Talk:Breast cancer

Cochrane Collaboration (CC)

Yes, the sentence can and should be referenced as coming from the CC. See[[1]], from the CC: "It is thus not clear whether screening does more good than harm. Women invited to screening should be fully informed of both the benefits and harms. To help ensure that the requirements for informed consent for women contemplating whether or not to attend a screening program can be met, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk." Additional text can come from the Nordic page as linked, also being part of the Collaboration.32cllou (talk) 23:37, 7 April 2013 (UTC)

The 2012 pamphlet is not an updated Cochrane review. Have provided a better ref for Europe. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:22, 8 April 2013 (UTC)

Thanks for the working link, but it's to a review of mammography mostly in Germany and four other EU nations. It is not a conclusion of the Council of Europe, as you write. Finally, I do not find any recommendation to mammography. I'll leave your mistaken text until you review and prove. Why did you mess up the order of the paragraphs?, as I read wikipedia wants paragraphs / sentences by date with most recent last.32cllou (talk) 01:00, 8 April 2013 (UTC) I think we should put a warning label on this article, as it is currently misleading.32cllou (talk) 01:00, 8 April 2013 (UTC) I found text that supports tho using many EU nations targets not recommend and made that change for you.32cllou (talk) 01:27, 8 April 2013 (UTC)

If you read the text in question it states "the Council of Europe recommends population-based organized mammography screening for breast cancer for women aged 50–69 years and requires that screening programs comply with the European guidelines" I am not sure what you above comment means. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:36, 8 April 2013 (UTC)

With respect to ordering we typically put newer and better content first. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:50, 8 April 2013 (UTC)

I'm sorry, I finally found your text above. You see that your statement was not supported (up to 74 with 2 year intervals). Thanks for fixing. You know when I first started editing I read through wikipedia rules and guidelines, and I'm sure it's most recent last. Also, as a technical writer, most current research, especially reviews, are always last. Usually you don't provide review conclusions based on data that is old and thus confusing. 2009 is too old for mammography! Articles are generally most recent last. Finally, I've read arguments in Talk that were resolved having most recent information / studies last. Please provide the wikipedia statement supporting your (odd) contention that supports the structure of your screening section where you have old data reviews placed so prominently.

Finally I object to your sentence "thus it may be reasonable to forgo screening regardless of age" when a direct quote states "it therefore no longer seems reasonable to attend” for breast cancer screening at any age, and warn of misleading information on the internet.32cllou (talk) 15:28, 8 April 2013 (UTC)

Please stop putting the Nordic Cochrane group leaflet in it, the Web page hosting it clearly says "Draft, not yet for distribution." Zad68 19:20, 8 April 2013 (UTC)

On my User Talk page, 32cllou wrote, "You can also use this as the reference [2]" - can you provide the PMID for the study update Cochrane published? Zad68 19:28, 8 April 2013 (UTC)

Take a look at the Cochrane Collaboration page[3], "last edited Oct 2012" with the text "Screening produces patients with breast cancer from among healthy women who would never have developed symptoms of breast cancer. Treatment of these healthy women increases their risk of dying, e.g. from heart disease and cancer. It therefore no longer seems reasonable to attend for breast cancer screening. In fact, by avoiding going to screening, a woman will lower her risk of getting a breast cancer diagnosis. However, despite this, some women might still wish to go to screening."32cllou (talk) 19:30, 8 April 2013 (UTC)

Yes, I see that, but I'm asking for the PMID or at least a DOI pointing to a update published in a peer-reviewed journal. Zad68 19:32, 8 April 2013 (UTC)

Reading wikipedia rules I find that the Cochrane Collaboration statements and conclusions are preferred (probably the best source you can find), so you should not expect me to find peer review for this group of 24,000 independent professionals! You have the reference (CC web page), which is all that is required per wikipedia.32cllou (talk) 20:02, 8 April 2013 (UTC)

Proposed text for last sentence (2012 CC text) is Text last updated Oct 2012, the Cochrane Collaboration states that mammography screening produces patients with breast cancer from among healthy women who would never have developed symptoms. "Treatment of these healthy women increases their risk of dying, e.g. from heart disease and cancer. It therefore no longer seems reasonable to attend for breast cancer screening."32cllou (talk) 20:04, 8 April 2013 (UTC)

I'm having trouble figuring out what the goal of this round of editing is. Do you two actually disagree with each other about the general facts? It doesn't look like it to me. WhatamIdoing (talk) 23:21, 8 April 2013 (UTC)

