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.

 

Too Much Pink Ms. Brinker?...Yes, yes there is!

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Anyone who has read my blog knows that I am a card-burning anti-pink rabble-rouser. Or in Ms. Brinker's [founder & CEO of Susan G. Komen] opinion...a grumbler. Nancy'sPoint - a blog that I follow and enjoy, insightfully scrutinized the following OP-Ed by, for, on behalf of Ms. Brinker - wherein Ms. Brinker defends the mission of SGK against plebeians like myself.

I am not going to try and compete with Nancy's dissection. [Check out Nancy'sPoint: http://nancyspoint.com/rumblings-grumblings-my-response-to-ms-brinker/.] I was so enraged, however, when I read Ms. Brinker's OP-ED piece myself, I just couldn't sit quietly. My own opinions and fingers started churning. I share Ms. Brinker's OP-ED in its entirety below.

First impression for the uninitiated [not meant to be derogatory, but only to categorize those who enjoy an envious life beyond researching anything and everything related to breast cancer] may be..hey, SGK sounds like they are on the front line for those living with breast cancer...PINK ON! Then, there is the fact-check. And Ms. Brinker's defenses, in my opinion, crumble. I share my opinion and my two cents in CAPS at the most egregious of her statements, below. I have also included  all of the posted comments to Ms. Brinker's OP-ED. They are articulate, respectful, and spot-on. They challenge the unsupported assertions of Ms. Brinker brilliantly, and made me proud to be an ANTI-PINK RABBLE-ROUSING GRUMBLING PLEBE.

Another View: Too much pink? Not while breast cancer still kills

Special to The [Sacramento] Bee

OPINION - Published Sunday, Oct. 30, 2011

Nancy G. Brinker, former ambassador to Hungary, is founder and CEO, Susan G. Komen for the Cure. She is responding to the Oct. 23 article by Francesca Lyman in California Forum, "Pink Inc. has many starting to see red."

October is Breast Cancer Awareness Month, and every year at this time we hear grumblings about pink, the color of the breast cancer movement.

"There's too much pink." "We have enough awareness." "Where is the money going?"

When a Portland woman is living in her car because she can't afford her cancer treatment; when a Chicago woman has to choose between paying bus fare to treatment or buying food for her family; and when treatments for metastatic breast cancer are often more debilitating than the disease itself, then there is not too much pink during October. We'd argue there's not enough.

MS. BRINKER, YOU NEGLECT TO SHARE THE LACK OF FUNDING THAT SGK ITSELF DIRECTS TOWARD METASTATIC BREAST CANCER RESEARCH & TREATMENT. YOU GLOSS OVER THE SAD FACT THAT SGK SOLELY FOCUSES ON EARLY DETECTION...WHICH DOES NOT NECESSARILY "SAVE LIVES." THE VERY TRAGIC IRONY IS THAT SUSAN G. KOMEN DIED FROM METASTATIC BREAST CANCER. SEE ALSO... http://boo-bee-trap.blogspot.com/2011/10/peaking-behind-pink-curtain.html

For the skeptics out there, we'd invite you to take a few minutes to learn what the pink is actually doing. You might be surprised to learn that 84 cents of every dollar spent by Susan G. Komen for the Cure over the past five years has gone to cutting-edge research, to community programs that get women into and through cancer treatment, to advocacy programs that preserved cancer funding in 19 states, and to things that mean a lot when you're sick, like wigs, groceries, co-pays and, hopefully, an end to having to choose between feeding your family and going to the doctor's office.

FOR THE "PINK BELIEVERS" OUT THERE, SGK HAS BEEN IN EXISTENCE FOR 32 YEARS, WHICH BEGS THE QUESTION: WHY DID SGK ONLY START DIRECTING FUNDING  TO "CUTTING-EDGE RESEARCH" FIVE YEARS AGO?  MORE CURIOUS IS THAT OF THE ESTIMATED $2.1 BILLION TOTAL PUBLIC SUPPORT AND REVENUE RAISED (1982-2010) SGK SPENT ONLY $500 MILLION ON RESEARCH.

