heebie's item 1b. seems an entirely reasonable point on its face; and (b) as NCP notes in 19.3 upthread, the panel's recommendations have not been adopted by HHS.


Posted by: parsimon | Link to this comment | 11-20-09 11:05 AM
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42: Gail Collins in her most recent column talks about detecting a lump via self-exam very shortly after getting a "clean" mammography report. (And that she and her doctor feel her cancer was caused by estrogen-replacement therapy -- another medical practice recently deemed to have more costs than benefits.)


Posted by: oudemia | Link to this comment | 11-20-09 11:05 AM
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I have no idea why I linked 47 back to 42.


Posted by: oudemia | Link to this comment | 11-20-09 11:07 AM
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Which is looked on with favor generally.

Dsquared is suspicious -- I think overly so, but he's got arguments.


Posted by: LizardBreath | Link to this comment | 11-20-09 11:07 AM
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Shamhat in 33 is helpful.


Posted by: heebie-geebie | Link to this comment | 11-20-09 11:16 AM
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49: Well, I know, and I've argued against it as well. I've been forced lately to acknowledge that there's something to it, at least to a degree. (When it turns into a prescription for minimizing the role of primary care physicians in favor of nurse practitioners supplemented by specialists, I balk. But that was one thread, a while ago.)


Posted by: parsimon | Link to this comment | 11-20-09 11:20 AM
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50: Yeah, I should have hat-tipped Shamhat's 33.2 in the course of my 46.


Posted by: parsimon | Link to this comment | 11-20-09 11:25 AM
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The wikipedia article also has a sidelong picture of mammographic boob squishing, which you don't normally see in the mainstream media.

Ok, I just wanted to say "sidelong picture of mammographic boob squishing." Please allow me life's small joys.


Posted by: rob helpy-chalk | Link to this comment | 11-20-09 11:29 AM
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The "advice" is: drink five glasses of water a day. The reality: *nobody asked you*. The truth: known by the government, by and by. *CIVILE*!


Posted by: Jeffrey Daniel Rubard | Link to this comment | 11-20-09 11:53 AM
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Studies of the value of a statistical life have come up with widely varying results, but the average is about $7.4 million, which is what EPA recommends.


Posted by: teofilo | Link to this comment | 11-20-09 11:54 AM
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The PR about the "anxiety" factor has been somewhat overplayed compared to what was actually in the report. It's a third or fourth consideration, after actual harm from biopsies, unneeded chemo, etc.


Posted by: Nathan Williams | Link to this comment | 11-20-09 11:58 AM
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The PR about the "anxiety" factor has been somewhat overplayed

Good, I was wondering if that was what had happened.


Posted by: heebie-geebie | Link to this comment | 11-20-09 12:00 PM
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10: I told my PCP a while ago that I don't do self-exams, and she said, "It's okay. The research says that they don't do anything. If you happen to notice something unusual, then come in."


Posted by: Bostoniangirl | Link to this comment | 11-20-09 12:00 PM
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58: That's dumb. Do self-exams. It's not like it's difficult.


Posted by: parsimon | Link to this comment | 11-20-09 12:06 PM
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That's dumb to say that's dumb.


Posted by: heebie-geebie | Link to this comment | 11-20-09 12:07 PM
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But if you are not doing them, then there is something difficult about it--there is a cost to getting into the habit. If there is some cost, and the benefits are negligible or unproven, there's no reason to stress about not doing them.


Posted by: rob helpy-chalk | Link to this comment | 11-20-09 12:12 PM
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60: Sorry. I just think it's silly for the doctor to tell a patient that self-exams are pointless. Feel yourself up every once in a while! What could it possibly hurt?


Posted by: parsimon | Link to this comment | 11-20-09 12:15 PM
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There's a big difference from giving yourself the occasional vague grope (I mean, I wash mine pretty much daily) and doing the fullscale this-is-a-breast-exam with the lying on your back making little circles with your fingertips and covering all areas of breast tissue including your armpits. I don't do the latter.


Posted by: LizardBreath | Link to this comment | 11-20-09 12:17 PM
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I don't do the latter.

That's all that I was saying. I do feel my breasts on a regular basis.

The thing that I don't really understand is what cancer is exactly. I mean my boyfriend'd father had a benign tumor on his optic nerve which had to be removed, because it was preventing him from seeing in that eye, but the tumor itself was benign and therefore not cancer according to the way that doctors use that term. But why wasn't it cancerous? Not growing now, but it was at some point.