Three things

1. This content "the Council of Europe recommends mammography between 50 and 69 with most programs using a 2 year frequency," keeps getting changed by this editor as in here [4] when the ref says "Nowadays, the Council of Europe recommends population-based organized mammography screening for breast cancer for women aged 50–69 years and requires that screening programs comply with the European guidelines"
2. 32 keeps adding "Updated in 2012, they state that advances in diagnosis and treatment has made mammography screening less effective and conclude that “it therefore no longer seems reasonable to attend” for breast cancer screening at any age, and warn of misleading information on the internet" to imply that this is supported by an updated Cochrane review. which links to this [5] which does not appear to me to be a Cochrane review let alone an update of the previous ref.
3. I guess the ordering does not really matter however IMO it was better before.Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:45, 9 April 2013 (UTC)

What Doc outlined is pretty much it. My strongest reservation was the use of this self-described "mammography leaflet" from the Nordic Cochrane Centre. The Web page title states that the document is Draft, not yet for distribution and describes a shift from being very equivocal about BC screening to making a positive recommendation against BC screening. I think based on 32cllou's comments that 32cllou now agrees not to use this document, but I'm not 100% sure.

A further reservation is, as found in 32cllou's edits like this one, describing this document in our article content as an "update" to PMID 21249649 ("Screening for breast cancer with mammography" from Cochrane), and attributing it to PC Gøtzsche, the main author of that meta-analysis and review. It's reasonable to think that Gøtzsche had his hands on it, but the document itself doesn't say so, and so listing him as the author, as 32cllou proposed, isn't supported. Also this isn't the normal way Cochrane publishes updates to their reviews. Normally we see updates published at http://www.thecochranelibrary.com and indexed in PubMed with a PMID, and that is not the case here. In fact the very latest from Gøtzsche and Cochrane on this subject is that PMID 21249649 (published January 2011) and it states "Screening is likely to reduce breast cancer mortality."

Given that, 32cllou seems to be OK with not using this document but instead is pointing to http://www.cochrane.dk/screening/index-en.htm. This doesn't say "Draft" but still has the same issues: no Cochrane library update is referenced or found and a specific author is not listed.

This is a significant shift in policy recommendation and the sourcing, although it's Cochrane-hosted materials, is a bit sketchy. My preference here is that we do not go with 32cllou's proposed content change at this time and instead wait for Cochrane to release their update through their normal publication process. Of course, if alternate, authoritative sourcing can be found for this proposed content, that might change matters.

I also though the ordering was better before. Maybe we'll open a separate section to discuss just that. Zad68 13:34, 9 April 2013 (UTC)

Just to be clear I am fine to use the pamphlet from the Cochrane collaboration as found here [6] just not okay with calling it a Cochrane review. Thus I reworded the text here [7] Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:51, 12 April 2013 (UTC)

I'll contact CC. Other edits may need to be made the the article. When I first put that Nordic CC leaflet into BC months ago, there was no Draft. And there is no Draft when you print it out. Note that the Nordic no less part of part of CC than the US branch.32cllou (talk) 22:55, 14 April 2013 (UTC)

Sounds like CC will produce a formal review soon and they referred me to that web page. This CC web page last updated Oct 2012 says "Screening produces patients with breast cancer from among healthy women who would never have developed symptoms of breast cancer. Treatment of these healthy women increases their risk of dying, e.g. from heart disease and cancer. It therefore no longer seems reasonable to attend for breast cancer screening. In fact, by avoiding going to screening, a woman will lower her risk of getting a breast cancer diagnosis. However, despite this, some women might still wish to go to screening."[[8]] Can I write this for the last sentence?

"The Cochrane Collaboration Web page, last updated Oct 2012 and titled "Screening for breast cancer with mammography" [[9]], concludes that it may longer be reasonable to attend for breast cancer screening. While women might want to continue to seek mammography screening, the imaging may identify patients among healthy women who would not have gone on to develop symptoms breast cancer, and there are treatment risks.32cllou (talk) 23:34, 15 April 2013 (UTC)

It is still not my preference to use a page like this, and I would much rather wait for Cochrane to publish an actual peer-reviewed journal article. However, something along the lines of what you are proposing, with attribution to Cochrane, would be an acceptable compromise to me, and when Cochrane does publish a journal article we can replace this reference with that. Suggested tweak to your proposal would be:

"The Cochrane Collaboration Screening for breast cancer with mammography Web page (last updated October 2012) states that, due to recent improvements in breast cancer treatment, and the risks of false positives from breast cancer screening leading to unnecessary treatment, mammogram screening may no longer be recommended.<reference to web page>"

Would also like to hear from Doc James. Zad68 14:21, 16 April 2013 (UTC)