Pink also pays for awareness, because despite the assumption that everyone knows all there is to know about breast cancer, women still tell me they don't need a mammogram because there's no history of breast cancer in their family (awareness check: most people diagnosed with breast cancer have no family history); or because they've never worn underwire bras (awareness check: underwire bras have nothing to do with breast cancer).

"FINDING CANCER DOES NOT ALWAYS SAVE LIVES....MAMMOGRAMS CAN RESULT IN FALSE-NEGATIVE RESULTS [AS MY PERSONAL HISTORY OF MAMMOGRAMS ATTEST]. REGRETTABLY, SCREENING MAMMOGRAMS MISS UP TO 20% OF BREAST CANCERS THAT ARE PRESENT AT THE TIME OF SCREENING. FURTHER... SCREENING MAMMOGRAMS ALSO FIND CANCERS & CASES OF DCIS THAT WILL NEVER CAUSE SYMPTOMS OR THREATEN A WOMAN'S LIFE, LEADING TO 'OVERDIAGNOSIS' [AND 'OVERTREATMENT'] OF BREAST CANCER...EXPOSING WOMEN UNNECESSARILY TO THE ADVERSE EFFECTS ASSOCIATED WITH CANCER THERAPY."

http://www.cancer.gov/cancertopics/factsheet/detection/mammograms 

So no, there's not too much awareness. And yes, all this pink does quite a bit of good.

The $685 million that Komen has invested in research over 30 years has helped reduce breast cancer death rates by 31 percent since 1991. It has helped improve five-year relative survival rates for early stage cancers to 99 percent, up from 74 percent when I started. It has paid for treatments that are making it possible for many women, even with aggressive or metastatic disease, to live longer, and it has provided key research findings for patients with other types of cancer, most notably those with BRCA 1 or BRCA 2 genetic mutations.

SGK's OWN 990 REPORTS INDICATE ONLY $500 MILLION INVESTED, NOT $685M.  I CULLED AGAIN THROUGH KOMEN'S REPORTS, AFTER READING MS. BRINKER'S OP-ED, AND COULD NOT FIND THE ADDITIONAL $185 MILLION SHE PADS ON TO THE ABOVE FIGURE. MORE IMPORTANTLY, HOWEVER, IN 1991, 43,583 WOMEN DIED FROM BREAST CANCER.  http://www.cdc.gov/mmwr/preview/mmwrhtml/00026281.html 
ACCORDING TO THE CDC, IN 2007 (the most recent year numbers that are currently available) 40,598 WOMEN DIED IN THE U.S. FROM BREAST CANCER. http://www.cdc.gov/cancer/breast/statistics/index.html THE DIFFERENCE IS 14.6 %, NOT 31%; AND SGK'S ACTUAL CONTRIBUTION TO THE ACTUAL DECREASE IN NUMBERS IS NOT DEFINITIVE. ANECDOTALLY, OF THE 3 ONCOLOGISTS I INTERVIEWED FOR  MY OWN CARE, ALL OF THEM CONCURRED THAT THERE REALLY HAS NOT BEEN A DECREASE IN THE DEATH RATE FROM BREAST CANCER IN 50 YEARS. THE REPORTED DIFFERENCES IS HOW THE DEATHS OF WOMEN ARE BEING CATEGORIZED. E.G. UTERINE CANCER, OVARIAN CANCER vs. MBC.

At Komen alone, the funds raised from pink paid for 700,000 breast screenings last year for poor and uninsured women, and provided financial and social support for another 100,000.

BY THE WAY, SGK OWNS STOCK IN GENERAL ELECTRIC - ONE OF THE LARGEST MAKERS OF MAMMOGRAPHY EQUIPMENT IN THE WORLD.

All told, Susan G. Komen has pumped $1.3 billion into programs in thousands of communities that provide this real help to real women, men and families facing breast cancer.

