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Canada Recommends Fewer Mammograms

 
 
Miller
 
Reply Mon 7 Oct, 2013 09:14 am
Canada Recommends Fewer Mammograms

Fran Lowry
Nov 28, 2011
Medscape

November 28, 2011 — Canadian women will now have to wait as long as 3 years between breast-screening mammograms, according to a new set of breast cancer guidelines released by the Canadian Task Force on Preventive Health Care (CTFOPHC).

They have also been told not to do breast self-exams, and their doctors have been told not to perform breast examinations in the office.

The CTFOPHC reasons that regular screening for breast cancer with mammography, breast self-exam, and clinical examinations — all practices that have been widely recommended to reduce breast cancer mortality — causes women too much anxiety, results in too many false positives, and is too costly.

Currently, women in Canada have yearly mammograms, and primary care physicians do manual breast exams, usually during a woman's annual physical examination.

The restrictive new recommendations were published in the November 22 issue of CMAJ.

Thousands of Women Will Die, Says ACR

These breast cancer screening guidelines will cost the lives of Canadian women, according to the American College of Radiology (ACR).

They "ignore the results of landmark randomized controlled trials, which show that regular screening significantly reduces breast cancer deaths in these women. While implementation of the CTFOPH guidelines may save money each year on screening costs, the result will be thousands of unnecessary breast cancer deaths," the ACR says.

Barbara Monsees, MD, a diagnostic radiologist from St. Louis, Missouri, who chairs the ACR's Breast Imaging Commission, said in a statement that "panels without profound expertise in breast cancer screening should not be issuing guidelines. These recommendations are derived from flawed analyses and they defy common sense. Women and providers who are looking for guidance are getting bad advice from both task forces."

In 2009, the United States Preventative Services Task Force (USPSTF) issued similar guidelines, which created a furor among breast cancer prevention advocates.

Canadian Task Force Should Be Congratulated

In an editorial accompanying the release of the new guidelines, Peter C. Gøtzsche, MD, from the Nordic Cochrane Centre, Copenhagen, Denmark, lauds the CTFOPHC for its recommendations.

He writes that the Canadian recommendations on mammography screening "are even more conservative" than those introduced 2 years ago in the United States, "which created an uproar...from people interested in maintaining the status quo."

Dr. Gøtzsche maintains that screening with mammography does not reduce the occurrence of advanced cancers. He also states that "rigorous observational studies" in Europe have failed to find an effect of mammography screening, and that mammography screening produces patients with breast cancer from among healthy women and increases the number of mastectomies.

"The best method we have to reduce the risk of breast cancer is to stop the screening program. This could reduce the risk by one third in the screened age group, as the level of overdiagnosis in countries with organized screening programs is about 50%," he writes.

"If screening had been a drug, it would have been withdrawn from the market. Which country will be first to stop mammography screening?" he asks.

Dr. Gøtzsche is well known for his outspoken views against mammography, and the Nordic Cochrane Group, of which is a member, was recently accused of orchestrating "an active antiscreening campaign" by an international group of breast screening experts in a letter to the Lancet.

Women in Their 40s Get Breast Cancer

The Canadian guidelines are even more negative than the American guidelines, noted radiologist Stamatia Destounis, MD, from Elizabeth Wende Breast Care, LLC, in Rochester, New York.

"The USPSTF said that for women 40 to 49, it should be a decision made with your doctor; they didn't come out and say don't do it. The Canadians even say no to breast self-exam and clinical breast exam. I don't know. We have patients coming in who have found lumps in their breasts that are significant lumps. We have doctors finding lumps in their patients that are significant lumps. It's very hard to know what to do when you have these kind of recommendations," Dr. Destounis told Medscape Medical News.

She recently did a retrospective review of patients who came to her center over a 10-year period and found that almost 20% of the breast cancers that were diagnosed were in women 40 to 49 years of age. About half of these were diagnosed in women with no known risk factors for breast cancer.

"These task forces say going through screening is stressful for women. But what woman is going to say: 'No, this is too stressful. I am not happy having extra views. I'm not going to have an ultrasound?' Most of us would say: 'I have family, I have kids, I have responsibilities. I want to make sure I'm ok and I'm a productive member of society at any age.' We women tend to be the care providers whatever our age, and we have a lot of things to do. So what woman is going to say: 'No, I'm too stressed to have this needle biopsy; it is just too much for me to handle'?" Dr. Destounis asked.

"Instead, I am going to say: 'Do whatever you need to do to make sure I'm ok.' Yes, it is stressful to go through these tests, but it's our lot as women. Saying don't do screening because it is stressful just doesn't make any sense."

Dr. Monsees is the chair of the American College of Radiology Breast Imaging Commission. Dr. Gøtzsche and Dr. Destounis have disclosed no relevant financial relationships.

CMAJ. 2011;183:1991-2001, 1957-1958. Abstract, Editorial
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Type: Discussion • Score: 1 • Views: 3,017 • Replies: 55

 
Foofie
 
  0  
Reply Mon 7 Oct, 2013 11:10 am
@Miller,
Why are you concerned about Canadian women? I am concerned about American women only. Women have all sorts of problems, including sometimes the men in their lives. We should be concerned about the mistreatment of women in some countries? Well, you can; but, must you be a feminist beyond the borders of the U.S. on a public forum? So much correlates to economies and societies. So, since every country has its own economic and social concerns, what is the point to worry about the breasts of Canadian women?

