March 19, 2013

"Six months after hearing they did not have breast cancer, women with these false positives experienced changes in 'existential values' and 'inner calmness' as great as for women who had cancer."

"They reported having more anxiety, feeling more pessimistic and having more problems with their sleep and sex lives — as well as other negative outcomes — than women who had normal mammograms."

You see where this is leading?
Screening less frequently could be one way to reduce the numbers of women who have to cope with false positives without greatly increasing their risk of developing advanced breast cancer, a separate team of researchers reported Monday in JAMA Internal Medicine....

41 comments:

Nomennovum said...

I don't believe in coincidences. So, Obamacare has nothing to do with this.

JAL said...

"If women had cancer, they cried," he said. "If it was not cancer, they cried too."

Women cry.

Hey -- I have had several questionable mammograms. They did follow ups 6 months later for about 2 years.

What's missing from this story is how long was it before the false positive was corrected from positive to negatiove. How was that determined? Follow up mammagram? Needle biopsy? Second opinion?

All of these would influence how e how the women might have responded, in addition to how to understand the "news" / information being conveyed in this article.

Note that that information is NOT provided.

Written as a scare piece.

Imagine the hell to pay when a positive diagnosis shows up that could have been caught earlier.

Oh. Wait. Under Obamacare my bet is there is no recourse for appeal or legal action. (That's one way to achieve "tort reform" wihtout calling it that.)

Nomennovum said...

"If women had cancer, they cried," he said. "If it was not cancer, they cried too."

"Women cry."


Someone should do a study to find out who is to blame.

Gahrie said...

Hey...who gives a shit about mammograms...Obama's going to give us free contraception and let us kill our babies!

Dante said...

More John Edwards, is where this is going.

Nomennovum said...

Hey...who gives a shit about mammograms...Obama's going to give us free contraception and let us kill our babies!

Yeah. Kill 'em before they grow tits!

AprilApple said...

Obama care!

Just take a pain pill.

Peter said...

"magine the hell to pay when a positive diagnosis shows up that could have been caught earlier."

Yet there is no hell to pay when the ionizing radiation absorbed from a mamogram causes an unnecessary cancer.

For younger women the risk exceeds the benefit. Yet the bias will always be toward more and earlier mamograms, since the missed diagnosis can be seen in individuals yet the excess cancer can only be inferred in the aggregate.

Which presumably applies to all that can be defined as "preventive medicine," now that it's all free.

Phil 3:14 said...

This is important information and frankly something known for some time. Its foolish to see politics in such a study.

There's an odd irony in conservatives bemoaning a threatened limitation of government-funded healthcare coverage.

If you want a mammogram, buy one. You can find them for about $100 or less. And if there were imited insurance coverage they'd be even cheaper.

No one should come between me and my doctor.

Leigh Fellner said...

A few years ago I was misdiagnosed with retinitis pigmentosa, which not only meant I'd soon go blind, but that my artist son had a 50% chance of doing so as well. It did indeed affect my existential values and inner calmness: I became more visually attentive, more appreciative of this moment, now, and more flexible, because I'd learned that what we are so sure is our future can change in a moment.

That month of misdiagnosis was a nightmare. And I'm eternally grateful it happened. Every day of sight since then has felt like a gift.

Dust Bunny Queen said...

What you don't know won't hurt you???

Right?

Nomennovum said...

"No one should come between me and my doctor."

Friend, it is far, far too late in the game to be saying something like that. That train has left the station, the horse is out of the barn, the cat's out of the bag, and that goose is cooked. Are you some kind of frog stuck in a pot over a lit stove?

edutcher said...

Hey, I ducked a bullet!!!

This time!!!!

Dust Bunny Queen said...

To be serious: Leigh's post shows just how differently people handle bad news. Some people can't get over the bad news even when it is shown to be false. Others face it head on: with courage and grace and become stronger persons for it.

The tendency of people and science statistics to try to lump everyone together as some homogenous group.....all women feel this way, for example, is foolish. To make decisions for everyone based on the bad experiences of a few is stupid. Of course....we all know this isn't about medicine or science...it is about money and control.