Posted by: Bostoniangirl | Link to this comment | 11-20-09 12:29 PM
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As stated above, there's a similar situation with prostate exams. The vast majority of people with detectable abnormalities will not suffer clinical symptoms. So the more people you test outside of the highest risk groups, the more people you are exposing to "unnecessary" risk from surgery etc. I'm not familiar with the statistics for mammograms and breast cancer, so I don't want to comment on that specifically, but the general point is that it's not about worrying people. It's about real harm.


Posted by: Ginger Yellow | Link to this comment | 11-20-09 12:40 PM
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Cancer (medical term: malignant neoplasm) is a class of diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, and do not invade or metastasize.


Posted by: M/tch M/lls | Link to this comment | 11-20-09 12:41 PM
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But a tumor is not controlled growth when it's growing--even if it's ultimately benign.

I mean, that's how it's defined, but it seems sort of arbitrary.


Posted by: Bostoniangirl | Link to this comment | 11-20-09 12:45 PM
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I don't know the clinical implications, but there are many, many types of neoplasia. Basically, rapid cell reproduction is triggered by any of a set of normally inactive genes-- think of them as accelerators. The term for these in oncogenes. There are also genes which act as brakes on runaway growth-- these are tumor suppresors. If the accelerator is stuck on, or the brakes are defective, then neoplasia.

This can be a lump of tissue that starves and stays, or it can grow its own blood vessels and grow very large, or the new cells can spread in the body and set off other growth centers under certain conditions. The rapidly reproducing cells differ in other ways from normal cells, of course, since the internal state of a reproducing cell is more complex than one gene more or less active.

Again, no idea how this relates to the current controversy, have not read up on it, but cell reproduction is complex and heterogeneous, a process with a pretty wide range of normal and lots of possible oddities. Like so much in the world, it barely works.


Posted by: lw | Link to this comment | 11-20-09 12:52 PM
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Huh. Interesting stuff to read, because my dad was just diagnosed with prostate cancer Tuesday. Thanks. Apparently it's a type of cancer and/or was found early enough that the survival rate is something like 98 percent, so we aren't exactly worried, but still, it's sobering.


Posted by: Cyrus | Link to this comment | 11-20-09 12:59 PM
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People are not rational when it comes to medical treatment guidelines.


Posted by: SP | Link to this comment | 11-20-09 1:00 PM
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Who would they give the finasteride to, SP? Would all men be expected to take it. Except, in rare circumstances--like evidenc ethat you are at fairly high risk of developing the disease, I find the idea of taking a drug to prevent illness kind of odd.


Posted by: Bostoniangirl | Link to this comment | 11-20-09 1:04 PM
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I find the idea of taking a drug to prevent illness kind of odd.
You and many other people, which is what doesn't make sense to me. People take vaccines to prevent illness. People take vitamins, even though in some cases they're worse than nothing. And as the article says, people are more used to it for something where there's a biomarker measurable effect (cholesterol lowering) than just not getting sick, because there's no way to know if you would have gotten sick. Yes, drugs have more side effects than vaccines so should be treated with more caution, but everyone's freaking out about 1/1900 fewer detections through testing when there could be a 50% reduction in all breast cancer through preventative treatment. (Although I think the 50% is an optimistic number)


Posted by: SP | Link to this comment | 11-20-09 1:27 PM
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Huh. My strong reaction to "take this drug daily to protect against a disease you don't have an elevated risk of" is "You first." Things like the all-menopausal-women-should-be-on-hormone-replacement; whoops, maybe not, routine give me the creeps.


Posted by: LizardBreath | Link to this comment | 11-20-09 1:33 PM
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I have no explanation, good or bad, for the way I chose to punctuate that last comment.


Posted by: LizardBreath | Link to this comment | 11-20-09 1:35 PM
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What if there were a drug to prevent grammatical errors?


Posted by: JP Stormcrow | Link to this comment | 11-20-09 1:37 PM
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SP, that's a really fascinating article.


Posted by: emdash | Link to this comment | 11-20-09 1:42 PM
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A simpler, cheaper, and more enjoyable prostate cancer prophylaxis.


Posted by: togolosh | Link to this comment | 11-20-09 2:05 PM
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75: Nosflow would become a modern day Ned Ludd and lead the copy editors of America's little magazines on a mission to destroy the tools of Big Pharma.


Posted by: Otto von Bisquick | Link to this comment | 11-20-09 2:10 PM
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I do feel my breasts on a regular basis.

How you do you ever leave the house?


Posted by: Josh | Link to this comment | 11-20-09 2:18 PM
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77: Who are these men who are only ejaculating between 4 and 7 times per month? Cancer is the least of their problems.


