1. When you have a hammer everything looks like a nail. Practitioner of any craft are prone to overuse any tool they have, aside from any profit motive that may exist.
2. Personal experience, so called anecdotal evidence, has enormous emotional resonance; but does not necessarily inform what the risk might be for someone else.
3
Not one size fits all. As someone who has been diagnosed twice with breast cancer, I am forever grateful for frequent screenings.
This article should address testing of individuals with familial predispositions to prostate and breast cancers.
3
A relative of mine had abdominal surgery in his 80s, and the surgeon discovered -- incidental finding unrelated to the surgery -- that he had colon cancer. The recommendation for cessation of colonoscopies is age 75. I wonder whether this man's cancer might have been spotted earlier had he gotten a scan at age 80.
4
Hilarious how Jane Brody gets her annual mammogram but recommends other people skip theirs.
1
Um...she had breast cancer.
7
Between 62 & 64, my PSA on annual physicals went from 3 to 7, still low, but my internist pushed for a biopsy. It and later surgery revealed a highly aggressive Gleason score 8 tumor which had already breached the prostate wall. With surgery and radiation, I will hopefully be ok for many years, but the PSA clearly saved my life. "Small potential benefit of reducing the chance of dying?" Hah, perhaps across millions, but for this one it was a 100% life-saver, and based on my experience I would feel ethically remiss in not urging any man to rigorously maintain PSA screenings.
3
Common sense guidelines to stay healthy, and control disease if present. As long as we can divest our personal financial interests, as professionals, from patient's benefits, we shall allow prudence to dictate our next step(s).
1
Why is cervical screening not mentioned here? It's a curious exclusion.
The 'safe or sorry' framing suggests you'll be one or the other. Screening is a really complex area and 'safe or sorry' doesn't begin to cut it when you're trying to establish a nuanced understanding of benefits and harms that can accrue as a result of looking for (risk of) disease in asymptomatic people.
The 'safe or sorry' framing suggests you'll be one or the other. Screening is a really complex area and 'safe or sorry' doesn't begin to cut it when you're trying to establish a nuanced understanding of benefits and harms that can accrue as a result of looking for (risk of) disease in asymptomatic people.
2
These self-anointed experts seem to be forgetting several things. First, it is the patient right to know and then it is their right to make a decision. You cannot make a knowledgeable decision unless you screen. It is my tail and not someone else's. I trust my physician and myself to make what may be the right decision for me. However, how do you know if you don't know?
3
Happen to go to VA for statins & other meds. Other than a revolving door for docs am happy except for new prostrate screening criteria. Was told that they are no longer PSA testing above a certain age because the test only marginally of benefit and potentially causes complications. My questions are this. Wouldn't it be better to know and then make a decision if one has prostate cancer? What do you do if you have the aggressive form that could have been treated. It would seem to me that the approach should be to still screen, but then make a decision. It is my understanding that there new tests that can determine how aggressive you should be. I have three friends that have died because they were too late in diagnosing prostate cancer. I am still getting PSAs from local physicians. It would seem to me that you should be watchful and not aggressive unless the numbers sky. But if you do not screen how are you going to know whether to be watchful or not.
1
For men 55 to 69, screening “offers a small potential benefit of reducing the chance of dying of prostate cancer..." Utterly ridiculous! Are you going to tell a 55-year-old guy who can expect to live at least 20 more years, that he should just give up and wait to die? Or a 70-year-old who may live for another 20 years? And much depends on the health (fitness) of the person. I'm sure you've seen marathon runners in their 80's who could live into their 90's. Shouldn't they be screened?
I am a 75-year-old, with prostate cancer, and I will use every conceivable test to extend my life. Most fortunately, in addition to a high or rapidly-rising PSA, there very non-invasive blood, urine and MRI tests now available to at least indicate the strong possibility of prostate cancer before one receives confirmation through a needle biopsy.
As to why people get screening (although they may not need it), I would suggest one strong reason is that one's spouse, kids, partner, friends, relatives...whomever...will push the loved one to the Gates of Hell to accept screening! They are often totally unaware of the consequences or the necessity, but no matter. It will put THEIR mind at ease that they are doing the right thing for the afflicted! This pressure is extremely difficult to resist, especially when it comes from persons who love you and sincerely want to help. I speak from experience.
I am a 75-year-old, with prostate cancer, and I will use every conceivable test to extend my life. Most fortunately, in addition to a high or rapidly-rising PSA, there very non-invasive blood, urine and MRI tests now available to at least indicate the strong possibility of prostate cancer before one receives confirmation through a needle biopsy.
As to why people get screening (although they may not need it), I would suggest one strong reason is that one's spouse, kids, partner, friends, relatives...whomever...will push the loved one to the Gates of Hell to accept screening! They are often totally unaware of the consequences or the necessity, but no matter. It will put THEIR mind at ease that they are doing the right thing for the afflicted! This pressure is extremely difficult to resist, especially when it comes from persons who love you and sincerely want to help. I speak from experience.
2
These cancer screening guidelines only look at mortality: does early screening save a life? They ignore the fact that early detection can improve treatment options. My tumor was found during a routine annual mammogram when I was 46. Since it was caught early, my oncologist dis-recommended chemo, I have a lower risk of recurrence, and my insurance company saved about $100,000. If I had skipped annual screenings, my prognosis would be much worse today.
Cancerland is a world of statistical analysis. Even if early detection “only” save a few more lives, those lives matter if the patient is you or someone who love. Plus the reason why many cancers are so deadly—like pancreatic cancer and ovarian cancer—is because there are no good tests for early detection. Why are we limiting the few tests that actually work? Let they patients decide if the burden of screening is too much for them or if they’d rather be safe than sorry.
Cancerland is a world of statistical analysis. Even if early detection “only” save a few more lives, those lives matter if the patient is you or someone who love. Plus the reason why many cancers are so deadly—like pancreatic cancer and ovarian cancer—is because there are no good tests for early detection. Why are we limiting the few tests that actually work? Let they patients decide if the burden of screening is too much for them or if they’d rather be safe than sorry.
" The widespread belief that it’s better to be safe than sorry."
Sounds good to me.
Sounds good to me.
2
Unlike early screening for the cancers discussed in the article, THIS IS NOT TRUE FOR LUNG CANCER. Unless it is accidentally detected in its early stages—early Stage 2, surgery is no longer option and the prognosis is much worse.
I am a lung cancer survivor now just short of five years. My lung cancer was discovered in Stage 2 quite by accident so surgery was still an option. Even when detected in Stage 2, undergoing chemo is needed. The survival rate five years out is only fifty percent even when diagnosed that early. Some of this is changing with gene therapy now which is exciting.
For older adults who are either smokers or former smokers with a long history of smoking or with long exposure to second-hand smoke, early screening is recommended by the American Cancer Society now and usually covered by insurance. It’s a specialized CT-scan that will detect lung cancer even early in Stage 1. For more specific info, go to:
https://www.cancer.org/cancer/lung-cancer/prevention-and-early-detection...
I am a lung cancer survivor now just short of five years. My lung cancer was discovered in Stage 2 quite by accident so surgery was still an option. Even when detected in Stage 2, undergoing chemo is needed. The survival rate five years out is only fifty percent even when diagnosed that early. Some of this is changing with gene therapy now which is exciting.
For older adults who are either smokers or former smokers with a long history of smoking or with long exposure to second-hand smoke, early screening is recommended by the American Cancer Society now and usually covered by insurance. It’s a specialized CT-scan that will detect lung cancer even early in Stage 1. For more specific info, go to:
https://www.cancer.org/cancer/lung-cancer/prevention-and-early-detection...
1
False positives [test says you have a disease but you do not have the disease] can cause problems.
If you test positive for some disease that does not mean you automatically have to proceed to a more invasive procedure
You can repeat the initial test.
I believe the American Cancer Society recommends mammograms at an earlier age than the Task Force.
If you test positive for some disease that does not mean you automatically have to proceed to a more invasive procedure
You can repeat the initial test.
I believe the American Cancer Society recommends mammograms at an earlier age than the Task Force.
This article supports rationing of care- no other way of looking at it. Sure, there are some who want every test done and do not want to be put to pasture. These guidelines are based on bell curves and mass population studies - beware if you are at either end of the curve and you fall out of the recommendations for" the masses". But why not, isn't whats good for the state good for you? And the fallacy that the intestinal wall is more likely to be injured during a colonoscopy in later life is just that , a fallacy. As a board certified gastroenterologist and geriatrician, the risk relates to the underlying general health of the person - individualized recommendations are common sensical and are appreciated by my geriatric patients. It's all a dollars game to the societies who promulgate the recommendations until it's your colon cancer that was missed.
6
You are assuming screening does no harm, that finding something early increases the chance of curing, and the patient knowing is a good thing. None of these are necessarily true. Read Dr Gilbert Welch's book "Less Medicine, More Health" to dispel these and other myths.
7
Before going for any sort of screening ask these simple questions: will it kill me? Is it curable? Will my quality of life be improved by knowing? If the answer to any is "no" don't go for the test. BTW; the medical profession cannot give reliable answers to the first two.
3
People should stop believing that testing is the perfect solution. From listening to people talk, almost brag about their numerous tests, they don't want to see the downside, only positive information about testing. Radiation is carcinogenic so that means mammograms are too. I remember when after years of badgering women to go, the radiologists finally admitted that they were using a much high amount of radiation than they had stated. Oops, sorry. Colonoscopy is also not the gold standard that is claimed. All polyps are not pre cancer, many flat cancers are missed as are those of the ascending colon. I have met people who are bemoaning their fate because they have cancer but didn't go for all the approved tests, I remind them that even if they had gone, it does not mean they would have been diagnosed correctly or any sooner. There are a lot of false negatives. People should remember that both mammography and colonoscopy is big business. It is their job to make sure the equipment is used as much as possible even if it is detrimental to the patient. Tests can kill. Just the prep for a colonoscopy is dangerous. If a cancer is found, will the patient survive the treatment or will it just torture their final months of life? People should read the book Over- diagnosed before they fall for the ploys of the testing industry.
16
Agreed. Screening can maim. I had one patient who at the urging of another doctor got a urine test. It showed blood. Repeat testing also showed blood. This was a healthy guy in his 40s. Ultrasound showed a suspicious lesion in the kidney. CT report noted suspicious for renal cell carcinoma. The only way to know would be to go in and cut out the kidney and so he did that. The final biopsy was a benign vascular lesion. This man basically lost a kidney true to an ill advised urine test for screening. He has some moderate renal failure now in his 40s.
7
A friend's 92 year old mother-in-law found a lump and just had a mastectomy--God bless her. She's up and moving--all 80 pounds of her. Given I want to make my own decisions about my health (pro-choice), I'm going to withhold judgement and say, "It's your call."
5
My PSA , done at age 65,showed an increase to 3.5 ( STILL IN A NORMAL RANGE ) after being lower for years . My doctor recommended a biopsy . The results were 11 of 12 biopsy sites having aggressive cancer . I had NO urinary symptoms . I am now 71 and have had prostate removal followed by recurrence of cancer and radiation treatments . I have had undetectable cancer for 3 years . The statistics game was put forth by a female non urology professional with no skin in the game . Your article , along with the self promoting study ,will result in the long painful death of many men , one of them a fellow classmate from high school. Proud of yourself ??
5
Sorry for your experience but your final two sentences are rather harsh. The columnist is discussing the issues and leaves the reader to decide which is a perfectly reasonable thing to do in a world of adults.
5
Hate to break it to you but the cancer probably would've never bothered you. Five year survival rates for prostate cancer is in excess of 99%.
5
I believe we have a whole generation of baby boomers who rely on doctors and testing as it the oracle and they don't believe they have much control over their own health. Testing is such a great way for insurance companies to make so much money but it has nothing to do with health. In fact out whole healthcare system is not focused on health but merely disease management. I hope younger generations change their attitude towards health or we are all in trouble...
6
As we reach the point in the US where everyone is tested, and often treated, for everything all the time, the problem is not the Insurance but the "Care". If we had common sense approach to "Health Care" we would not be so desperate and focused on Health Insurance.
1
I also had breast cancer; I do cancer screening and, reject the idea that others, doctors or not decide if I am too old or too sick. I am proud of managing my health and do not rely on crystal balls.
I feel more comfortable going along with science and avoiding being that "small percentage" of the "OOOPS!" group. I keep being a person, not a statistic.
I feel more comfortable going along with science and avoiding being that "small percentage" of the "OOOPS!" group. I keep being a person, not a statistic.
11
The science says to stop screening because mammograms can do more harm than good especially at older ages. If you really listened to science you would stop screening past a certain age.
4
At 79 and veryvactove and healthy I was suddenly diagnosed with ovarian cancer, stage 3. No symptoms at all until my abdomin started to swell with fluid. Then an ultrasound revealed a tumor. I had requested an ultrasound, but my doctor said it was not recommended screening for gynecological cancers. I feel it should be part of a woman's yearly exam. My doctor also told me I did not need a gynecologist. She said they couldn't detect these cancers in time. But I feel one might have detected it earlier than she did. Ultra sounds should be included. Don't stop seeing a gynecologist. my insurance is now paying a lot for surgery and chemo and it may not save me.
14
the short answer to your headline question and the only one that makes sense to a patient is YES!
for whom is being "sorry" an option?
for whom is being "sorry" an option?
8
As in every other medical issue and life itself, balance is important. Women who are 75 have a life expectancy of 90 or more. Therefore it may behoove them to continue screening tests.
My mother's experience is a sad example of what can happen when screening tests are not performed. When she was 78 (12 years ago), she finally asked her doctor why he had not recommended a colonoscopy or even a sigmoidoscopy (the previous standard exam when she was younger).
Her colonoscopy showed advanced colon cancer, resulting in the removal of 12 inches of her colon, her duodenum and a small part of her small intestine. While she was able to avoid a colostomy, she had intestinal problems, including bowel urgency, for the remainder of her life, another five years, at which time she died of a separate malignancy, pancreatic cancer.
This was all avoidable, if only her doctor had ordered regular screening tests. If your doctor is not ordering screenings, I recommend finding one who will. In any case, make sure you know the tests you should have and make sure you get them.
My mother's experience is a sad example of what can happen when screening tests are not performed. When she was 78 (12 years ago), she finally asked her doctor why he had not recommended a colonoscopy or even a sigmoidoscopy (the previous standard exam when she was younger).
Her colonoscopy showed advanced colon cancer, resulting in the removal of 12 inches of her colon, her duodenum and a small part of her small intestine. While she was able to avoid a colostomy, she had intestinal problems, including bowel urgency, for the remainder of her life, another five years, at which time she died of a separate malignancy, pancreatic cancer.
This was all avoidable, if only her doctor had ordered regular screening tests. If your doctor is not ordering screenings, I recommend finding one who will. In any case, make sure you know the tests you should have and make sure you get them.
13
Nine years ago, at the age of 63 and with no history of breast cancer in my family, I was diagnosed with lobular carcinoma, an insidious, symptom-free form of breast cancer that is undetectable through a mammogram and difficult to diagnose even from an ultrasound. It afflicts 8%-15% of American women annually.