In California, Komen has funded $64 million since 1982 to research at institutions across the state, including 68 active research projects totaling $30 million today. The eight Komen Affiliates serving California have awarded millions to local community programs and fought to preserve state-funded breast cancer programs for California's low-income and underserved women.

The research we're funding here, and globally, is investigating environmental factors in breast cancer, real prevention strategies, ways to find breast cancer before symptoms appear, ways to stop it before it spreads, and ways to effectively treat the deadliest forms of this disease for those with metastatic and aggressive disease. The community programs target women who, without our help, will not get access to screenings, cancer treatment and follow-up care.

GLAD YOU BROUGHT UP ENVIRONMENTAL FACTORS MS. BRINKER...WHAT ABOUT SGK'S REQUISITION OF ITS NEW PERFUME, "PROMISE ME," THAT CONTAINS GALAXOLIDE - A KNOWN HORMONE DISRUPTER, AND TOLUENE - A POTENT NEUROTOXICANT BANNED BY THE INTERNATIONAL FRAGRANCE ASSOCIATION. http://boo-bee-trap.blogspot.com/2011/09/promise-me-pink.html
WHAT ABOUT SGK'S FLIP-FLOPPING ON THE IMPACT OF POLYCARBONATE PLASTICS CONTAINING BPAs ON OUR HEALTH. SEE, SGK WEBSITE 02/2011. COULD SGK'S INCONSISTENT STANCE ON BPA LADEN PLASTICS BE ATTRIBUTABLE TO ITS BRAND NAMED SPONSORS: COCA-COLA, GENERAL MILLS, GEORGIA-PACIFIC, 3M - INDUSTRIES THAT ALL USE BPAs IN THEIR MANUFACTURING AND PACKAGING.  MS. BRINKER, I NOTE THAT YOU ARE ALSO SILENT AS TO THE FACT THAT SGK OWNS STOCK IN SEVERAL PHARMACEUTICAL COMPANIES, INCLUDING ASTRA-ZENECA (aka AZKONOBEL), THE MAKER OF TAMOXIFEN - WHOSE SIDE EFFECTS INCLUDE UTERINE CANCER.

Research and community programs cost money, and we make no apologies for raising the funds that make them possible. In fact, we need to raise more, because - despite our advances - a woman is still being diagnosed with breast cancer every 19 seconds and a woman dies of breast cancer every 74 seconds somewhere in the world.

WHILE WOMEN CONTINUE TO DIE AT RATES THAT HAVE NOT SIGNIFICANTLY CHANGED SINCE 1960, SGK SPENDS NEARLY $1 MILLION YEARLY SUING SMALL CHARITIES FOR THE USE OF THE WORD: "CURE." SGK'S GENERAL COUNSEL, JONATHAN BLUM, WHEN COMMENTING ON A LEGAL BATTLE INVOLVING SGK AND A SMALL LUNG CANCER NON-PROFIT, FOR USING THE WORD "CURE", STATED: "WE SEE IT AS RESPONSIBLE STEWARDSHIP OF OUR DONOR'S FUNDS.

Do consumers need to be aware of where their dollars are going? Absolutely. We urge people to do their homework before donating to ensure that their dollars go to organizations that are legitimately engaged in ending breast cancer.

WHICH IS WHY IN REVIEWING SGK'S 990s YOU CAN DISCOVER THAT THE CLAIMS BY MS. BRINKER, ON BEHALF OF SGK, DO NOT PAN OUT.

If you do like pink - and our surveys say most people do - then I thank you for seeing it for what it is: the symbol of a movement that is doing all that it can to end suffering from the leading cancer killer of women worldwide. Half a million women will die of breast cancer in the world this year, including 40,000 right here in the United States.

AGAIN, MS. BRINKER, IT CANNOT BE OVERSTATED, THAT THIS NUMBER HAS NOT SUBSTANTIVELY CHANGED IN 50 YEARS, DESPITE THE BILLIONS RAISED...AND SPENT BY SGK.