Posted by: emdash | Link to this comment | 11-20-09 2:19 PM
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People take vitamins, even though in some cases they're worse than nothing

I've heard (more or less) this before, but I don't get it. Setting aside superdoses, which I can imagine screwing up your body the way anything in great excess can, why wouldn't your body just be able to piss away an extra few hundred mg of Vitamin C?


Posted by: JRoth | Link to this comment | 11-20-09 2:21 PM
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Between the link in 77 and this finding you've got a pretty good justification for a fun weekend.


Posted by: rob helpy-chalk | Link to this comment | 11-20-09 2:24 PM
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81: I believe it's hard to do any damage with C. Vitamin A is the one I remember being cited in the popular press as being able to do some harm at lower levels.


Posted by: Otto von Bisquick | Link to this comment | 11-20-09 2:27 PM
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More.

It has been estimated that 75% of people may be ingesting more than the RDA for vitamin A on a regular basis in developed nations. Intake of twice the RDA of preformed vitamin A chronically may be associated with osteoporosis and hip fractures.

Posted by: Otto von Bisquick | Link to this comment | 11-20-09 2:31 PM
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83: Also the primary reason (barring the difficulty of acquisition) not to eat polar bear liver.


Posted by: LizardBreath | Link to this comment | 11-20-09 2:34 PM
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Oh yeah, and I forgot about the recent finding that C and E might curb the benefits of exercise.


Posted by: Otto von Bisquick | Link to this comment | 11-20-09 2:36 PM
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Tell that to Lady Bird, won't you?


Posted by: Dwight Eisenhower | Link to this comment | 11-20-09 2:39 PM
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87: You don't mean Mamie?


Posted by: Otto von Bisquick | Link to this comment | 11-20-09 2:41 PM
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Lady Bird Eisenhower died from a surfeit of polar bear liver?


Posted by: Cryptic ned | Link to this comment | 11-20-09 2:41 PM
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I thought it was Mrs. Coolidge.


Posted by: JP Stormcrow | Link to this comment | 11-20-09 2:41 PM
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Freudian slip. That Lady Bird sure is something, isn't she? But I meant Mamie.


Posted by: Dwight Eisenhower | Link to this comment | 11-20-09 2:43 PM
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85: I guess I'll have to change my Thanksgiving dinner plans, then.


Posted by: Otto von Bisquick | Link to this comment | 11-20-09 2:44 PM
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I'm stuck inside of the wrong joke I think.


Posted by: JP Stormcrow | Link to this comment | 11-20-09 2:45 PM
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94

Lady Bird Coolidge was the one who was beheaded by a helicopter rotor.


Posted by: Cryptic ned | Link to this comment | 11-20-09 2:46 PM
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94: Right. During the filming of The Bridge over the River Kwai.


Posted by: JP Stormcrow | Link to this comment | 11-20-09 2:48 PM
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93: It's OK. "I thought it was Mrs. Coolidge" is a pretty good all-purpose punchline.

"Why did the chicken cross the road?"
"I thought it was Mrs. Coolidge!"

"A guy walks into a bar--"
I thought it was Mrs. Coolidge!


Posted by: Otto von Bisquick | Link to this comment | 11-20-09 2:48 PM
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Medicines to Deter Some Cancers Are Not Taken

I'll never get my head around US headline idiom. This one makes every journalistic bone in my body ache. Surely the point of a headline is to get people to read the story. So why make them so bland?


Posted by: Ginger Yellow | Link to this comment | 11-20-09 3:01 PM
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Not a bland headline.


Posted by: Otto von Bisquick | Link to this comment | 11-20-09 3:03 PM
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Headless Body Found in Topless Bar

Beat that, punk.


Posted by: OPINIONATED NEW YORK POST | Link to this comment | 11-20-09 3:04 PM
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The Post, as a Murdoch paper, doesn't count.


Posted by: Ginger Yellow | Link to this comment | 11-20-09 3:10 PM
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Was it already Murdoch that long ago? I think that headline's pre-Murdoch.


Posted by: LizardBreath | Link to this comment | 11-20-09 3:12 PM
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5

I have never heard anyone challenge the notion that early detection is key, before.

The benefits, if any, of early detection of breast cancer have been controversial for a long time. See here , here or here for example.


Posted by: James B. Shearer | Link to this comment | 11-20-09 3:19 PM
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Wikipedia claims he bought it in 76, and the headline was in 83.


Posted by: Ginger Yellow | Link to this comment | 11-20-09 3:28 PM
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99: Easy.