We could even sorten more "Cochrane states that, due to recent improvements in breast cancer treatment, and the risks of false positives from breast cancer screening leading to unnecessary treatment, mammogram screening may no longer be recommended.<reference to web page>" As long as we are not stating it is an updated systematic review I am okay with this. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:34, 16 April 2013 (UTC)

I'd rather the reference be attributed to a Cochrane Web page in the article, so that it's clear the source isn't a Cochrane review. Either way, as it's not my preference to use this at all, I won't be making the article update, but if something along the lines of what we're discussing gets put into the article I won't revert it either. Zad68 18:22, 17 April 2013 (UTC)

But you're missing the main point, which is "it therefore no longer seems reasonable to attend for breast cancer screening." How about this as the last sentence: A Cochrane Web page (last edited Oct 2012) now states that, due to recent improvements in breast cancer treatment, and the risks of false positives from breast cancer screening leading to unnecessary treatment, "it therefore no longer seems reasonable to attend for breast cancer screening" at any age.<reference to web page>"32cllou (talk) 00:35, 18 April 2013 (UTC)

awful photo

The image under discussion here is File:RecurrentbreastCA1.gif. (note from TenOfAllTrades(talk) 18:48, 21 October 2013 (UTC))

Just wondering if the photo of the woman with advanced breast cancer is really necessary? Presumably many people looking on this site have either had a diagnosis or are close to someone who has. It's a very gruesome photo. Thanks 125.239.252.86 (talk) 22:14, 1 May 2013 (UTC)

Many diseases are. Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:55, 2 May 2013 (UTC)

I agree with the questioner above. I am not a doctor, but truly do not understand the reasoning behind the odd decision to upload the photo visible to the right of the "Prognosis" section, captioned "An example of recurrent breast cancer". A photo of such an extreme, atypical case of BC recurrence - one that apparently has been allowed to fester and become gangrenous (?) - seems both scientifically inaccurate and highly inappropriate. Could another more relevant, accurate image not be found? At the very least, both for reasons of medical accuracy and out of concern for the millions of women who will happen upon this image after receiving a BC diagnosis and going to this section to understand their prospects for survival, the caption should be modified to explain that the photograph does not show a typical case of BC recurrence. I hope that "Doc James", who seems to have chosen and uploaded the photo, will be able to explain why in a persuasive and polite manner, and confirm whether or not it shows a "typical", or even anywhere near to "typical", case of BC recurrence. In fact, I found the snide tone of his response to the original questioner to be quite unhelpful and rude, and hope that my enquiry will not be treated similarly. Thank you in advance for any clarifications you can provide, as I am truly interested in hearing your response. 93.35.8.243 (talk) 15:34, 21 October 2013 (UTC)

I think that 93.35.8.243 makes a good case for removing the photo. Perhaps I could be convinced otherwise, but right now I tend to agree that it should go. Gandydancer (talk) 15:42, 21 October 2013 (UTC)

I have removed the photo, per this discussion. Its inclusion is not necessary to augment the points made in the text. In fact, it places undue weight on the most serious forms of recurrence (we show no images of the far more common cases of recurrence at less advanced stages). The goal of the article should be to inform, not to shock. Dezastru (talk) 17:12, 21 October 2013 (UTC)

I reverted you. To say you have removed it per discussion is...irritating. Keep in mind that thousands of WP readers have viewed this page without comment re the photo. That does not prove that it is appropriate, but it certainly does suggest that just because two editors, you and 93, don't agree to it that it should go. I may very well change my mind if discussion suggests that it is appropriate. Let's wait for discussion. Gandydancer (talk) 17:29, 21 October 2013 (UTC)

I have no objection to waiting for further discussion. If you are irritated, perhaps you did not notice that apparently 4 contributors in this discussion which I cited in my edit comment had said that inclusion of the photo was problematic for the article while only one (the same editor who had originally added the photo) argued for keeping it. WP:BOLD is a customary practice on Wikipedia. Dezastru (talk) 18:01, 21 October 2013 (UTC)

It does seem to represent something of a 'worst-case' presentation (in terms of both prognosis and 'ick' factor) of recurrence. Though we should not shy away from discussing potential outcomes, using this image – particularly in isolation – probably puts us over the line of WP:UNDUE in terms of the emphasis we are placing on one particular extremely negative outcome. (Incidentally, aren't distant metastases more common than locoregional recurrences in BC, anyway?) Per 93.35's query above, I would also wonder if this presentation is particularly gruesome because the disease has not been monitored as closely as it should or could have been, and whether or not it represents even a very poor 'typical' outcome in an individual receiving gold-standard care.