Roulette Wheels as breast markers
...nice. At least they're organic [?]

There won't be enough pink until the fight against this disease is won.

© Copyright The Sacramento Bee. All rights reserved.

Showing 8 comments (these are the total comments that were posted)

• 
  Bobbalino                                           

  You say that your research over the last 30 years "has helped reduce breast cancer death rates by 31 percent since 1991. " But breast cancer mortality is going up not down!

  

• Carrie Anne Kelly                                           

  Lets stop "cutesifying" Breast Cancer with all the pink nonsense and get to the matter at hand which is that your organization is aligning itself with the very industries that are suspect to be using harmful material in the production of their products. If you are really interested in finding the cure, then show us by demanding accountability from the food, cosmetic and household cleaning industry. Oh right. You're too busy suing smaller organizations for using the term "For the Cure".

  
  
• 
  BBZinger                                           

  Ms. Brinker has been defending pink for years. Her anecdotes don't prove her point. If women with breast cancer are living in their cars, they don't need pink, they need money. When I was Executive Director of Breast Cancer Action, and since, I have heard numerous complaints about Komen's non-responsiveness to individuals in need of help, despite the enormous resources at Komen's disposal. Pink is a pretty color, but there is nothing pretty or happy about a breast cancer diagnosis. For a different view, see www.barbarabrenner.net
• 
  natrum                                           

  Ms Brinker, What I do not understand, is why so very little, if any, of the Komen Millions of dollars is spent on education regarding prevention. There is good information out there, and much benefit could come from people learning about diet, the protection afforded by adequate vitamin D, the fact that ingested sugar directly feeds cancer cells, the toxins in our consumer products, the dangers of radiation.... the list is very long. Heredity is a small part of risk. And even then, gene expression is not an absolute. The environment plays a key role. Pink buckets filled with chicken pumped with hormones and antibiotics, coated in who-knows-what, fried in genetically modified soy oil, is an example of the environmental dangers to avoid.
  Breast cancer "awareness" needs to include actions to take to avoid it, even at the risk of offending industrial sponsors whose products are implicated in causation.  This is information I want my sister to know.
• 
  Erika Munson Sudz                                           

  Funny thing, I looked ALL Over the Komen web site for assistance regarding prescriptions/travel/insurance/lodging. All I found were links to OTHER organizations to ask for assistance there was nothing there showing how Komen was offering to help anyone. Such a scam

  
• ricaLIVESTRONG                                           

  The Pink Machine driven by Komen is a FARCE. I have called and tried to contact Komen for support during my breast cancer battle. Those requests for help, the chance to redeem themselves in my eyes, were ignored, though I WAS subscribed, unwillingly, to their marketing material. Thanks, Komen, but LIVESTRONG will get every cancer-fighting dime I have to give.
  
  The ongoing hypocrisy of Komen is sickening, to the point that I need to ingest some pink - Pepto-Bismol.
  
  Partnering with companies like KFC for a pink bucket, which only ENCOURAGES behavior that can INCREASE CHANCES of breast cancer, selling perfume and glamorizing the fight by wrapping it up in pink bows, and showing beautifully made-up bald women (who are obviously wearing bald caps) is false advertising and INSULTING to those of us in the throes of the fight.
  
  And do I even need to bring up the despicable habit of taking over the phrase "For The Cure?" Well, here. Sue me.
  
  I encourage EVERYONE out there to REBEL For The Cure.
  Pink ribbons are not welcome in my home, or hospital room. Yellow is.
  
  LIVE STRONG.     
• 
  CA_Comment                                          

  Ms. Brinker - respectfully the public does support the need to help connect and drive critical funds to research that will deliver a cure, improve awareness, improve early detection, aid diagnosis, and help women and men get access to critical care for this cancer so they may fight and survive this disease, as well as regain quality and quantity of life. To say we do not care about this because we question the current implementation of the pink campaign is incorrect.
  