The year before, I had routine mammo and follow-up ultrasound that produced something suspicious enough to prompt the clinic to have me come back for a second go-round, at which point I was told that it was "up to me" whether to have a biopsy or not, though the radiologist (who talked about the hard time insurance companies gave her clinic) made it clear that she didn't think one was really necessary. The next year, I went to a different clinic, where the radiologist a follow-up biopsy. Two weeks later I learned that I had what would turn out to be stage 3 breast cancer that had already infiltrated 2/3 of my lymph nodes. Today I am cancer-free--and happy to get a mammogram/ultrasound every year in my remaining breast.
This happened several years before the recommendation that women 50-75 be tested only every two years in order to avoid the supposed "ordeal" of a biopsy in the case of a false positive and the resulting expense to the health-care system. If that recommendation had been in place and I had followed it, I'd probably be dead by now, or well on my way. I'm sure there are already women in my age group who have listened to it and aren't as lucky as I was.
The year before, I had routine mammo and follow-up ultrasound that produced something suspicious enough to prompt the clinic to have me come back for a second go-round, at which point I was told that it was "up to me" whether to have a biopsy or not, though the radiologist (who talked about the hard time insurance companies gave her clinic) made it clear that she didn't think one was really necessary. The next year, I went to a different clinic, where the radiologist a follow-up biopsy. Two weeks later I learned that I had what would turn out to be stage 3 breast cancer that had already infiltrated 2/3 of my lymph nodes. Today I am cancer-free--and happy to get a mammogram/ultrasound every year in my remaining breast.
This happened several years before the recommendation that women 50-75 be tested only every two years in order to avoid the supposed "ordeal" of a biopsy in the case of a false positive and the resulting expense to the health-care system. If that recommendation had been in place and I had followed it, I'd probably be dead by now, or well on my way. I'm sure there are already women in my age group who have listened to it and aren't as lucky as I was.
9
Some of the "harmful effects" of testing can be avoided by how people react to a potentially troubling result. I had an elevated PSAT recently (age 72). Some men would end up getting biopsies, which are uncomfortable and can have risks. My internist suspected a symptom-free prostate infection and gave me a prescription for an antibiotic (not Cipro, I was nervous about that). After two weeks of that, the PSAT was back to my usual level.
4
Most urologists would advise the same, depending on family history and other factors.
"Elevation" can mean different things. You don't define.
Moreover, you are simplifying; every situation is different, even in nowhere land.
"Elevation" can mean different things. You don't define.
Moreover, you are simplifying; every situation is different, even in nowhere land.
There are certain physicians responding who are experts in the field of Mammography and breast cancer detection. Please heed their responses.
The National Task force is, unfortunately, a false source of information, performs inadequate searches of the literature for data and promotes incorrect information to the ultimate benefit of less expenditure of money by states, insurance companies and the government.
When I have personally found 8 breast cancers in 28-37 year old patients in the past 6 months, I find the recommendations of the task force abhorrent.
That 50 should be the beginning age and that 75 is too old is outrageous. That breast cancer can disappear is not validated.
However, the disparities between the National Task Force and the American Cancer Society's Guidelines, when compared to the American College of Radiology, Society for Breast Imaging and The American Congress of Obstetricians and Gynecologists are causing significant confusion among women and is diminishing the number of women seeking to avail themselves of a probably life saving screening mammogram. Those that patients that refuse to get mammograms or wait two years or start at 50, may have later stage disease when detected.
One sees in magazines and news articles- how to stay healthy.
An annual screening mammogram certainly fits into this category ands when results come back as normal, often release an underlying and pervading fear.
The National Task force is, unfortunately, a false source of information, performs inadequate searches of the literature for data and promotes incorrect information to the ultimate benefit of less expenditure of money by states, insurance companies and the government.
When I have personally found 8 breast cancers in 28-37 year old patients in the past 6 months, I find the recommendations of the task force abhorrent.
That 50 should be the beginning age and that 75 is too old is outrageous. That breast cancer can disappear is not validated.
However, the disparities between the National Task Force and the American Cancer Society's Guidelines, when compared to the American College of Radiology, Society for Breast Imaging and The American Congress of Obstetricians and Gynecologists are causing significant confusion among women and is diminishing the number of women seeking to avail themselves of a probably life saving screening mammogram. Those that patients that refuse to get mammograms or wait two years or start at 50, may have later stage disease when detected.
One sees in magazines and news articles- how to stay healthy.
An annual screening mammogram certainly fits into this category ands when results come back as normal, often release an underlying and pervading fear.
13
For people with dense breast tissue yearly mammography is recommended independent of age , according to my doctors.
11
Independent of age? So as soon as they develop breasts? Until they die? These types of remarks add to confusion.
2
I cannot address the inaccuracies in only 1500 characters.
Screening doesn’t stop saving lives at the age of 70. Cure from breast cancer is rare unless the cancer is detected and treated before it has become metastatic. Since we cannot predict spread occurs, earlier detection is the best and proven way to save lives. A woman who has reached the age of 75 has a greater chance of reaching age 90 than a woman at the age of 50. She should have every opportunity to extend her life as long as she wishes and may prefer to die peacefully in her sleep at age 90 (or older) than a painful death from cancer years earlier.
A great deal of misinformation has been promulgated by unethical medical journals that continue to publish papers that are scientifically unsupportable, and this is being spread to the public by an uncritical media. There is no legitimate evidence that invasive breast cancers found by mammography would disappear if left undetected. This is a fabrication. No one has ever seen this happen, including the few authors who fallaciously claim there are tens of thousands each year.
Women who are in good health with a life expectancy of more than 5-8 years should have access to annual breast cancer screening. Each should decide for herself whether or not to participate. The decision should be made by women, not for women by some inexpert panel.
Screening doesn’t stop saving lives at the age of 70. Cure from breast cancer is rare unless the cancer is detected and treated before it has become metastatic. Since we cannot predict spread occurs, earlier detection is the best and proven way to save lives. A woman who has reached the age of 75 has a greater chance of reaching age 90 than a woman at the age of 50. She should have every opportunity to extend her life as long as she wishes and may prefer to die peacefully in her sleep at age 90 (or older) than a painful death from cancer years earlier.
A great deal of misinformation has been promulgated by unethical medical journals that continue to publish papers that are scientifically unsupportable, and this is being spread to the public by an uncritical media. There is no legitimate evidence that invasive breast cancers found by mammography would disappear if left undetected. This is a fabrication. No one has ever seen this happen, including the few authors who fallaciously claim there are tens of thousands each year.
Women who are in good health with a life expectancy of more than 5-8 years should have access to annual breast cancer screening. Each should decide for herself whether or not to participate. The decision should be made by women, not for women by some inexpert panel.
33
I am glad to see a world renowned expert of breast radiology weighing in on this issue. The patients under the care of Dr. Kopans at Dana Farber-Harvard Cancer Center are fortunate, especially the elderly, to have a physician who is applying their skill and knowledge based on the patient before them and who understands that "best practice" includes what is best for this individual patient not just what is best for the statistically average patient. Perhaps society's often unspoken low regard for the value of the elderly unduly influences medical policy and decision making.
No one wants the vulnerable elderly subjected to pointless, ineffective treatments that degrade quality of life or lead to further illness/death. Nor should we give up on caring for people who may have the constitution to live years longer with timely, appropriate care. 70-75 is awfully young to write people off...I say this as someone with many nonagenarian/octogenarian relatives. How could it be anything but neglect and negligence to reduce medical care to such people because screening policy logic hues to a statistical mean where mean life expectancy is 78 year? Thank you, Dr. Kopans, for pointing out the obvious fact of which people either are ignorant or just dismissive...if you have the fortune to survive into your mid-70s, it is statistically likely you will keep on thusly, IF you receive the quality medical prevention and intervention which now seems under attack for often specious reasons.
No one wants the vulnerable elderly subjected to pointless, ineffective treatments that degrade quality of life or lead to further illness/death. Nor should we give up on caring for people who may have the constitution to live years longer with timely, appropriate care. 70-75 is awfully young to write people off...I say this as someone with many nonagenarian/octogenarian relatives. How could it be anything but neglect and negligence to reduce medical care to such people because screening policy logic hues to a statistical mean where mean life expectancy is 78 year? Thank you, Dr. Kopans, for pointing out the obvious fact of which people either are ignorant or just dismissive...if you have the fortune to survive into your mid-70s, it is statistically likely you will keep on thusly, IF you receive the quality medical prevention and intervention which now seems under attack for often specious reasons.
12
Thank you for posting your comments. I am 70+, and my gynecologist who is an excellent physician recommends that I get a screening mammography every year as well as do self-breast exams. I trust her and believe her advice is correct.
10
Dr. Kopans, I agree 1500 characters is limiting to discuss things as complex as medicine and issues that are grey. However, I would be very interested in you adding another comment with the names of the journals that you have labeled as being unethical, from your point of view. Perhaps there are other studies and recommendations those editors are supporting that we should be at least aware of being less than the gold standard. Will you expand on your comment please?
1
Correction on your statement that "...a suspicious rise in the PSA test that results in multiple biopsies of the prostate." A rise in PSA does not result in a biopsy. A biopsy should always and only be a result of extensive discussions with your practitioner. There are so many factors with PSA testing, not the least of which are age, and rate of change over time. And biopsies of the prostate should absolutely not be taken lightly, as they come with their own risks. PSA is not perfect, but it's the only metric we have right now, so please continue tracking PSA with an educated understanding of what it means. And yes, I have had prostate cancer twice.
5
Lots of people die before their time despite having no known risk factors for what killed them, my next-door neighbor among them. Is the author seriously arguing, like the health insurance industry might, that it's better not to know about a potentially fatal problem because it might be a false positive? If false positives are SUCH a problem, perhaps the simple test should be repeated if it's positive, as positive AIDS antibody tests used to be. Concerns about overtreatment should be dealt with by not overtreating, not by never finding out if a serious condition might be present.
9
Doctors, no matter how bright and devoted to your health, are not magicians. The existing technology is limited and false positives can have terrible results even with well-meaning docs. I believe individual patients should be informed of pros and cons by a doc who knows their history, advises them as individuals, and the patient allowed to choose which risks they will take. This is impossible if PCPs have 10 minutes to spend with a patient.
2
In the cancer research, breakthrough theory and therapy is rising. It is actually the restoration of the hypothesis that cancer is not a genetic disease but a mitochondrial metabolic disease, a Nobel-prize winning theory in 1831 by Dr. Otto Warburg that became recently confirmed by a group of scientists like Dr. Thomas Seyfried, Dr. Dominic D'Agastino et al. These scientists kill cancer cells ( that devour/ferment glucose/glutamine withthout oxygene) by ketosis and hyperbaric oxygen treatments with non-toxic cancer drugs. For nearly a century, cancer researchers and therapists have been ignoring Dr. Warburg's finding and have been applying toxic chemotherapy and radiation. Unfortunately the recent gene therapy that continues to argue nuclear gene mutations as the cause of cancer will be a wrong approach. They are chasing the rusults instead of root cause. They don't accept Warburg theory, namely cancers are caused the impairment of mitochondrial metabolic activities (triggered by all the known carcinogens). Therefore not only new therapies by Dr. Seyfried be accepted but also new cancer screening methods have to be developed.
1
Correction: 1931 instead of 1831
I was alarmed when my sister-in-law told me my 70-year old brother had had his last colonoscopy--he wouldn't need any future ones because of his age. Our mother had colon cancer and I and another brother have had polyps found during each colonoscopy. Doesn't this put him in a high risk group? Maybe some people thinking living till their early 80's is as good as it gets, but I want him around for as long as possible. I'm going to try to talk him in to one more colonoscopy in his mid to late 70's. If no polyps then, well then, okay.
11
Was this funded by insurance companies. Women in their 80's get breast cancer, men with very high PSA well thats bad news.
I get so angry with these article that point out the risks of breast biopsies for women because poor dear will be so upset and anxious. Women have enough trouble with Physicians respecting us without more of this sexism.
I get so angry with these article that point out the risks of breast biopsies for women because poor dear will be so upset and anxious. Women have enough trouble with Physicians respecting us without more of this sexism.
18
I respectfully disagree that concern for a patient's state of mind is sexist. I had a feamale MD order a mamogram for me. No discussion. When I saw her next, she was angry that I had not had the exam because she had "ordeted me" to get it. I now jave a doc who discusses screening with me instead of otdering me. Being concerned about false positives with mamograms isn't about little- ol- me helpless female nonsense. The procedures and results of false positives can have life- changing ramifications. Nothing sexist about my being awate that mamograms are not all pink ribbons and butterflies.
2
My sister-in-law's mother suffered from serious dementia, and I remember my sister-in-law complaining about the hard time she had when she took her 85-year-old very confused mother for a mammogram. If only there were a screening for common sense. And a cure for the lack of.
8
"If only there were a screening for common sense. And a cure for the lack of."-sherry
The "cure" appears to be what everyone is trying to avoid.
The "cure" appears to be what everyone is trying to avoid.
2
As a cancer survivor ( early screening saved my life ) it's important that screening procedures must be accessible and affordable , especially in this chaotic health insurance mess.
8
My doctor retired. When I saw my new doctor she suggested a mammogram and a test for osteoporosis. I was 76 at the time and my last mammogram was when I was 70 years old. I knew I didn't need a mammogram, but did not want to go head to head with my new doctor. So I had the screening mammogram.
It was "suspicious". We want to do a diagnostic mammogram.
I had the diagnostic mammogram. It was "suspicious". They wanted to do a needle biopsy. I proceeded to tell the the radiologist what the odds of me dying from breast cancer were (very slim, less than two percent of actually having a cancer that would metastasize). I told her I was not going to start on that train ride, needle biopsy, surgery, radiology, chemo and I was getting off the train. She told me she had had two needle biopsies and they were both negative (she was in her 50's).
I told her I was not having the needle biopsy. She asked if she could hug me and I said I don't need a hug and she said she did. So she hugged me and then she started to cry. This is the radiologist, a professional doctor.
As soon as I left the office she called my doctor, who then called me. I told her the same thing. My primary, my children, and my friends have been supportive of my decision
Now they want me to go for a repeat mammogram, I'm not sure why as I will again refuse the needle biopsy.
It was "suspicious". We want to do a diagnostic mammogram.
I had the diagnostic mammogram. It was "suspicious". They wanted to do a needle biopsy. I proceeded to tell the the radiologist what the odds of me dying from breast cancer were (very slim, less than two percent of actually having a cancer that would metastasize). I told her I was not going to start on that train ride, needle biopsy, surgery, radiology, chemo and I was getting off the train. She told me she had had two needle biopsies and they were both negative (she was in her 50's).
I told her I was not having the needle biopsy. She asked if she could hug me and I said I don't need a hug and she said she did. So she hugged me and then she started to cry. This is the radiologist, a professional doctor.