While Wikipedia's philosophy of incremental growth often holds that any image is better than no image, and carries the (generally reasonable) expectation that interative improvement will eventually fill in the gaps, in this instance it appears that we're starting from the very edge of the spectrum and thereby inadvertently offering an unbalanced view of the topic. Until there is an appropriate context in which to place this image, I am inclined to agree with the proposal that it be removed. TenOfAllTrades(talk) 19:42, 21 October 2013 (UTC)

I have read everyone's comments with interest; I continue to await the response of the man who originally uploaded the image. I truly hope that it will be taken down and replaced with a more appropriate image. 93.35.5.193 (talk) 22:24, 21 October 2013 (UTC)

User:Jmh649, is "recurrent" really the most salient description of that image? Perhaps "extremely advanced" would be better? It seems to me that even an original/non-recurrent breast cancer could look like that in the advanced stages. WhatamIdoing (talk) 00:52, 22 October 2013 (UTC)

User:Jmh649, Please read all of the recent posts above. I continue to await your response as I believe you are the person who decided to upload the image in question. I hope that it will be taken down ASAP and replaced with a more appropriate image, or at the very least that its caption will be modified to accurately describe what viewers are seeing. There's something extremely odd about such a photo -- of all possible photos of cases of recurrent BC -- having been chosen and posted and I would really like to know why this happened/was allowed to happen. 93.35.9.217 (talk) 11:50, 22 October 2013 (UTC)

Whoa—hold your horses, 93.35. It's only been a day or so since this issue was (re)raised, and only a handful of hours since Jmh649 would have been notified through the use of his username in this discussion thread. He hasn't edited Wikipedia since the 19th of October, so it's pretty likely that he's not even seen this discussion. In general, I've found he approaches Wikipedia editing with a great deal of competence and clue; it's not helpful to come at him with a chip on your shoulder. If we don't hear from him soon, it would be reasonable to proceed on the basis of whatever consensus is established in his absence. TenOfAllTrades(talk) 00:35, 23 October 2013 (UTC)

Apologies. This is the first time I've intervened on a Wikipedia Talk page and I'm not an expert on how it all works, so thanks for the tips. However, I really don't have a chip on my shoulder; I'm just concerned about the many more women newly diagnosed with BC who will chance upon this photo in the meantime... It seems to me that the discussion of the past few days has established a certain consensus, but per your instructions I'll keep checking in to read further points of view, including that of Jmh649. 93.35.4.194 (talk) 11:00, 23 October 2013 (UTC)

I have poor Internet right now. When I was assisting in neurosurgery we had a case of a spinal tumor. When the anesthesiologist was preping the patient for surgery on the spine she exposed the chest and we saw a breast cancer similar to this one. I spoke for a long time with this women afterwards regarding how long she had had this mass (more than 3 years) and why she did not mention it to anyone (she did not think it was a problem as it didn't hurt).

Breast cancer is more than just "pink ribbons" and happy running / walking events supported by industry. It is a horrible disease. I disagree with attempts to turn it into a mild disease (which we do somewhat by diagnosing people with breast cancer who do not have it).

I did not upload this image BTW. It does not belong in the lead and the caption could be improved per WAIDs suggestion. IMO it does belong in the article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 10:04, 24 October 2013 (UTC)

On the question of audience: Wikipedia is not written for patients. "It might scare patients" isn't a valid reason for suppressing factual information. People here at the English Wikipedia also sometimes do "mean" and "hope-destroying" things like saying, in plain, unmistakable language, that fatal diseases are fatal, even though this isn't popular or pleasant for a subset of readers. But I want you to think about what you're asking:

You are asking us to suppress information because it produces unpleasant emotions. I agree that this photo might scare and disgust a patient or loved one, in the sense that it might provide a patient with an accurate understanding of what untreated or extremely advanced cancer can look like (sometimes). (This reminds me of the study on oncologist–patient communication: the worse the patients understood their situations, the better the patients thought the onc's communication skills were.) But this photo might also scare other people, like policy makers who are trying to decide whether to continue funding cancer research or women trying to decide whether it's worth the hassle to make an appointment to discuss a "probably harmless" lump. In that sense, scaring people might actually be in the best interests of the women with breast cancer, even if it's not pleasant for anyone. WhatamIdoing (talk) 11:24, 24 October 2013 (UTC)

