Talk:Breast cancer screening

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BCtect[edit]

looks like advertising, lacks essential information about how it works, no references. Will be deleted soon unless improved. Richiez (talk) 15:42, 23 June 2010 (UTC)

Improving by deleting[edit]

I've removed this:

An analysis of Norwegians published in 2010 found a 10% reduction in breast cancer mortality (2.4 deaths per 100,000 person-years) attributable to screening but this difference was non significant.≤ref>Kalager M, Zelen M, Langmark F, Adami HO (2010). "Effect of screening mammography on breast-cancer mortality in Norway". N. Engl. J. Med. 363 (13): 1203–10. doi:10.1056/NEJMoa1000727. PMID 20860502. Unknown parameter |month= ignored (help)</ref>

which is good, but basically redundant with what we've already got. WhatamIdoing (talk) 03:49, 8 March 2011 (UTC)


This:

  • Schwartsmann Gilberto (2001). "Breast Cancer in South America: Challenges to improve early detection and medical management of a public health problem". J Clin Oncol. 19: 118–124.

looks interesting, but we don't actually seem to have used it. Also, I deleted a long list of what technically qualifies as being higher risk for BRCA mutations. WhatamIdoing (talk) 05:00, 8 March 2011 (UTC)

Actually that is better than the current saying 15% reduction, both being non signficant. But now we can ref / say the reduction is non sign.32cllou (talk) 21:43, 8 July 2012 (UTC)

Before removal[edit]

All the stuff 2.1 - 2.5 should be deleted as obsolete. Comments. I could put in all the risk and harms listed in cochrane 2012 but better women read that review themselves.32cllou (talk) 00:59, 30 June 2012 (UTC)

Do you really believe that every bit of the more than 1,700 words is obsolete? I'd be happy to have you update it, but I think that you are overstating the situation rather significantly. (And it's all very well to say that "better women read that review themselves", but the fact is that 99% of them won't do it, and half of them can't.) WhatamIdoing (talk) 01:33, 30 June 2012 (UTC)
Please read http://www.cochrane.dk/screening/mammography-leaflet.pdf and come back to discuss. Updated research finds more benefit to treatments, but that makes screening even less worthy. Since mammography is not recommended at any age, inclusion of some 2.1 - 2.5 may wrongly encourage women to seek mammograms, and seems like much of those sections are now obsolete.32cllou (talk) 17:11, 7 July 2012 (UTC)
The "Nordic Cochrane Center" brochure—NB not an actual peer-reviewed paper by the actual Cochrane Collaboration, but a simple advertisement of their beliefs put out by a separate organization—is about what (in the opinion of its four authors) should be recommended and done for average-risk women. What we're mostly reporting here is what is recommended and done. So: four smart people say that mammography shouldn't be recommended... and dozens of charitable organizations, government agencies, etc., have continued to recommend it anyway. "Four smart people said don't do it" does not give us any reason to pretend that the rest of the world agrees with them.
Furthermore, did you notice their continual harping on "healthy women"? They completely ignore unhealthy women, who need breast cancer screening because of BRCA mutations or prior breast cancer. Your recent changes removed the accurate information about screening in high-risk women. This isn't a one-size-fits-all issue.
And, finally, I invite you to read the article. You recommend removing a huge section on the grounds that it's all wrong. Can you tell me, just to give one example, what exactly is wrong in the sentence, "The X-ray image, called a radiograph, is sent to a physician who specializes in interpreting these images, called a radiologist"? WhatamIdoing (talk) 05:08, 12 July 2012 (UTC)

Not supported[edit]

Yobol, the first sentence is not supported by the reference. See recent text edit, which fix a few problems with dated, unsupported, not referenced info.32cllou (talk) 16:39, 7 July 2012 (UTC)

Cochrane Collaboration (CC)[edit]

See [[1]]32cllou (talk) 17:43, 6 May 2013 (UTC)

Scientific evidence[edit]

Is it acceptable that a wiki article on a scientific topic is so different from the scientific evidence? The whole article refers mostly to the publications against screening, which are far from constituting the majority of the available evidence and the consensus in the scientific community. Anybody to fix that? — Preceding unsigned comment added by PiotrDohg (talkcontribs) 14:43, 13 August 2013 (UTC)

