The Associated Press on the new recommendations re screening mammograms

http://news.yahoo.com/s/ap/20091116/ap_on_he_me/us_med_mammogram_advice

It's interesting how the potential harms listed talk about unnecessary biopsies and other false alarms but in my mind it would be much more harmful to be diagnosed with breast cancer unnecessarily.  As stated earlier in this blog,  the best estimate we have state that for every one woman saved by a screening mammogram 10 women are diagnosed with a cancer they didn't need to know was there.   

What exactly do we mean by an "unnecessary diagnosis":

A cancer that would resolve on its own or a "pre-cancer" called DCIS that would resolve on its own or a cancer that was so slow growing that it would never grow large enough to affect the person's life or health or even become clinically apparent.  

So for every woman who has her life saved from screening mammography,  there are 10 women walking around who think of themselves as breast cancer survivors.  They spend the rest of their lives following strict follow up with oncologists and surgeons and getting yearly mammograms waiting for the cancer to "come back".   Most of them underwent surgery, radiation and sometimes chemo to treat their "early cancer".  

The magnitude of harm done over 30 years by screening mammograms will have to be admitted at some point in these disclosures and discussions.  

Interesting also how the title of the article is "new advice".  And throughout the article there's this impression that women between the ages of 40 and 50 are somehow not worth all those resources mammograms represent.  What they don't say is screening mammograms HARM HEALTHY WOMEN.  

The radiology organizations fought successfully to reverse a report by the national cancer institute in 1997 when the NCI's expert panel suggested that there was no proof mammograms between the age of 40 and 50 did more good than harm.  

We'll see if there's a similar backlash this time.  

the US Preventive Task Force Changes Mammogram Recommendations!

http://www.nytimes.com/2009/11/17/health/17cancer.html

The new recommendations reverse longstanding guidelines and are aimed at reducing harm from overtreatment, the group says. It also says women age 50 to 74 should have mammogramsless frequently — every two years, rather than every year. And it said doctors should stop teaching women to examine their breasts on a regular basis.

Just seven years ago, the same group, the United States Preventive Services Task Force, with different members, recommended that women have mammograms every one to two years starting at age 40. It found too little evidence to take a stand on breast self-examinations.

While many women do not think a screening test can be harmful, medical experts say the risks are real. They include unnecessary tests, like biopsies that can create extreme anxiety. And mammograms can find cancers that are better off not found. Some cancers grow so slowly that they never would be noticed in a woman’s lifetime. When they are found, women end up being treated unnecessarily.

This is huge!   The US Preventative Task Force has a lot of impact on what screening tests get done and what doesn't.  After nearly 30 years of recommending a test that does more harm than good,  it's starting to look like there's going to be some recognition and improvement.  This will result in an immediate drop in the number of women needlessly diagnosed with breast cancers that posed no risk to their health.  It will cut the needless anxiety from a false alarm dramatically as well.  

All you hospitals out there that budgeted to make more money on screening mammograms next year compared to this year,  you might want to redo the budget. 

Just sayin'

Thanksgiving

FYI

I'm going to be out of town for the week of Thanksgiving

Will still be checking emails but probably not as often 

Won't be around for house calls,  so no one get sick that week.

Drug Companies Price Gouging to Prepare for Health Care "Reform"

http://www.nytimes.com/2009/11/16/business/16drugprices.html?_r=2&hp

Since the pharmaceutical giants *promised* to shave 80 billion in costs from the national health care bill over 10 years,  they have been increasing prices in preparation.  

Brilliant move on their part.  But hard to imagine how the people will afford the increases during the great recession.  

Kiva Hits 100 Million Today

Kiva Fast Facts

49
months old

$100,667,535
raised

98%
repayment rate

246,720
entrepreneurs funded

586,995
Kiva users

172
countries represented

kiva.org

CDC Flu Charts

Let's look at the laboratory confirmed influenza hospitalization rates for children during different flu seasons and compare it to this year using the CDC's own data.   Now pay attention to the X axis which gives you an idea of the risk of children being hospitalized with the flu.  We're talking around 3 our of 10,000 children for a lot of these seasons.  

This 1st graph shows several years including 2003-4 season where around 8 out of 10,000 children ages 0-4 were hospitalized.  

http://www.cdc.gov/flu/weekly/weeklyarchives2007-2008/EIPF0708.htm

Compare that to the swine flu, pictures on the left and some recent seasons on the right.  For children ages 0-4 so far we're still below 3 out of 10,000 hospitalized.  This is despite the fact that swine flu infects more children than the regular flu.  

http://www.cdc.gov/flu/weekly/weeklyarchives2009-2010/EIP42.htm

So this far into the outbreak,  we're still dealing with a virus that hospitalizes fewer children that most of the seasonal flu viruses for the past several years.  

Interview with an influenza Guru

http://www.spiegel.de/international/world/0,1518,637119,00.html

SPIEGEL: For a number of years, as part of the Cochrane Collaboration, you have been systematically evaluating all the studies on immunization against seasonal influenza. How good does it work?

Jefferson: Not particularly good. An influenza vaccine is not working for the majority of influenza-like illnesses because it is only designed to combat influenza viruses. For that reason, the vaccine changes nothing when it comes to the heightened mortality rate during the winter months. And, even in the best of cases, the vaccine only works against influenza viruses to a limited degree. Among other things, there is always the danger that the flu virus in circulation will have changed by the time that the vaccine product is finished with the result that, in the worst case, the vaccine will be totally ineffectual. In the best of cases, the few decent studies that exist show that the vaccine mainly works with healthy young adults. With children and the elderly, it only helps a little, if at all.

SPIEGEL: But aren't those the exact groups that influenza immunization is recommended for?

Jefferson: Indeed. That's one of the contradictions between scientific findings and practice, between evidence and policy.

SPIEGEL: So, what's behind this contradiction?

Jefferson: Of course, that has something to do with the influence of the pharmaceutical industry. But it also has to do with the fact that the importance of influenza is completely overestimated. It has to do with research funds, power, influence and scientific reputations!