As soon as I left the office she called my doctor, who then called me. I told her the same thing. My primary, my children, and my friends have been supportive of my decision
Now they want me to go for a repeat mammogram, I'm not sure why as I will again refuse the needle biopsy.
10
"Now they want me to go for a repeat mammogram, I'm not sure why as I will again refuse the needle biopsy."
All "religions" seek to be universally applied. Humans survive by pleasing others. You cannot prove you are right. The odds are against you, not regarding cancer, but, against resisting conforming to please. The tears/hug reflected the social pressures.
Show of hands, reality is not a function of expert consensus? Best expert guesses are not validated by repetition into becoming something else other than ritual. Both collectives and individuals have the same logical options:
"Ad Hoc Rescue (also known as: making stuff up, MSU fallacy)
Description: Very often we desperately want to be right and hold on to certain beliefs, despite any evidence presented to the contrary. As a result, we begin to make up excuses as to why our belief could still be true, and is still true, despite the fact that we have no real evidence for what we are making up."
We were people before we became a prognosis. It might be time to think that factory farming symptoms isn't going to alter anything in a meaningful way. The shell game being played for professional and financial profit is, "What else would you rather die of...eventually?"
All "religions" seek to be universally applied. Humans survive by pleasing others. You cannot prove you are right. The odds are against you, not regarding cancer, but, against resisting conforming to please. The tears/hug reflected the social pressures.
Show of hands, reality is not a function of expert consensus? Best expert guesses are not validated by repetition into becoming something else other than ritual. Both collectives and individuals have the same logical options:
"Ad Hoc Rescue (also known as: making stuff up, MSU fallacy)
Description: Very often we desperately want to be right and hold on to certain beliefs, despite any evidence presented to the contrary. As a result, we begin to make up excuses as to why our belief could still be true, and is still true, despite the fact that we have no real evidence for what we are making up."
We were people before we became a prognosis. It might be time to think that factory farming symptoms isn't going to alter anything in a meaningful way. The shell game being played for professional and financial profit is, "What else would you rather die of...eventually?"
Unless the test have a proven record of being very accurate with a viable treatment option, avoid it.
Most of these tests are part of our de facto criminal health system enabling medical billionaire types to make money off the backs of the US taxpayer.
Most of these tests are part of our de facto criminal health system enabling medical billionaire types to make money off the backs of the US taxpayer.
2
My routine mammography, age 48, No family history, breastfed 3 children, found my tumor so early that I didn't even have lymph node involvement. Yet this test has been reported as inaccurate, with many incidents of false-positive results. Your point is?????????
3
I want to know if my comment will be added to the discussion
This article didn't touch on a critical problem with many of our screening recommendations: the lack of diverse populations in the screening data. One third of all breast cancers in African American women are diagnosed before the age of 50. If. African American women were to follow the USPSTF guidelines, 1/3 of women would never have been offered a life saving intervention for early detection. Breast Cancer mortality is 40% higher in African American women and this group can not afford the current confusion about when and how often to screen. Similarly for prostate cancer, African American men have the highest mortality of any ethnic and racial group in the world- 2.4 x greater or one out of 23 AA men die of prostate cancer. Hardly a non lethal disease in this group. Unfortunately the screening trials didn't have enough African American men to report any conclusions but our national data has indicated a 40% reduction in the death rate since screening was introduced throughout the country . So for many, the opportunity to screen is truly lifesaving and when we discuss the false positives, it's important to review the difficulty of receiving treatment when disease has spread and the opportunity for cure has passed.
21
It is generally known that 10% of solid tumors of the breasts do not show on mammogram. Starting with age 30, or earlier, women should do self examination monthly, just after menstruation or by the calendar if menstruation has been nixed by hormones. here is no expense and no radiation involved. The technique is shown on the American Cancer Society site. If a mass is found, it should be examined by a breast surgeon or gynecologist with cancer training. There are too many women in their 30s and 40s who have breast cancer that should not wait for mammography. Shirley Temple was 44 when she found hers, the only female recipient f the Fields Medal died recently at age 40, Judy Holiday at age 37, a number of Metropolitan Opera sopranos in their 40s. Breast cancer is often lethal, and kills about 30% of those who have it.
5
With all due respect, Dr. Canter, breast cancer in the US kills a little over 10% of its victims, using the five-year survival rates - and it very rarely kills those diagnosed before stage III!
Luckily, we need not depend for all of our information on those in the breast cancer industrial complex.
Luckily, we need not depend for all of our information on those in the breast cancer industrial complex.
9
Dr. Carter:
I don't think the article is talking about women in their 30's and 40's. I think the article is referring mainly to people in their 70's. In the elderly only 20% are likely to have breast cancer and of those less than two percent of tumors ever metastasize or cause any problems. Furthermore women in their 70's are more likely to die from some other disease than cancer even if they have cancer.
I don't think the article is talking about women in their 30's and 40's. I think the article is referring mainly to people in their 70's. In the elderly only 20% are likely to have breast cancer and of those less than two percent of tumors ever metastasize or cause any problems. Furthermore women in their 70's are more likely to die from some other disease than cancer even if they have cancer.
3
Thankyou , last year 28 year old cousin, dead , best friend age 35 dead and other friend five yrs. ago at 40 dead. Its an epidemic in which I've lost 14 women friends and several clients.
2
"Practice guidelines for physicians called Choosing Wisely advise not recommending cancer screening to patients with a limited life expectancy." Show me a person with an UNlimited life expectancy.
6
It would help if the author would address what factors are used in developing criteria and how they are weighted. Yes, I see potential harms of the screening mentioned but what role does cost to system play? Recommendations that may optimize outcomes for the larger healthcare system may not optimize outcomes for individuals
1
No, you are correct. These guidelines are based on many studies of reasonably robust strength (they don't look at weak study data) and applied to a population health model. And yes, occasionally things will be missed, and that's tragic for the individual. However, screening everyone for everything all the time is cost-prohibitive and rife with risk of over diagnosis and complications due to screening and follow up testing. The USPSTF is a little conservative for many clinicians but it is based on sound science, is not influenced by industry lobbyists, and holds firmly to my favorite maxim in practice, FIRST DO NO HARM.
1
Actually, the USPSTF was highly politicized. No one with any expertise in caring for women with breast cancer was on the panel and anyone with expertise in screening was not permitted.
In fact, the USPSTF wrote that the most lives are saved by screening starting at the age of 40, but the panel members, claiming to want to reduce "harms", said women can wait until the age of 50 and then be screened every two years admitting that this would result in the unnecessary loss of tens of thousands of lives.
In fact, the USPSTF wrote that the most lives are saved by screening starting at the age of 40, but the panel members, claiming to want to reduce "harms", said women can wait until the age of 50 and then be screened every two years admitting that this would result in the unnecessary loss of tens of thousands of lives.
3
Is there any source that clearly discusses who was on the panel and what institutional ties they may have, which might inform their opinion. As I have found, what information you get sometimes depends on who you ask and what school of thought influences where they've chosen place emphasis and confidence among competing ideas. That the panel could lack a screening expert or breast cancer care experts is puzzling and seems a gross oversight.
2
I've also witnessed among senior friends and acquaintances the notion that "denying" them screening after a certain age is depriving them of their "rights" to whatever medical care they feel they are entitled to. This kind of thinking, while totally counterproductive, seems almost impossible to overcome. The notion of entitlement surely contributes to our skyrocketing medical costs. And I say this as a senior myself.
9
I am 73, I am aware of the negatives on colonoscopy and mammograms for women my age . Yesterday, I told a prospective doctor in Portland, Oregon affiliated with a leading hospital, that I would not accept any recommendations for screening. She refused to take me as a patient because it was very important, she said, for me to continue screening. I don't question her sincerity but do question the cost and dangers to health from screening, the profits to be made from possibly detrimental screening. I am upset that I am unlikely to find a doctor in this hospital's network of providers, because I don't want screening.
17
Please spare me the senior dissing. I have as much right as a younger person to get screened for cancer and other illnesses. So what age should we draw the line for screening? 50, 60, 70 or beyond. I know very active seniors in their 80's who found their cancers through screening (skin cancer, thyroid, etc.). Are we going to deny people health care just because they are deemed "over the hill." Give me a break.
Do what you want with your health, but no one has any right to tell someone else they are "too old and too entitled" to live productive lives after a certain age because they have no right to get checked for serious illness. Enough with the "only younger people matter" meme. It's insulting.
Do what you want with your health, but no one has any right to tell someone else they are "too old and too entitled" to live productive lives after a certain age because they have no right to get checked for serious illness. Enough with the "only younger people matter" meme. It's insulting.
17
You are entirely right. And I reserve my right to share your costs based only on the best available empirical evidence. (I am >70 also, as age seems important to your argument.)
2
One thing to remember... these stories about people being saved by a screening test that wasn't the "standard recommendation" are anecdotes. Anecdotes don't drive public health policy. Public health policy, such as screening guidelines for a large population at "average" risk of a given disease, consider outcomes, statistically, for large groups of people. Population based statistics drive polices such as cancer screening guidelines.. Individual factors, such as family history of disease, personal values and goals, tolerance for various types of risk, and many other 'intangibles,' drive individual decisions, which may or may not align with general policy guidelines and health screening recommendations.
19
in fact, they are less than anecdotes. among the many reasons that screenings are curtailed is that for many cancers, there is no advantage to finding the cancer before it becomes noticeable without the screening. What this means is that for many cancers there is no difference in survival rates for those who had the cancer found during a screening, or sometime later when the lump or other symptoms brought the patient to a doctors attention.
7
Okay, so let's quite screening everyone, because, after all, only statistics matter, not individual lives. At least that's what some people believe.
5
As with tests conducted during pregnancy, these cancer screens are often not well explained. Providers may do a good job of informing patients what the test is for, but often skip the crucial piece of what the implications of a positive test might be. I believe that if more patients were to consider what might be the next step, some would choose against the procedures. But as it stands now, many folks see not reason not to have them.
I refused amniocentesis that was offered merely because of my age, feeling that the dangers outweighed any information we might get at the time. Not everyone makes the same decision, and there is much more to learn these days, but to what end? We decided we would not abort even for anencephaly, since we could donate the baby's organs. Same with annual mammograms. I once had a suspicious one, but it turned out to be fine. But my doctor was not aware that recommendations for women after 50 had changes--I was the first to tell her.
I do have a family history of colon cancer and have had both an upper-GI cancer and a polyp, so that means I will likely continue with colonoscopies every five years. I need throat dilations much oftener than that, so can have both procedures together, saving some money and time.
I refused amniocentesis that was offered merely because of my age, feeling that the dangers outweighed any information we might get at the time. Not everyone makes the same decision, and there is much more to learn these days, but to what end? We decided we would not abort even for anencephaly, since we could donate the baby's organs. Same with annual mammograms. I once had a suspicious one, but it turned out to be fine. But my doctor was not aware that recommendations for women after 50 had changes--I was the first to tell her.
I do have a family history of colon cancer and have had both an upper-GI cancer and a polyp, so that means I will likely continue with colonoscopies every five years. I need throat dilations much oftener than that, so can have both procedures together, saving some money and time.
4
As an Anaesthesiologist who works two days a week with a Urological surgeon, I've noticed a trend of increasing elderly men being referred for prostate biopsy for "elevated PSA". Some of these men are not well, and clearly wouldn't cope well with radical surgery or maybe even brachytherapy, but here we are, subjecting men in their mid- to late-eighties to what I consider to be an effectively useless and potentially dangerous intervention.
Educating primary care physicians is the most important thing. They should be taught the best evidence, how to counsel patients against unnecessary invasive testing, and to resist the temptation to order that PSA level in the first place. Specialists also need to learn to say no, and be prepared to argue their point of view. Unfortunately, I fear my Urologist sees only the $900 he charges for doing a trans-rectal prostate biopsy. Cynicism? Perhaps, but I see it allll the time.
Educating primary care physicians is the most important thing. They should be taught the best evidence, how to counsel patients against unnecessary invasive testing, and to resist the temptation to order that PSA level in the first place. Specialists also need to learn to say no, and be prepared to argue their point of view. Unfortunately, I fear my Urologist sees only the $900 he charges for doing a trans-rectal prostate biopsy. Cynicism? Perhaps, but I see it allll the time.
64
Yes its risky in the old old but what about the small camera endoscopy . I know its not as valid as a colonoscopy but there is very small risk of it getting stuck and otherwise a painless, harmless test. Look into the new robotic testing that will be our future soon its in development stages.
Jane, Jane, Jane...this is all meaningless statistical mumbo-jumbo. My grandmother was in perfect health with all her marbles intact at age 94 when she was diagnosed with colon cancer. No walker, not even a cane...she could still do jumping jacks. Had she had a colonoscopy, she no doubt would have lived at least another terrific 10-15 years. All the statistics mean nothing if the exception is your loving Nana!
12
Looking at populations and statistical outcomes is not mumbo-jumbo. I'll take statistics over an anecdote any day.
8
another 15 years?
109?
get a grip - she had a nice long life -
celebrate what she had and stop moaning what might have been
many of us would be more than happy to get to 94
109?
get a grip - she had a nice long life -
celebrate what she had and stop moaning what might have been
many of us would be more than happy to get to 94
14
A colonoscopy is not a test without risk. It requires sedation and the invasion of, in her case, a 90+ year old colon. Those tissues are more fragile in the elderly.
The presumption that a colonoscopy would have found the polyp or pre-cancer soon enough to extend her life is also faulty. It might merely have turned her into a cancer patient at a younger age. The side effects of an earlier diagnosis and treatment my have precluded her from even seeing age 94, let alone doing jumpingjacks until that age.
The presumption that a colonoscopy would have found the polyp or pre-cancer soon enough to extend her life is also faulty. It might merely have turned her into a cancer patient at a younger age. The side effects of an earlier diagnosis and treatment my have precluded her from even seeing age 94, let alone doing jumpingjacks until that age.
20
I might be wrong here, but I think that it's not the testing that potentially does more harm than good (re: "though I, having previously had breast cancer, am likely to be the only one among them for whom the potential benefit might conceivably outweigh the risks.") it's what you do with the test results once you have them. I don't like my breasts being smashed but there is really no harm from it.
What is potentially deadly is having surgery. I've now had three friends who died from run-away infections after "routine" surgeries, two of them recommended by their physicians. A fourth had a catastrophic stroke under anesthetic from which he never recovered.
Three of these men would be alive if their physicians had recommended watchful waiting.
What is potentially deadly is having surgery. I've now had three friends who died from run-away infections after "routine" surgeries, two of them recommended by their physicians. A fourth had a catastrophic stroke under anesthetic from which he never recovered.
Three of these men would be alive if their physicians had recommended watchful waiting.
21
"I think that it's not the testing that potentially does more harm than good"
The interesting thing about PSA screening is that what they do as a result of the test performs so poorly and harmfully that we don't know that it's even worth doing the test at all. It's possible that a much more circumspect response to the test may have a different outcome but circumspection is not something doctors do when it comes to treatment, especially when there are financial rewards involved.