It seems to me that "the scientific community" and "the medical community" have somewhat different views at the moment. WhatamIdoing (talk) 01:32, 18 August 2013 (UTC)
What is the issue you are referring to? Many national bodies recommend screening however the evidence for it is not great. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:59, 18 August 2013 (UTC)

Molecular breast imaging[edit]

A new editor is continually changing the content to state that MBI is an "adjunct" rather than "under study" suggesting that it is a widespread accepted modality, which does not appear to be true (see this for example). I invite this new editor to stop editwarring and please justify this change. Yobol (talk) 15:28, 10 December 2013 (UTC)

Hello, the reason I believe it is not under study is because 1-Medicare/Medicaid covers it and over 5000 patients across the US have had the procedure and have had success with billing and insurance claims unlike 3D mammography "Tomosynthesis" which has not had success in billing and reimbursement. 2-A number of licensed and qualified breast radiologists across the US do not consider it investigational. 3- All 3 commercially available are labeled "non-investigational" that is they have PMA through the FDA and 510(k) acceptance letter .

Here are some references: Siegal E, Angelakis E, Morris P, Pinkus E. Breast molecular imaging: a retrospective review of one institution's experience with this modality and an analysis of its potential role in breast imaging decision making. The Breast Journal. 2012; 18: 111-117. — Preceding unsigned comment added by Anon 013189 (talk • contribs) 14:31, 10 December 2013 (UTC) Conners AL, Hruska CB, Tortorelli CL, et al. Lexicon for standardized interpretation of gamma camera molecular breast imaging: observer agreement and diagnostic accuracy. Eur J Nucl Med Mol Imaging. 2012; 39(6): 971-982. Conners AL, Maxwell RW, Tortorelli CL, et al. Gamma camera breast imaging lexicon. AJR Am J Roentgenol. 2012; 199(6): 767-774. Hruska CB, Rhodes DJ, Collins DA, Tortorelli CL, Askew JW, O’Connor MK. Evaluation of molecular breast imaging in women undergoing myocardial perfusion imaging with Tc-99m sestamibi. Journal of Women’s Health. 2012; 21(7): 730-738. — Preceding unsigned comment added by Anon 013189 (talk • contribs) 14:30, 10 December 2013 (UTC) Hruska CB, Weinman AL, Skjerseth CM, et al. Proof of concept for low-dose molecular breast imaging with a dual-head CZT gamma camera. Part II. Evaluation in patients. Med. Phys. 2012; 39(6): 3476-3483. Mangasarian OL, Street WN, Wolberg WH. Breast Cancer Diagnosis and Prognosis via Linear Programming. Operations Research. 1995; 43: 570-577. Carney PA, Miglioretti DL, Yankaskas BC, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med. 2003; 138: 168-75. Rhodes DJ, Hruska CB, Phillips SW, Whaley DH, O’Connor MK. Dedicated dual-head gamma imaging for breast cancer screening in women with mammographically dense breasts. Radiology. 2011; 258(1): 106-118. Mandelson MT, Oestreicher N, Porter PL, et al. Breast density as a predictor of mammographic detection: comparison of interval-and screen-detected cancers. J Natl Cancer Inst. 2000; 92: 1081-7. Pisano ED, Hendrick RE, Yaffe MJ, et al. Diagnostic accuracy of digital versus film mammography: exploratory analysis of selected population subgroups in DMIST. Radiology. 2008; 246: 376–383. Berg WA, Zhang Z, Lehrer D, et al. Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 2012; 307(13): 1394-1404. Killelea BK, Long JB, Chagpar AB, et al. Trends and clinical implications of preoperative breast MRI in Medicare beneficiaries with breast cancer. Breast Cancer Research and Treatment. 2013; 141:155-163. Gur D, Abrams GS, Chough DM, et al. Digital breast tomosynthesis: observer performance study. AJR. 2009; 193:586-591. Boyd NF, Dite GS, Stone J, et al. Heritability of mammographic density, a risk factor for breast cancer. NEJM. 2002; 347: 886-894. Mankoff DA. A definition of molecular imaging. J Nucl Med. 2007; 48(6): 18N, 21N. Kelloff GJ, Krohn KA, Larson SM, et al. The progress and promise of molecular imaging probes in oncologic drug development. Clin Cancer Res. 2005; 11:7967-7985.

