Talk:Breast cancer/Archive 3

Archive 1

Archive 2

Archive 3

Archive 4

BC Culture, Politics of BC (re "Is every lump...?"

(Although this is without annotation, Review Articles in Peer-Reviewed journals (and.or Introduction Sections of other articles) could be sources of appropriate annotation of my comments.)

Discussion of BC Culture was the only obvious (on skimming article) critical remark about BC politics. I am glad this is there, but there is more that is missing: The huge increase in ability of mammography's ability to detect suspcious lesions results in dramatic increase # of "unnecessary" biopsies. (The concept of "unnecessary" biopsy is specious, though, because, e.g., with melanoma, it would be rare to call a biopsy "unnecessary" just because it showed that the suspected lesion was benign. When reporting risks and complications of mammography, one thing mentioned is the increased anxiety (and life-interruptions when "something unknown" results in a biopsy that would not have been indicated, except for the ability of mammography to hyper-detect lesions of concern. Taking this to politics, some women refuse treatment, others refuse screening and/or biopsy on these or related grounds. e.g., "Well, I will agree to a physical exam, but, if you find anything, that does not mean I am going to agree to a mammogram or a diagnostic test - as those are not without risk to me."

In the context of "Is every lump...?" there are two unstated questions, "Is every lump an indication of cancer?" (No.) Is every lump something that should be brought to attention of medical provider?" ("Every lump of xyz characteristics...." - or, if uncertain, "Yes.") Again, this is a place to indicates (with statistics) the high percentages of different types of evaluations and surgeries indicate "no evidence of disease." This promotes debate of, "It this good or no? - with differing opinions.

Someone could add a section like this, worded more appropriately, and annotated, perhaps placed within historical and clinical context. --KnowLimits (talk) 15:05, 4 December 2011 (UTC)

A paragraph or two on overdiagnosis would probably be appropriate. WhatamIdoing (talk) 23:00, 3 January 2012 (UTC)

A paragraph or two on overdiagnosis sourced to a peer-reviewed journal would be appropriate. --Nbauman (talk) 05:27, 12 February 2012 (UTC)

Review

• Harris, SR (2012 Apr 15). "Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals". Cancer. 118 (8 Suppl): 2312–24. PMID 22488705. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)Doc James (talk · contribs · email) 12:34, 12 June 2012 (UTC)

Screening

Another good review [1] Doc James (talk · contribs · email) (please reply on my talk page) 00:03, 9 July 2012 (UTC)

Cochrane meta is much better. Note how OLD your review is. Not relevant now.32cllou (talk) 00:25, 9 July 2012 (UTC)

Yes 8 months old.Doc James (talk · contribs · email) (please reply on my talk page) 01:24, 9 July 2012 (UTC)

Info improves as more data comes in from the trials. Same trials over time = better data. 2009 USPSTF narrows the age rec and screen frequency, 2011 rec becomes moderate, and they say maybe screen biannual at this interval not sure of value. ECU is 2011 also and says only every 3 years (down from USPSTF 2). 2012 more data comes in, find treatments improve making screening less import, and they find more harm from early treatments. Same trials more data finding 'do not recommend at any age. I understand that the U.S. Preventive Services Task Force is updating their (only moderate) recommendation to the new data.

If you must add "nat'l orgs" recs include old data from the same trails you can't be vague. You must name each org, date each rec in order of date / data set, state the strength, age range, and interval of each rec, the fact that they all are using the same trials, and the fact that the 2012 current data set finds DO NOT RECOMMEND AT ANY AGE. Do it right instead of reverting old data set recs as though they were valuable. The most and only value is to the best / longest / largest meta which is the 2012 Cochrane.

Reference the first sentence in the last para or remove as misleading. My understanding is that it's not supported and not factual using 2012 data.32cllou (talk) 03:36, 9 July 2012 (UTC)

These are the most current recommendations. And they remain the national recommendations until these bodies change them. If they accept the conclusions of the 2012 Cochrane handout than they will change them soon. Until they change them however we leave the current conclusions here. Doc James (talk · contribs · email) (please reply on my talk page) 08:37, 9 July 2012 (UTC)

I know you should include natl org recommendations, but you have to list who, dates, and exactly what they recommend. Your vague sentences are misleading, simplistic, and will be reverted. Your picture is a fraud (marketing picture from GE?). Please present suggested sentences and picture here before you degrade wiki with such vague misleading historical or marketing info.32cllou (talk) 16:32, 9 July 2012 (UTC)

That comment is a concentrated example of what not to do in addressing a content dispute. Please make at least a token effort to engage the substance of the question instead of making off-handed and far-fetched accusations against other editors. It's not just a good idea; it's policy.