SICK TRANSIT'S GLORIOUS MONDAY


Posted by: OPINIONATED NY DAILY NEWS | Link to this comment | 11-20-09 3:29 PM
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I've been enjoying all the headlines like this one


Posted by: rob helpy-chalk | Link to this comment | 11-20-09 3:33 PM
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Biopsy isn't just anxiety-inducing. It can be invasive and somewhat disfiguring surgery. Not doing that unnecessarily is a good thing.


Posted by: Not Prince Hamlet | Link to this comment | 11-20-09 3:41 PM
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Belo, 2 others face criminal raps over botched butt job.


Posted by: JP Stormcrow | Link to this comment | 11-20-09 3:42 PM
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81: I believe the distinction is between fat soluble vitamins (which your body stores) and water soluble vitamins (which you excrete any excess of).


Posted by: Di Kotimy | Link to this comment | 11-20-09 4:10 PM
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Johnson misled Parliament over Nutt sacking


Posted by: Ginger Yellow | Link to this comment | 11-20-09 4:10 PM
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See, I read the article linked in 70 and I think: Drug companies' profits are down. Really, I have limited trust in prophylactic medication to begin with, and even less when the message is coming to me via drug companies, studies funded by drug companies, and a science-medical complex that is focused on intervention as the solution to illness.

It's almost impossible for a doctor not to live within the culture that assumes that "Medical treatment is good." Once you're OK with interventions, the question becomes whether you're a super-responsible doctor (recommending interventions based on rigorous and uncontaminated studies) or a normal one (recommending based on a stew of half-digested studies combined with conference presentations, free pens and tote bags with the relevant drug name on them, etc.) And there are so many stories -- not just the hormone replacement therapy -- where even if the medication DOES prevent what it's supposed to prevent, it causes other things. Just not worth it.

As far as the taking vitamins, AFAICT the whole issue is fairly complex and there are different benefits and risks associated with specific vitamins, but the two I'm most familiar with are:
- Taking some vitamins makes tumors grow faster. So if you already have some type of cancer (and most of us have "abnormal" cells floating around all the time; the question is whether they turn into something to worry about).
- The body absorbs vitamins better from food than from pills, so if you really think you're not getting enough ___, you're better off trying to eat that specific item rather than a scattershot approach to "taking vitamins."

And on anxiety: The study described here certainly seems to indicate that there are some measurable increases in stress when waiting for biopsy results. It's not hard to extrapolate that that anxiety could increase if you were actually diagnosed and being treated.


Posted by: Witt | Link to this comment | 11-20-09 5:23 PM
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See, I read the article linked in 70 and I think: Drug companies' profits are down.

I'm pretty cynical, but I don't think I'm that cynical. After all, generally speaking there's less money to be made in preventing disease than in curing it (see, for instance, the U.S. health care system).


Posted by: emdash | Link to this comment | 11-20-09 6:47 PM
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I've heard (more or less) this before, but I don't get it. Setting aside superdoses, which I can imagine screwing up your body the way anything in great excess can, why wouldn't your body just be able to piss away an extra few hundred mg of Vitamin C?

the study is probably the one on betacarotene and lung cancer in smokers. the most likely explanation is b-carotene competes with teh uptake of other carotenoids, which are actually teh protective ones. probably a similar thing with vitamin E, alpha tocotrienol is less important than others of the 8 forms.

also vitamin D & A work together, taking more A while still not having enough D causes problems. a big problem is most studies are in 'average americans' who have crap diets, no exercise, various environmental pollution, etc.


Posted by: yoyo | Link to this comment | 11-20-09 6:56 PM
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111: Not if that nasty something can be prevented by having you take a pill every day starting in your late teens or early twenties and going on until intensive care finally fails. Look at the statins for a good example.


Posted by: Biohazard | Link to this comment | 11-20-09 7:11 PM
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generally speaking there's less money to be made in preventing disease than in curing it

I don't disagree, in general. But for drug companies specifically, I'm not so sure. They can make a lot of money on lifelong medications -- see, e.g., Biohazard's 113. And a lot of the expense involved in "curing" disease is medical, surgical, and other procedures -- not medications per se.


Posted by: Witt | Link to this comment | 11-20-09 7:18 PM
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114: That's true, but if we're looking to cut costs in the system in general, preventing cancers would be worth looking into. And, should one pass up a potential disease-preventing or even life-saving intervention to spite the drug companies?

I think some skepticism is warranted, but if you write off the entire "science-medical complex," how can you possibly evaluate any possible medical treatment?


Posted by: emdash | Link to this comment | 11-20-09 7:23 PM
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I think some skepticism is warranted, but if you write off the entire "science-medical complex," how can you possibly evaluate any possible medical treatment?

Rumors and the internet, duh!


Posted by: Sifu Tweety | Link to this comment | 11-20-09 7:25 PM
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Not to mention your brother-in-law.