I also have a number of external links related to the topics MBI casts wider net for improved breast cancer diagnosis: http://www.auntminnie.com/index.aspx?sec=spt&sub=mbi&pag=dis&itemID=91850 New imaging tools address challenges of dense breast tissue: http://www.auntminnie.com/index.aspx?sec=spt&sub=mbi&pag=dis&itemID=91901 Cardiolite (Tc99m-Sestamibi): http://www.cardiolite.com/index.asp National Cancer Institute; Breast Cancer: http://www.cancer.gov/cancertopics/types/breast Are You Dense: http://www.areyoudense.org/ Are You Dense Advocacy: http://areyoudenseadvocacy.org/ The National Consortium of Breast Centers: http://www.breastcare.org/ The Susan G. Komen Breast Cancer Foundation: http://ww5.komen.org/ American Breast Cancer Foundation: http://www.abcf.org/ American Cancer Society: http://www.cancer.org/ Food and Drug Administration: http://www.fda.gov/ — Preceding unsigned comment added by Anon 013189 (talk • contribs) 14:14, 10 December 2013 (UTC)


Anon 013189 (talk) 15:41, 10 December 2013 (UTC)

The ACS in my link above suggests it is more in the experimental category and not in widespread use. You will need to find a WP:MEDRS compliant source that states otherwise to change the text of the article. Yobol (talk) 15:52, 10 December 2013 (UTC)
All those references are from biomedical journals, which
1-Is clearly listed as a WP:MEDRS compliant source
2-According to my thesis mentor, professors, and time in medical school are much much more reliable than a .org link....
Anon 013189 (talk) 16:08, 10 December 2013 (UTC)
You mean like the multiple .org links you provided above? Nevertheless, please find a WP:MEDRS compliant source that states it is not experimental in use as a screening test for breast cancer; just being published in a journal does not meet WP:MEDRS standards, which would be clear if you had read the guideline. Yobol (talk) 16:11, 10 December 2013 (UTC)

Those were external links not references. So according to that I just need to grab the PubMed Ids? Easily doable..or I could just give up and let wikipedia continue to be a useless source. I only did this as a favor for my cousin who is fighting breast cancer and felt patients should be educated about the available technologies for diagnosis and screening, and there are not many free resources...PubMed articles also aren't available to the general public, but I didn't realize Wikipedia was so biased. Anon 013189 (talk) 16:17, 10 December 2013 (UTC)

If you want to contribute to Wikipedia, it is advisable that you follow our guidelines on how to appropriately source content. If you have journal articles to present that state MBI is not experimental, I am more than happy to look at them. Please review WP:MEDRS and present those sources that meet this guideline when you have them. Yobol (talk) 16:21, 10 December 2013 (UTC)


I did just provide those is what I am trying to say. I just don't know how to hyperlink them, because I have never used html.

According to WP:MEDRS:

'Peer reviewed medical journals are a natural choice as a source for up-to-date medical information in Wikipedia articles.' Radiology (listed above) is a peer-reviewed journal. It is the leading scientific article for medical imaging and is used widely at RSNA which is the biggest medical conference in the US.

PubMed link 1=http://www.ncbi.nlm.nih.gov/pubmed/?term=Dedicated+dual-head+gamma+imaging+for+breast+cancer+screening+in+women+with+mammographically+dense+breasts.

PubMed link 2= http://www.ncbi.nlm.nih.gov/pubmed/?term=reast+molecular+imaging%3A+a+retrospective+review+of+one+institution's+experience+with+this+modality+and+an+analysis+of+its+potential+role+in+breast+imaging+decision+making

PubMed Link 3=http://www.ncbi.nlm.nih.gov/pubmed/?term=Evaluation+of+molecular+breast+imaging+in+women+undergoing+myocardial+perfusion+imaging+with+Tc-99m+sestamibi.

and so forth

'Core general medical journals include the New England Journal of Medicine, The Lancet, the Journal of the American Medical Association (JAMA), the Annals of Internal Medicine, the British Medical Journal (BMJ), and the Canadian Medical Association Journal. Core basic science and biology journals include Science, Cell, and Nature.'

Some of the articles I listed are from NEJM, JAMA, & Ann Intern Med.