Plus, what if certain populations, due to eating habits, have a higher or lower incidence of breast cancer? Then mammograms have a context that is not explained in your post. Your concerns may be more valued in a forum for oncologists.
contrex
 
  3  
Reply Mon 7 Oct, 2013 11:32 am
@Foofie,
Foofie wrote:
I am concerned about American women only.


Where does it say in the Able2know constitution that only US concerns are allowed?
Miller
 
  2  
Reply Mon 7 Oct, 2013 12:10 pm
@contrex,
contrex wrote:


Where does it say in the Able2know constitution that only US concerns are allowed?



It doesn't, at least as far as I know.
0 Replies
 
Setanta
 
  1  
Reply Mon 7 Oct, 2013 12:13 pm
The Miller/Foofie troll has a hard-on about Canadians. Miller has twice used "Canadian" as a term of disapprobation recently. They are the same person posting under two different accounts.
Walter Hinteler
 
  2  
Reply Mon 7 Oct, 2013 12:27 pm
@Miller,
In Canada, regular screening mammograms (breast x-rays) are available for women ages 40-79 who have no new breast problems.
For women ages 50 to 74, regular mammograms (every 2 to 3 years) are recommended by the Canadian Task Force on Preventive Health Care.

That's free, of course, too, like elsewhere.

And can be done in a regular local clinic/hospital or mobile. Like in any other country.


(In Germany, it's done for free any two years. But although the mobile screening buses are driven to the tiniest villages, even in smaller rural hospitals the screening can be done, and even if those women are invited by personal letters - not too much go there.)
Miller
 
  1  
Reply Mon 7 Oct, 2013 02:34 pm
@Walter Hinteler,
Walter Hinteler wrote:

In Canada, regular screening mammograms (breast x-rays) are available for women ages 40-79 who have no new breast problems.
For women ages 50 to 74, regular mammograms (every 2 to 3 years) are recommended by the Canadian Task Force on Preventive Health Care.

That's free, of course, too, like elsewhere.
If it os free. than why do they worry about the cost? Do they mean the cost to the Government?
The CTFOPHC reasons that regular screening for breast cancer with mammography, breast self-exam, and clinical examinations — all practices that have been widely recommended to reduce breast cancer mortality — causes women too much anxiety, results in too many false positives, and is too costly

Quote:
The CTFOPHC reasons that regular screening for breast cancer with mammography, breast self-exam, and clinical examinations — all practices that have been widely recommended to reduce breast cancer mortality — causes women too much anxiety, results in too many false positives, and is too costly



Miller
 
  1  
Reply Mon 7 Oct, 2013 02:40 pm
@Walter Hinteler,
In the US, mammography is free to all women who lack health insurance and who don't have cash to pay for the procedure.

In the US, today, most physicians want mammography to start at age 40 years and from 40-50 years, be performed every 6 months. For women with a family history of breast cancer, mammography might be offered to those under the age of 40 years.

From 40-50, mammographs are given to healthy ( no breast cancer ) every year. At age 60 -73 ( or 69 if the Swedish model is followed, mammograms are given ( usually ) every 3 years.

In the US, American women have pushed very hard for free mammograms for women who lack insurance and/or money.
0 Replies
 
Walter Hinteler
 
  2  
Reply Mon 7 Oct, 2013 02:44 pm
@Miller,
Miller wrote:

Quote:
The CTFOPHC reasons that regular screening for breast cancer with mammography, breast self-exam, and clinical examinations — all practices that have been widely recommended to reduce breast cancer mortality — causes women too much anxiety, results in too many false positives, and is too costly

Well, my source are the Guidelines - Recommendations on screening for breast cancer in average-risk women aged 40–74 years by the Canadian Medical Association.

I suppose, it is costly - since it seems to be free for patients in the USA as well: doctors/institutions do it for charity or do they bill the insurence companies like elsewhere?
0 Replies
 
Miller
 
  1  
Reply Mon 7 Oct, 2013 02:50 pm
@Foofie,
Foofie wrote:

Why are you concerned about Canadian women? I am concerned about American women only.


I'm glad you're concerned about American women, but the real issue is that of breast cancer in women and the use of mammography for early detection of the disease.

For interest whynot compare the use of mammography in American, Canadian and Sweden women. There are differences.
0 Replies
 
Foofie
 
  0  
Reply Mon 7 Oct, 2013 04:02 pm
@contrex,
contrex wrote:

Foofie wrote:
I am concerned about American women only.


Where does it say in the Able2know constitution that only US concerns are allowed?



The key word is "I." I have to be concerned about non-U.S. folks?
contrex
 
  1  
Reply Mon 7 Oct, 2013 04:08 pm
@Foofie,
Foofie wrote:

The key word is "I." I have to be concerned about non-U.S. folks?


Then why do you pour out so much bilge about Israel?