Posted by: JP Stormcrow | Link to this comment | 11-20-09 7:27 PM
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My brother-in-law is pretty thoroughly embedded in the science-medical complex, Stormcrow. Can't trust him.


Posted by: Sifu Tweety | Link to this comment | 11-20-09 7:29 PM
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That's why I said not to mention him.


Posted by: JP Stormcrow | Link to this comment | 11-20-09 7:31 PM
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see, e.g., Biohazard's 113.

What, and scroll up all that way?


Posted by: M/tch M/lls | Link to this comment | 11-20-09 7:35 PM
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but if we're looking to cut costs in the system in general, preventing cancers would be worth looking into.

Some cancers. You don't have to have watched someone suffer terribly to wish very much that a pill could have prevented their disease -- it's easy to imagine situations in which we would all be extremely grateful to have such a pill. Heck, I'm grateful for the sealants on my teeth, and all they prevented were some cavities.

But if I were a guy, and I looked at the prostate cancer stats, absent some actual family history or other known risk factor, I think I'd say, "Thanks, but no thanks."

And, should one pass up a potential disease-preventing or even life-saving intervention to spite the drug companies?

I don't think I suggested that, and if I did, I didn't intend to. I meant to suggest that one should assess claims of "disease prevention" or "life-savingness" in the context of acknowledging that there is a large and well-funded lobby of people whose job it is to get you and your doctor to buy their product. It doesn't mean that their product is never worth it.

I think some skepticism is warranted, but if you write off the entire "science-medical complex," how can you possibly evaluate any possible medical treatment?

I'm probably farther over on the skepticism curve than most people, but I'm hardly writing off the entire medical world. I am basically OK with a personal version of the precautionary principle, though, and that often involves ignoring or overriding medical advice, suggestions, and outright marketing.

Getting a whole-body scan just to make sure I don't have cancer? Doesn't seem wise at all to me, and yet that service is out there and being marketed, and I know a woman who did it. Turning to hormone-heavy fertility treatments at age 28 because OMG it's been a year and I'm not pregnant yet? Seems like a crazy risk to me, and yet there are people who do it.


Posted by: Witt | Link to this comment | 11-20-09 7:36 PM
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Witt, is 121.last just an example, or are you trying to get pregnant?


Posted by: M/tch M/lls | Link to this comment | 11-20-09 7:43 PM
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Are you volunteering? I think Sir K. is around here somewhere.

(No. And I'm not in my 20s either.)


Posted by: Witt | Link to this comment | 11-20-09 7:44 PM
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Getting a whole-body scan just to make sure I don't have cancer? Doesn't seem wise at all to me, and yet that service is out there and being marketed, and I know a woman who did it. Turning to hormone-heavy fertility treatments at age 28 because OMG it's been a year and I'm not pregnant yet? Seems like a crazy risk to me, and yet there are people who do it.

I agree! However, neither of these seems remotely analogous to taking a medication that has been shown in a clinical trial to halve the incidence of a particular cancer that one is at-risk for.

absent some actual family history or other known risk factor

I'm pretty sure the article seemed to suggest that the drugs in question wer ebeing recommended for those with exactly such risk factors. I agree that putting them in the water is probably not a good idea.

You are absolutely right that the relationship between pharmaceutical companies and doctors makes it difficult to trust your doctor's advice when it comes to prescription drugs. I'm not sure who else's advice to take, though.


Posted by: emdash | Link to this comment | 11-20-09 7:46 PM
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I'm not sure who else's advice to take, though.

Hmm. Any suggestions for a re-write on this sentence?


Posted by: emdash | Link to this comment | 11-20-09 7:51 PM
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123: I was only volunteering to send, um, good vibes your way, I swear!


Posted by: M/tch M/lls | Link to this comment | 11-20-09 7:54 PM
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125: "Ain't sure who-all to listen at on the occasion then, no sir."


Posted by: Sifu Tweety | Link to this comment | 11-20-09 7:56 PM
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"I'm not sure who else to turn to, though. Jesus? Mohammed? Batman? OH GOD I'M ALL ALONE."


Posted by: Sifu Tweety | Link to this comment | 11-20-09 7:56 PM
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"I not advice am take then from who. Else?"


Posted by: Sifu Tweety | Link to this comment | 11-20-09 7:59 PM
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For someone all alone, you sure do keep up quite a conversation!


Posted by: M/tch M/lls | Link to this comment | 11-20-09 8:01 PM
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That's what she said!


Posted by: Sifu Tweety | Link to this comment | 11-20-09 8:02 PM
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128 would be a good suggestion, if it weren't for the fact that my primary care physician is Jesus M. Batman, M.D.