Think of it as a near death experience in some ways. My husband when he was young almost bled to death from a bleeding ulcer. He literally died until they were able to transfuse and restart his heart. His view of life, death, purpose and how you handle everything from then on changed. Oh.....he is still an asshole, but changed :-D Death is not scary.....not living to the fullest and not appreciating life is scary.

Tim said...

"...without greatly increasing their risk of developing advanced breast cancer..."

"without greatly increasing their risk" DOES NOT EQUAL "no increasing of their risk."

I wonder if the women who this policy is ostensibly designed to benefit will think it worth the trade-off?

I wouldn't be surprised if they did.

People are irrational in so many different ways.

Mitchell the Bat said...

All I can say is I'm not looking forward to the day they x-ray my balls.

Leigh Fellner said...

Death is not scary.....not living to the fullest and not appreciating life is scary.

Exactly, DBQ. What you describe has happened to several people I know. All were profoundly changed. One became debilitatingly risk-averse. The rest (including one chronic depressive) decided the time they had left was a gift, squeezing two days' worth of life into every 24 hours.

Bob R said...

Or we could just teach people probability theory. Then they'd understand the high probability of false positives.

MayBee said...

England starts mammograms at age 50.

The number of friends I have in the states who have had to go back for follow up mammograms and ultrasounds is shocking. The test is either too imperfect or it doesn't cost enough so clinics want to do the more expensive follow up. I've become pretty cynical about them. I believe the every year starting at 40/45 is a political choice, not a health choices.

traditionalguy said...

I know a young lady, about 30, who was diagnosed with breast cancer in one breast and had the surgeons remove both breasts so that she would not have to fear it coming again soon in her other breast.

Amartel said...

Anything to get costs down. Thanks, Obamacare!
False positives in a cancer test would still result in an unexpected brush with reality which would cause a person to do some real thinking about life. Better late than never and this is a poor excuse to cut back on necessary diagnostic procedures.

tim in vermont said...

"Yet there is no hell to pay when the ionizing radiation absorbed from a mamogram causes an unnecessary cancer." - Peter

There is good data on this somewhere? We know that missing cancers kills people, we are speculating that low levels of radiation cause x amount of cancers.

tim in vermont said...

Even if radiation causes breast cancers, screening for them moderates the risk once again.

On the other hand, you have the certainty of a number of deaths. But hey! No price is too high to pay to let liberals run everybody's life. What a utopia they will create!

Achilles said...

This is why it is better to have un-elected beauracrats make decisions about peoples health care than to have doctors and patients make decisions about their own health care. Working for the government makes you way smarter than the little people.

n.n said...

Nomennovum:

Notice that Obamacare focuses on revenue generation. Not on increasing resources (e.g. hospitals, equipment, doctors, nurses, etc.) to meet the demand. It is health care affordability offered in the same spirit as the "new economic" model (e.g. Cyprus) he spoke of five years ago.

Sam L. said...

So, fewer mammograms is THE answer, yes?

Alex said...

So mammograms cause cancer!

Michael K said...

Blogger Peter said...

"magine the hell to pay when a positive diagnosis shows up that could have been caught earlier."

Yet there is no hell to pay when the ionizing radiation absorbed from a mamogram causes an unnecessary cancer.

For younger women the risk exceeds the benefit. Yet the bias will always be toward more and earlier mamograms, since the missed diagnosis can be seen in individuals yet the excess cancer can only be inferred in the aggregate."

Would you mind sharing with me the source of your information about cancer being caused by mammograms ? I've only been doing breast surgery since 1967 and must have missed it. You do have a reference, don't you ?
I haven't seen one; only speculation by anti-nuclear types.

sydney said...

Take away third party payers and this conversation would not be happening. Then the conversation would be: If you get mammograms starting at age 40 you have this much of a chance of having a false positive, and this much of a chance of requiring further costly testing to prove the false positive at X cost to you, vs. the chance of finding cancer. Then you, the patient, decide whether you want to invest that money and time in early mammograms or wait to do it later when they are more cost effective. It really should be an individual choice, but when someone else is paying for it, people tend to only see the benefit, not the cost.

Mel said...

My grandmother had breast cancer, so I had a baseline mammogram at 40 and have had follow ups every two years. My doc wants me to go every year because of family history, but grandmother was post-menopausal when her cancer developed, so I do what I want to and won't sue my doc over my own health decisions.