This isn't a zero-sum game. The Cochrane Library review is a good source, and the Canadian Task Force review is a good source. I really think that the goal of writing a good article is getting lost in the battleground mentality you're displaying here. Is your argument seriously that major national guidelines published 8 months ago are "too old" to use as a source? Or am I missing something? MastCell ^Talk 16:56, 9 July 2012 (UTC)

Yep, you are missing the facts from the updated meta 2012 cochrane. If you look to the basis for older meta conclusions, you see they are all drawing from the same large group of trials. Those trials PROGRESS, producing more info and stronger results. 8 months old is OLD when new data make old meta WRONG factually. Cochrane per wiki is primary. Later dated research meta is always preferred to older as long as the breadth of trials reviewed is as large of larger.32cllou (talk) 14:55, 12 July 2012 (UTC)

The English Wikipedia requires us to present the mainstream, generally held views. The WP:MEDRS sourcing guideline recommends including at least two review cycles, covering multiple years, so that we're not relying on a single, possibly wrong or overstated, opinion.

The goal here isn't to provide the single most WP:RECENT view as if it were the uncontested Gospel truth. If we did that, then we'd have been saying that neutrinos move faster than light until someone discovered the loose cable. We're trying to document where the majority of daily practice is, not where you believe it should be. WhatamIdoing (talk) 21:59, 12 July 2012 (UTC)

Lifestyle section

It contains this paragraph: There is an increased incidence (but lower mortality) correlated with higher income include observations such as lower birth rates correlated with higher income and better education, possible overdiagnosis and overtreatment because of better access to breast cancer screening, and the postulation of as yet unexplained lifestyle and dietary factors correlated with higher income. It's in need of some work. Anybody?... Gandydancer (talk) 20:23, 18 July 2012 (UTC)

Yes I am in the process :-) Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 22:00, 18 July 2012 (UTC)

Have removed it until a ref is found. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:14, 18 July 2012 (UTC)

Problem with 'Breast Cancer in Art' Section

In the Rubens painting, the woman in question is Rubens' wife of that time, Hélène Fourment. She was the daughter of a friend, and he married her when she was sixteen and he was fifty-three, after his first wife died. She was the model used for all of his paintings of women that followed, and is the model for all of the women in "Three Graces." The original citation for this claim, http://www.ncbi.nlm.nih.gov/pubmed/11678312 , asserts that this woman clearly has advanced breast cancer and clearly didn't live long thereafter. However, this simply is not true. Hélène Fourment was born in 1614, married Rubens in 1630, bore Rubens five children, easily out-lived him, lived long enough to see grandchildren, and died in 1673 at the age of 59 - a very respectable lifespan in the 17th century. And no, she did not die of breast cancer. The other two paintings cited in the wikipedia article both have similar issues with veracity of the claims. This section should be removed. Xaa (talk) 05:20, 12 July 2012 (UTC)

Thank you! I started to research this awhile back because I had serious doubts. Then, as sometimes happens, I didn't finish up with a note similar to yours and I forgot to follow through. Yes, please delete this connection. Gandydancer (talk) 15:07, 12 July 2012 (UTC)

How do we know that the model with possible breast cancer in The Three Graces (Rubens) is his wife? There are three women there.

How do we know that his wife didn't have breast cancer? Fifty-nine is a pretty common age for dying from breast cancer, and just because you "have" breast cancer doesn't mean that you're not allowed to die from something unrelated or something that would have looked unrelated in the 17th century. WhatamIdoing (talk) 22:06, 12 July 2012 (UTC)

It is his wife and I get the same info that Xaa does. Xaa, here is a good source. [2] I agree that the others are in question as well. Gandydancer (talk) 23:01, 12 July 2012 (UTC)

A letter to the editor is not generally believed to be a "good source".