The interesting thing about PSA screening is that what they do as a result of the test performs so poorly and harmfully that we don't know that it's even worth doing the test at all. It's possible that a much more circumspect response to the test may have a different outcome but circumspection is not something doctors do when it comes to treatment, especially when there are financial rewards involved.
5
I have two second cousins who had prostate surgery in their 40s, and are alive in their 70s today. Our grandfathers, who were brothers, all died of prostate cancer in their 60s. People are individuals, not statistical averages.
3
Thank you William Burgess Leavenworth. I am so sick and tired of statistics and studies ruling health care. In the end they mean nothing if the individual lives are not considered to be more important. There are always exceptions in life and if you rely mostly on "averages" you'll skip over the "uncommon" successful living stories.
1
Why do we do cancer screening? -- to presumably A) live longer, and B) have no symptoms of distress. Otherwise, why bother to look for cancer?
One must look at the actuarial tables for one's age: Will the quality and (even) quantity of life at (e.g.) age 65 for an undiagnosed/asymptomatic cancer trump the quality/quantity of life of a DIAGNOSED cancer at age 65? If the answer is YES -- don't go looking for that cancer!
As a physician, I continue to be amazed at how we all continue to drink the Koolaid of "more is more" medicine. As I am approaching 65, I'm going to pass on that koolaid.
One must look at the actuarial tables for one's age: Will the quality and (even) quantity of life at (e.g.) age 65 for an undiagnosed/asymptomatic cancer trump the quality/quantity of life of a DIAGNOSED cancer at age 65? If the answer is YES -- don't go looking for that cancer!
As a physician, I continue to be amazed at how we all continue to drink the Koolaid of "more is more" medicine. As I am approaching 65, I'm going to pass on that koolaid.
43
Sadly cancer is diagnosed in many people much younger than 65 who are otherwise in excellent health, have no family history or elevated risk profile. I was diagnosed at age 48 with aggressive breast cancer, and I am grateful to have been able to have the screenings and treatment to currently be alive to raise my three children. Sadly, it seems to be hitting more people younger every year.
1
Sorry, but the screening is not worth it. Not everyone even if they find out they have cancer wants to treat it and the reasons are varied. However, some are making this decision because of the cost of it because even with insurance the costs of treatment are outrageous. The patients are still expected to pay not only their premium each month but their copay for each visit to the doctor whether it's for the chemo on site or the visits in between those sessions to see how they are doing, but the lab work that is required to make sure that blood counts aren't low as those low counts will affect treatment continuing. This is of course important that treatment don't stop so that it kills the cancer, so if the blood counts are low that means infection may have set in or some other problems. And of course, you also have the deductible for the insurance that has to be met that may apply toward not only the treatment itself in the way of the drugs, but the lab work, and the surgeries regardless of how many surgeries there are to be had.
Sorry, but I don't agree that these tests are that good. And as for the person below saying that if she had waited until 50 to have the mammogram that she would be dead. She does not know that for a fact. Breast cancer is one of the more slow growing cancers of the body.
Sorry, but I don't agree that these tests are that good. And as for the person below saying that if she had waited until 50 to have the mammogram that she would be dead. She does not know that for a fact. Breast cancer is one of the more slow growing cancers of the body.
7
By slow growing, you mean it may be years before a mass is palpable or visible; once it is diagnosed, the pathology can often give some indication of its indolence or aggressiveness. Inflammatory breast cancer is very aggressive and can spread like wild fire; even an early stage breast cancer can metastasize
1
Why isn't an annual skin exam listed here?
5
Why should it be? What are the data to support it?
3
Oh please. If I had waited for my first mammogram at age 50 I'd be dead. I'm going for every screening test my doctor gives me. And every single day I thank God I live in a country where human life is valued for real, and people are not made to feel like they are wasting valuable time and resources to be tested. Cancer is a silent killer, all the exercise and diet in the world can't prevent it if your number is up, and it has to be caught early if you want to have a hope of surviving. I have zero patience for articles like this.
14
Oh please? You don't know that for a fact that if you had waited for your first mammogram to occur at age 50 that you would be dead.
Sounds to me that by you wanting to go ahead and have every screening test your doctor gives you, including the Pap Smear, that you are more interested in keeping him busy so that h's not bored during the day.
Cancer may be a silent killer, but did you know that we are exposed to cancer of some sort every single day of our life and nothing comes of it? It does not have to be caught early if one wants to have a chance of surviving. Not everyone wishes to know if they have cancer or treat it. And as for having zero patience for articles like this, I am sorry to hear that but finally they are starting to wake up to the reality that these screenings are not beneficial for everyone, no matter how old someone is.
Sounds to me that by you wanting to go ahead and have every screening test your doctor gives you, including the Pap Smear, that you are more interested in keeping him busy so that h's not bored during the day.
Cancer may be a silent killer, but did you know that we are exposed to cancer of some sort every single day of our life and nothing comes of it? It does not have to be caught early if one wants to have a chance of surviving. Not everyone wishes to know if they have cancer or treat it. And as for having zero patience for articles like this, I am sorry to hear that but finally they are starting to wake up to the reality that these screenings are not beneficial for everyone, no matter how old someone is.
3
Tell that to my patient who had a biopsy for an elevated PSA and died due to sepsis.
Oh, you can't, because he's DEAD.
Oh, you can't, because he's DEAD.
4
Your "good luck" story is countered by the women whose false-positive mammograms have led them to have unnecessary biopsies, unnecessary surgery (with the attendant risks, which are very serious), and the dread fear of having cancer, all for nothing. I'm pleased you're alive, don't get me wrong, but there are many women who have suffered unnecessarily because of over-zealous breast cancer screening.
5
As long as they have people coming in for physicals, why don't they test hearing and look in their ears? I guess they think people don't die from loss of hearing ....
3
Old people want to keep having these tests is because they don't want to accept the reason why these tests are not recommended any more. The tests are a comforting ritual that says, "I am like anyone else, not like a prisoner on death row."
7
A very close family member had a mammogram at 72, which found a malignant tumor. After the removal of both breasts, she is now able to babysit her great grand children 10 years later at 82 (one born 3 years ago, one on the way), and continues to care for her grandchildren daily after school, immeasurably adding to their, and her daughters' and other family members, lives. Everyone should be able to decide for themselves what is best for their own lives
, without judgment or pressure. Comparing the contributions of those who happen to have been on this earth for longer than most to those of death row inmates is inaccurate and unkind. The choice of medical care and testing needs to be respected, whether it prolongs or shortens the life of the individual who makes that choice.
, without judgment or pressure. Comparing the contributions of those who happen to have been on this earth for longer than most to those of death row inmates is inaccurate and unkind. The choice of medical care and testing needs to be respected, whether it prolongs or shortens the life of the individual who makes that choice.
3
I found as I aged Physicians practice what they learned in Med School. The c current batch practice what they call preventative medicine and that involves a whole lot of test and procedures. Those test usually find something they treat with medicine.
5
In the 1970's when I was a young child, the great aunt for whom I'm named received the news she most feared. When told that the Mammogram indicated breast cancer, she had a stroke. She was 84, well beyond the current recommended age cut-off. The stroke was fatal.
That aunt was adopted and I have no family history of breast cancer among blood relatives. I think of her when I opt to lessen the frequency of my own mammograms. But family history or not, each of us has a higher risk of Heart Disease, Stroke and Diabetes than of breast or any other kind of cancer. Notably, the #1 cancer killer is NOT routinely screened for, even among smokers. If instead of endless debate of over the benefits of specific cancer screening, we each focused on reducing our risk of Heart Disease, we would reduce incidences of Heart Disease, Stroke, Diabetes and most types of cancers. We would also improve bone density, reduce risk of falls and depression and prolong mobility and independence. Early detection has nothing on prevention.
That aunt was adopted and I have no family history of breast cancer among blood relatives. I think of her when I opt to lessen the frequency of my own mammograms. But family history or not, each of us has a higher risk of Heart Disease, Stroke and Diabetes than of breast or any other kind of cancer. Notably, the #1 cancer killer is NOT routinely screened for, even among smokers. If instead of endless debate of over the benefits of specific cancer screening, we each focused on reducing our risk of Heart Disease, we would reduce incidences of Heart Disease, Stroke, Diabetes and most types of cancers. We would also improve bone density, reduce risk of falls and depression and prolong mobility and independence. Early detection has nothing on prevention.
5
"When told that the Mammogram indicated breast cancer, she had a stroke."
Thus avoiding death from breast cancer. This is what disease-specific screening does, possibly reduce the disease specific cause of death but advocates of disease-specific screening ignore overall mortality.
Thus avoiding death from breast cancer. This is what disease-specific screening does, possibly reduce the disease specific cause of death but advocates of disease-specific screening ignore overall mortality.
2
American medicine and medics are slow to change. Revision is needed in the reccomendations of the United States Preventive Services Task Force. The long-term study (1980 - 2010) in Denmark published in the Annals of Internal Medicine this year, Breast Cancer Screening in Denmark: A Cohort Study of Tumor Size and Overdiagnosis, by Karsten Juhl Jørgensen, MD et al conclude that:
''Breast cancer screening was not associated with a reduction in the incidence of advanced cancer. It is likely that 1 in every 3 invasive tumors and cases of DCIS diagnosed in women offered screening represent overdiagnosis (incidence increase of 48.3%).''
''Breast cancer screening was not associated with a reduction in the incidence of advanced cancer. It is likely that 1 in every 3 invasive tumors and cases of DCIS diagnosed in women offered screening represent overdiagnosis (incidence increase of 48.3%).''
5
Mentioned, but not emphasized is the emotional toll of having a test that identifies "something" that needs lifelong surveillance. Every day, thinking you're going to die prematurely, even with the understanding that, statistically, you probably won't, affects one's quality of life.
13
"Likewise for men with a suspicious rise in the PSA test that results in multiple biopsies of the prostate."
That is an obsolete approach. The current approach after a concerning PSA level is first to do an MRI of the prostate to see if there is any matter of concern. If there is, that is followed by a biopsy that is guided by image to the spot for the biopsy. The biopsy is of the area of concern, not random sampling of the prostate. I know because I had a sudden change in PSA reading and that was the process followed by my medical team.
It is true that 85% of prostate cancers are of the slow growing type and most men will die of something else. However, absent the biopsy no one knows whether any particular prostate cancer is in that 85% group or in the 15% group that kills.
Others may have a different view, but a 15% chance of something killing me is a risk I choose to avoid.
That is an obsolete approach. The current approach after a concerning PSA level is first to do an MRI of the prostate to see if there is any matter of concern. If there is, that is followed by a biopsy that is guided by image to the spot for the biopsy. The biopsy is of the area of concern, not random sampling of the prostate. I know because I had a sudden change in PSA reading and that was the process followed by my medical team.
It is true that 85% of prostate cancers are of the slow growing type and most men will die of something else. However, absent the biopsy no one knows whether any particular prostate cancer is in that 85% group or in the 15% group that kills.
Others may have a different view, but a 15% chance of something killing me is a risk I choose to avoid.
5
"absent the biopsy no one knows whether any particular prostate cancer is in that 85% group or in the 15% group that kills."
That also applies after the biopsy too.
"a 15% chance of something killing me is a risk I choose to avoid"
Getting it treated won't make much difference to this 15% and probably won't make any difference.
That also applies after the biopsy too.
"a 15% chance of something killing me is a risk I choose to avoid"
Getting it treated won't make much difference to this 15% and probably won't make any difference.
1
Another test being pushed now is breast sonogram along with the mammogram for women with "dense breasts" that make the mammo harder to read. My experience was that this test discovered a tiny, nonpalpable lump that the radiologist was very sure was a benign fibroadenoma, but he recommended a needle biopsy anyway. It was exactly as he predicted, but the procedure and recovery were more painful than I was told, and 9 months later I still have residual pain which they told me was "normal" (funny how they didn't mention this at the time). Imagine having multiple procedures that all find no pathology but each leaves a scar or residual pain. I will think very carefully about the indications and necessity before having this again.
Imaging tests often show irregularities that mean nothing and can lead to recommendations for surgery. I found this out when having a back MRI (for pain that was later treated with physical therapy) that showed oddities and herniations nowhere near the site of pain, that were best left alone. Later I refused another MRI which also turned out to be unnecessary. All this must be weighed when agreeing to major and potentially invasive tests and procedures.
Imaging tests often show irregularities that mean nothing and can lead to recommendations for surgery. I found this out when having a back MRI (for pain that was later treated with physical therapy) that showed oddities and herniations nowhere near the site of pain, that were best left alone. Later I refused another MRI which also turned out to be unnecessary. All this must be weighed when agreeing to major and potentially invasive tests and procedures.
22
As a doctor, who reviews hundreds of scans every month, I can tell you that I rarely will ever see a pristine "normal" back MRI.
Same with ultrasounds and the like. Nobody is ever completely "normal."
Same with ultrasounds and the like. Nobody is ever completely "normal."
20
I had an MRI that incidentally found a nodule in my lung. I had a normal CT scan 6 months after that (no change in the nodule) and I opted out of any further follow up for it.
4
Re PSA
You say no screening before age 55; what if your Dad or brother or uncle was diagnosed with aggressive prostate cancer when they were 45 or 50? What if you are African American? And you say stop screening at age 70? What if you are a healthy 73 year old whose Dad lived to be 90? No, your " suggestions" are too dictatorial and could cause lives lost and years of unnecessary suffering. Knowledge is the answer. No fear based decisions is the answer. Men have a right to know what is going on in their bodies and enough information to make sound decisions.
You say no screening before age 55; what if your Dad or brother or uncle was diagnosed with aggressive prostate cancer when they were 45 or 50? What if you are African American? And you say stop screening at age 70? What if you are a healthy 73 year old whose Dad lived to be 90? No, your " suggestions" are too dictatorial and could cause lives lost and years of unnecessary suffering. Knowledge is the answer. No fear based decisions is the answer. Men have a right to know what is going on in their bodies and enough information to make sound decisions.
6
"what if your Dad or brother or uncle was diagnosed with aggressive prostate cancer when they were 45 or 50?"
Getting diagnosed is one thing. Whether treatment is going to make a difference to disease-specific death is another. And whether treatment is going to make a difference to overall survival is another thing again.
The only things we do know is that PSA screening has never been shown to improve overall survival anywhere in any trial and that it has only been shown to reduce prostate cancer specific mortality in two isolated trials out of many. Hardly a roaring success.
Getting diagnosed is one thing. Whether treatment is going to make a difference to disease-specific death is another. And whether treatment is going to make a difference to overall survival is another thing again.
The only things we do know is that PSA screening has never been shown to improve overall survival anywhere in any trial and that it has only been shown to reduce prostate cancer specific mortality in two isolated trials out of many. Hardly a roaring success.