I will have to figure out how to properly cite PubMed according to Wiki's guidelines rather than citing it in AMA style. — Preceding unsigned comment added by Anon 013189 (talkcontribs) 16:33, 10 December 2013 (UTC)

All these studies are primary studies, which we generally avoid in favor of secondary studies. You would know this if you had read WP:MEDRS (See the Respect Secondary Sources section). Also, none of these describes the context in which molecular breast imaging are accepted as non-experimental. Yobol (talk) 16:36, 10 December 2013 (UTC)


It is curious that many of the other wiki pages I look at do not list any primary or secondary sources (such as the Tomosynthesis page which seems entirely biased toward hologic but fails to mention other competitors such as GE healthcare, Phillips, Siemens, etc? My cousin's cancer was missed on mammography and found on MBI. Most researchers do not write an article stating that something is used non-investigationally in medicine because that doesn't constitute research but rather states a fact that all physicians practicing in that area already know. I know her physician is publishing a book on MBI so that should be available for citing soon, and I know Mayo clinic has written some things about the extensive use of MBI (fyi the link to ref 28 on the breast cancer screening page under MBI is not a viable link that blog no longer exists-I had linked it to an active report that stated the economic differences between the 2 modalities, but see that has been removed also)

In the meantime I will look into PubMed and Google Scholar for systematic reviews since wikipedia only uses secondary sources for some pages.. but apparently not all, and I will tell my cousin that if we wish to educate women then we should just start a blog or something, because this seems to be a failed avenue. Thanks — Preceding unsigned comment added by Anon 013189 (talkcontribs) 17:19, 10 December 2013 (UTC)


Why don't you watch this free CME course http://courses.icpme.us/class_learn?course=340 and learn something instead of incorrectly educating people?? - Have you ever even met someone who has cancer??? What is wrong with you??? Scinitmammography is not used in clinics.. it is not in existence and is not even close to the same thing as MBI- ask radiologists or physicists. Thankfully you have taught me how truly flawed Wiki is and I am thankful I have never used it for reliable information/education purposes. Anon 013189 (talk) 19:00, 10 December 2013 (UTC)

Also this is useful in differentiating the two if you read it carefully it highlights the difference in nuclear medicine imaging applications in breast imaging- those that used to exist, and those that currently exist http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748346/ — Preceding unsigned comment added by Anon 013189 (talkcontribs) 19:05, 10 December 2013 (UTC)

I contacted the ACS about that disparity and asked of the names of the physicians on the board and was informed that there are no breast radiologists on the board and that they update their website once a year only. So I provided them with a few peer-reviewed articles and the free CME course and they informed me it was useful information to pass on.. so hopefully that will be corrected soon. It seems wrong that an organization dedicated to cancer knowledge would not know the difference or educate people on that. I also gave them some information about billing codes and medicare reimbursement rates graciously given by my cousin's diagnosing breast radiologist. So they can see how the payments and methods are different. — Preceding unsigned comment added by Anon 013189 (talkcontribs) 19:35, 10 December 2013 (UTC)

You didn't spell American correctly when editing the reference #28 in breast cancer screening page. fyi.. Anon 013189 (talk) 20:39, 10 December 2013 (UTC)

Take a look at this too:

http://www.areyoudense.org/worxcms_published/stories_page205.shtml

Hopefully you will stop educating people incorrectly on options that could save their lives. MBI is not scintimammography the CZT and collimator designs as well as the specialized electronics that are used in these MBI scanners allow for greater sensitivity and reduced scattering with less than half the dose of what scintimammography was using in the past when it was utilized. Medical research shows that it is more accurate in detecting cancers not visualized on mammograms. I implore you to watch that CME course? Have you ever looked at an MBI image and then the mammogram image from the same patient? I have looked at quite a few- if you watch that CME course you will be able to see a number of women who were read as negative or inconclusive and diagnosed better with an MBI. The prognosis of each woman was greatly improved because of the technology.

2011 review [2] states that "99mTc-sesta-methoxyisobutylisonitrile (MIBI) and 18F-2-deoxy-2-fluoro-d-glucose (FDG) radiotracer dosimetry are associated with lifetime attributable risk of cancer that is an order of magnitude greater than that of conventional mammography; thus, it is doubtful that modalities that use these tracers would become screening tools.7 However, the risk–benefit ratio is greater in women with dense breasts and/or suspected lesions.8" Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:16, 10 December 2013 (UTC)
PMID 19671027 (the PMC link Anon gave above) is an acceptable source. So is PMID 23561631, which is more recent and gives information about multiple types. WhatamIdoing (talk) 00:32, 11 December 2013 (UTC)
Agree and the first ref is in the article. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:48, 11 December 2013 (UTC)