Foofie
 
  1  
Reply Mon 7 Oct, 2013 04:08 pm
@Setanta,
Setanta wrote:

The Miller/Foofie troll has a hard-on about Canadians. Miller has twice used "Canadian" as a term of disapprobation recently. They are the same person posting under two different accounts.


Or, two accounts by two people, with certain possible similarities due to having a common ancestor in the past two millenia, or maybe a little longer? Those Jewish genes really do make Jews similar, in my opinion. Something to think about as we approach All Saint Hallows Eve. A grand Celtic holiday.

All I want for Christmas is a Setanta sock puppet. Or, maybe an Izzy sock puppet? Imagine the arguments between an Irish and Brit sock puppet. Hours of fun.
Foofie
 
  1  
Reply Mon 7 Oct, 2013 04:10 pm
@Walter Hinteler,
Since many German women, based on their hereditary genome, are more than a little zaftig (Yiddish for plump) , is there a high rate of breast cancer?
Foofie
 
  0  
Reply Mon 7 Oct, 2013 04:13 pm
@contrex,
contrex wrote:

Foofie wrote:

The key word is "I." I have to be concerned about non-U.S. folks?


Then why do you pour out so much bilge about Israel?




For the same reason that many American Episcopaleans are concerned about their British heritage. Or, Irish Americans are concerned about their Irish heritage. My heritage was Russian; however, many Russians were/are rabid anti-Semites, so I can only look to Israel as a land where Jews can be Jews, and will be considered some day to be the homeland of all Diaspora Jews, just like all Gentiles have a homeland. Even playing field.

The other reason, is I know it annoys so many non-Americans. I really have little love for foreigners of European background. WWII and all that rot.
0 Replies
 
contrex
 
  1  
Reply Mon 7 Oct, 2013 04:13 pm
@Foofie,
Foofie wrote:
Imagine the arguments between an Irish and Brit sock puppet.


A British ventriloquist starts to make his dummy tell an irish joke. Immediately a burly guy in the audience with a long upper lip jumps to his feet. "I won't have youse sayin' dat Oirish people are tick! We're not tick!" The ventriloquist tries to apologise, but the burly guy won't have any of it. "Oi'm not talkin' to ye! Oi'm talkin' to the little feller on your knee!"
Foofie
 
  1  
Reply Mon 7 Oct, 2013 04:32 pm
@contrex,
contrex wrote:

Foofie wrote:
Imagine the arguments between an Irish and Brit sock puppet.


A British ventriloquist starts to make his dummy tell an irish joke. Immediately a burly guy in the audience with a long upper lip jumps to his feet. "I won't have youse sayin' dat Oirish people are tick! We're not tick!" The ventriloquist tries to apologise, but the burly guy won't have any of it. "Oi'm not talkin' to ye! Oi'm talkin' to the little feller on your knee!"



In the 19th century, there were jokes based on the Irish not being too intelligent. Well, most Irish I have met are more educated than most Brits, and intelligent also, in my opinion. Perhaps, you should read Studs Lonigan - The Trilogy by James T. Farrell. The book, in a fictional form, chronicles a 1920's Irish-American. What the book also points out, in my opinion, that the days of struggling Irish might have just left the intelligent ones as todays Irish. The others might have died off. That might also have happened to Jews. It can even be extrapolated to Israelis, perhaps.

The fact that such humor is still circulating amongst Brits is telling. And, not a compliment.
contrex
 
  1  
Reply Mon 7 Oct, 2013 04:38 pm
@Foofie,
Foofie wrote:

The fact that such humor is still circulating amongst Brits is telling. And, not a compliment.


If it has pissed you off, it achieved its intended result. You are quite dim, aren't you?

Foofie
 
  1  
Reply Mon 7 Oct, 2013 04:44 pm
@contrex,
contrex wrote:

Foofie wrote:

The fact that such humor is still circulating amongst Brits is telling. And, not a compliment.


If it has pissed you off, it achieved its intended result.



Why would it piss me off. You do not appear to know what is inappropriate for U.S. posters. Our Vice-President is Irish-American. Many people in high positions are Irish-Americans. Your being a Brit might be reflected in what you choose to offer as great humor? You are likely not malevolent in your choice of jokes. I would just think ignorant of what is appropriate for Americans. That is the downside of this forum.

The correct response would have been an apology. However, you are imbued, in my opinion, with the false pride that seems to be in the British character amongst some.
0 Replies
 
Walter Hinteler
 
  1  
Reply Mon 7 Oct, 2013 10:43 pm
@Foofie,
Foofie wrote:

Since many German women, based on their hereditary genome, are more than a little zaftig (Yiddish for plump) , is there a high rate of breast cancer?
I do know jiddisch though not all yiddish words.
But is that really a fact? US-American women have a BMI of 29, German of 26,2.

http://i1334.photobucket.com/albums/w641/Walter_Hinteler/a_zps4a658fb4.jpg
PUBLISHED: 17:11 GMT, 29 March 2013


And according the the latest data on wikipedia, the average height for a German woman is 1.680 m (5 ft 6 in), for an US-American woman 1.622 m (5 ft 4 in)
 

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