Posted by: emdash | Link to this comment | 11-20-09 8:03 PM
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Clearly you should be getting all your medical advice from Sifu.


Posted by: teofilo | Link to this comment | 11-20-09 8:04 PM
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125: Do you know the advice from other users?


Posted by: essear | Link to this comment | 11-20-09 8:04 PM
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I'm pretty sure the article seemed to suggest that the drugs in question wer ebeing recommended for those with exactly such risk factors.

Ah, you know, I read the thing a week ago when it came out, and I didn't remember all the details. I just went back and reread it.

You're right; although it is front-loaded with suggestions that make it sound like they're talking about everybody, there are two specific examples at the end that are clearly about patients who are identified as having high risk factors.

Although I still think it conflates issues in a confusing way. Even if you believe you're high risk (a big if) and even if you trust your doctor, you still have to trust that the unknown costs of the medication will outweigh the known benefits. If the article is believed, about half of patients are willing to take that gamble. That doesn't seem like a shockingly low percentage to me.

And I didn't catch this on first read-through, either. One doctor comes off especially well:

Instead, he said, perhaps it is time to rethink the way studies are done. "This should be a stimulus to our research community to say, How can we conduct observational studies in a way to reveal more reliable information?" Dr. Prentice said.

Woo-hoo rethinking research approaches!


Posted by: Witt | Link to this comment | 11-20-09 8:05 PM
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because OMG it's been a year and I'm not pregnant yet

28 is young for such a reaction, I suppose, but this seems like an oddly trivializing characterization. A year is a good long time if you're talking about concerted, educated, focused efforts, so it's not as if some level of anxiety and concern is misplaced there. "OMG" makes it sound like the notional not-pregnant person is wigging out just because she's had a few bad dice rolls in a row.


Posted by: redfoxtailshrub | Link to this comment | 11-20-09 8:26 PM
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(I'm not at all personally affronted, I should say, having never been in that position.)


Posted by: redfoxtailshrub | Link to this comment | 11-20-09 8:32 PM
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136 seconded, actually, having been married to someone in that position.


Posted by: emdash | Link to this comment | 11-20-09 8:34 PM
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To 136, I should say that when I heard the story I was mostly reacting to the 0-60 mph escalation. Going from "normal" to "hormone shots" seems remarkably extreme to me. No adjustments in diet? No charting of one's cycle and making sure to have lots of sex during the fertile periods? Not even getting your husband's sperm count tested? Going RIGHT to the high-octane treatment that is very expensive and involves monkeying around with a poorly-understood bodily system with substances that are implicated in several cancers?

It's much less about the pregnancy stuff per se. I've known a couple of women who really struggled with getting pregnant, and it was a deeply emotional and individual process for them. I don't think it's easy to gauge any of it from the outside, but in this particular instance I was pretty weirded out by the rapid escalation.


Posted by: Witt | Link to this comment | 11-20-09 9:03 PM
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Shorter 139: I don't think it was educated efforts.


Posted by: Witt | Link to this comment | 11-20-09 9:04 PM
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#104. Sick Gloria in Transit: Monday.

(Props to the late M.B., who first pointed out to me that headline. You were a drunken fool, but you made me laugh.)


Posted by: Populuxe | Link to this comment | 11-20-09 9:14 PM
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Ah. It wasn't clear that you were talking about one particular case.


Posted by: redfoxtailshrub | Link to this comment | 11-20-09 9:21 PM
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Huh, yeah, I did write "people." Whoops. I was actually thinking of one particular recent instance, although I've heard (firsthand) of somewhat similar versions in the past.


Posted by: Witt | Link to this comment | 11-20-09 9:30 PM
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124: taking a medication that has been shown in a clinical trial to halve the incidence of a particular cancer that one is at-risk for.

But how much "at risk"? The news media tends not to report on absolute risks, they go for (and the paper authors and the companies like to concentrate on) the relative risks and their reductions.

So, buy this helmet! For $19.95 (plus S&H) it will reduce your chance of dying from getting hit by a chunk of blue ice from a malfunctioning airplane toilet to ZERO!


Posted by: Biohazard | Link to this comment | 11-20-09 9:53 PM
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On the cancer front, the Parisian public transport authority has banned a poster for a film about Serge Gainsbourg because he's smoking. It's funny just how fast public policy has changed in Europe on this front. I can remember how back in the late eighties or early nineties the German courts ruled that non smoking zones were a violation of constitutional rights. In France just a decade or so ago you could smoke pretty much anywhere, now it's like NYC.