NB that the text here doesn't say that these models definitely had any disease. It only claims that some signs are visible that someone once claimed might have be related to breast cancer. WhatamIdoing (talk) 23:22, 12 July 2012 (UTC)

How many people have looked at this famous artwork and how many people have got a wild hair up their ass and decided that it was obvious that one of the artist's models had breast cancer? If we are going to include unusual suggestions we need first rate sources - which we do not have here. As for my suggestion to Xaa, as you well know, I know what a letter to the editor is and I also know that it does not usually work as a WP source. You say, "It only claims that some signs are visible that someone once claimed...". You are going to have to show that the "someone [who] once claimed" was a person in a position to be considered to be some sort of an authority on the subject and a reasonable amount of that person's peers agreed that there was merit to the claim. Gandydancer (talk) 19:35, 13 July 2012 (UTC)

Question: "How do we know the woman is his wife?" Answer: 1) Her face is identical to the portrait he painted of his wife, and historical documents related to the painting that are extant from the period cite her as the model for all three women. 2) She is acknowledged as his wife in every historical resource that talks about the painting outside of ones that promote this "breast cancer" theory. Question: "How do we know she didn't die of breast cancer?" Answer: 1) Because we know when she was born, we know when she died, and we know when the painting was done. The image was painted when she was 17 or 18, and she died at 59. This invalidates the conclusion that the shape of her breast indicates late-stage breast cancer. 2) Because the woman's life is not a mystery, she is a known historical personage and her life has been researched and discussed for over four hundred years. Conclusion: The Wikipedia article makes a scientific claim that is easily cited in several sources. However, it is just as easily refuted by browsing any historical resource that pre-dates this assertion, as the assertion requires ignorance (willful or otherwise) that this is his wife, she was in her teens at the time of the painting, and she died at 59. Promoting Breast Cancer awareness is very important. Promoting it through incorrect information is counter-productive. Xaa (talk) 22:44, 15 July 2012 (UTC)

Good, I'm glad we can be certain of the model's identity.

Why do you think the article "makes a scientific claim" that these models all have breast cancer? Here's the text:

Several historical paintings show anomalies that have been interpreted as visible evidence of breast cancer; retrospective diagnoses are discussed in the medical literature. Possible signs of breast cancer such as a typical lump, differences in breast size or shape and the peau d'orange skin texture can be found for example in works by Raphael, Rembrandt and Rubens.[104][133][134][135]

The paintings and the historical context do not give enough information to conclude whether or not the visible changes are really signs of breast cancer[136] and alternative explanations such as tuberculous mastitis or a chronic lactational breast abscess need to be considered.[137]

Do you see anything here that says anything like "every single one of these women definitely has breast cancer"? I don't. I see a sentence that says "anomalies that have been interpreted as" breast cancer. I see "retrospective diagnoses are discussed in the medical literature". I see that the paintings "do not give enough information to conclude whether" it's really breast cancer or not. All of that adds up to us saying that some sources talk about the possibility of breast cancer in these models—we're not disputing that various sources have talked about this, right?—but nobody has actually proven anything.

What do you see in the text of this article? When you read the sentences I've copied above, do you believe that the text says that these cases are completely proven? WhatamIdoing (talk) 22:58, 15 July 2012 (UTC)

Question: "Why do you say the article makes a scientific claim?" Answer: Because of the citations. The inline citations themselves make the assertion as fact, regardless of the text of the article itself, and the article links to images of the paintings in direct support of the assertion. I originally brought this up on the talk page rather than simply deleting this section myself as counter-factual because given the serious nature of the subject (Breast Cancer, the #1 cancer affecting women), I saw revert-warring over this (and other forms of online wiki head-butting) to be extremely counter-productive. However, since it's clear you strongly support keeping this section as-is despite that it is counter-factual and neither your position on this matter nor mine is subject to change, I suppose this conversation is ended. I enjoyed the conversation, thank you, and do have a nice day. Xaa (talk) 06:06, 16 July 2012 (UTC)

Xaa, there are 111 citations at FC Bayern Munich. Are all those sentences "scientific claims", too?