  We are giving you valuable feedback that the pink campaign is important (otherwise no one would care to give you feedback), We are telling you it appears the pink campaign is at risk of becoming distracted/diluted and in some business alliances and implementations the campaign is downright hijacked. You may not like this message...but this message is real and affords an opportunity for you and others working to make a difference to consider and adjust. We are not telling you to stop. We are however telling you there is a need to make some changes or you risk alienating even more of your supporters.
  
  Although your organization holds a position as a leading voice on this cause...you must remember this is a human issue we all own. We are your stakeholders. We want and need you (and other organizations who can help us make a real impact) to be successful. In exchange for our support, we are demanding a vigilance by you or anyone else that takes this role. Our message is be attentive that the means-to-an-end approach does not become the actual downfall for the support needed to defeat the cancer itself. What decisions you make...good or bad...not only reverberate to breast cancers...but they spill over to work being done for all cancers.
  
• Miss Susie                                         

  I have to agree with this idea. When I saw the pink KFC basket, I thought, really? Fast food containers for cancer--doesn't that just encourage people to live a lifestyle that promotes disease while allowing themselves to feel good about it because it's going to cancer? I felt the same way when another chain (or maybe it was also KFC) was promoting a beverage special--read: cola--to help the fight against diabetes.
  
  When it's all about buying 'pink,' you run the risk of marginalizing the issue--it's not a serious medical issue, we can just solve it by shopping. The various partnerships make it also seem a little hokey. I never buy pink because I always stop and think to myself, well, once the money spent goes to pay for the actual item, the costs of shipping and production, marketing, packaging, et cetera, there's probably very little left for actual breast cancer. (The few things I need that come in pink don't really match my house, like the KitchenAid mixer I saw when I was buying one.)
  
  I'm all in favor of getting more pink out there for the awareness, but I think there is a valid point to be made about being cautious of various commercial partnerships.

  
  

13 Facts You Should Be Aware Of During Breast Cancer Awareness Month

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"While there is no cure for metastatic breast cancer, some individuals are able to live longer with the disease. However, metastatic breast cancer remains a clinical challenge in the oncology community. October 13 places emphasis on the disease stressing the need for new, targeted treatments that will help prolong life." - William Gradishar, MD, Northwestern University Feinberg School of Medicine

13 Facts Everyone Should Know about Metastatic Breast Cancer ~ reprinted from the Metastatic Breast Cancer Network. mbcn.org

1. No one dies from breast cancer that remains in the breast. The lump itself is not what kills. The metastasis of cancerous cells to a vital organ is what kills.

2. Metastasis refers to the spread of cancer to different parts of the body, typically the bones, liver, lungs and brain. [ILC (invasive lobular carcinoma) is atypical in where it will metastasize first, e.g., lymphatic system, peritoneum, uterus]

3. An estimated 155,000 Americans are currently living with metastatic breast cancer. Metastatic breast cancer accounts for approximately 40,000 deaths annually in the U.S.

4. Treatment for metastatic breast cancer is lifelong and focuses on control and quality of life vs. curative intent. (“Treatable but unbeatable.”)

5. About 6% to 10% of people are Stage IV from their initial diagnosis.

6. Early detection is not a cure. Metastatic breast cancer can occur ANY time after a person’s original diagnosis, EVEN if the patient was initially Stage 0, I, II or III and DESPITE getting annual checkups and annual mammograms.

7. Between 20% to 30% of people initially diagnosed with regional stage disease WILL develop metastatic breast cancer.

8. Young people DO get metastatic breast cancer.

X-ray of a woman with metastatic breast cancer
 in her bones

9. There are many different kinds of metastatic breast cancer.

10. Treatment choices for MBC are guided by hormone (ER/PR) and HER2 receptor status, location and extent of metastasis (visceral vs. nonvisceral), previous treatment and other factors.

11. Metastatic breast cancer isn’t an automatic death sentence. Although most people will ultimately die of

their disease, some can live long and productive lives.