My last comment was not intended to be insulting, but rather to get him/her to realize that there are far too many women being diagnosed with stage 3 and 4 cancers that were missed on mammography. If those women were properly educated on other options their cancers may have been found sooner with better outcomes & thank you Doc James, I have read enough MBI articles to make my eyes bleed and have talked to a couple of the specialists. — Preceding unsigned comment added by Anon 013189 (talkcontribs) 14:20, 11 December 2013 (UTC)

I'm sorry to hear about your eyes, but that does not relieve you of your duty to respect secondary sources when writing for this encyclopedia. I've looked at the sources suggested and done my best to clean up the section and the references. Hopefully that reflects the mainstream view that mammography remains the preferred general screening method, while MBI looks like being a useful addition for those with dense breast tissue, particularly as equipment and techniques are refined. At some point in the future, we should be able to update the present position. P.S. I've removed the extra external links - if they are not good enough for references, they're not good enough for external links; we don't use ELs to do an end-run around MEDRS. If the material is relevant, add it to the article with MEDRS-compliant sources. Cheers --RexxS (talk) 16:16, 11 December 2013 (UTC)

What is this?[edit]

"There is however, no radiation dose (ionizing or not) that is believed to be completely risk free, which is why MBI is primarily used in clinics only in women with dense breast tissue, which often results in inconclusive mammograms. Researchers continue to devote their time to improving the technology, changing scan parameters, and reducing dose to patients."Development of radiation dose reduction techniques for cadmium zinc telluride detectors in molecular breast imaging". Proc SPIE. Retrieved 10 December 2013."

And why was it added to the article? It is completely wrong.[3] Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:55, 11 December 2013 (UTC)

I thought the thrust of the argument was made by O'Connor in PMC2997811 which I agree seems primary evidence - although it does come from the Department of Radiology at the Mayo Clinic and O'Connor has numerous articles on the topic, which suggests his status as an expert. I checked Trip database, which gave http://www.bcbs.com/blueresources/tec/vols/28/breast-specific-gamma-imaging.html (2013) as its top secondary result, but that review says very little specifically about MBI. Perhaps we need to collect here the best sources we can find that discuss MBI and find a consensus on which are MEDRS-compliant? That ought to allow us to make a proper summary of the best evidence. --RexxS (talk) 18:01, 11 December 2013 (UTC)
Sort of mis read it. We need to stick to secondary sources though. Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:28, 11 December 2013 (UTC)

NPOV[edit]

As much as I personally agree that the latest science seems to indicate that mammograms do not actually reduce mortality, this article does not seem to balance the different opinions on the subject. For example, the third paragraph begins, "The use of mammography in universal screening for breast cancer is controversial for not reducing all-cause mortality and for causing harms through unnecessary treatments and medical procedures." That seems to state the ineffectiveness of mammograms as an absolute fact, as opposed to the findings of some recent studies. The American Cancer Society still recommends annual mammograms for women 40 and over. The American Medical Association currently has the same stance, last updated in 2012. Fnordware (talk) 16:23, 7 May 2014 (UTC)

Sure many organizations recommend, do any state however that it reduces all cause mortality? Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:59, 7 May 2014 (UTC)
Well, I guess that's part of the flawed methodology. The figure they usually named is the "survival rate," which you improve by diagnosing people with caner who were never going to die anyway. The point is that there are many experts who haven't yet come around on this and still think screening with mammograms is the right approach, and the article should reflect that. For example where we write, "The presumption was that by detecting the cancer in an earlier stage, women will be more likely to be cured by treatment," that implies that people don't still believe that, but many do. Fnordware (talk) 21:47, 7 May 2014 (UTC)
We could say the "presumption by some" Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:53, 7 May 2014 (UTC)
I think that wouldn't help. It both was and is a presumption. (It was a very widely held presumption; now it is a less-widely held presumption.) Perhaps something like, "Since the early 20th century, many people have presumed that..." would work. WhatamIdoing (talk) 23:22, 7 May 2014 (UTC)
Using "presumed" at all is problematic, because it implies that they were wrong. To be neutral, this article should treat both points of view as possibly valid. For any other medical condition, correctly diagnosing that condition as early as possible is going to be in the patient's best interest, so thinking that about breast cancer is not unreasonable. Really the problem with breast cancer is not that the diagnosis is too early, but that it is not accurate enough and treatment is started based on that limited accuracy. I would change it to something like: "Mammograms are performed on seemingly healthy women with the belief that early detection will increase the odds of successful treatment, reducing the number of breast cancer deaths. Recent studies suggest this may not be the case." Fnordware (talk) 16:22, 8 May 2014 (UTC)