The citations prove that someone actually said this (the actual claim being made in the article). It does not prove that the someone is correct. WhatamIdoing (talk) 23:46, 19 July 2012 (UTC)

I began the long ordeal of refuting each claim, which would have required that the section first be rewritten. Xaa has already proven that the Ruben's paintings do not hold up. The Rembrant's mistress claim is made by one Italian surgeon--hardly adequate to include even with an opposing POV. Same thing for the Raphael claim--one article (which is followed by a response suggesting the claim doesn't hold up very well [3] ). Eventually I made a decision to just delete the section. If someone else whats to return it complete with info that puts the claims in perspective, they can do that. Let's be careful not to make this another case of a poorly sourced claim gaining ground just because people copied it from Wikipedia and spread it around. Gandydancer (talk) 17:17, 18 July 2012 (UTC)

No, Xaa proved that someone else said that he believed the first group is wrong. Nothing has actually been proven either way—and for us to side with one source or the other is prohibited WP:OR. We can legitimately say that Dr X said it looked kind of like breast cancer, and that Dr Y said it didn't, but we can't announce that Dr Y is right.

Blanking the section has the unfortunate effect of pretending that this significant conversation between academics simply didn't happen, which might be a WP:DUE problem. WhatamIdoing (talk) 23:46, 19 July 2012 (UTC)

Oral contraceptives

I have rewritten the information re oral contraceptives. The meta-analysis is the most recent and appears to have been well-received even though it is a change from previous findings. I did remove the section that somewhat refuted the study per (as far as I understand) WP policy. I'm certainly open to any other POVs. For anyone interested, I did find some interesting information here [4] Gandydancer (talk) 13:27, 19 July 2012 (UTC)

Incidentally, the head researcher of the meta-analysis "stated that he and the entire team believes that in accordance with the standards informed consent, women must be apprised of the potential risk of premenopausal breast cancer prior to commencing drug use." Gandydancer (talk) 13:33, 19 July 2012 (UTC)

Not sure why you removed the 2010 review article? Also we do not use blogs and the 2006 review deals only with a specific group of cancer (which are in far the minority) which are the premenopausal type. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:14, 19 July 2012 (UTC)

This ref states "the absolute risk (excess breast cancer cases due to OC exposure) is very small. For example, only a small number of additional cases of breast cancer were noted among 10,000 European or North American women in the 10 years after discontinuation of OCs: 0.5 cases, for OC use from age 16 to 19 years; 1.5 cases, for OC use from age 20 to 24 years; and 4.7 cases, for OC use from age 25 to 29 years. This very small excess risk must be put into perspective when counseling women and weighing the overall risks vs benefits of OC use. Furthermore, these studies29, 30 are based on older data with higher-dose estrogen and older progestin OC formulations. The largest modern study, published in 2002, enrolled more than 4500 patients with breast cancer and 4500 controls aged 35 to 64 years from the United States from 1994 to 1998.31 Key findings included no breast cancer risk among current (OR, 1.0; 95% CI, 0.8-1.3) or former (OR, 0.9; 95% CI, 0.8-1.0) OC users and no risk associated with duration of use or dose of estrogen. Moreover, a recent study of OC use in more than 4200 patients with breast cancer found no association between breast cancer mortality and OC use when duration of OC use, time since first use, age at first use, and use of specific formulations were examined.32 Breast cancer risks with the newest formulations of OCs are still unknown but are predicted to show no association with the dose and composition of the estrogens and progestins being used. However, future studies will need to evaluate this empirically." Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:54, 19 July 2012 (UTC)

I believe that this should be included, but I prefer the "absolute effect" language for this rather than the misleading relative risk. Relative risk is the sensational friend of headline writers, but the fact remains that a significant increase over a very small baseline is still a very small amount. Only about one out of 700 women in their 40s will develop breast cancer this year. A 40% increase is, well, still about one woman in that group getting breast cancer (since it's not possible for four-tenths of a woman to get breast cancer).