4
I have my annual physical today, and I am hoping that he will forgo the pelvic exam this go around and present me with my prescription for estrace cream anyway. He has evolved a bit; it has been several years since my last pelvic exam (he used to require it annually). Having always had a normal result and being asymptomatic of any issue in the area, I feel strongly that I should be allowed to decline this bothersome and invasive exam. I would much prefer spending time on a more thorough physical exam on the rest of my body, leaving plenty of time for my questions and expecting to receive thorough answers. I have had an extremely low vitamin D levels in the past, to the point that my "floating ribs" ached (possibly related to a prior kidney infection). I expect that he will choose to skip a CBC and vitamin D test yet insist on a pap.... I plan to be politely assertive. It will be an interesting day.
18
" I feel strongly that I should be allowed to decline this bothersome and invasive exam." What is the matter with you? "Should be allowed . . ."? You have an absolute right to refuse to consent to this and to almost all diagnostic and therapeutic procedures.
17
I thought pelvic exams were de-recommended recently. This just shows how biassed towards invasiveness the medical profession are.
6
All went well. No pelvic exam!!!! There was plenty of time to have a thorough exam and have all my questions answered. I have my estrace prescription. MainLaw, I have had other physicians over the years refuse to renew prescriptions relating to estrogen if I were to not have a female exam. It used to be quite standard. I have refused a multitude of procedures and diagnostic recommendations (i.e. colonoscopy, mammogram) yet he, and other physicians over the years, always held strong on the hormones only with exam, etc. I had one doctor send me a letter years ago dropping me as a patient following a molar pregnancy since I refused the monthly chest x-rays yet agreed to blood tests and birth control pills for a year. My next doctor was fine with the monthly blood work and birth control for six months before trying to become pregnant again. I am really a rather tough patient as well as patient advocate for family members. I have had to be extremely assertive over the years, and thankfully, the chasm between medical/scientific research and medical practice is closing, slowly, but surely. Thirty years ago, many moronic hospital policies mandated a chest x-ray prior to any c-section but perhaps the most emergent. It is indeed easier to fight these things in recent years. Also, here are the newer guidelines for pelvic exams:
https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detec...
https://www.cancer.org/cancer/cervical-cancer/prevention-and-early-detec...
2
In every other discipline learning about a problem sooner vs later helps -- enormously. Just because the medical community hasn't done enough work on curing certain diseases doesn't mean we should remain ignorant. If anything, having more patients identified earlier will bring research dollars to a disease. This "early detection won't help" should be an embarrassment to the medical community and not a recommendation to consumers.
9
Sorry, but I disagree about that having more patients identified earlier will bring research dollars to a disease. It will bring more money to doctors for procedures and tests that were unnecessary.
Healthcare has become a business of making money big time when it comes to some specialties and Cancer and Oncology is one of them.
Healthcare has become a business of making money big time when it comes to some specialties and Cancer and Oncology is one of them.
3
I had a screening mammogram that showed calcifications in one breast. Repeat mammo, same result. Biopsy showed atypical Ductal Hyperplasia and another "precancerous" lesion. Lumpectomy biopsy showed no atypia.
The result is that one breast is deformed and painful. I'm told to have another mammogram this year but haven't decided what to do.
The result is that one breast is deformed and painful. I'm told to have another mammogram this year but haven't decided what to do.
6
One can live for decades with mammograms showing breast calcifications. This sounds like medical personnel wording tests and procedures for their own profit.
I hope a conscientious doctor will weigh in on this issue.
I hope a conscientious doctor will weigh in on this issue.
2
"[Prostate cancer] Screening is not recommended for men 70 and older."
That's too sweeping a statement that can be misinterpreted. Men who are on active surveillance for prostate cancer will continue to be tested as will men at higher risk due to certain symptoms or family histories/genetics.
That's too sweeping a statement that can be misinterpreted. Men who are on active surveillance for prostate cancer will continue to be tested as will men at higher risk due to certain symptoms or family histories/genetics.
5
The vast majority of men over the age of 70 have prostate cancer. Most will never die of this disease.
5 year survival rate is 99%. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-stagin...
5 year survival rate is 99%. https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-stagin...
2
Brian - The key is identifying men who have aggressive prostate cancer. The newer blood tests plus testing whether a man has one or more known inherited and somatic mutations favoring aggressive cancer help clarify individual risk.
1
We have been indoctrinated to believe that medicine cures all but that is simply not true. All of us over a certain age have been exposed to unnecessary testing because the doctors do not know much about being older. We are not like the younger patients because we have experienced more illnesses. This can change the picture for us and yet many doctors do not know what to do with that information. Also, maybe we should not be so quick to agree to testing but weigh the consequences. Most of us have had our career, our family and a long life, so what is the hurry.
8
People should continue the tests as breast cancer increases with age. A person would prefer to have a skin scan for melanoma before some physician has to cut out cancer from your face, etc. Many cancers increase with a person's age. It depends, of course, on your family history and living factors although in some cases there can be an environmental issue.
3
I don't buy one single bit about that many cancers increase with a person's age, or in family history and genetic predisposition for certain cancers and disease. That's just another excuse for them to say, "I don't know what caused this". Which in reality is the truth. Cancer has been around longer than most of us that are currently alive.
"People should continue the tests as breast cancer increases with age."
The issue is not detecting cancer. The issue is curing cancer for a real benefit such as saving lives. Detecting cancer does not automatically mean lives are going to be saved by treatments. There needs to be a demonstration that treatments save lives as well as detection.
The issue is not detecting cancer. The issue is curing cancer for a real benefit such as saving lives. Detecting cancer does not automatically mean lives are going to be saved by treatments. There needs to be a demonstration that treatments save lives as well as detection.
7
According to the AMA, a man is almost certain to have cancer cells in his prostate by the time he reaches 80 years of age. Yet he is more likely to die with the cancer than from it.
My 80 year old neighbor was often seen out with his wife at antique shows, until he was treated for prostate cancer. Radiation treatment left him incontinent, so he rarely leaves home now. Another successful cure.
My 80 year old neighbor was often seen out with his wife at antique shows, until he was treated for prostate cancer. Radiation treatment left him incontinent, so he rarely leaves home now. Another successful cure.
33
"a man is almost certain to have cancer cells in his prostate by the time he reaches 80 years of age. Yet he is more likely to die with the cancer than from it."
It is true that 85% of prostate cancers are of the slow growing type and those with it likely will die of something else. The problem is that absent a biopsy, no one knows whether the cancer is the slow growing type or the 15% of cancers that if not treated will kill.
If your neighbor received radiation treatment for prostate cancer, it most likely was of the 15% that kills. His choice really came down to risk of incontinence or dying of the cancer. In his situation, which choice would you make? I know which one I'd make.
It is true that 85% of prostate cancers are of the slow growing type and those with it likely will die of something else. The problem is that absent a biopsy, no one knows whether the cancer is the slow growing type or the 15% of cancers that if not treated will kill.
If your neighbor received radiation treatment for prostate cancer, it most likely was of the 15% that kills. His choice really came down to risk of incontinence or dying of the cancer. In his situation, which choice would you make? I know which one I'd make.
2
"Another successful cure."
This is why overall survival is the true measure of success.
This is why overall survival is the true measure of success.
2
A lot of money is wasted on removing skin cancers on older people.If one is over the age of 70 the possibility of a common skin cancer causing death is very remote as old age will get you first. I believe that the word "cancer" should not be used for non-melanoma skin lesions, especially for elderly people.
8
Non melanomas won't kill you, but left untreated they itch like crazy, bleed, and disfigure. Old people can be useful if they are in decent health. They can drive grand kids to soccer games, and so on. But nobody wants to be around an old person whose nose is falling off due to basal cell carcinoma. Also, to follow your logic, we should not treat old people for other non-lethal things such as cataracts, hearing loss, or arthritis. Fact is, if an old person is helpless, you have to pay for their care until the time comes when we can just euthanize them.
5
@Mark..I am 76 years old. I see too many of my friends worrying about health problems that come naturally with old age. Of course if the skin cancer is causing problems, get rid of it. But if it is just a mole that looks funny, live with it. Old people can, of course, be useful. I still work and still have time for my grandkids
2
Sometimes it is hard to tell the difference between a melanoma and a non-deadly skin cancer. Dermatologists are the ones to decide what you have, and that is done by a biopsy if the doctor feels that to be the appropriate form of treatment.
Skin cancers do not destroy just the top of the skin, they invade the subsurface of the visible skin and can go down very deeply and sideways.
Melanomas, left untreated, do this, "In metastasis, cancer cells break away from where they first formed (primary cancer), travel through the blood or lymph system, and form new tumors (metastatic tumors) in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.."
That quotation is from the National Cancer Institute.
I watched a friend die from metastasized melanoma and become blind as one of the first effects of the cancer invading his brain. He lost his vocabulary, ability to form sentences, and went downhill from there.
I really don't think that anyone either over 70 or under 70 is casual about these conditions.
Perhaps you should read about this, learn something, and make sure you have a whole body skin examination every year.
Skin cancers do not destroy just the top of the skin, they invade the subsurface of the visible skin and can go down very deeply and sideways.
Melanomas, left untreated, do this, "In metastasis, cancer cells break away from where they first formed (primary cancer), travel through the blood or lymph system, and form new tumors (metastatic tumors) in other parts of the body. The metastatic tumor is the same type of cancer as the primary tumor.."
That quotation is from the National Cancer Institute.
I watched a friend die from metastasized melanoma and become blind as one of the first effects of the cancer invading his brain. He lost his vocabulary, ability to form sentences, and went downhill from there.
I really don't think that anyone either over 70 or under 70 is casual about these conditions.
Perhaps you should read about this, learn something, and make sure you have a whole body skin examination every year.
5
I think that it's the doctors who believe that "it's better to be safe than sorry" much more than the patients do....
15
Correct, and like the article says many of them are concerned about litigation. Also, when I asked a doctor recently about watching and waiting on an abnormal result his answer was that this is what the textbooks say to do. There's your cookie cutter medicine. Sorry, but a body (and I know mine definitely doesn't) does not know how to read a text book so you can't do that for everyone. Also, like I told him text books can be wrong.
1
Pap smears also should have an end-date of about 65 years for women who have been having normal ones...
9
Yes, Anne-Marie, UNLESS women have new or multiple sex partners . . . There are a lot of std infections in my cohort, and at least one (HPV variation) can induce cervical cancer.
8
Yes, the age of aquarius and the pesky HPV virus--and Pap smears are so simple.
That is the cut off age, per my OB/GYN. Insurance does not cover it, at least Medicare states they will not.
Are there no good data that can inform decisions about at what age various cancer screening tests can safely be skipped in the absence of symptoms and family history?
Mammograms?
Colonoscopies?
Even this article does not frame the question that way. It's always "safe" for a doctor to recommend an annual mammogram. It's a non-invasive and at worst no more than uncomfortable procedure. But what is the probability that a woman's life is going to be significantly prolonged - by say 3 or 4 years - by surgery much less by chemotherapy on top of it? Where are the data?
Mammograms?
Colonoscopies?
Even this article does not frame the question that way. It's always "safe" for a doctor to recommend an annual mammogram. It's a non-invasive and at worst no more than uncomfortable procedure. But what is the probability that a woman's life is going to be significantly prolonged - by say 3 or 4 years - by surgery much less by chemotherapy on top of it? Where are the data?
3
You need to read to the end of the article because they're giving you the information that you were looking for about when to start, frequency and when to end testing.
2
Decades of mammograms can result in radiation-caused cancers, as radiation exposure is CUMULATIVE. This is a potential danger far more serious than a mammogram's potential discomfort. And one most women are never warned about.
9
Re cumulative radiation exposure - I didn't mention it but my point exactly. Potential benefit has to outweigh potential harm. So what about mammograms for someone my age - 74? I'm inclined to ignore by doctor's standard recommendation. Fortunately, he's a sensible person.
1
Interesting article. I would like to add that if you have "dense" breast tissue (not uncommon), any anomaly will look like a white kitten in a snowstorm; new laws in 37 states require a "discussion" between a patient with dense breasts and her doctor regarding a second type of screening (ultrasound, MRI or breast-specific-gamma-imaging). We can thank Joan Lunden for this change! Also - colonoscopies are no longer viewed favorably in Canada, which now screens using stool samples. There are dangers associated with improperly sanitized endoscopes, which can transfer infection between patients undergoing colonoscopies. Eighty percent of doctors use Cidex, which tends to "embalm" the material on the endoscope rather than eliminate it - make sure peracetic acid is used instead.
16
Actually, there are 32 states with legislation that requires physicians to notify women of their dense breast tissue. And we have to thank the hard work of grassroots efforts lead by Nancy M. Cappello, PhD, who founded the two nonprofits Are You Dense, Inc and Are You Dense Advocacy, Inc. More information can be found at the organizations' websites.
3
Colonoscopies are regularly done in Canada according to provincial guidelines.
I didn't find it helpful to be told that I have dense breast tissue, since the mammogram center didn't offer advanced screening. There's also disagreement over which type of screening is likely to be accurate.
3
I'm 69. I am at low risk forr colon cancer, breast cancer, cervical and uterine cancer, heart disease ... I am quite sure I will die someday, maybe from something they can test and treat. Most probably not. I don't do any of their stupid testing. I'll take my chances thank you very much.
55
Good for you.
Maybe more, lucky you.
I had an annual check-up from age 60 (after my husband died) to age 70. At age 70, I left the cooperative where we had been living for 20 years, bought a house and started a garden ("playing in the dirt" as a neighbor calls it). No time for annual check-ups; besides, my doctor is 9 miles away and I don't like to drive. I see him once or twice a year, as needed (broken wrist, painful knee, that kind of things). The only medications I take are aspirin (every day) and ibuprofen (as needed). I will be 83 next fall and, like you, I am quite sure I will die someday; meanwhile, I am living doctor- and drug-free.
At age 70 I've yet to meet a health care practitioner who presents the potential harms as well as the benefits of cancer screening. I feel lucky when I meet one who respects my decision to forego screening rather than trying to change my mind. In my experience which choice is safe and which may lead to sorrow isn't as clear as usually presented.
62
Get a copy of Dr Gilbert Welch's book, Overdiagnosed. Bring it to the doctor with you and say, "No thanks," unless you've got risk factors or a history. It usually stops the conversation.
5
I don't know how to square this with the numbers of people whom I have personally known who without any known risk factors have developed breast or colon cancer at late ages- in their upper 70's through 80's.
9
And at those ages, the treatment may be worse than the disease.
3
The disease outcome is death ... I've known too many folks in their 60s and older whose cancer was diagnosed at Stage 4 when treatment is far less likely to be successful. Had they had testing, the cancer might have been found at far earlier stage when treatment has much greater success rates.
You may see it differently, but I have a hard time conceiving of treatment effects that are worse than death.
You may see it differently, but I have a hard time conceiving of treatment effects that are worse than death.
5
It's outrageous that, because I followed the guidelines at the time, I exposed myself to unnecessary radiation. Supposedly you were to have your first mammogram at age 35, then annually after that. Great, 10 unnecessary mammograms! These recommendations have ZERO credibility!