I can quite easily argue for keeping the photo as well. A few things to keep in mind: I don't know the stats, but I do know that some women actually do develop obvious disease, as shown in the photo, because they are fearful and resist going to the doctor. Then, as time goes on, what started out as fear turns to shame as the cancer grows and they are too embarrassed to expose what they have left to go on for so long. I wish I knew how frequently this happens, but I don't--I'd guess that it is more often than we'd like to think. I have seen it once in a woman who was drug/alcohol addicted and only revealed her advanced breast cancer once she was in treatment for her addiction. It would be assumed that untreated breast cancers in underdeveloped countries may sometimes? often? advance to this stage as well. Gandydancer (talk) 13:29, 24 October 2013 (UTC)

(ec) Trying to a achieve a "balance of fright" between scaring patients unnecessarily and scaring politicians usefully isn't really the approach we should be following either, though. The concern I have is one of fairly representing the topic. Right now, the image is the sole illustration at the top of the Prognosis section of the article. Purely as a matter of undue weight, we should ask ourselves if this is a reasonable and representative case. The answer is no—it's way out on the end of the spectrum, combining advanced disease with apparent neglect. It's like illustrating the Culture and contemporary life section of New York City with a single picture of a tourist being stabbed. Yes, it is a true representation of something that could occur, but it's a poor representation of an outcome that is likely to occur.

To be clear, I am not endorsing the "Cancer is all about fluffy bunnies and buying pink iPods" marketing flacks, nor am I suggesting that we should pull any punches when we talk about outcomes and prognosis. If possible, we should consider adding a properly-sourced section or discussion to our article on the very real problem of delays in seeking treatment. TenOfAllTrades(talk) 13:58, 24 October 2013 (UTC)

TenofAllTrades has put it very well. We should be judicious in selecting images, so as not to overemphasize an unusual aspect of the disease. The text makes clear that people do die from breast cancer, so we are not suppressing information. Dezastru (talk) 17:15, 24 October 2013 (UTC)

I did find this [10] which relates to frequency of advanced cancer. Gandydancer (talk) 14:56, 24 October 2013 (UTC)

Is that article discussing recurrent disease, which is the relevant topic? Dezastru (talk) 17:15, 24 October 2013 (UTC)

I think that there is agreement that the photo would be better titled advanced than recurrent. I don't know if the study I found is useful or not. My question remains: How frequently does lack of adequate medical care or patient neglecting to seek medical care result in an advanced stage as is seen in the photo. I assume that it is fairly rare in developed countries, but is it still fairly common or less rare in less developed countries? If true, there is reason for the photo to remain in the article.

Would there be agreement that the photo caption be changed to "An example of untreated, extremely advanced breast cancer"? Gandydancer (talk) 12:34, 25 October 2013 (UTC)

We don't know that it was untreated. In fact, it probably was treated, given that it's described as "recurrent". I think it would be better to say "An example of advanced breast cancer" (or "extremely advanced", if you prefer). WhatamIdoing (talk) 14:52, 25 October 2013 (UTC)

The reason that I included the word "untreated" is that I find it very hard to believe that a "treated" breast cancer would ever look like as shown in the picture, because I can't imagine that the woman's breast would still be intact if she had ever had treatment. I guess that it could be argued that she had had a lump removed and it was not enough to stop the spread, but that would suggest that she had access to medical care and/or that she had made herself available for treatment, rather than the type of person that is psychologically resistant to seeking medical assistance. Gandydancer (talk) 15:38, 25 October 2013 (UTC)

Wouldn't the appropriate step to take be to ask the person who uploaded the photo to Wikimedia Commons and labeled it "recurrent" whether he or she is sure that it is recurrent, rather than to make assumptions about it and potentially mislabel it? At some point weeks, or likely months, prior to the photo being taken, the patient had access to at least some medical care, because there is a subcutaneous intravenous catheter port in place on her upper right chest. Although the resolution of the image in that area isn't great, there do not appear to be any signs of a very recent skin incision, indicating that the port has been in place for a while. Dezastru (talk) 16:44, 25 October 2013 (UTC)

On a related point, is the ==Prognosis== section intentionally (almost) free of simple stats, like five-year survival rates (which average about 90% for all stages of invasive breast cancer)? That seems like the kind of thing readers will want to know, e.g., 60% of women who are diagnosed with invasive cancer (e.g., excluding DCIS) have Stage 1 and have a 98% chance of being alive five years later. WhatamIdoing (talk) 14:52, 25 October 2013 (UTC)

It doesn't seem almost intentionally absent. It seems to be a reflection of the page having been written to include what the editors are interested in rather than what most readers are likely to be interested in, which is why the topic discussed in this thread is important. Recall that until yesterday there was a list of breast cancer cell lines making up a large part of the Breast Cancer Research section. Dezastru (talk) 16:16, 25 October 2013 (UTC)

I also couldn't have said it better than TenOfAllTrades, whom I (re)quote: "The concern I have is one of fairly representing the topic. Right now, the image is the sole illustration at the top of the Prognosis section of the article. Purely as a matter of undue weight, we should ask ourselves if this is a reasonable and representative case. The answer is no—it's way out on the end of the spectrum, combining advanced disease with apparent neglect. It's like illustrating the Culture and contemporary life section of New York City with a single picture of a tourist being stabbed. Yes, it is a true representation of something that could occur, but it's a poor representation of an outcome that is likely to occur."