We should include hormonal contraception as a risk factor, but we shouldn't emphasize it. WhatamIdoing (talk) 00:02, 20 July 2012 (UTC)

Agree with WAID. What do you think of the current text? And how to you suggest we summarize the absolute risk numbers? Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 00:26, 20 July 2012 (UTC)

Cochrane Collaboration (CC)

Yes, the sentence can and should be referenced as coming from the CC. See[[5]], 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 [6]" - 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[7], "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 [8] 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 [9] 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 [10] just not okay with calling it a Cochrane review. Thus I reworded the text here [11] 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."[[12]] 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" [[13]], 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)

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)

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 [14] 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)

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)

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)

Psychological impacts as own section

The section on prognosis begins with, "A prognosis is a prediction of outcome and the probability of progression-free survival (PFS) or disease-free survival (DFS). " The psychological impact of having breast cancer is related to the prognosis but it is also related to treatments and side effects, and so doesn't strictly fall into a subsection of prognosis. Moreover, the discussion in the psychological impact section does not discuss or relate to prognosis. That's why I think psychological aspects belongs as its own section. Jmh649 what are your reasons for keeping psychological impacts within the prognosis section? Ca2james (talk) 03:58, 12 March 2014 (UTC)

I have corrected the definition of prognosis. Disease free survival also depends on treatment. Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:22, 12 March 2014 (UTC)

I disagree that psychological impacts are related just to prognosis, even with your revised definition, and I think the previous definition was more precise. Prognosis specifically refers to the long-term outcome of the disease, or "[t]he forecast of the probable outcome or course of a disease; the patient's chance of 'recovery." medterms definition (I know this probably isn't MEDRS but it seems to be the standard dictionary definition). Prognosis typically doesn't include side effects of treatment; it's a "how many people with this diagnosis and treatment have been alive after x period of time" question, not a "what will people with this diagnosis and treatment experience in their lives" question.

The psychological impacts of breast cancer are related not just to the disease or its prognosis but also the side effects of treatment and changes to the body as a result of treatment. From Psychological adjustment to breast cancer "[t]here is little evidence of a direct association of psychological distress with disease prognosis and type of treatment," and from Health-related quality of life in breast cancer patients: A bibliographic review of the literature from 1974 to 2007, "[t]he diagnosis of the disease, importance of fears and concerns regarding death and disease recurrence, impairment of body image, and alteration of femininity, sexuality and attractiveness are factors that can cause unexpected psychological distress even years after diagnosis and treatment." The section properly discusses these additional psychological impacts but doesn't discuss prognosis and psychological impacts, which implies that the subsection is either coatracking or doesn't belong there; either way, Psychological Impacts should be its own section. Ca2james (talk) 17:05, 16 March 2014 (UTC)

Prognosis is actually supposed to include more than just five-year survival. It should include psychological effects (many of which, by the way, are long-term but not actually permanent), the need for specialized follow-up care, any directly related social issues (e.g., someone with a severe brain injury might not be able to live independently), etc. Your description of "what will people with this diagnosis and treatment experience in their lives" (once the initial treatment is over) sounds just about right to me. WhatamIdoing (talk) 21:18, 27 May 2014 (UTC)

Add Research sub-section for work that seems to show Cyclopia inhibits growth?

The section titled "Research" has only two sub-sections: "Breast cancer cell lines" and "Transcription factors". This seems to imply that no other lines of research are currently active, which I believe to be incorrect. In particular, today CCTV (China-Central TeleVision) "Africa Live" reported that South African research tentatively shows that an extract from Cyclopia (apparently a legume endemic to South Africa) inhibits estrogen-promoted growth of breast-cancer cells. Perhaps new sub-sections should be added for this and any other currently-active lines of research that have been reported in the responsible media? 198.144.192.45 (talk) 19:01, 26 May 2014 (UTC) Twitter.Com/CalRobert (Robert Maas)

We typically use review articles per WP:MEDRS. Popular press is often not accurate. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:14, 27 May 2014 (UTC)

Something like that might be a good candidate for inclusion at Experimental cancer treatment. An article on such a big subject as breast cancer normally doesn't include any specifics on experimental work (because which of the hundreds of research programs would you include?). WhatamIdoing (talk) 21:21, 27 May 2014 (UTC)

Text

We have "In those in whom the cancer has spread to other parts of the body, treatments are mostly aimed at improving quality of life and comfort." supported by this ref [15] which says "Treatment for systemic disease is palliative in intent. Goals of treatment include improving quality of life and prolongation of life." Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:43, 30 June 2014 (UTC)

Thanks for the link; since you did just add "mostly", which modifies the statement, I'm satisfied with it now because it leaves open the possibility that other treatment goals may exist. Note that extending survival time is also a treatment goal:

• Despite advances in treatment strategies, metastatic breast cancer (MBC) remains incurable and the goals of therapy range from symptom palliation to extending survival.[16]
• The key goal in the treatment of metastatic breast cancer is to prolong survival, with an emphasis on restricting treatment-related toxicity as much as possible[17]
• The goal of treatment is to help the woman survive (sometimes for several years) and to remain free of symptoms as long as possible.[18]

Curative treatment is also definitely being explored, at least for limited or localised metastatic disease:

• The current data suggest that in certain patients with metastatic breast cancer, an aggressive multidisciplinary approach including both local treatment of macroscopic disease and systemic treatment of microscopic disease can result in prolonged disease control. Whether patients with prolonged disease control are “cured” remains controversial. ... It is important to realize that metastatic breast cancer is not always a death sentence. [19]
• The present analyses clearly indicate that OMBC is a distinct subgroup with long-term prognosis superior to MBC, with reasonable provability for clinical cure[20]
• The presented data, overall, seem to suggest the possibility of a curative, multidisciplinary therapeutic approach for at least a fraction of patients with limited MBC[21]

--Ca2james (talk) 16:51, 1 July 2014 (UTC)

The phrases "spread to other parts of the body" and "localised metastatic disease" don't appear to be talking about the same things. I'd say that if it's spread to other parts of the body, then it's not localized metastatic disease, wouldn't you? WhatamIdoing (talk) 03:17, 5 July 2014 (UTC)

No, I wouldn't say that. The cancer can spread to other parts of the body and be confined to one organ or bone. For example, a person with breast cancer mets to only the sternum has metastatic breast cancer (because the cancer has spread beyond the breast and axilliary lymph nodes) AND localized metastatic disease (because the spread is limited to a single location). --Ca2james (talk) 21:42, 5 July 2014 (UTC)

adding Miso soup link?

"In 2003, researchers at Japan's National Cancer Centre suggested that "eating three or more bowls of the Japanese delicacy Miso soup every day could cut women's risk of developing breast cancer"." I would imagine that a person looking up breast cancer could be interested in something like that. Then again I never read the guidelines, so I'll leave it for someone who has to decide. --84.165.175.174 (talk) 06:07, 30 October 2014 (UTC)

Breast Cancer Culture section

The breast cancer culture section is extremely opinionated and does not read like encyclopedic text. " Appearing to have suffered bravely is the passport into the culture" is most definitely not wikipedia correct tone. — Preceding unsigned comment added by 169.230.71.50 (talk) 18:23, 23 October 2014 (UTC)

I have submitted a revision that revises some of the language critiquing the pink ribbon campaign, and flagged the "breast cancer culture" section with what I think are appropriate templates. We should probably talk here about how to rework the section so that it introduces the same content in an appropriate way. Acone (talk) 22:09, 19 February 2015 (UTC)

Your revision, unfortunately, departed from what the sources said, making the text both wrong and unverifiable. Patients' rights in the context of breast cancer mean things like "Do not perform a mastectomy without my explicit permission". You are obviously too young to remember this, but back in the day, women used to go in for a "diagnostic biopsy" and wake up hours later with a breast missing. Once upon a time, radical mastectomies were performed even when the woman directly demanded a lumpectomy instead. Or the doctors would ask their husbands for consent, rather than the women themselves. There are still places in the world where doctors diagnose cancer and refuse to tell the patient! (Japan was notorious for this; the doctors would send patients home with chemotherapy in pill form and not tell them what the drugs were or why they needed to take them.) This has absolutely nothing to do with abortion.

Wikipedia is most encyclopedic when it reflects what the sources say. Saying what the sources say is the definition of neutrality. (WP:Brilliant prose is a minor goal.) If you can find a source that disagrees with this – that says, for example, that attitude doesn't affect social acceptance in survivor support groups – then we need to update the article. I've read half a dozen of them, though, and I've found unanimity on this point. WhatamIdoing (talk) 23:07, 1 March 2015 (UTC)

Pregnancy and breast cancer clarification needed

Doc James, I would like to raise an area that needs revision on this page concerning the interaction between pregnancy and breast cancer. It has been found that there is a period of increased risk in developing breast cancer following birth. This has been reported in the mainstream news, many epidemiological studies, primary research papers, and review articles. This is in contrast to the risk of developing breast cancer while pregnant, which is correctly stated as having the same risk compared to a non-pregnant woman. This is very important because this page consistently states that pregnancy is either not a factor, or is actually helpful in reducing risk of breast cancer. It turns out that while pregnancy can be protective long-term, pregnancy can enhance risk of breast cancer for 5-10 years following a recent childbirth. This is so important, because these breast cancers, termed postpartum breast cancer, more often result in metastatic disease and carry a very poor prognosis compared to other breast cancers. This is emerging as a very important subtype of breast cancer, and young women need to be informed so they can be more aware of any/all breast changes that occur postpartum.