This "For any other medical condition, correctly diagnosing that condition as early as possible is going to be in the patient's best interest" is not true for a number of conditions including dementia, benign cysts, and many cases of prostate cancer. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:19, 8 May 2014 (UTC)

I am happy with your wording though. Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:20, 8 May 2014 (UTC)
So you mean for conditions that will not or can not be treated, it is better to just not know about them, right? I meant purely from a physical health perspective, and for things that should actually be treated. Psychological effects aside, medically it would always be better to have an accurate diagnosis earlier, even if that didn't mean treatment started earlier. Right?
But again, I'm just using this passage as an example. To me, the majority of this article is not neutral and needs a lot of re-working. Fnordware (talk) 15:47, 9 May 2014 (UTC)
What matters is improving real outcomes for people. For example doing whole body MRIs on people who have no symptoms or signs is bad for them health wise. You find stuff like cysts. These cysts could be cancer. So you biopsy them. Complications occur more often than benefit. Harm results. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:50, 9 May 2014 (UTC)
  • Hello, I have nothing to say about this general mammogram issue, but can say something about a specific case and screening in general. As James says, doing a screening without an indication often is more likely to lead to a false positive and consequentially unnecessary treatment and its harms than it is to find an unexpected problem. For that reason, no, it is not correct to say "it would always be better to have an accurate diagnosis earlier". Diagnosis should be made when it is indicated to make one. As one case, ASTRO recommends that women who have already had breast cancer in a certain situation not get routine mammograms because it is so likely that harm will come to the patient if they get these. Blue Rasberry (talk) 15:32, 4 March 2015 (UTC)

history request[edit]

Please add a history section. When did various testing modalities become available? Who invented them? — Preceding unsigned comment added by Skysong263 (talkcontribs) 04:29, 15 June 2014 (UTC)

Results[edit]

Have reverted [4] as the study states "Screening biennially from ages 50 to 69 years achieved a median 16.5% (range, 15% to 23%) reduction in breast cancer deaths versus no screening. Initiating biennial screening at age 40 years (vs. 50 years) reduced mortality by an additional 3% (range, 1% to 6%), consumed more resources, and yielded more false-positive results." Taking one small bit rather than the main summary is not really reasonable IMO. Doc James (talk · contribs · email) 00:03, 4 March 2015 (UTC)

Would it not be better to add in the whole segment that you just described above then? i.e. expand rather than remove - given this is a whole article on screening? The page has 21kb of prose and hence plenty of room for more content Cas Liber (talk · contribs) 04:38, 4 March 2015 (UTC)
Agree it should not go in as it was worded - from 2009 it is also getting rather old now. Johnbod (talk) 04:41, 4 March 2015 (UTC)
The USPSTF guidelines are still based on the publications from 2009 that are referenced in this wiki page. Peter Eby (talk) 00:01, 8 March 2015 (UTC)
I am primarily concerned that rather than taking the overall conclusions of the paper they selected some inner details. Doc James (talk · contribs · email) 04:53, 4 March 2015 (UTC)
There isn't always room in the abstract for all the important results. Some important findings are elsewhere and we are obligated to review the entirety to fully understand what is being presented. I don't understand why the text that I provided can not remain on the page. It is clearly valid. Peter Eby (talk) 00:01, 8 March 2015 (UTC)
My main worry about what Peter added is that it lumps together very different groups, and implies that the benefits for each age are similar. In fact, the benefit to an average 40 year old (or an average 85 year old) is very different from the benefit to an average 65-year-old woman. WhatamIdoing (talk) 22:04, 4 March 2015 (UTC)
Please review the paper and you will find a table on breast cancer mortality benefit for multiple different age and screening combinations. I choose the widest range. Any range you choose will demonstrate that screening mammography results in a decrease in deaths from breast cancer. The USPSTF used these data to make their recommendations. Peter Eby (talk) 00:01, 8 March 2015 (UTC)
The number that people really care about is all cause deaths. Those are a little less variable than deaths do to a specific cause. Doc James (talk · contribs · email) 01:17, 8 March 2015 (UTC)

Content[edit]

This content is a useful format for presentation

"If 1,000 women in their 50s are screened every year for ten years, the following outcomes are considered typical in the developed world:[citation needed]

  • One woman's life will be extended due to earlier detection of breast cancer.
  • 2–10 women will be overdiagnosed and needlessly treated for a cancer that would have stopped growing on its own or otherwise caused no harm during the woman's lifetime.
  • 5–15 women will be treated for breast cancer, with the same outcome as if they had been detected after symptoms appeared.
  • 250–500 will be incorrectly told they might have breast cancer (false positive).
  • 125–250 will undergo breast biopsy."