19
I never read that mammograms were to start at age 35. Where did you see that recommendation? Or are you at high risk such as a BRCA and they started early on mammograms? Although often times for BRCa they alternate with MRI screening.
"Where did you see that recommendation?"
There will be some surgeon somewhere who recommends screening starts at 35.
There will be some surgeon somewhere who recommends screening starts at 35.
25 years ago the standard in the USA was for a "baseline" mammogram at age 35. If that showed some "abnormality" like a calcification, welcome to an annual mammogram and all the radiation that entails from that point on.
Nice to learn that Medicare covers yearly -- unnecessary, or at least unnecessarily frequent -- mammograms, when my private insurance covers me only every other year (the current recommendation for those who have always had clear mammograms). Adding insult to injury, I had to switch to high deductible insurance, thanks to Obama. So I pay out of pocket anyway.
7
Do you understand that the ACA and Medicare are different programs?
18
Note that Lung Cancer screening is not even mentioned.
Now, regardless of the proven life saving benefits of Early Detection Lung Cancer Screening; qualifying to detect this deadly cancer, continues to be limited to smokers and former smokers. A discriminatory and exclusive criteria for detecting a disease that affects anyone that breathes.
There are 3X more risk factors and "causes" of lung cancer than any other cancer... yet in an effort to promote public health policy (Tobacco Control and Anti-Smoking Campaigns) those that suffer this indiscriminating disease are targeted as "Smokers"; resulting in scant public support for those suffering.
The only thing more deadly than lung cancer is the myth that it is a "Smokers Disease".
When will media wake up? When will journalists research info from unbiased sources?
When will this devastating disease that affects anyone with lungs shed this deadly Stigma and become worthy of mention, support, services and funding?
Most likely, when despite your healthy lifestyle, young age and excellent physical condition...it hits You. Tragically, those of us that fight this disease and have lost countless loved ones, can attest to this.
Now, regardless of the proven life saving benefits of Early Detection Lung Cancer Screening; qualifying to detect this deadly cancer, continues to be limited to smokers and former smokers. A discriminatory and exclusive criteria for detecting a disease that affects anyone that breathes.
There are 3X more risk factors and "causes" of lung cancer than any other cancer... yet in an effort to promote public health policy (Tobacco Control and Anti-Smoking Campaigns) those that suffer this indiscriminating disease are targeted as "Smokers"; resulting in scant public support for those suffering.
The only thing more deadly than lung cancer is the myth that it is a "Smokers Disease".
When will media wake up? When will journalists research info from unbiased sources?
When will this devastating disease that affects anyone with lungs shed this deadly Stigma and become worthy of mention, support, services and funding?
Most likely, when despite your healthy lifestyle, young age and excellent physical condition...it hits You. Tragically, those of us that fight this disease and have lost countless loved ones, can attest to this.
26
A very dear friend died of lung cancer three years ago. He never smoked in his life.
After cancer treatments, exercise can help to rebuild not only your muscles, but also your self confidence. During treatments I was still doing some exercise that kept me positive.
As I train with weights and ride a Me-Mover now I can still increase strength and endurance, even at 79 years of age.
Always stay positive, but never be in denial, listen to facts, act on them and follow through with medical advice.
As I train with weights and ride a Me-Mover now I can still increase strength and endurance, even at 79 years of age.
Always stay positive, but never be in denial, listen to facts, act on them and follow through with medical advice.
10
"Always stay positive, but never be in denial, listen to facts, act on them"
Amen ... the wisdom of age :-)
Amen ... the wisdom of age :-)
1
At the risk of stating the obvious:
1. Screen.
2. Examine the results.
3. Fully consider your options.
4. Take whatever action you feel is correct, given that you have garnered as much information as is possible about a very serious medical issue.
1. Screen.
2. Examine the results.
3. Fully consider your options.
4. Take whatever action you feel is correct, given that you have garnered as much information as is possible about a very serious medical issue.
2
This is incomplete. Screening itself carries risks, as does following up on its results. Anecdotes aren't evidence, but here is an anecdote as an illustration.
Some years ago, while visiting us in NJ, my father had an episode of syncope: he fainted as his heart faltered. He was taken to an ER (ambulance $13k, ER $more) but recovered without treatment other than lying down.
We took him to a cardiologist who told him he needed a pacemaker stat.
He went home to the UK. He went to a cardiologist who examined him (my father was in his 80s). The cardiologist told him he could not recommend or approve him for a pacemaker unless he wanted it done privately. The reason was this: the NHS pays for treatments that improve your prognosis.
He was in his 80s. There was a greater risk of him dying or reacting badly to the anaesthesia and the surgery itself than there was of a heart attack for the time being. The heart attack risk was rising over time, faster than the surgical risk. Come back for a review next year.
He did. The year after that the pacemaker-defibrillator was installed, without incident. He's now 91.
Had the screening required exploratory surgery or radiation this process applies: screening interventions come with a risk. If this risk exceeds the probable benefit from the screening it should not be done.
However, this won't wash in a courtroom where the plaintiff will get sympathy from the jury, even if the proper risk-reward process was followed.
Some years ago, while visiting us in NJ, my father had an episode of syncope: he fainted as his heart faltered. He was taken to an ER (ambulance $13k, ER $more) but recovered without treatment other than lying down.
We took him to a cardiologist who told him he needed a pacemaker stat.
He went home to the UK. He went to a cardiologist who examined him (my father was in his 80s). The cardiologist told him he could not recommend or approve him for a pacemaker unless he wanted it done privately. The reason was this: the NHS pays for treatments that improve your prognosis.
He was in his 80s. There was a greater risk of him dying or reacting badly to the anaesthesia and the surgery itself than there was of a heart attack for the time being. The heart attack risk was rising over time, faster than the surgical risk. Come back for a review next year.
He did. The year after that the pacemaker-defibrillator was installed, without incident. He's now 91.
Had the screening required exploratory surgery or radiation this process applies: screening interventions come with a risk. If this risk exceeds the probable benefit from the screening it should not be done.
However, this won't wash in a courtroom where the plaintiff will get sympathy from the jury, even if the proper risk-reward process was followed.
10
"1. Screen.
2. Examine the results.
3. Fully consider your options."
And when the surgeon who just told you the results asks you when you want to be booked in for surgery, exactly how long do you have to "fully consider your options"?
2. Examine the results.
3. Fully consider your options."
And when the surgeon who just told you the results asks you when you want to be booked in for surgery, exactly how long do you have to "fully consider your options"?
As we learn more about cancer and its many permutations (cancer is not one disease, but many), the hope is that we can be more precise about who will benefit from screening, and at what interval. While it is scary to think about living with a cancerous tumor inside of us, many of us are. Scientists are discovering that some tumors are indolent and will not progress (may even regress). Whereas, other tumors may be very aggressive and even resistant to most treatments. New discoveries about cancer are accelerating rapidly, albeit we are struggling as a country to address how the cost of cancer--and the cost of improved diagnostic and tumor profiling tools--will be managed at the societal and individual level.
That's why it has NEVER been more important to invest in biomedical research, especially funding for the National Institutes of Health (includes the National Cancer Institute. The more we can learn upstream about tumor biology and the molecular/genetic profiles of cancer, the more we can hasten the development and precision targeting of therapeutic interventions. Not everyone would benefit from a $100,000 cancer biologic therapy. Better diagnostic tools can pinpoint this.
That said, we all know a cancer diagnosis is terrifying. Informed decisions about screening should be made by a doctor and her/his patient. Clinicians are well-positioned to reduce some of the terror by taking the time to explain options & trade-offs, but sadly "information therapy" isn't reimbursed.
That's why it has NEVER been more important to invest in biomedical research, especially funding for the National Institutes of Health (includes the National Cancer Institute. The more we can learn upstream about tumor biology and the molecular/genetic profiles of cancer, the more we can hasten the development and precision targeting of therapeutic interventions. Not everyone would benefit from a $100,000 cancer biologic therapy. Better diagnostic tools can pinpoint this.
That said, we all know a cancer diagnosis is terrifying. Informed decisions about screening should be made by a doctor and her/his patient. Clinicians are well-positioned to reduce some of the terror by taking the time to explain options & trade-offs, but sadly "information therapy" isn't reimbursed.
22
"While it is scary to think about living with a cancerous tumor inside of us, many of us are."
Indeed, most men have prostate cancer inside them before they die.
Indeed, most men have prostate cancer inside them before they die.
Well, you're going to die anyway, so why bother. My sister didn't have a colonoscopy until she severe bleeding. Doctors removed numerous polyps. Shortly thereafter she started bleeding again at which, they found a benign tumor on an ovary. Instead of removing the ovary, they performed a complete hysterectomy. She died three weeks later from sepsis after negligent care in a nursing home. She was almost ninety. After very old age,what measures should be taken?
52
I wrote an article today on Medium.com about my sister's poor outcome because her family physician missed something he should have done--a simple x-ray. A smoker for 30 years and having quite for 20, he never picked up that she should be screened periodically for lung CA, but he didn't do that. She had every test that was recommended for CA screening and now she's dead. Three years and all, perhaps, because a family physician failed to do the obvious in a past smoker.
10
I am so, so sorry for what your sister had to endure and what you and the rest of your family went through with her.
Note that Lung Cancer screening is not even mentioned. Courtesy of the American Cancer Society's media influence & continuing propaganda that this #1 cancer killer of both Men and Women is a "smokers disease"... For 70 years ACS's recommendation has been -"Just quit Smoking". Now, regardless of the proven benefits of Early Detection Lung Cancer Screening; qualifying to detect this deadly cancer continues to be limited to smokers and former smokers. A discriminatory and deadly criteria for detecting a disease that affects anyone that breathes.
There are 3X the risk factors and "causes" of lung cancer than any other cancer... yet in an effort to promote public health policy (Tobacco Control and Anti-Smoking Campaigns) those that suffer this indiscriminating disease are targeted as "Smokers".No public support for these pariahs!
When will media wake up? When will journalists research sources?
When will this devastating disease that affects anyone with lungs shed this deadly Stigma and become worthy of mention, support, services and funding?
Most likely, when despite your healthy lifestyle, young age and excellent physical condition...it hits You. Tragically, those of us that fight this disease and have lost countless loved ones, can attest to this.
There are 3X the risk factors and "causes" of lung cancer than any other cancer... yet in an effort to promote public health policy (Tobacco Control and Anti-Smoking Campaigns) those that suffer this indiscriminating disease are targeted as "Smokers".No public support for these pariahs!
When will media wake up? When will journalists research sources?
When will this devastating disease that affects anyone with lungs shed this deadly Stigma and become worthy of mention, support, services and funding?
Most likely, when despite your healthy lifestyle, young age and excellent physical condition...it hits You. Tragically, those of us that fight this disease and have lost countless loved ones, can attest to this.
14
And Trump thinks manufacturers should renew and invigorate asbestos production, cuz you know, its a great insulator. Really, who contributed how much for Trump to "spokesperson" asbestos?! Disgraceful and willfully ignorant man.
37
Is this true? Are you being sarcastic?
Medicare covers the cost of this test every two years for people 50 and older at high risk and every 10 years for people at average risk. (Colonoscopy can actually prevent cancer, not just detect it; if a polyp is found in which cancer could develop, it can be removed during the screening.)
__
Well no. It only 'sort of" covers the cost.
If all that is done is "look" - yep Medicare pays with no copays or out-of-pocket costs
If, on the other hand, the physician snips something off, now it is diagnostic and the patient gets hit with a 20% copay for procedure and the pathology report.
__
Well no. It only 'sort of" covers the cost.
If all that is done is "look" - yep Medicare pays with no copays or out-of-pocket costs
If, on the other hand, the physician snips something off, now it is diagnostic and the patient gets hit with a 20% copay for procedure and the pathology report.
13
However, they are getting value for their money.
4
"If, on the other hand, the physician snips something off, now it is diagnostic and the patient gets hit with a 20% copay for procedure and the pathology report."
And if something is found and the procedure is not done, the patient could die. That's why the pathology report is important in sorting out the situation. What's the trade-off between the co-pay and possibly dying? Many medicare supplement plans cover all or most of the co-pays (mine does).
And if something is found and the procedure is not done, the patient could die. That's why the pathology report is important in sorting out the situation. What's the trade-off between the co-pay and possibly dying? Many medicare supplement plans cover all or most of the co-pays (mine does).
1
Note that Lung Cancer screening is not even mentioned.
Now, regardless of the proven benefits of Early Detection Lung Cancer Screening; qualifying to detect this deadly cancer continues to be limited to smokers and former smokers. A discriminatory and deadly criteria for detecting a disease that affects anyone that breathes.
There are 3X the risk factors and "causes" of lung cancer than any other cancer... yet in an effort to promote public health policy (Tobacco Control and Anti-Smoking Campaigns) those that suffer this indiscriminating disease are targeted as "Smokers"; resulting in scant public support for these pariahs!
When will media wake up? When will journalists research sources?
When will this devastating disease that affects anyone with lungs shed this deadly Stigma and become worthy of mention, support, services and funding?
Most likely, when despite your healthy lifestyle, young age and excellent physical condition...it hits You. Tragically, those of us that fight this disease and have lost countless loved ones, can attest to this."
Now, regardless of the proven benefits of Early Detection Lung Cancer Screening; qualifying to detect this deadly cancer continues to be limited to smokers and former smokers. A discriminatory and deadly criteria for detecting a disease that affects anyone that breathes.
There are 3X the risk factors and "causes" of lung cancer than any other cancer... yet in an effort to promote public health policy (Tobacco Control and Anti-Smoking Campaigns) those that suffer this indiscriminating disease are targeted as "Smokers"; resulting in scant public support for these pariahs!
When will media wake up? When will journalists research sources?
When will this devastating disease that affects anyone with lungs shed this deadly Stigma and become worthy of mention, support, services and funding?
Most likely, when despite your healthy lifestyle, young age and excellent physical condition...it hits You. Tragically, those of us that fight this disease and have lost countless loved ones, can attest to this."
6
"regardless of the proven benefits of Early Detection Lung Cancer Screening; qualifying to detect this deadly cancer continues to be limited to smokers and former smokers."
That's probably because the proven benefits only exist for smokers and former smokers. Nothing wrong with making use of proven benefits.
That's probably because the proven benefits only exist for smokers and former smokers. Nothing wrong with making use of proven benefits.
4
Since the article is really about disagreements among doctors, why quote only US public health agencies? What do the French, the Norwegians, the Japanese recommend? Do we have any reason to think the US agencies are better?
80
Canada is completely consistent with the US, but colonoscopy is not the recommended colon screen in our provincial screening programs - FOBT is. That would certainly be a more sensible approach for older Americans as well.
5
There is an international collaboration for recommendations and guidelines, http://www.cochrane.org/
Doctors all over the world know what their colleagues elsewhere are doing. The British compare their guidelines with the American guidelines, etc. A rheumatologist treating rheumatoid arthritis would read a journal or go to a medical conference and compare the recommendations of the European League Against Rheumatism with the recommendations of the American College of Rheumatology
It's possible to make reasonable choices about how to interpret the data, and come to slightly different conclusions. So some groups may recommend mammograms starting at age 50, while another group starts at 55.