In the section called “pregnancy” it states that “Cancers found during or shortly after pregnancy appear at approximately the same rate as other cancers in women of a similar age.” I propose this should read: Breast cancers occur during pregnancy at the same rate as breast cancers in non-pregnant women. However, 5-10 years following a recent pregnancy there is an increased risk of developing breast cancer, termed postpartum breast cancer, and these cancers have worse prognoses (refs 1-8). Women diagnosed with breast cancer 5-10 years post-partum have an increased risk of disease progression and metastasis as well as decreased survival.

Also, I would like to discuss how we could edit the sentence in the opening of the article that states “ having children late or not at all..” is a risk factor for breast cancer. Since we know it is much more complicated, and actually being within 5-10 years of a pregnancy could be considered a risk factor.

1. Lambe M, Hsieh C, Trichopoulos D, Ekbom A, Pavia M, Adami HO. Transient increase in the risk of breast cancer after giving birth. N Engl J Med. 331(1):5-9, 1994.

2. Colditz GA, Rosner B. Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the Nurses' Health Study. Am J Epidemiol. 152(10):950-64, 2000.

3. Willett WC, Tamimi RM, Hankinson SE, Hunter DJ, Colditz GA. Chapter 20: Nongenetic Factors in the Causation of Breast Cancer, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 4th edition, Lippincott Williams & Wilkins, 2010.

4. Ewertz M, Duffy SW, Adami HO, et al. Age at first birth, parity and risk of breast cancer: a meta-analysis of 8 studies from the Nordic countries. Int J Cancer. 46(4):597-603, 1990.

5. Albrektsen G, Heuch I, Hansen S, Kvale G. Breast cancer risk by age at birth, time since birth and time intervals between births: exploring interaction effects. Br J Cancer. 2005;92:167-75.

6. Chie WC, Hsieh C, Newcomb PA, et al. Age at any full-term pregnancy and breast cancer risk. Am J Epidemiol. 2000;151:715-22.

7. Liu Q, Wuu J, Lambe M, Hsieh SF, et al. Transient increase in breast cancer risk after giving birth: postpartum period with the highest risk (Sweden). Cancer Causes Control. 2002;13:299-305.

8. Schedin P. Pregnancy-associated breast cancer and metastasis. Nat Rev Cancer. 2006;6:281-91.

We try to use refs from the last 5 to 10 years User:Cbba1656. (3) appears okay but need a page number if possible.Doc James (talk · contribs · email) 22:20, 12 May 2015 (UTC)

What about this review [22] from 2012? Doc James (talk · contribs · email) 22:26, 12 May 2015 (UTC)

WRT “ having children late or not at all..” cancer.gov states "Older age at first birth or never having given birth." as a risk factor [23] Doc James (talk · contribs · email) 22:29, 12 May 2015 (UTC)

Thank you for the response Doc James. The review from 2012 is great, however doesn't necessarily talk about metastasis, so inclusion of Schedin P 2006 may be necessary as well.

In response to the risk factor part of the article, could we consider adding a recent childbirth? Since these articles support the idea that there is increased risk of developing breast cancer 5-10 years postpartum? We could use the same references.--Cbba1656 (talk) 22:51, 12 May 2015 (UTC)

Sure so we can use Viswanathan, S; Ramaswamy, B (December 2011). "Pregnancy-associated breast cancer". Clinical obstetrics and gynecology. 54 (4): 546–55. PMID 22031245.. What exactly do we want to change or add? Doc James (talk · contribs · email) 22:54, 12 May 2015 (UTC)

Hi Doc James. Can we add "a recent childbirth" to the current sentence:

Risk factors for developing breast cancer include: female sex, obesity, lack of physical exercise, drinking alcohol, hormone replacement therapy during menopause, ionizing radiation, early age at first menstruation, having children late or not at all, and older age.[2][4] Citations that support this addition are: PMID 22785217 and PMID 16557280.