This ref however is not very good Welch, H. Gilbert; Woloshin, Steve; Schwartz, Lisa A. (2011). Overdiagnosed: Making People Sick in the Pursuit of Health. Beacon Press. p. 149. ISBN 0-8070-2200-4.

Are there better refs? Doc James (talk · contribs · email) 18:44, 28 April 2015 (UTC)

found info here [5] Doc James (talk · contribs · email) 18:51, 28 April 2015 (UTC)

New scoping review on consensus methods[edit]

"Review of the evidence on the use of arbitration or consensus within breast screening: A systematic scoping review". Bondegezou (talk) 11:19, 20 February 2017 (UTC)

Forked content - cut and redirect back to here[edit]

There was a long, out of date section on breast cancer screening at cancer screening. I cut it from there and I copypasted this below.

This is a content fork and what should happen is that the summary there should send people here to seek more detailed information. Such content should not be developed in multiple places.

Extended content

There is general agreement in the scientific community that breast screening reduces mortality from the disease.[not in citation given][1][needs update] There is some controversy however about the number of lives saved by breast screening and the number of cancers diagnosed and treated that would not have caused any health problems in the participants' lifetime, sometimes known as over-diagnosis and over-treatment.[2][3] Non-invasive breast cancers, or ductal carcinoma in situ, sometimes progress to invasive cancer but sometimes do not. Since doctors cannot usually distinguish which DCIS will go on to invasive cancer, most are treated. This is where over-treatment can arise.

Recommendations to attend to mammography screening vary across countries and organizations, with the most common difference being the age at which screening should begin, and how frequently or if it should be performed, among women at typical risk for developing breast cancer.[4] For example, in England, all women were invited for screening once every three years beginning at age 50,[5] though this is transitioning to a start at age 47 by 2016.[6] Some other organizations recommend mammograms begin as early as age 40 in normal-risk women, and take place more frequently, up to once each year. Women at higher risk may benefit from earlier or more frequent screening. Women with one or more first-degree relatives (mother, sister, daughter) with premenopausal breast cancer often begin screening at an earlier age, perhaps at an age 10 years younger than the age when the relative was diagnosed with breast cancer.

The U.S. Preventative Services Task Force (USPSTF) recommends population screening mammography once for every two years for all women aged 50–74, with decisions about screening younger and older women being determined by consideration of the individual's risk factors and the benefits and harms of screening. They do not recommend either breast self-examination or clinical breast examination.[7] Their recommendation is similar to the World Health Organization's, and less aggressive than some American organizations. A 2011 Cochrane review came to slightly different conclusions with respect to breast cancer screening stating that routine mammography may do more harm than good.[1]

As the debate about the benefits and harms of mammography screening escalated in the United Kingdom, the National Clinical Director for Cancer and the Executive Director of Cancer Research UK commissioned a panel of whom the members had not previously published on breast screening to review the evidence. Members were experts in medical statistics, epidemiology, oncology and a patient representative. This independent review was published in the Lancet on October 30, 2012.[8] The main conclusion of the independent panel was that screening reduced breast cancer mortality, although overdiagnosis also occurs.