Exactly. This has nothing to do with sugar-coating or prettifying breast cancer or any other kind of cancer, or with "suppressing" photos or info because they "produce unpleasant emotions". It has to do with the desire for scientific/medical accuracy when talking about BC prognosis. I see that someone has ever so slightly altered the caption on the photo from "An example of recurrent breast cancer" to "An example of advanced breast cancer". To me it looks like the photo shows a case of BC that is a lot more than just "advanced", and I continue to hope, per Dezastru's comments and my own earlier ones, that the person who I believe originally uploaded and captioned the photo, Jmh649, will soon elucidate. I continue to believe that the photo should be substituted with a more accurate one, and I agree with TenOfAllTrades that it might be a good idea to add "a properly-sourced section or discussion to our article on the very real problem of delays in seeking treatment". 93.35.6.9 (talk) 17:06, 27 October 2013 (UTC)

The original contributor of the photo to the Wikimedia Commons was Kauczuk (contribs | talk) in 2007. The description provided for it was: "This is a personal photo from a patient with advanced local-regional recurrence of breast cancer with an ulcerating axillary mass. Identifying features of the patient have been cropped. The round bump over the woman's right breast is a port". As far as I can tell, Doc James (AKA Jmh649) just cropped the original photo to focus the image on the locally-advanced cancer lesion and then added the cropped photo to the Breast Cancer article here on Wikipedia. Dezastru (talk) 19:07, 29 October 2013 (UTC)

I suspect that your idea of "accurate" is "common, assuming access to modern medical treatment". This is accurate, in the sense that this really is what happens to some people. It's not some sort of trick photography.

As for how common it is: about 10% or so of breast cancer patients die from breast cancer in less than five years in the U.S. Another non-trivial group lives more than five years, but still dies from it. Most women, however, have non-aggressive tumors and can be cured. But that's here in the wealthy west: throughout most of history, and currently in the much of the developing world, this picture is an accurate picture of the prognosis for a sizable minority of women with cancer.

I understand the concern about putting this picture in the ==Prognosis== section. Where do you think it would be more appropriate to place it? WhatamIdoing (talk) 12:52, 29 October 2013 (UTC)

'Visibly apparent lesions of breast cancer can sometimes look like this. Exclusion of this image would be sugar-coating what is often a horrible disease, which would be a violation of the principle that Wikipedia is not censored'. Is that a fair summary of the position you and Doc James are taking? Dezastru (talk) 19:20, 29 October 2013 (UTC)

I wouldn't put it that way, although that may be close enough. I'm concerned more about the DUE weight issues than about censorship per se. Since nearly half a million women die from breast cancer each year, having one image of a woman who is going to die from breast cancer seems appropriate and DUE. Whether this particular image is that one representation of those half-million women's experience, and whether that image is placed in this section, is not especially important to me. WhatamIdoing (talk) 16:00, 7 November 2013 (UTC)

The number of responses in the discussion seems to have fallen off, but I don't think we've reached a resolution. 93.35.6.9, perhaps you should consider starting a Request for Comment so that other Wikipedia contributors can weigh in. Dezastru (talk) 03:01, 4 November 2013 (UTC)

Hello and apologies for my absence. I see that Dezastru has uploaded a second photo in the prognosis section, with another possible outcome of BC. Its caption reads: "Breasts after double mastectomy followed by nipple-sparing reconstruction with implants". I think this provides a good counterbalance. At this point, I'd suggest keeping both images on the page (provided that is the consensus; personally I still have some issues with the image under discussion), but further altering the caption of the second image in order to be equally clear about what viewers are seeing. I propose that the caption be changed thus, per the description by Kauczuk, its original contributor to Wikimedia Commons: "An example of an advanced recurrent breast cancer with an ulcerating axillary mass." What do you think, Dezstru (and others in the discussion)? 93.35.6.59 (talk) 14:55, 7 November 2013 (UTC)

Is Breast Cancer a Deficiency Disease?