Doctors all over the world know what their colleagues elsewhere are doing. The British compare their guidelines with the American guidelines, etc. A rheumatologist treating rheumatoid arthritis would read a journal or go to a medical conference and compare the recommendations of the European League Against Rheumatism with the recommendations of the American College of Rheumatology
It's possible to make reasonable choices about how to interpret the data, and come to slightly different conclusions. So some groups may recommend mammograms starting at age 50, while another group starts at 55.
Canada says triennial after 50, if memory serves.
Why no mention of lung screening for the high risk population? Lung cancer is almost always diagnosed at an advanced stage. Early detection via lung screening reduces mortality by 20%. More here: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/lung-ca...
7
Isn't it also true that the older we are, the more slowly a cancer will likely grow? If true, it seems that would also take some of the pressure off of screening as ages advance.
4
I have never heard the statement that the older person is the slower the cancer will grow. How fast or slow cancer grows is determined by the type of cells. Highly undifferentiated cells are indicative of a very fast-growing and differentiated indicator of slower growing from what I know.
5
Not true ... where did you pick up that misinformation. Kathleen Bahler is correct ... it is the type of cancer, not our age, that determines how fact a cancer grows.
1
My previous doctor had an after thought, after about 2 years he never asked for a PSA test, when he did, it was high. The biopsy confirmed I had aggressive prostate cancer.
If it wasn't for his after thought things could have been different, I was surprised after learning that at my age of 67 he did't ask for a PSA test before, but he was concerned more with my cholesterol.
I was fortunate to have an excellent urologist who got me through. I cannot see why anyone would not want to be tested for cancer. Is it fear of the possibility of having cancer?
Why gamble with your life, odds are with you if a test is done early.
If it wasn't for his after thought things could have been different, I was surprised after learning that at my age of 67 he did't ask for a PSA test before, but he was concerned more with my cholesterol.
I was fortunate to have an excellent urologist who got me through. I cannot see why anyone would not want to be tested for cancer. Is it fear of the possibility of having cancer?
Why gamble with your life, odds are with you if a test is done early.
11
My endocrinologist is the one who started the PSAs when I was 65. When it got high enough he demanded I go to my Urologist where a biopsy showed active growing cancer with a Gleason Score of 7 (4+3). It hadn't left the prostate and the Eligard chemical treatment and 44 radiation treatments got my PSA score down from 6.8 to 0.04.
My accountant's got out and he has six metastasized points. One of my customers waited way too long and his brother says he will not survive. I don't care what some say. There's nothing wrong with getting the tests. Better to know you're clean than to be surprised and have to wrap your affairs up quickly.
My accountant's got out and he has six metastasized points. One of my customers waited way too long and his brother says he will not survive. I don't care what some say. There's nothing wrong with getting the tests. Better to know you're clean than to be surprised and have to wrap your affairs up quickly.
10
"I cannot see why anyone would not want to be tested for cancer."
Little wrong with just getting a test. Trouble is, doctors' advice based on the results of that test are motivated by avoiding getting sued regardless of what's best for the person.
Little wrong with just getting a test. Trouble is, doctors' advice based on the results of that test are motivated by avoiding getting sued regardless of what's best for the person.
2
PSA is a simple blood test. The other tests discussed here involve radiation.
2
No one mentioned the risk of false negatives. Nearly five years ago, a mammogram showed something, but the radiologist said, Probably enlarged lymph nodes. Six months later a mammogram indicated the "something" was indeed a tumor. Had the tumor been properly identified 6 months earlier, treatment would probably not have included chemotherapy. If any of my future mammograms turns out to be a false positive, I'll deal with it. But it wouldn't impact my life as seriously as the false negative did.
6
Unfortunately, nothing can be done about false negatives since the tests indicate no disease - unless you are suggesting every women in America be treated for breast cancer since every woman will either test positive, or, true or false negative.
2
@AI - False negatives on mammograms are usually caused by dense breast tissue. The presence of dense tissue has be noted on the radiologist's report. Some women are lucky to get an MRI, which is more sensitive than a mammogram. But usually women must wait for a positive mammogram. My surgeon estimated that my tumor had been growing for 5 years before it showed up. That's 5 annual false-negative mammograms. Finally I found the lump. So mammograms were useless for me.
If dense tissue were an accepted indicator for an MRI, most false negatives on mammograms would be avoided.
If dense tissue were an accepted indicator for an MRI, most false negatives on mammograms would be avoided.
3
I wish you good health reports going forward. In this situation, I don't think you could call this a false negative so much as a medical error. Something unusual was definitely detected and noted but the radiologist interpretation was overly conservative. They could easily have sent you for a non-invasive, relatively inexpensive breast ultrasound to determine if further invasive diagnostics were required, as my doc did after a questionable manual breast exam. And a breast biopsy is uncomfortable but not traumatic or grossly invasive or even that expensive. The radiologist could have consulted with other diagnosticians to bring more eyes to the picture. I wonder about whether the mantra of concern about false positives improperly influences doctors in cases where they ought to seek more diagnostic clarification. Articles like Brody's piece confuse rather than clarify the issues because they are too simplistic.
4
Dr. Gilbert Welch, professor at Dartmouth and VA doctor, has been singing this song in his books for years. He writes that the fastest way to get (name the disease) is to be screened for it. Once you know you have it... you cannot stop worrying... even if is likely you will die of something else. More screening can be dangerous to your health... physical and mental. Many health care providers skip lightly over the downsides of screening if they mention them at all.
Welch cautions that if you have symptoms that something is wrong.... see a doctor! Now!
Welch cautions that if you have symptoms that something is wrong.... see a doctor! Now!
32
"Welch cautions that if you have symptoms that something is wrong.... see a doctor! Now!"
By the time most people have symptoms of cancer, it likely is too late.
By the time most people have symptoms of cancer, it likely is too late.
1
"By the time most people have symptoms of cancer, it likely is too late"
but not with prostate cancer. There is no difference in overall survival between men who are detected early (with PSA screening) and men who are detected through symptoms.
but not with prostate cancer. There is no difference in overall survival between men who are detected early (with PSA screening) and men who are detected through symptoms.
1
There's no way around doing your homework, and based on your personal background, deciding for yourself.
I'm 70 and decided to space mammograms farther apart because the recent ones have been good; with a long life expectancy and some family history, I wouldn't rest easy with no screenings ( and I was indoctrinated in getting regular exams- there is almost a guilty feeling for not doing them) I am not afraid of false positives, because I have access to good doctors. Perhaps I have done my last colonoscopy -that gastroenterologist will be retired in 10 years.
If you have a primary Dr. familiar with your history, whose opinion you trust, use their valuable guidance. S/he can help tailor your care to your own needs, not an average.
Screenings like the PSA for men are not useful alone- that doesn't mean they're useless, only that they are but one tool - to be used in context with other cues and tests. Drs. need to explain that.
The risk for people who habitually forego ALL screenings may be that some will not see a Dr. at all until they are ill, which is the worst time to be making critical decisions. And there's no baseline for what is normal for them.
It would be stupid for my mother at 95 to have a mammogram( or other screening), Not so if you have 25 years to go. There's considerable grey area.
The issue: how will the results of a screening guide your decision about future treatment? Be hard-nosed about gains or losses, and what YOU are willing to do.
I'm 70 and decided to space mammograms farther apart because the recent ones have been good; with a long life expectancy and some family history, I wouldn't rest easy with no screenings ( and I was indoctrinated in getting regular exams- there is almost a guilty feeling for not doing them) I am not afraid of false positives, because I have access to good doctors. Perhaps I have done my last colonoscopy -that gastroenterologist will be retired in 10 years.
If you have a primary Dr. familiar with your history, whose opinion you trust, use their valuable guidance. S/he can help tailor your care to your own needs, not an average.
Screenings like the PSA for men are not useful alone- that doesn't mean they're useless, only that they are but one tool - to be used in context with other cues and tests. Drs. need to explain that.
The risk for people who habitually forego ALL screenings may be that some will not see a Dr. at all until they are ill, which is the worst time to be making critical decisions. And there's no baseline for what is normal for them.
It would be stupid for my mother at 95 to have a mammogram( or other screening), Not so if you have 25 years to go. There's considerable grey area.
The issue: how will the results of a screening guide your decision about future treatment? Be hard-nosed about gains or losses, and what YOU are willing to do.
14
Cancer screening does not reduce mortality, period. This, it does not "save lives". There are many well-conducted studies of this issue that all reach the same conclusion. Disease-specific mortality reductions do not equate with overall mortality reductions.
One reason for this is the fact that all medical interventions have both harms and benefits. For instance, mammograms find many non life-threatening cell changes that look like cancer but are meaningless healthwise. The woman then receives full-blown cancer treatment with all its harms, but receives no benefit. The sad fact is, it appears that unnecessary cancer treatment shortens lives to the extent that mammograms do not increase life expectancy.
Doctors should be required to explain the real facts about cancer testing and longevity to patients.
One reason for this is the fact that all medical interventions have both harms and benefits. For instance, mammograms find many non life-threatening cell changes that look like cancer but are meaningless healthwise. The woman then receives full-blown cancer treatment with all its harms, but receives no benefit. The sad fact is, it appears that unnecessary cancer treatment shortens lives to the extent that mammograms do not increase life expectancy.
Doctors should be required to explain the real facts about cancer testing and longevity to patients.
47
Screening may not reduce mortality for some diseases, but there are certainly more than a few where it is shown to be beneficial. Breast cancer, colon cancer, and cervical cancer screening for instance are considered cost-effective by the majority of the scientific community. Cost effective means that benefits and harms are both taken in account when doing these type of calculations.
9
Tell that to women who are diagnosed for breast cancer and who treat it effectively. If you are afraid to be tested that's your perogative but save the diatribe...it is pure nonsense
I don't know where you're getting your information, but nobody gets "full-blown cancer treatment" without a definitive diagnosis of invasive breast cancer. Sorry, but nobody gets chemo, radiation, extensive surgery and endocrine therapy for "changes that look like cancer but are meaningless healthwise." (At least nobody who isn't a victim of malpractice).
And that diagnosis comes only after not just screening but then diagnostic imaging (often repeated and analyzed for accuracy) and biopsy. Biopsy can be minimally invasive (mine took 10 minutes). And after the diagnosis is made, in most cases the tumor itself is tested (in the lab) for hormone receptors, growth factors, and genomic characteristics to determine treatment going forward.
I was diagnosed with a Grade 2 (moderately differentiated) invasive ductal carcinoma. That further genomic testing enabled me to skip chemo; and the size of the tumor, lack of cancer in the lymph nodes, and my age enabled me to get a much shorter and targeted course of radiation. I also was able to keep my breast without disfigurement.
Without diagnosis & treatment, my tumor would likely eventually have metastasized (it might still, but much later). And there are thousands of women diagnosed with metastatic breast cancer from the get-go--without the testing and life-lengthening treatment they'd have died much earlier and more gruesome deaths.
"Screening adults aged 76 to 85 should be individualized depending on the patient’s overall health and prior screening history; they should have a reasonable life expectancy and be healthy enough to withstand treatment if cancer is found." Is this how we currently practice medicine, in general, for the elderly? Pay careful attention to the sentence, "...they should have a reasonable life expectancy and be healthy enough to withstand treatment...." I've been managing the healthcare of my 95-year-old father in recent years, and current practice seems to be: "Throw everything at them, including the kitchen sink, regardless of life expectancy and ability to withstand treatment." This, of course, is a big issue in managing healthcare costs, and will become increasingly important with an aging population.
24
I'm an American citizen who lives here and takes full advantage of the wonderful health care system in Austria. Every year I visit my list of doctors who personally know me, how I live, and have complete family histories of my parents, grandparents. I want to KNOW. I'm 62 years old. I have not even had a cold or taken an aspirin since I came to this country. I have gone for Mammograms since I was 35. We have the best breast center in Austria where I live. They found something a year ago that they needed to "define" and sent me for 4 MRI screenings--which without my full coverage I couldn't afford. Everything was normal. When I filled out forms, twice, for Colonoscopy, both times the nurses came to me when I had empty spaces for mediations I take. I told them I take nothing at all. They refused to believe it! When I read about "Trumpcare" and the threat it poses for millions of Americans who need care and exams and other health needs I feel truly fortunate that the country where I live feels this is a "birthrite" and so is education. This never figured into my decision in coming to live here--that was fated through love but the older I am the more I feel blessed in my good health and especially to my loyal doctors who I trust and who know me as a human being. They listen, they spend time with you, they make you FEEL that they are truly there for your HEALTH! And that's been great for my health and well being!
73
Why don't you ask the Austrian Cochrane Collaboration to explain to you why you didn't need all those mammograms, and why they might have done more harm than good?
http://austria.cochrane.org/medizin-transparent
http://www.cochrane.org/news/cochrane-austria-recognized-success-promoti...
http://austria.cochrane.org/medizin-transparent
http://www.cochrane.org/news/cochrane-austria-recognized-success-promoti...
1
What about prevention? Why is there so little discussion about how to reduce your risks of suffering from debilitating and sometimes fatal diseases? I have read that our diet (the Standard American Diet), or SAD, can account for up to 80% of the risks of suffering from these diseases. Some publications conclude that our diet is even more deleterious to our health than smoking. Screening does not prevent cancer (with the sole possible exception of screening for colon cancer, and even then, it's anecdotal evidence, the data isn't in from a Randomly Controlled Trial). I keep waiting for my doctor to have an evidence-based discussion about prevention, which as far as I know, includes eating a Whole Foods Plant Based diet and exercising, and not drinking alcohol or smoking.
35
Most doctors have very little training in nutrition or proactive prevention. You have to learn about that stuff on your own. (And yeah, I agree that it shouldn't be this way.) I think they should, at the very least, have a list of good books and web sites they can recommend to patients, even if they don't have the time or knowledge to do this.
2
"not drinking alcohol"
Just on the subject of alcohol, it should be a concern to people as they get old simply for dietary reasons. Some people say that sugar is bad for you because of its "easy" calories but alcohol is even worse than sugar in this respect. This may not matter much when you're young with a high metabolic rate and get plenty of exercise but getting old slows your metabolism and may make it harder to get plenty of exercise. Result: alcohol adds to your dietary issues when you get old.
Just on the subject of alcohol, it should be a concern to people as they get old simply for dietary reasons. Some people say that sugar is bad for you because of its "easy" calories but alcohol is even worse than sugar in this respect. This may not matter much when you're young with a high metabolic rate and get plenty of exercise but getting old slows your metabolism and may make it harder to get plenty of exercise. Result: alcohol adds to your dietary issues when you get old.
2
"for such men the test can result in more harm than good"
No-one has shown that PSA screening saves lives, not even from prostate cancer in the vast majority of trials. Most men treated are made impotent or incontinent and some are even killed by treatment. Doctors are cynical about PSA screening. They only do it to avoid the risk of being sued. Don't trust doctors who tell you to get PSA screened or biopsied or treated.
