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dr sanjay gupta takes on mammography


Breast Cancer Prevention

After dealing yesterday with the twin nightmares of OVER-DIGANOSIS & OVER-TREATMENT, I figured I needed to give you a real-life example — this one having to do with BREAST CANCER.  Neurologist and celebrity physician (I believe he is a regular on CNN) ran an article by Staff Contributor Shannon Firth in yesterday’s edition of his daily column, the “Gupta Guide,” called Mammography’s $4-Billion Problem.  The article was based on a study from this month’s edition of Health Affairs called National Expenditure For False-Positive Mammograms And Breast Cancer Overdiagnoses Estimated At $4 Billion A Year.

In the study, two doctors at Boston Children’s Hospital, Ken Mandl and Mei-Sing Ong (Mandl is also a professor at Harvard School of Medicine) stated that, “There’s a $4-billion problem, and it’s $4 billion dollars being spent on two undesirable outcomes.”  The two undesirable outcomes they were talking about were those ugly twins I mentioned in the first sentence of this post.  It is their belief that for the most part, “providers, patients, and their families” are failing to grasp the magnitude of this problem.  The Overdiagnosis rate was over one in ten, which means that of the nearly 30 million women getting their BREASTS X-RAYED every year, over 3 million received “False Positive” diagnosis at a cost of nearly three billion dollars. 

The shocker, however, were the statistics for DCIS (Ductal Carcinoma in Situ), where the rate of Overdiagnosis is 86%.  In English, this means that for every 100 people diagnosed with DCIS, 86 of them did not have the problem —- they were “False Positive”.  Gulp!  Frith went on to write that, “For years, a DCIS finding automatically led to bilateral mastectomy. However, providers now realize that it often does not progress and sometimes is actually not even cancerous.”  And now we have celebrities like Angelina Jolie affecting public opinion by opting for a DOUBLE MASTECTOMY (not to mention a complete hysterectomy) just because SHE CARRIES A CERTAIN GENE

Despite lots of discussion, there were no tangible recommendations by the study’s authors other than the ultra-vague, “limiting screening to women for whom it clearly has a positive benefit-harm balancing“.  Unfortunately, not even these researchers could really say what this means.   I realize you’ll all be shocked, but as always, the reasons boil down to money.  Listen to what Firth says about their conclusions.    After sharing something that was likewise revealed in YESTERDAY’S POST —- that the “status quo of current practices is so firmly entrenched” —– Mandl states that because, “Any change in recommendation will shift the revenue one way or another….. that has to be an explicit part of the conversation.”    So, even though we have study after study after study on this topic by the research side of the medical community, the practicing side of the medical profession wants exactly what the research side says they shouldn’t have — largely because to follow their lead would drastically diminish income (“shift revenue“).  And the CHASM continues to grow.

If you are interested in Cancer Prevention as opposed to Cancer Detection (not sure our medical system or government has figured out the difference yet), you might want to at least skim over THIS SERIES OF POSTS.


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