A question: Is Breast Cancer a Deficiency Disease? It is a testable hypothesis. Not being a medic I lack a ‘POV’, and the author is my father so I will be presumed to lack ‘N’. Should it be mentioned? Others with more expertise should decide. JDAWiseman (talk) 14:22, 15 June 2013 (UTC)

Glad you asked here rather than adding given your potential WP:COI. If there are reliable sources published in reputable biomedical journals or textbooks, i.e. review articles or similar from people without a conflict of interest, then it could be considered for inclusion. Absent such sourcing, generally no. -- Scray (talk) 20:16, 15 June 2013 (UTC)

I’m a good boy about such things.

The linked essay does not meet that standard, but it expands upon an earlier paper by the same author, Breast cancer hypothesis: a single cause for the majority of cases, Journal of Epidemiology & Community Health, November 2000 (PDF on my website). JE&CH is a BMJ Journal, so ∈ “reputable biomedical journals”. JDAWiseman (talk) 20:33, 19 June 2013 (UTC)

I agree that JE&CH paper is in a reputable journal, but it's a primary source. Let's wait until it gets coverage by an independent (similarly reputable) source. -- Scray (talk) 21:40, 19 June 2013 (UTC)

Very fair. All agreed. JDAWiseman (talk) 15:54, 20 June 2013 (UTC)

I look forward to my next encounter with you. I hope you'll become an active editor on WP, wherever your interests take you - there's plenty of work to be done, and you're clearly a level-headed editor. Cheers! -- Scray (talk) 21:22, 20 June 2013 (UTC)

Section on overemphasis on breast cancer

The following passage is problematic:

One result of breast cancer's high visibility is that statistical results can sometimes be misinterpreted, such as the claim that one in eight women will be diagnosed with breast cancer during their lives—a claim that depends on the unrealistic assumption that no woman will die of any other disease before the age of 95.[139] This obscures the reality, which is that about ten times as many women will die from heart disease or stroke than from breast cancer.

The sentence that begins "this obscures the reality" does not follow from the first sentence, and makes the paragraph misleading (WP:SYNTH). The statement that 'one in eight women will be diagnosed with breast cancer' does not say 'one in eight women will die from breast cancer,' which is what it would need to say for the second sentence to be reasonably follow. A woman can have her life disrupted by being diagnosed with breast cancer, after which she endures an extended course of treatment and healing, and then die from heart disease years later. That she eventually dies from heart disease does not make the experience of having had breast cancer any less significant for her.

There is actually other information in the Tampa Bay Times article cited in the passage that would be more useful for this section of the article, such as some of Samantha King's claims. Dezastru (talk) 20:21, 25 July 2013 (UTC)

I think you need to go read up on the methodology used to produce this statistic. As explained in the cited source, the statistic does not tell you how many women are diagnosed with breast cancer. It tells you how many women would be diagnosed with cancer, assuming that it was impossible for them to die from anything else before getting breast cancer.

So you start with 100 baby girls, and they say, how many of these babies will die before age 30? Maybe one or two? But, they say, she died in a car accident and never had breast cancer, so we pretend the victim of that car accident is still alive and still capable of being diagnosed with breast cancer. In reality, you only have 99 people alive, but according to this model, that one dead person is still alive and could still get breast cancer. This process repeats through every age. If you die from a heart attack, but never had breast cancer, then you're still "alive" as far as this analysis is concerned.

It's a useful approach for certain purposes (especially comparing diseases to each other), but when you push that number to regular people, they hear something very different: they hear that one out of eight living women will be diagnosed with breast cancer. Normal people don't expect someone who actually died from heart disease at age 60 to be capable of "getting breast cancer" ten years later.

The difference in the methodology is why the one group says that one in eight women ought to get diagnosed breast cancer, but when you review medical histories from actual (dead) women, you find that only about one in ten or one in twelve actually did. WhatamIdoing (talk) 03:06, 5 September 2013 (UTC)

Neutrality with Regard to Breast Cancer Culture Section

The wording in this section seems extremely biased against this interpretation of breast cancer culture, and all of the citations are from a single source. Additionally, the source is not an empirical study or a research article but a 12-year-old editorial from a trade magazine. The following excerpts demonstrate this bias without offering any balancing perspective, and the voice actually sounds angry:

"To fit into this mold, the woman with breast cancer needs to normalize and feminize her appearance, and minimize the disruption that her health issues cause anyone else. Anger, sadness and negativity must be silenced."

"The primary purposes or goals of breast cancer culture are to maintain breast cancer's dominance as the preëminent women's health issue, to promote the appearance that society is "doing something" effective about breast cancer, and to sustain and expand the social, political, and financial power of breast cancer activists."