No-one has shown that PSA screening saves lives, not even from prostate cancer in the vast majority of trials. Most men treated are made impotent or incontinent and some are even killed by treatment. Doctors are cynical about PSA screening. They only do it to avoid the risk of being sued. Don't trust doctors who tell you to get PSA screened or biopsied or treated.
20
Indeed, and the person who discovered PSA has stated publicly that the PSA test should not be used for screening for prostate cancer and that it does more harm than good. In his words, "the test is hardly more effective than a coin toss."
See the end of the following segment in the Wikipedia article for more from Dr. Ablin:
https://en.wikipedia.org/wiki/Prostate_cancer_screening#Controversy_abou...
See the end of the following segment in the Wikipedia article for more from Dr. Ablin:
https://en.wikipedia.org/wiki/Prostate_cancer_screening#Controversy_abou...
2
If it weren't for a routine PSA test at age 51, my husband's prostate cancer would have been missed. He was "young" for this type of cancer, but the cancer didn't know that. It was a faster growing cancer, too, so even with conservative watchful waiting, thus delaying biopsies, it developed much faster and to a frightening degree. He is recovering from a radical prostatectomy that certainly was necessary if not somewhat belated.
Carpe diem.
Carpe diem.
6
At the age of 51, nearly half of men have prostate cancer. If a prostate cancer was going to kill you, it is unlikely that detecting it early through PSA screening and treating it early would reduce the risk of dying from prostate cancer. Treating all prostate cancers that might be "treatable" carries the risk of death from treatment: http://www.abc.net.au/news/2012-04-25/cassidy-life-as-a-prisoner-of-war/...
There is nothing more life affirming and threatening than to hear your name and a cancer diagnosis coming from your doctor. Until it happens to you there is no way of knowing how you will respond. I wanted to know. Some members of my family did not. And some have been regretful and others vindicated.
Whether or not you test nature will take it's course and you will die when, where and how you are supposed to die from the pre-existing condition of a use-by mortality date. But proper timely testing and medical treatment can delay or eliminate some causes.
Whether or not you test nature will take it's course and you will die when, where and how you are supposed to die from the pre-existing condition of a use-by mortality date. But proper timely testing and medical treatment can delay or eliminate some causes.
10
"There is nothing more life affirming and threatening than to hear your name and a cancer diagnosis coming from your doctor."
Indeed, which means that you MUST be prepared for this situation if you have been set up to face the likelihood that it may happen to you. This is especially true if there is enormous uncertainty about the quality of advice that the doctor gives you such as when you get a prostate cancer diagnosis initiated by PSA screening.
Indeed, which means that you MUST be prepared for this situation if you have been set up to face the likelihood that it may happen to you. This is especially true if there is enormous uncertainty about the quality of advice that the doctor gives you such as when you get a prostate cancer diagnosis initiated by PSA screening.
1
This is an instance where the conventional medical wisdom makes little sense. If a patient gets a prostate screening, for example, that indicates an increase in PSA levels, a discussion with the patient's primary care physician or a urologist will provide advice as to whether to be concerned or to wait for the next test. People are living longer in the 21st Century so the old advice that a patient will not live long enough to benefit from the test is specious and those who represent the medical profession do a disservice in making blanket advisories as to who should be tested, when, and how often.
Patients would also benefit from more aggressive screening for the most dangerous cancers such as liver, pancreatic, brain, melanomas and other cancers which too often are discovered too late but if caught early may be successfully fought.
For me, know more and discussing it with my physician is preferable to relying and gambling blindly on the algorithms of insurers and their actuaries.
Patients would also benefit from more aggressive screening for the most dangerous cancers such as liver, pancreatic, brain, melanomas and other cancers which too often are discovered too late but if caught early may be successfully fought.
For me, know more and discussing it with my physician is preferable to relying and gambling blindly on the algorithms of insurers and their actuaries.
28
There is a finite number of healthcare dollars available, and routinely screening nearly every organ in the body for cancer is not the best way to spend them, and is often counter-productive.
South Korea recently found this out when they chose to start aggressively screening their population for Thyroid cancer. They discovered that a truly ridiculous number of people tested positive, many of which ended up having their thyroid removed (requiring a lifetime of delicate treatment to make up for it.) After all this aggressive screening and treatment, actual deaths due to thyroid cancer didn't budge. Not one bit.
Most people develop harmless "incidentalomas" as they age, and screening tests in asymptomatic people are virtually guaranteed to result in a large amount of expensive and possibly harmful overtreatment.
South Korea recently found this out when they chose to start aggressively screening their population for Thyroid cancer. They discovered that a truly ridiculous number of people tested positive, many of which ended up having their thyroid removed (requiring a lifetime of delicate treatment to make up for it.) After all this aggressive screening and treatment, actual deaths due to thyroid cancer didn't budge. Not one bit.
Most people develop harmless "incidentalomas" as they age, and screening tests in asymptomatic people are virtually guaranteed to result in a large amount of expensive and possibly harmful overtreatment.
19
It is not so much that we have a finite number of healthcare dollars, but rather dollars period.
The largest amount of money by far that we waste disproportionate to our risk is 'anti-terrorism' money.
The largest amount of money by far that we waste disproportionate to our risk is 'anti-terrorism' money.
"People are living longer in the 21st Century so the old advice that a patient will not live long enough to benefit from the test"
Trials of PSA screening have continued into the 21st Century so their results are certainly not "old advice". These trials all do not show that PSA screening saves lives and in all but 2 isolated trials don't even show a reduction in prostate cancer mortality.
"Conventional" medical wisdom depends on the financial interest of who's saying it, by the way.
Trials of PSA screening have continued into the 21st Century so their results are certainly not "old advice". These trials all do not show that PSA screening saves lives and in all but 2 isolated trials don't even show a reduction in prostate cancer mortality.
"Conventional" medical wisdom depends on the financial interest of who's saying it, by the way.
2
Ms. Brody's essay closes with a focus on USPSTF guidelines. Less attention is given (she does mention some things) to competing recommendations made by the American Cancer Society Guidelines: https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidel... . There are also variances with some specialty societies. It is no surprise that a person can find different sets of recommendations for breast, colon, prostate and other cancers.
There is no easy way around this for the general public. There is no one size fits all, as noted in this essay. Getting patients to understand and physicians to agree on risk-benefit analyses was never simple, and is arguably getting even more complex as we try to find ways to do away with frequently needless and expensive testing.
In addition to the notion that "this test would not help you live longer," some added discussion of what harms may come from a test (even something noninvasive such as mammography or PSA).
I do not think one can make the public feel comfortable with all this. They need to have some understanding of the importance and inevitability of ignorance and failure in the history of medical science. They should expect guidelines to change. If physicians have trouble keeping up with varying guidelines (and they do) and the logic/data behind them, the flaws in analysis, then the public cannot do this.
There is no easy way around this for the general public. There is no one size fits all, as noted in this essay. Getting patients to understand and physicians to agree on risk-benefit analyses was never simple, and is arguably getting even more complex as we try to find ways to do away with frequently needless and expensive testing.
In addition to the notion that "this test would not help you live longer," some added discussion of what harms may come from a test (even something noninvasive such as mammography or PSA).
I do not think one can make the public feel comfortable with all this. They need to have some understanding of the importance and inevitability of ignorance and failure in the history of medical science. They should expect guidelines to change. If physicians have trouble keeping up with varying guidelines (and they do) and the logic/data behind them, the flaws in analysis, then the public cannot do this.
9
"then the public cannot do this"
And yet supposedly the public is capable of having a useful discussion with their doctor about it.
And yet supposedly the public is capable of having a useful discussion with their doctor about it.
2
Annual visits to the doctor are usually a whirlwind of new vaccines and medications that are thrown at with the expectation that you will agree to inflict on yourself to “be healthier.” The thought of these new medical innovations sound perfect because they lead you to believe that they will help you live longer because they will be preventing further diseases. Due to the lack of education patients have on these advancements they agree because the results sound promising. But, not until after defects from medications, tests, or vaccines do we really look into the risks that these advancements are running. Last summer I made the decision to try the medication Accutane for my acne. I was told that the results would be clear skin for life and all it would take woud blood work and a regimented pill. So, I began the process and it was the worst 6 months of my life. I had no idea that this medication would bring on dramatic mood swings, loss of appetite, joint pain, and migraines. I was constantly experiencing these symptoms that I had no knowledge of before I decided to go through this process. When I spoke to my doctor about my concerns she just told me it would over before I knew it and she handed me a book about the medications to put my mind at ease. The book was filled with a list of birth defects that could occur form this medication. Doctors need to do a better job on education their patients so they make the safest decision for them and not what they are told.
26
No doctor prescribes Accutane without detailing the laundry list of side effects, and including mandatory contraception owing to serious birth defects. Sorry, this is just not a credible comment.
3
Never take any drug that you don't research yourself first. It's worth going to the drug maker's web site directly and looking at the list of side effects. People's Pharmacy is a good resource, too.
2
After a very bad eisode of depression caused by gabapentin and cessation of testosterone production because of opiates (No, I can't stop them) I found that not one of the doctors knew of these side effects. I had to go online to find out and stop the drugs affecting me. It seems that every new drug has depression as a side effect lately. Even Metformin for diabetes. What's going on with the research?
5
"for such men the test can result in more harm than good"
No. No., Many times No. The PSA is simply a blood test, not a biopsy and someone writing about clinical situations should really be aware of the implications of her words.
Also, "...*can* result in more harm..." is not the same as *surely* will result in more harm than good. Professional ethics should prevent the use of such sweeping generalizations.
I don't know how it happened, but Jane Brody is opposed to cancer testing, and even mentions, "cancers that would not ever have become a health threat". Ever? She's dealing with clairvoyance in that statement, not clinical accuracy.
It's the response to a simple blood test that may be the problem, and there are two adults in the room discussing the situation. Neither of those two affected people is Jane Brody.
I dislike the implication that both the doctor and the patient are incapable of rational thought after receiving a score on a simple blood test.
Ms. Brody's chief background is in nutritional sciences. We all learn things that are not in our principal path of study, but not all of us publish articles based on glimpses of information.
No. No., Many times No. The PSA is simply a blood test, not a biopsy and someone writing about clinical situations should really be aware of the implications of her words.
Also, "...*can* result in more harm..." is not the same as *surely* will result in more harm than good. Professional ethics should prevent the use of such sweeping generalizations.
I don't know how it happened, but Jane Brody is opposed to cancer testing, and even mentions, "cancers that would not ever have become a health threat". Ever? She's dealing with clairvoyance in that statement, not clinical accuracy.
It's the response to a simple blood test that may be the problem, and there are two adults in the room discussing the situation. Neither of those two affected people is Jane Brody.
I dislike the implication that both the doctor and the patient are incapable of rational thought after receiving a score on a simple blood test.
Ms. Brody's chief background is in nutritional sciences. We all learn things that are not in our principal path of study, but not all of us publish articles based on glimpses of information.
65
Ms. Brody is indeed correct. The PSA test itself can lead to more harm than good through false positives that may lead to biopsies, over treatment of cancers that will never cause problems, and psychological stress.
53
Ms. Brody wrote: -- for men ages 55 to 69, doctors should inform them that screening “offers a small potential benefit of reducing the chance of dying of prostate cancer,” as well as the potential for harm from testing of overdiagnosis, overtreatment and ensuing complications. -- Not what this statement did not say: It did not say that overall mortality is improved. i.e., your small risk of not dying from prostate cancer is offset by a small increased risk of dying from something else. Everything I've read indicates exactly this: Overall mortality is not improved by PSA testing. But quality of life after treatment for prostate cancer is by definition immediately decreased, and in some cases, long lasting, including incontinence, anal leakage, and impotence (up to 2/3 of men who undergo treatment).
25
Ok. I'm completely persuaded by your logic, especially because you can tell which cancers will never cause problems. And which cancers are those? Let's do nothing whatsoever and let the fates decide. Oh wait. One of my uncles tried that and died horribly of prostate cancer, while his younger brother got tested and treated about 20 years ago and he is now 95. I guess the first uncle guessed wrong, huh? Well, that's life for ya.
Luckily you are not at risk, so you won't be faced with having an obviously incompetent, greedy doctor and clueless patient conference about what to do. Test values are information; they can lead to biopsies, but they can also lead to simply being observant.
We are talking about real cancer here, not some abstract concept... This is about a tumor spreading to liver, lungs, neck. Having injections that cause your teeth to fall out. Real pain all over the body. Incontinence. Vomiting. Would you talk to some man and tell him to just take a chance on not having cancer? "You've got some of the symptoms, but why don'tcha just ignore them and maybe take some herbs?"
Only live people have the post-operative problems that the anti-testers mention. Let's ask a few of them - "Do you wish you were dead?" How many suicides have you heard about lately that were prompted by ED or incontinence?
We can all hope for better testing in the future, but right now it does not make sense to throw out one of the few tools we have.
Luckily you are not at risk, so you won't be faced with having an obviously incompetent, greedy doctor and clueless patient conference about what to do. Test values are information; they can lead to biopsies, but they can also lead to simply being observant.
We are talking about real cancer here, not some abstract concept... This is about a tumor spreading to liver, lungs, neck. Having injections that cause your teeth to fall out. Real pain all over the body. Incontinence. Vomiting. Would you talk to some man and tell him to just take a chance on not having cancer? "You've got some of the symptoms, but why don'tcha just ignore them and maybe take some herbs?"
Only live people have the post-operative problems that the anti-testers mention. Let's ask a few of them - "Do you wish you were dead?" How many suicides have you heard about lately that were prompted by ED or incontinence?
We can all hope for better testing in the future, but right now it does not make sense to throw out one of the few tools we have.
10
And more relevant for people who have the Braca genetic link as well as other ancestral causes of health issues....preventive medicine our great goal.
9
Here you go again: inaccurate reporting: the American Cancer Society and American College of OB/GYN recommend annual mammograms after 40; your screening guidelines are inaccurate. Lesion size at the time of detection determines outcomes and survival: smaller size means better outcomes, less treatment , and better survival.
6
I would not say it is inaccurate reporting because she provided a citation to her source for when screening should begin and end.. Badger liberal has provided additional citations that differ.
5
Lesion size is not the only determinant of outcomes and survival. Some large lesions will not kill a woman after it is removed and some small, aggressive lesions will lead to death no matter how they are treated.
26
What about recommendations for cervical, uterine, ovarian screenings for women?
7
There is no screening test for ovarian cancer. The most effective early detection test for endometrial cancer is biopsy, and therefore its use is limited to women at high risk. For cervical cancer, ACS and USPSTF recommend Pap test every 3 years for women ages 21 through 65; women ages 30 through 65 can opt for Pap plus HPV test every 5 years. Cervical cancer screening should stop after age 65 for women who've been screened regularly with normal results who are not at high risk. Keep in mind that screening guidelines are for people at average risk, so you & your doctor may decide to screen at different intervals.
3