Posted by: teraz kurwa my | Link to this comment | 11-20-09 11:40 PM
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The answer to q1 is, simply, that the evidence suggests that 90% of them were misdiagnosed.

http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001877/pdf_standard_fs.html


Posted by: dsquared | Link to this comment | 11-21-09 5:23 AM
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Am I allowed to comment on the basis of the Plain Language Summary? That looks suspiciously like evidence based medicine.


Posted by: OFE | Link to this comment | 11-21-09 6:16 AM
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When you wake up at 5:30, you're ready for a nap by 7:30. According to Hawaiian Punch. According to the rest of us, it's freaking absurd.


Posted by: heebie-geebie | Link to this comment | 11-21-09 6:31 AM
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|| Who doesn't envy the lucky gal marrying this fellow?|>


Posted by: CharleyCarp | Link to this comment | 11-21-09 6:50 AM
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Hooray 146!


Posted by: Sifu Tweety | Link to this comment | 11-21-09 6:55 AM
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146: It's funny, that does seem to be what the articles say, but it seems bizarre. I'd figure that a false positive would mean that the mammogram found something, a biopsy was done, and at some point a pathologist figured out that there wasn't any cancer there. What it looks like from reading the linked stuff is that there's a substantial number of false positives that involve a mammogram finding something, and full breast cancer treatment as a result, never figuring out that there wasn't really any cancer (or, whatever the definition is, anything that would have been symptomatic) there to begin with. I suppose it's possible, but I wouldn't have guessed it.

Come to think of it, though, Ogged nearly got his stomach removed accidentally, so I guess that sort of thing does happen.


Posted by: LizardBreath | Link to this comment | 11-21-09 6:57 AM
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Norm!


Posted by: JP Stormcrow | Link to this comment | 11-21-09 7:06 AM
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151: well, if the test gives 98 or 99% correct results or whatever, it's easy for people to get confused about the real probability of a false positive.


Posted by: Sifu Tweety | Link to this comment | 11-21-09 7:18 AM
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148:When you wake up at 5:30, you're ready for a nap by 7:30. According to Hawaiian Punch. According to the rest of us, it's freaking absurd.

Speak for yourself, and getoffmylawn.


Posted by: | Link to this comment | 11-21-09 7:22 AM
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The USPSTF found fair evidence that women who have screening mammography die of breast cancer less frequently than women who do not have it, but the benefits minus harms are small for women aged 40 to 49 years. Benefits increase as women age and their risk for breast cancer increases. However, there are relatively few studies of mammography for women aged 75 years or older. The potential harms of mammography include anxiety, procedures, and costs due to false-positive results and receiving a diagnosis and treatment of cancer that never would have surfaced on its own within a woman's natural life time. They found that the benefit of mammography every 2 years is nearly the same as that of doing it every year, but the harms are likely to be half as common. They found no evidence that self- or clinical examination reduces breast cancer death rates.
(my italics, from here) I wonder if the recommendation, balancing benefits and harms, would pan out the same if the costs to the patient were negligible, as in non-American health care systems? This isn't America bashing, I just wonder if this conclusion is actually universally applicable or an artifact of the social context in which the work is done.
Posted by: OFE | Link to this comment | 11-21-09 7:22 AM
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154 was me


Posted by: bob mcmanus | Link to this comment | 11-21-09 7:23 AM
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Bayes for the counter-intuitive win.


Posted by: JP Stormcrow | Link to this comment | 11-21-09 7:23 AM
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154 was me


Posted by: bob mcmanus | Link to this comment | 11-21-09 7:23 AM
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The cells removed during the biopsy may indeed be cancer, in the sense that they are immortalized and transformed (no longer exhibit normal growth/boundary behavior). However, they would not have progressed to a larger tumor and eventually metastasized.

It was originally thought that all small cancers eventually progress to become life-threatening, and that by removing cancerous cells before they spread, lives could be saved (or more correctly, death postponed and perhaps caused by something else).

This turns out not to be the case. Some just sit there and do nothing, particularly if the body has surrounded them with layers of calcifications that prevent growth (until the needle biopsy pierces the shell).

This is similar to the 70's theory that cerebral palsy was caused by asphyxiation during the birth process, that oxygenation of the fetus could be monitored by measuring the fetal heart rate, and that doing cesarean sections whenever the "tracing" indicated possibly poor oxygenation would thus decrease the occurrence of cerebral palsy. Thus electronic fetal monitoring during labor became standard of care.

However, it turned out that cerebral palsy rates did not decrease, infant mortality rates did not decrease, but cesarean section rates increased from 5% to 30% (40% at my hospital in 2007). Ironically, malpractice suits for cerebral palsy increased based on the theory that the OB/GYN could prevent it even though that turned out not to be the case.

