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Another new study, this by Danish breast cancer researchers, compared mortality rates in areas with screening programs and those without screening programs in which post-menopausal women undergo routine mammography to help detect tumors have virtually no impact on reducing breast cancer deaths.

Published in the British Medical Journal, the study says that while breast cancer mortality has fallen sharply over the years, there is no evidence this is due to systematic screening. The gains are likely due to better treatment and heightened awareness among women about breast health.

Dr. Karsten Jorgensen, a medical researcher at the Nordic Cochrane Center and lead author of the paper, said that "Public institutions and large patient advocacy groups have been unwilling to admit that there are serious problems. They have tried to paint a rosy picture against mounting evidence of much small benefits than was orginially promised and very serious harms.

The study included data on all Danish women recorded in the Cause of Death Register and Statistics Denmark database between 1971 and 2006. It included 17 years in which there was universal breast cancer screening programs for women aged 55 to 74 in two areas, Copenhagen and Funen County because in the rest of the country there is no organized screening.

Nonetheless, the research team analyzed and compared data from the regions with screening and those without and found:

In the 55-to-74 age group, breast cancer mortality declined by 1 per cent annually in areas with screening and 2 per cent a year in areas where there was no screening.

In the 35-to-54 age group, where screening is not recommended, breast cancer mortality fell 5 per cent a year in areas with screening and 6 per cent in those without.

In the 75-and-over age group, there was no change in mortality in any area.

Breast-cancer mortality dropped steadily in the 10 years prior to screening beginning.

The decision to undergo mammography is a very personal one, which entails both benefits (early detection and treatment of cancer, the peace of mind that comes from receiving a clean bill of health) and risks (the effects of radiation or false positives).

[url]http://www.bmj.com/cgi/content/full/340/mar23_1/c1241[/url]

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Gary Schwitzer's HealthNewsReview Blog points out about our review of every day health news coverage, far too many unacceptably naive, fawning, cheerleading "churnalism" that may do more harm than good. News organizations need to grasp that there can be harm caused by superficial reporting.

HealthNewsReview is a website dedicated to improving the accuracy of news stories about medical treatments, tests, products and procedures, helping consumers evaluate the evidence for and against new ideas in health care.

They have spoken and written about the imbalance in the news coverage about the U.S. Preventive Service Task Force's new guidelines on mammography in November 2009.

If stories and communications are going to use anecdotes, then for every anecdote about a woman who claims her life was saved by a mammogram in her 40s (something that can't be proven), there should be a countering anecdote with a woman who had a mammogram in her 40s and got a diagnosis of DCIS or ductal carcinoma in situ.

Well, the New York Times has nailed that story, under a headline, "Prone to Error: Earliest Steps to Find Cancer." It covers what was missing too often in the discussion about mammography screening. There are tradeoffs of harms and benefits. There is a need for fully informed shared decision-making in the face of this diagnosis. This story makes that clear. Much of the public discussion has not.

[url]http://www.nytimes.com/2010/07/20/health/20cancer.html?_r=1[/url]

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It is said that unskilled pathologists could come across as the problem. Cancer Medicine: Priinciple of Multidisciplinary Management (6th Edition) tells us that pathologic uncertainty is a shaky foundation on which to build therapeutic strategy. When doubt exists concerning the nature of a neoplasm, additional opinions are always appropriate.

Pathology is a very visual science. It appeals to people who have a talent for recognizing patterns. This pattern recognition comes after years of practice. Cancers grow in recognizable patterns that allow for their identification. A breast cancer has a certain growth pattern that differs from a carcinoma of the lung. Benign conditions also have patterns.

It is said that a pathologist will never make a diagnosis unless they are 200% sure of the diagnosis. Having said that, there are situations where a definitive diagnosis cannot be rendered. Sometimes it is because the biopsy sample that was taken by the surgeon is too small, or perhaps taken from an area that is not representative of the patient's lesion.

Physicians tend to settle on the smallest amount of tumor tissue possible, often with a fine needle aspirate that collects just a few cells, for biopsy analysis. Larger bore needles (tru-cut) are needed to perform core biopsies or even remove entire lymph nodes, so that they can collect enough "live" tissue to more reliably determine the histologic and molecular features of a cancer.

Then there comes a time when a pathologist must admit that they do not know. Considering that the rarest of diseases pass under the pathologists' microscope, this is not surprising. There are several diagnostic tests or special stains (immunohistochemistry) which the pathologist can turn to which may aid in the diagnosis.

In a statistical analysis, the tentative diagnosis, the interpretation of stains and conclusions drawn from immunohistochemistry are independent factors in reaching a diagnosis. The immunohistochemical (IHC) staining test is performed on microscope slides, with intact cells and looks for proteins themselves.

The cell-block technique is useful for IHC and can give morphological (structural) details by preserving (iin paraffin wax) the architectural patterns. However, according to cell function analysis, investigators can only measure those analytes (subtance or chemical constituent) in paraffin wax that they know to measure. If you are not aware of and capable of measuring a biologically relevant event, you cannot seek to detect it.

Cell-blocks are paraffin-embedded and paraffin-embedded tissue can change over time. These proliferating populations of cells are biologically distinct in their behavior from "fresh" live cells that comprise human tumors.

Because the results of the IHC test can sometimes be ambiguous, many doctors suggest the FISH (fluorescent in situ hybridization) test for a second opinion. However, there has been poor concordance in terms of FISH testing in a central laboratory compared to local laboratories, which the prevalent notion regarding FISH is that it is 100% accurate.

They have yet to explore all the quality control issues of FISH. Several things can be done to improve performance and reduce variability. One thing is to train the interpreter. Another is to have the laboratory be certified. According to clinicians at the Mayo Clinic, oncologists need to be more aware of which laboratory performs the tests and who interprets the results, because it can make a huge difference.

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A thoughtful "sounding board" piece was published in the New England Journal of Medicine about the miscommunication that took place last November of what the USPSTF tried to convey and the complicity of certain organizations in adding to that confusion.

[url]http://healthpolicyandreform.nejm.org/?p=12525[/url]