12. There are no hard and fast prognostic statistics for metastatic breast cancer. Everyone’s situation is unique, but according to the American Cancer Society, the 5 year survival rate for stage IV is around 20%. (Ahhh...this is where radiation onc got her figures when she played out for me her interpretation of the grim reaper. She gave me the cookie-cutter stats!)

13. October 13 is National Metastatic Breast Cancer Awareness Day. To learn more about it as well as resources specifically for people with metastatic breast cancer see www. mbcn.org.

PSA: The Need for Systemic Change Should be the Real Call for Awareness in the Upcoming (dreaded) "Pinktoberfest"

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Executive Director Karuna Jaggar
By Karuna Jaggar, Breast Cancer Action Executive Director

In anticipation of National Breast Cancer Awareness Month this October, Susan G. Komen for the Cure’s CEO Nancy Brinker is calling for “less talk, more action” on breast cancer. I am struck by how similar the urged “action” looks to what the organization has been advocating for years. Komen’s “take action” emphasis continues to be on individual women getting annual mammograms.

At Breast Cancer Action, we bring a markedly different understanding of what action we all need to take—for ourselves, each other, our mothers, daughters, and granddaughters—to truly end the breast cancer epidemic. Komen’s faith in mammograms to bring the “end to breast cancer” is misplaced.

Mammograms don’t prevent breast cancer; they detect breast cancers that have already developed.

Mammograms don’t detect all breast cancers: according to the National Cancer Institute, “mammograms miss up to 20 percent of breast cancers that are present at the time of screening.” (In my situation...Invasive Lobular Carcinoma is not detected by mammograms - prior to my stage III diagnosis done via biopsy and MRI, my mammograms "detected" my 6.2 cm cancer tumor as "fibrous breast tissue - only.)

And unfortunately, there are plenty of women diagnosed, by mammography, with early stage breast cancer who end up dying of breast cancer.

More women getting more mammograms is not going to end the breast cancer epidemic. Neither, of course, are healthy diets and good exercise regimes. (I am woman who has been physically active all my life - dance 14 yrs; martial arts (29 years and counting); hiking; running; weight training; yoga, etc. I have also been a fruit, veggie and mostly pescetarian eater my adult life - and a vegetarian for 4 years in my youth.)

One of the ugly truths of breast cancer is that more than half of all breast cancers have no known cause and scientific evidence suggests that many cases are linked to exposure to environmental toxins. (This is the perspective and approach of my current naturopathic doctors - see "Recommended Provider" page.)

This means that, even if a woman follows Ms. Brinker’s call to exercise, never smoke, reduce alcohol consumption, and control her weight, she may still get breast cancer. (I have never smoked. My alcohol consumption leveled off to a "glass and half" in my early 20s. My top non-pregnant weight has been 105.)

Today the greatest risk for breast cancer is being a woman. In fact, a woman today has a 1 in 8 lifetime risk of getting breast cancer, up from 1 in 20 in the 1960s and 1 in 14 in the 1980s. (In short, there is no medical stereotype for breast cancer!)

We need actions that benefit the health of all women, not just ourselves.

• Action that does not assume synthetic chemicals are innocent until proven guilty.
• Action that begins with corporations and extends to our state and federal regulatory systems.
• Action that addresses the fact that too many women lack the health insurance of Ms. Brinker’s audience.
• Action that turns the tide on the inequities that mean African American women are more likely to die from breast cancer than their white counterparts.

Action that produces more effective, less toxic treatments, including for metastatic disease.

We need meaningful action to turn the tide of the breast cancer epidemic so fewer women are diagnosed with the disease and fewer women die from breast cancer. We will continue to take action to bring the systemic changes that will end the epidemic.

So if you are going to don the Pink Ribbon and run with the herd this coming October - do yourself and your loved ones a favor and be truly aware.  