My mother and her dad both died of an aneurysm at an age younger than my grandmother got cancer. Same age and location, highly likely to be genetic in nature. I have had an MRI looking for that and to get a baseline and go back next year (10 years) to get another. If they find it, it's operable. Worth the MRI, I think.
If they don't find it next year, it'll be another 10 years before I let them look again. And then on my birthday in my 59th year because that's when mom died. After that, I'm in the clear, I think, and if I'm not, my youngest will be well into his twenties.

These are *my* medical decisions, made after discussing with my doctor. I do hope that the ACA doesn't mean that I can't keep to those decisions the same way it's meant that my insurance has changed...

The Godfather said...

I knew a guy who had a heart attack in his early '60's, and survived. In response, to avoid a recurrence, he significantly reduced his level of strenuous activity, foregoing a number of pursuits that he had previously enjoyed. About five years later, he had a bout with cancer, which he also survived. After THAT, he went back to all his old favorite strenuous activities, expressly on the theory that he wasn't going to live forever, so he might as well enjoy whatever time he had.

He died of a heart attack in his mid-'70's while engaged in a strenuous activity.

I personally think he made the right decision for himself, and I hope that's the decision I make if faced with the same issue.

Michael K said...

"Take away third party payers and this conversation would not be happening. Then the conversation would be: If you get mammograms starting at age 40 you have this much of a chance of having a false positive, and this much of a chance of requiring further costly testing to prove the false positive at X cost to you, vs. the chance of finding cancer. Then you, the patient, decide whether you want to invest that money and time in early mammograms or wait to do it later when they are more cost effective."

Sorry to burst your bubble but the following is a quote about Obamacare from an MD Congressman.


Under President Obama’s health care law, should the HHS Secretary determine that performing mammograms on women younger than 50 violates a standard of care, the provider must comply, regardless of his or her concerns. Failure to do so would allow the Secretary to shut down a medical practice. The powers given to the Secretary are so broad, he or she could literally dictate how all physicians nationwide practice medicine.

Deb said...

I don't give a shit how upset they get. I've known too many women whose lives were saved by early detection. I'm not willing to risk my life, or my daughters' lives (in a few years) because a handful cry babies.

Deb said...

@Michael K: So one could not pay out of pocket just because HHS deems it unnecessary?

wyo sis said...

When I read the headline I assumed the consequences of the false positives were similar to cancer patients who get energized and empowered by facing cancer and beating it. Of course it couldn't be that. That would affirm the strength of the human spirit and not produce a need for legislation.

Michael said...

I get the non-recommended PSA test as do Urologists. A false positive? Ill take it. A positive positive? Ill take that too since it will likely be found very early. Because i take the non-recommended PSA like Urologists do.

sydney said...

@Michael K,

I consider Obamacare a third party payer. My point was that if the patient paid for the mammogram, it would be different conversation.

Michael K said...

"
3/19/13, 8:00 PM
Blogger sydney said...

@Michael K,

I consider Obamacare a third party payer. My point was that if the patient paid for the mammogram, it would be different conversation."

The Obamacare enforcers will try to make the "guidelines" mandatory for all MDs.

kentuckyliz said...

I was diagnosed at age 42, (from a PET CT fusion scan, not a mammo), and it was my third primary cancer.

Informatics don't deal with outlier statistical freaks like me.

I will probably be denied care at some point because I've had 3 primary cancers and had my fair share of health care.

Theranter said...

"@Michael K: So one could not pay out of pocket just because HHS deems it unnecessary?"

Correct. When full-blown o-care is in place, you CANNOT elect a non-IPAB approved test and pay for for it yourself. (But of course offshore you could.)

To really get the full picture of what it will be like in a fun read, see "drrich" a blog with a free book "Open Wide and Say Moo" - he is an M.D. that has done extensive research on O-care and writes in a clear, entertaining fashion.

And fwiw, I had bc, double mastectomy, chemo, rads and there are many dead women that waited too long for mammos. Better anxious and "crying" than dead, unless you're a lib? (not you, the people obviously starting the propaganda simply to justify decreasing mammo services.)

We are doomed.

breastimagingofoklahoma said...

Amazing how simple it can be to communicate with people and have them understand a certain topic, you made my day.

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