And also edit the "pregnancy" section to say this:

Breast cancers occur during pregnancy at the same rate as breast cancers in non-pregnant women. However, 5-10 years following a pregnancy there is an increased risk of developing breast cancer, termed postpartum breast cancer, and these cancers have worse outcomes. Women with postpartum breast cancer have an increased risk of distant spread of their disease and mortality(PMID 22785217 and PMID 16557280).

And I will start working on a postpartum breast cancer entry that could link to this article where further information could be found.--Cbba1656 (talk) 23:19, 12 May 2015 (UTC)

This ref does not say recent pregnancy is a risk factor in the abstract just those that get breast cancer associated with preg do worse PMID 22785217 correct?

The next ref does not mention an increased risk in the abstract just the increased severity. Which sentence in these sources support "a recent childbirth" Doc James (talk · contribs · email) 23:41, 12 May 2015 (UTC)

Ah here we go "It is known that pregnancy exert a bi-directional effect on breast cancer development with a short-term increase in risk (up to 5 or 10 years), and a somewhat protective effect afterwards" Doc James (talk · contribs · email) 23:43, 12 May 2015 (UTC)

Updated here [24] Doc James (talk · contribs · email) 23:49, 12 May 2015 (UTC)

Doc James The edits look great, and are accurate according to the literature and the references cited. Thanks for your help. --Cbba1656 (talk) 20:13, 13 May 2015 (UTC)

Thanks User:Cbba1656 for raising this :-) Feel free to continue editing Doc James (talk · contribs · email) 20:17, 13 May 2015 (UTC)

New text

The ref by Hayes states "Current and recent users of oral contraceptives have a 24% increase in the risk of breast cancer compared with never users; RR 1.2 (1.2–1.3), 3,18 but this declines after stopping use, with no excess risk 10 years from last use.31"

Not sure how this supports " but whether oral contraceptives use may actually cause premenopausal breast cancer is a matter of debate." Doc James (talk · contribs · email) 06:01, 1 August 2015 (UTC)

That claim was previously unsourced; I wonder whether it is actually true that there is actually a debate. I thought that there was good (but not great) evidence that it had a small effect, especially if used late (and by "small", I mean "saves lives, net, because of its causative role in reducing ovarian cancer"). The NHS and Cancer.gov seem to take it as settled that there is an effect, despite their interest in more research.

Perhaps the solution is to remove the claim that a serious debate still exists. WhatamIdoing (talk) 21:38, 1 August 2015 (UTC)

The next ref discusses the question of whether or not the link is causal. Doc James (talk · contribs · email) 11:13, 2 August 2015 (UTC)

External link to a risk calculator

A lot of our articles related to this cancer talk about low-risk or high-risk women, and a lot of American women incorrectly believe that they are high-risk. I wonder whether it would be good to include a link to this risk calculator. It covers more than the old Gail model, and with the article under Pending Changes, I don't think we need to worry about it becoming spambait. What do you think? WhatamIdoing (talk) 21:40, 1 August 2015 (UTC)

Sure Doc James (talk · contribs · email) 11:20, 2 August 2015 (UTC)

DCIS JAMA Oncol 2015

The study of DCIS in JAMA Oncology should change a lot of this entry. I posted links in the DCIS talk page, Talk:Ductal_carcinoma_in_situ#JAMA_Oncol_2015. They did a large epidemiological study which found that DCIS doesn't increase mortality from breast cancer, in my understanding. --Nbauman (talk) 17:23, 22 August 2015 (UTC)

Reference to Edwin Papyrus in the 'History' section

The Edwin Smith Papyrus describes 8 cases of tumors or ulcers of the breast that were treated by cauterization

I cannot find any reference for this assertion in the translation of the Edwin Smith Papyrus, although it is repeated over and over on the web. All I can find is a description of chest tumors (Case 45, 15,9-19), that could be breast tumors, although the writer definitely talks about a male person. See for yourself at the National Library of Medicine — Preceding unsigned comment added by Cyana (talk • contribs) 21:56, 1 October 2015 (UTC)

References