Cancer: Sometimes it's a Shell Game

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I have been chasing the ellusive pea in a shell game, and I am growing cross-eyed!

Those who share my shoes blanche at the usual cancer tropes. My newest personal visualization is not original, but it sums up my fall season.  Monitoring my health has not been a game of medical skill, but of chance and opportunity. With all such slight-of-hands, if you stay focused you can get lucky and track the path of the disease. Take your eyes off the trajectory for a second and the forces will push the "pea" to unexpected destinations. The gamer, as always, is unscrupulous.

June 2011 - "Evolving lymphatic metastasis" / "hypermetabolic focus also seen in the anterior abdominal wall near the base of the umbilicus...soft tissue metastasis cannot be excluded"

...I then started on an aggressive regimen of supplements; bi-weekly high dose IV vitamin C; and weekly ozone infusion treatments...

November 2011 - "July 2011, core biopsy sampling of left axillary lymph node demonstrated metastatic invasive lobular cancer [but at this time] no suspicious abnormalities are identified...may represent positive response to treatment."

...I then tapper off aggressive regimen and opted to do a modified maintenance program of supplements only...veins can only take so much sticking.

August 2012 - Concurrent pneumonia and shingles. Both controlled with broad-based antibiotics.

September 2012 - Sharp intermittent chest pains and shortness of breath unresolved. PCP orders EKG and Chest CT, and refers to pulmonologist and cardiologist.

October  2012 - "Subpleural nodule in the left lower lobe" / "metabolic activity in left axillary"

November 2012 - "Shadow present on right lung...recheck in 2 months with follow up chest CT with contrast"

...Weight loss of 6 lbs over the course of a two plus weeks...Chest pains are now accompanied with nausea and heart burn. Falling asleep curled up in weeble position, propped up because laying on back increases pain. Laying on side makes rib cage feel like its splintering. Not much recuperative sleep happening. Sucks!

November 2012 - "Chronic pericarditis secondary to invasive lobular carcinoma...recheck in 2 months with follow up echocardiagram"

...Restart ozone infusion treatments. Start pounding "Meriva (aka Curcumin") like "skittles" (to challenge the inflammation).  Scheduling IV vitamin C treatments. The game plays on.

 

I am part of the 8%. Lucky me.

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Original Article

Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence

Archie Bleyer, M.D., and H. Gilbert Welch, M.D., M.P.H.

N Engl J Med 2012; 367:1998-2005November 22, 2012DOI: 10.1056/NEJMoa1206809

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Background

To reduce mortality, screening must detect life-threatening disease at an earlier, more curable stage. Effective cancer-screening programs therefore both increase the incidence of cancer detected at an early stage and decrease the incidence of cancer presenting at a late stage.

Methods

We used Surveillance, Epidemiology, and End Results data to examine trends from 1976 through 2008 in the incidence of early-stage breast cancer (ductal carcinoma in situ and localized disease) and late-stage breast cancer (regional and distant disease) among women 40 years of age or older.

Results

The introduction of screening mammography in the United States has been associated with a doubling in the number of cases of early-stage breast cancer that are detected each year, from 112 to 234 cases per 100,000 women — an absolute increase of 122 cases per 100,000 women. Concomitantly, the rate at which women present with late-stage cancer has decreased by 8%, from 102 to 94 cases per 100,000 women — an absolute decrease of 8 cases per 100,000 women. With the assumption of a constant underlying disease burden, only 8 of the 122 additional early-stage cancers diagnosed were expected to progress to advanced disease. After excluding the transient excess incidence associated with hormone-replacement therapy and adjusting for trends in the incidence of breast cancer among women younger than 40 years of age, we estimated that breast cancer was overdiagnosed (i.e., tumors were detected on screening that would never have led to clinical symptoms) in 1.3 million U.S. women in the past 30 years. We estimated that in 2008, breast cancer was overdiagnosed in more than 70,000 women; this accounted for 31% of all breast cancers diagnosed.

Conclusions

Despite substantial increases in the number of cases of early-stage breast cancer detected, screening mammography has only marginally reduced the rate at which women present with advanced cancer. Although it is not certain which women have been affected, the imbalance suggests that there is substantial overdiagnosis, accounting for nearly a third of all newly diagnosed breast cancers, and that screening is having, at best, only a small effect on the rate of death from breast cancer.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
We thank Lynn Ries, M.S., of the Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, for her help in analyzing Surveillance, Epidemiology, and End Results data.

Source Information

From the Quality Department, St. Charles Health System, Central Oregon, and the Department of Radiation Medicine, Oregon Health and Science University, Portland (A.B.); the University of Texas Medical School at Houston, Houston (A.B.); and the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH (H.G.W.).
Address reprint requests to Dr. Bleyer at 2500 NE Neff Rd., Bend, OR 97701, or at ableyer@gmail.com.