Woloshin & Schwartz have done an excellent job in explaining the lack of a relationship between mammography screening and 5 year survival. So what is next? Given the small positive impact of mammography screening, let alone its downsides, it is time to replace this lead (Pb, not gold) standard. I’ve reviewed the prospects*. The major concept is that it is high time that breast imaging researchers aim at replacements for screening mammography, rather than second class adjuncts to it. This requires pushing imaging approaches to their physical limits. As extrapolations of epidemiological data suggest >99% cure if 100% of tumors were found and destroyed before they reach 2-4mm*, this may be an attainable goal.
One unfortunate consequence of the failure of mammography is that this has colored perception of all breast imaging methods. For example, the National Breast Cancer Coalition and Friends for an Earlier Breast Cancer Test seem to eschew imaging approaches. Another unfortunate consequence is that Woloshin & Schwartz castigate “overdiagnosis”. Of course, many small tumors will not end up killing the asymptomatic patient. But at present we can’t find most of the premetastasis tumors because of inadequate imaging methods, nor would we be able to distinguish which would kill from those that would not. The rational approaches here are: 1) imaging research to seek prediction criteria (downside: politics of redirecting research money); 2) watchful waiting (downside: anguish); 3) ablation or excision (downside: minor discomfort for tiny tumors). The latter is the standard of practice in dermatology (excise on suspicion, then do pathology).
*Gordon, R. (2011). Stop breast cancer now! Imagining imaging pathways towards search, destroy, cure and watchful waiting of premetastasis breast cancer. In: Breast Cancer – A Lobar Disease. Eds.: T. Tot. London, Springer: 167-203.
Contact: DickGordonCan@gmail.com
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Re: How a charity oversells mammography
Woloshin & Schwartz have done an excellent job in explaining the lack of a relationship between mammography screening and 5 year survival. So what is next? Given the small positive impact of mammography screening, let alone its downsides, it is time to replace this lead (Pb, not gold) standard. I’ve reviewed the prospects*. The major concept is that it is high time that breast imaging researchers aim at replacements for screening mammography, rather than second class adjuncts to it. This requires pushing imaging approaches to their physical limits. As extrapolations of epidemiological data suggest >99% cure if 100% of tumors were found and destroyed before they reach 2-4mm*, this may be an attainable goal.
One unfortunate consequence of the failure of mammography is that this has colored perception of all breast imaging methods. For example, the National Breast Cancer Coalition and Friends for an Earlier Breast Cancer Test seem to eschew imaging approaches. Another unfortunate consequence is that Woloshin & Schwartz castigate “overdiagnosis”. Of course, many small tumors will not end up killing the asymptomatic patient. But at present we can’t find most of the premetastasis tumors because of inadequate imaging methods, nor would we be able to distinguish which would kill from those that would not. The rational approaches here are: 1) imaging research to seek prediction criteria (downside: politics of redirecting research money); 2) watchful waiting (downside: anguish); 3) ablation or excision (downside: minor discomfort for tiny tumors). The latter is the standard of practice in dermatology (excise on suspicion, then do pathology).
*Gordon, R. (2011). Stop breast cancer now! Imagining imaging pathways towards search, destroy, cure and watchful waiting of premetastasis breast cancer. In: Breast Cancer – A Lobar Disease. Eds.: T. Tot. London, Springer: 167-203.
Contact: DickGordonCan@gmail.com
Competing interests: No competing interests