PSA - Overdiagnosis Is Not a Trivial Matter

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One in Three Cancers Diagnosed with Free Mammogram Screening Is an "Overdiagnosis"
by David Gutierrez, staff writer

(NaturalNews) In countries with public breast cancer screening programs, one in every three diagnosed with invasive breast cancers would never have produced symptoms in a patient before she died of other causes, a new study has revealed.

"Screening for cancer may lead to earlier detection of lethal cancers but also detects harmless ones that will not cause death or symptoms," wrote the researchers, from the Nordic Cochrane Center in Denmark, in the British Medical Journal.

"The detection of such cancers, which would not have been identified clinically in someone's remaining lifetime, is called overdiagnosis and can only be harmful to those who experience it."

Researchers analyzed breast cancer diagnosis rates among both screened unscreened women in Australia, Canada, Norway, Sweden and the United Kingdom for at least seven years before and after the public breast cancer screening programs in those countries began. As expected, they found that breast cancer diagnosis rates in every country increased in conjunction with the introduction of screening programs. Breast cancer rates among older women did not undergo a corresponding decrease, however – suggesting that rather than detecting cancers earlier, screening was merely detecting cancers that would otherwise never have produced a detectable effect on a woman's life.

When all forms of breast cancer were taken into account, the rate of overdiagnosis after public screening programs were introduced ranged from a low of 46 percent (in Sweden) to a high of 59 percent (in Canada), with an average overdiagnosis rate of 52 percent. When only invasive breast cancers were taken into account – cancers that have spread beyond the mammary tissue and are more likely to be lethal, and thus more likely to be treated aggressively – the average rate of overdiagnosis was still 35 percent, or more than one in three.

This was the second time that this research team had found evidence that overdiagnosis is a serious consequence of public screening programs.

"[The study] means that screening for cancer, in this case breast cancer, is a much closer call than has been previously advertised," wrote Gilbert Welch of the Dartmouth Institute for Health Policy in an accompanying editorial. "It has the opportunity to help some women but it also has the consequence of leading others to be treated needlessly for cancer and that's not a trivial thing."

Because no tests exist that can predict how aggressive or dangerous a cancer will be, all women diagnosed with breast cancer are referred to similar treatment programs, many of which – such as chemotherapy, radiation and breast surgery – carry serious and even dangerous side effects.

Screening advocates insisted that the benefits of screening still outweigh the risks of overdiagnosis.

"Without screening, women would face the prospect of having to wait for a visible symptom of cancer, such as a lump, to become apparent before treatment could start," said Emma Pennery of Breast Cancer Care.

Sarah Cant of Breakthrough Breast Cancer agreed, but said that women should be given clear information about screening in order to make informed decisions.

Welch also believes that better information is essential, saying that doctors should show women a simple statistical table quantifying the relative risks and benefits of screening for them, based on their own risk profile.

"Mammography undoubtedly helps some women but hurts others," he said. "No right answer exists, instead it is a personal choice."

Researchers do not know how many lives are saved for every case of overdiagnosis, with estimates ranging between one in two and one in 10.

Welch noted, however, that "the amount of overdiagnosis is a function of the mammographer's threshold to recommend biopsy."

"The time has come for a randomized controlled trial to test higher thresholds, such as only recommending biopsy for breast masses larger than a certain size," he wrote.

Sources for this story include: news.bbc.co.uk; www.cancerpage.com ; www.tehrantimes.com; www.oncologyupdate.com.

TC Postscript: What the above article does not delve into is that mammogram is not an effective diagnostic tool to detect Invasive Lobular Carcinoma ("ILC"). Each time I confirmed my diagnosis with another health care professional, I asked each of them the question: If I had had regular mammogram screening (as my "Buddy Check 12" -- AZ reference) reminded me to do via email, and which I did not heed, would my ILC been detected at an early stage? The unanimous answer by all was, NO. It has something to do with the pattern of infiltration in and outside of the mammary tissue and the indolent nature of ILC.

Consequently, I will continue in not having regular mammograms, but rather, will be having diagnostic ultrasounds.