74.108.75.131 (talk) 06:04, 29 August 2013 (UTC)Ali Rodriguez

Perhaps the section could be rewritten to more clearly indicate, such as through explicit attribution, that Wikipedia is describing a POV but not necessarily condoning that POV. (There are also other, much more positive aspects of breast cancer culture that are not explored.) Regardless, additional sources are needed; and the section should be trimmed, as it is currently overweight, particularly in terms of discussing the allegedly negative aspects.

If more information on the subject is available, from a variety of sources, a separate article discussing Breast Cancer Culture might be a possibility. Dezastru (talk) 16:42, 29 August 2013 (UTC)

See Breast cancer culture, if you want. NB that the source for the last sentence complained about is a scholarly book published by Oxford University Press, not just some random magazine article, and that the OUP book cites the very same "trade magazine editorial" on the first page as being a historically important publication that triggered a significant public response.

If you would like to improve this section, I strongly recommend that you spend some time reading independent reliable sources (i.e., not just whatever the breast cancer fundraising and support groups say about themselves). There are plenty of them out there, and as far as I can tell, this section summarizes the generally held scholarly opinions pretty well. The goal at Wikipedia is to accurately summarize independent opinions. The goal is not to be "even-Steven", with every sociologist who says that breast cancer culture punishes (yes, they do use that exact word) women for feeling angry or hopeless being balanced with the POV of a fundraiser saying that they're just trying to save the world by telling women who express anger that they need to see a psychotherapist before their emotions cause their cancer treatment to fail (which really does happen, by the way). WhatamIdoing (talk) 03:21, 5 September 2013 (UTC)

I really enjoyed reading the article "Breast Cancer". The pictures I felt were an extra boost to the reality of this deadly

disease, while the pictures had offended others it was real medical at it's best.Yellowmellow1 17:44, 26 September 2013 (UTC) — Preceding unsigned comment added by Yellowmellow1 (talk • contribs)

Axillary node interventions

Systematic review in JAMA - doi:10.1001/jama.2013.277804. Worthy of inclusion. JFW | T@lk 11:56, 2 October 2013 (UTC)

Proposal to split section on List of Breast Cancer Cell Lines to a separate article

The focus of this article is on breast cancer as it is experienced by patients and their social circles and by doctors who care for individuals with breast cancer. A few paragraphs describing something about breast cancer research in broad outlines fit appropriately, but the chart listing breast cancer cell lines seems out of place, in that it involves a highly technical topic of interest only to a very specialized audience (scientists who work on cancers). The list is useful information that deserves a place in the encyclopedia, but I believe it to be beyond the scope of the page. Thoughts? Dezastru (talk) 17:30, 21 October 2013 (UTC)

I think that's a great idea. Please do it. WhatamIdoing (talk) 00:47, 22 October 2013 (UTC)

That sounds totally reasonable. TenOfAllTrades(talk) 01:05, 22 October 2013 (UTC)

Staging

The staging section is confusing, because it refers to the descriptive TMN staging system, but lists summative "number stages". These are two distinct concepts. They are often confused or conflated, even on professional web sites, but Wikipedia should do better! For example, TMN stage T2N1M0 corresponds to number stage 2B (or IIb). The article should use a single staging system throughout, preferably TMN, but mention other staging systems. Sgs50 (talk) 10:39, 3 December 2013 (UTC)

Hi Sgs50, Thank you for your suggestion. When you believe an article needs improvement, please feel free to make those changes. Wikipedia is a wiki, so anyone can edit almost any article by simply following the edit this page link at the top.
The Wikipedia community encourages you to be bold in updating pages. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. You don't even need to log in (although there are many reasons why you might want to). WhatamIdoing (talk) 23:37, 21 December 2013 (UTC)

lobular carcinoma in situ

The use of the phrase "lobular carcinoma in situ" to describe a risk factor for cancer does not make sense to a lay reader reader, since (according to Wikipedia) a carcinoma is already a cancer. It appears that the loose use of the word "carcinoma" originates within the domain of medicine, or perhaps it is a loose use of the term "cancer". Someone who knows should clarify here, in the entry carcinoma, and the entry lobular carcinoma in situ.Macdust (talk) 17:52, 20 December 2013 (UTC)

Yes there has been talk of changing the term "lobular carcinoma in situ" Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:20, 20 December 2013 (UTC)

Thank you. Now how do we communicate to Wikipedia readers that the sloppiness is inherent in the domain of medicine and is not a symptom of collaborative writing? I offer myself as a datum that without clarification, a self-contradiction like this undermines the authority of the entire article.Macdust (talk) 15:01, 21 December 2013 (UTC)