There was an earlier list posted here: eggs/heart disease, HRT/heart disease, etc. At least avoiding eggs was harmless.


Posted by: Shamhat | Link to this comment | 11-21-09 7:26 AM
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Thanks Shamhat for this and 33. Well-reasoned and temperate discussions of these emotional hot-button medical/scientific subjects are rare. Perhaps you could give the NYTimes a hand at it. They do need help.


Posted by: JP Stormcrow | Link to this comment | 11-21-09 7:44 AM
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Every time I see the word mammogram I first read it as mammalgram, as if it was a service that allowed you to send people a gift of a squirrel or a wolverine.


Posted by: togolosh | Link to this comment | 11-21-09 8:03 AM
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Or a box of ferrets.


Posted by: togolosh | Link to this comment | 11-21-09 8:04 AM
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Wow, the violence described in 149 is pretty extensive. I feel sorry for the bartenders, police, wait staff, and bystanders who had to deal with those guys.


Posted by: Witt | Link to this comment | 11-21-09 8:23 AM
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Or kittens, togolosh. What's wrong with a nice box of kittens?


Posted by: emdash | Link to this comment | 11-21-09 8:48 AM
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Or sea kittens?


Posted by: heebie-geebie | Link to this comment | 11-21-09 8:50 AM
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Kittens are good. Also bunnies and puppies. Monkeys are probably not good gifts. Or polar bears.

You could send your boss a weasel with a note saying "Thinking of you."

I am going to get so fucking rich off this.


Posted by: togolosh | Link to this comment | 11-21-09 10:41 AM
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I would send Rudy Giuliani a box of ferrets every day for the rest of his life, if this were available. Friendly, affectionate ferrets, who would hide in his clothing and luggage.


Posted by: LizardBreath | Link to this comment | 11-21-09 10:46 AM
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160-

Thanks, JP. I really appreciated. I've been de-friended on Facebook over a similar comment, to someone who posted that the new guidelines were an Obama cost-cutting measure that would have killed her and all of her best friends. I know, good riddance, but it feels weird.

I'm not trying to minimize anyone's experience of facing death, treatment, recovery, paying for it, etc., but the majority of the breast cancer survivors who are so upset about the guideline change are probably actually victims of overscreening.


Posted by: Shamhat | Link to this comment | 11-21-09 12:29 PM
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159: Thus electronic fetal monitoring during labor became standard of care.

Shamhat has it exactly right. Back then I was deeply involved in trying to come up with some repeatable, rational, and meaningful ways of interpreting contraction info and fetal HR data to link to oxygenation and eventual outcomes.

We found all sorts of interesting but weak correlations. However, for some reason mothers were reluctant to hand over their newborns for sacrifice and autopsy so we couldn't actually measure brain damage even though Rhesus monkeys showed some under similiar circumstances.

That E/d H/on was a major stockholder in Cor/o/metrics would raise eyebrows now but didn't much back then.

Bottom line is, when I hear "risk factor" I reach for my car keys.


Posted by: Biohazard | Link to this comment | 11-21-09 4:26 PM
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SP--There are also people trying to use psychotropic drugs preeventatiely in teenagers. There's a schizophrenia prevention project. It worries me a bit given how bad the side effects of those drugs can be and the fact that we're talking about developing brains, but I'm fully in favor of the early screening aspect and would like to see active psychosocial interventions in these extremely high risk people in the prodromal phase--especially if that allows you to use much lower doses of meds when or if they become necessary.


Posted by: Bostoniangirl | Link to this comment | 11-22-09 6:14 AM
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I do take a sort of natural multivitamin; it's got mixed carotenoids or whatever, extra vitamin d in the winter and calcium/magnesium.

She'll also ask me my opinions of books about how taking certain amino acid supplements might treat depression, because she's afraid of Phrma.

I'm kind of nervous about ever discussing this with my aunt who had breast cancer about 7 or 8 years ago. She sends me articles about how drinking water out of plastic bottles increases one's risk for breast cancer. I guess at Johns Hopkins they figured out that the plastic in regular bottled water when heated in a car does weird things.

I think she must have been just 50 when she got it, and it was real. The initial lumpectomy was inadequate, and they had to do a mastectomy.


Posted by: Bostoniangirl | Link to this comment | 11-22-09 6:22 AM
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Gina Kolata's cancer reporting bugs me sometimes, but she's got a helpful timeline of mammogram recommendations and controversy since 1963.


Posted by: Sir Kraab | Link to this comment | 11-22-09 11:29 AM
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