Awarenes

******
October is Breast Cancer Awareness Month and the Pink Ribbons are flying!

What does that really mean ... AWARENESS???????

Before I was diagnosed with Invasive Lobular Carcinoma, I was aware of the prevalence of breast cancer. I knew it was a disease that struck mostly post menopausal women. I was aware that women who have family histories; who smoked; who took oral contraceptives for prolonged periods of time were more likely to be stricken with breast cancer. I was aware of mammograms and lumps and lumpectomies and mastectomies. I was aware of the existence of radiation and chemotherapy treatments.

I was aware of our local news station and its "Buddy Check 12" campaign. I was aware of the Pink Ribbon campaigns. I was aware that every October there was a hub-bub about the Susan B. Komen Race for the Cure. I was so aware that for the last 15 years I ran the Race for the Cure; ironically shaving off up to 8 minutes in my pace time each year. (As it turns out, I guess I wasn't running fast enough!!!!)

It wasn't until I was blind-sided with a diagnosis of breast cancer this summer that I became aware of the breadth of my ignorance. There was, and still is, so much that I did not know about the disease and its treatment. And, none of the information I received over the last 15 years of my "pink" involvement ever even hinted at the depths of my naivete.

For example . . .

I did not know there were myriad of causes of breast cancer - the majority being environmental
I did not know that women without genetic predispositions could get breast cancer
I did not know that women who did not live a high-risk lifestyle could develop breast cancer
I did not know that there were subsets to breast cancer (ductal, lobular, inflammatory and Paget's Disease)
I did not know that as a pre-menopausal woman in good health I could develop breast cancer
I did not know about sentinel node biopsies
I did not know about drainage tubes ("d-bombs")
I did not know about tram flaps; or that as a 100+/- lb person I am not a candidate for one (And thank the Creator for that one - not a procedure I would have wanted!)
I did not know about the long term effects of chemotherapy
I did not know about Adriamycin (aka "Red Devil")
I did not know about Tamoxifen (or that outside of the U.S. it is listed as a cancer-causing carcinogen)
I did not know about Herceptin and Aromatase
I did not know that the medical community treated pre-menopausal women differently than post menopausal women
I did not know about Oncotype DX and MammaPrint tests for chemo efficacy
I did not know about how a cancer is "staged"
I did not know that mammograms are not a reliable or effective way to early-detect Invasive Lobular Carcinoma
I did not know that a Vitamin D deficiency can be a contributing cause in the development of breast cancer
I did not know how key Vitamin C is in preventing the occurrence and recurrence of breast cancer
I did not know that a build up estrogen in the body is toxic.
I did not know that the only way the body effectively disposes of unneeded estrogen is through daily waste elimination
I did not know about E-cadherin and protein tests and saliva tests and hormonal balancing
I did not know about the vast discrepancies in how breast cancer is approached and treated in the U.S. as compared to Europe - and that stateside we are not on the higher road

and so it goes on, and on, and on . . . . AND

I did not know what an insidious and pervasive industry that breast cancer has generated in the U.S.

I did not know that the med-pros really do not have a "CURE" for breast cancer, but rather a "PROTOCOL" - that they are vociferous in the application of their established protocol; that the protocol has not changed much in 50 years; and that despite the protocol women are still dying - at times as a result of the protocol.

I did not know that even though 100s of millions are raised for research, awareness, marketing and merchandising that we are still no closer to a cure.

I did not know that some of the pharmaceutical companies that produce & distribute cancer treatment drugs consciously include cancer-causing carcinogens in the household products and foods we consume.


I did not know that I would need to become my own "lay expert" in order to earn a voice in the discussion regarding my own health and treatment.

October is Breast Cancer Awareness Month. And, I am a little more aware this October of 2009 than I have been in all my previous years. I am also excruciatingly aware that my new found knowledge and the continuing pursuit of knowledge has nothing to do with the flying of little Pink Ribbons!