  1. ^ a b Gøtzsche, PC; Nielsen, M (2011). "Screening for breast cancer with mammography". Cochrane Database of Systematic Reviews (1): CD001877. doi:10.1002/14651858.CD001877.pub4. PMID 21249649. Update at doi:10.1002/14651858.CD001877.pub5
  2. ^ Duffy, SW; Tabar, L; Olsen, AH; Vitak, B; et al. (2010). "Absolute numbers of lives saved and overdiagnosis in breast cancer screening, from a randomized trial and from the Breast Screening Programme in England". Journal of Medical Screening. 17 (1): 25–30. doi:10.1258/jms.2009.009094. PMC 3104821. PMID 20356942.
  3. ^ McPherson, K (2010). "Screening for breast cancer--balancing the debate". BMJ. 340: c3106. doi:10.1136/bmj.c3106. PMID 20576707.
  4. ^ Ying, Chen; Klingen, Tor A.; Wik, Elisabeth; Aas, Hans; Vigeland, Einar; Liestøl, Knut; Garred, Øystein; Mæhlen, Jan; Akslen, Lars A.; Lømo, Jon (2014). "Breast Cancer Stromal Elastosis Is Associated With Mammography Screening Detection, Low Ki67 Expression And Favourable Prognosis In A Population-Based Study". Diagnostic Pathology. 9 (1): 116–133. doi:10.1186/s13000-014-0230-8.
  5. ^ "Why are women under 50 not routinely invited for breast screening?", Public Health England, accessed 19 May 2014
  6. ^ "Age Extension Full Randomised Control Trial", Public Health England. Retrieved 19 May 2014.
  7. ^ "Screening for Breast Cancer". U.S. Preventative Services Task Force. December 2009. Retrieved December 13, 2012.
  8. ^ Independent UK Panel on Breast Cancer Screening. (Nov 2012). "The benefits and harms of breast cancer screening: an independent review". The Lancet. 380 (9855): 1778–1786. doi:10.1016/S0140-6736(12)61611-0. PMID 23117178.

Blue Rasberry (talk) 15:53, 27 February 2017 (UTC)

Sounds good. Doc James (talk · contribs · email) 15:49, 28 February 2017 (UTC)

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Moving[edit]

Moved here:

"The New England Journal of Medicine published a study concluding that the use of mammography screening is "hard to justify" and propose the possible abolishment of mammographies.[1] The authors noticed that the debate on this issue is based on outdated trials. Over 50 years ago in New York City, the first trials on mammographies begun with the last tried occurring in 1991 in the U.K. However, none of these trials were initiated in time of current breast-cancer treatment, which has dramatically improved the prognosis of women with breast cancer.[1] Secondly, the authors were struck by the fact that the benefits of mammography were not obvious when compared to their harms. The study found that the relative risk reduction was approximately 20% in breast-cancer mortality associated with mammography, which came at the price of a considerable diagnostic cascade, with repeat mammography, biopsies, and overdiagnosis of breast cancers.[1] Moreover, a follow up large scale study on mammography published in the British Medical Journal reported that screening healthy women with mammography to find breast cancers, before a lump could be felt, did not lead to lower death rates for average-risk women in their 40s and 50s.[2]"

First it is not "a study" but a commentary. The last one is a primary source and we should be using sectiondary sources.

Some of what was added was a little spammy. Others it is unclear how it relates to screening such as:

"Circulating tumour cells (CTCs) are cancer cells that shed off from the primary tumour and circulate in the bloodstream.[3] CTCs are extremely rare, occurring in 1 in a billion nucleated hematopoietic cells, yet their detection leads to numerous applications in the field of cancer detection and screening such as CTC-based liquid biopsies, disease monitoring and progression, treatment efficacy, and predicting patient outcomes.[3] CTC detection technologies work by an initial enrichment method to highlight the CTCs and reduce background noise followed by an immunodetection method. Some common enrichment methods include immunomagnetic, microfluidic, density-gradient centrifugation, and filtration approaches.[3] Immunodetection methods include the use of immunocytochemistry, immunofluorescence, reverse transcription polymerase chain reaction (RT-PCR), or flow cytometry.[3]" Doc James (talk · contribs · email) 16:09, 24 October 2017 (UTC)

  1. ^ a b c Biller-Andorno, Nikola; Jüni, Peter (2014-05-21). "Abolishing Mammography Screening Programs? A View from the Swiss Medical Board". New England Journal of Medicine. 370 (21): 1965–1967. doi:10.1056/nejmp1401875.
  2. ^ Miller, Anthony B.; Wall, Claus; Baines, Cornelia J.; Sun, Ping; To, Teresa; Narod, Steven A. (2014-02-11). "Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial". BMJ. 348: g366. doi:10.1136/bmj.g366. ISSN 1756-1833. PMID 24519768.
  3. ^ a b c d Lee, Jin Sun; Magbanua, Mark Jesus M.; Park, John W. (2016-12-01). "Circulating tumor cells in breast cancer: applications in personalized medicine". Breast Cancer Research and Treatment. 160 (3): 411–424. doi:10.1007/s10549-016-4014-6. ISSN 0167-6806.