Women’s Health: New Study Finds Most Breast Cancer Deaths Happen in Women Who Don’t Get Screened — Should You Care?


Dr. Elaine Schattner

Writer, physician

An intriguing new study found that the vast majority of deaths from breast cancer occur among women who didn’t have routine mammography. The report, published in the journal Cancer, applied “failure analysis” — a way, typically used in engineering to see what might have gone wrong — to expose possible factors in women’s deaths. There was a striking find. Among patients who were 40-49 years old at the time of a stage I, II or III invasive breast cancer diagnosis, 77 percent who died of the disease hadn’t had regular screening.

The paper’s method is flawed, and conclusions limited. But sometimes an imperfect study can hint at real insights. In this report, the apparent concentration of deaths among middle-aged women who “opted out” from screening and had breast cancer suggests that that not having a mammogram is a risk factor for dying from the disease. The new findings are consistent with the view, or model that was once a tenet in oncology, that early detection matters in breast cancer survival.

The researchers evaluated records of 7,301 breast cancer patients with charts at the Massachusetts General or Brigham and Women’s Hospital in Boston. The cases were detected between 1990 and 1999. Women’s deaths were noted in medical charts, Massachusetts and National Death Registries through 2007. This study, with a focus on screening, omits mention of male breast cancers. The investigators honed in on women with invasive Stage 1, 2 or 3 disease — stages when breast cancer is clearly malignant but hasn’t yet spread. It’s at these levels, precisely, when screening could make all the difference. That’s because once a woman has metastatic (Stage 4) breast cancer, early detection is no longer relevant. And by not including DCIS (Stage 0) or pre-malignant conditions, the authors avoid exaggerating a possible benefit of mammography.

The investigators identified 609 patients who died from breast cancer. It was this group — women with limited-stage, invasive breast cancer who later succumbed to the malignancy — that formed the basis of the “failure analysis.” Only 118 (19 percent) of women who died from breast cancer had tumors detected upon regular screening. Sixty women, nearly 10 percent of the group, felt or otherwise found cancer between regular screens; these lethal “interval tumors” represent screening failures. Overall, 71 percent of the breast cancer deaths occurred in women who had no screening or irregular mammography, defined as an interval of greater than two years between tests.

Not surprisingly, the breast cancer deaths occurred disproportionately in younger women. The median age at finding breast cancer for all patients in the study was 55 years, but for those who died from the disease it was 49 years. Among those women who died of other causes, the median age at diagnosis was 72 years. One point that did draw my attention is that over 25 percent of the cases, lethal and otherwise, fell into the 40-49 year age bracket at diagnosis. That’s a lot of invasive breast cancer in women who are in the midst of life, and a huge number of possibly preventable deaths.

Where I’ll go with this is to ask my readers — patients and doctors, oncologists and primary care physicians, health care policy makers and economists, reporters and editors, whoever’s in a position to act upon this news — to consider the possibility that mammography, done right, can save lives. Keep an open mind, and realize that most published studies on breast cancer screening are flawed, too, by their observational, retrospective or meta-analytical natures.

Please don’t tire of this topic. Breast cancer remains a leading killer of middle-aged women. Getting a tumor out before it has metastasized can, still, make the difference between a small surgery and limited treatment vs. life-long therapy for an incurable condition. Early detection affects the quality of women’s lives. The costs of failed detection, and late diagnoses, are great.

Read More:  http://www.huffingtonpost.com/elaine-schattner/breast-cancer-screening_b_3909170.html?utm_hp_ref=womens-health

Women’s News: What Do You Do When Your Best Friend Tells You She Might Be Gay?


Shannon Bradley-Colleary

Aging vaintress, wife dominatrix, mom butler and humble author who is slightly mustachioed

I’ve known Maggie since we were freshmen in high school. We’re now both married moms who don’t get to see much of each other because she lives in a different state. But occasionally she comes back to California to visit her parents who still live here.

When I first met Maggie she really bugged me. She was so freaking chipper all the time, especially first thing in the morning. I’d arrive on-campus at 8:00 a.m. still half-dead, being a night owl who stayed up late to watch horny Benny Hill reruns, and there Maggie would be in homeroom, bouncing cheerfully off-the-walls wanting to instantly talk really really really fast! And did she mention she was sooo excited to just greet the sunrise and all of the possibilities before her for that one so very special day?

One time, in first period wood shop, I told her if she didn’t lower the decibels of her morning greeting I was going to put her head in one of the C-clamps on the lathing table and tighten the screws. Somehow she put up with my early morning homicidal tendencies and we’ve been friends ever since.

Then recently, on her last visit to California sans family, we went out for lobsters and beers at Shutters in Santa Monica and she confessed she was struggling in her marriage. This surprised me because the last time we’d seen them all they’d seemed so in sync and happy.

Then she added the kicker. She told me she was beginning to wonder if she might be gay. There was a girlfriend in her life back home she found herself attracted to.

I was completely blindsided. Maggie looked and sounded exactly the same, but it was as though she’d shape-shifted into something unfamiliar. And worse still, this admission suddenly colored the unfurling pageant of memories I had of our friendship. All of those nights we lay side-by-side in one of our beds giving each other massages and tickles as we shared confidences about our lame love lives took on new meaning.

My mind went into hyper drive. Had she known she was gay then and did she just make those crushes up? Did she feel attracted to me? Which was followed swiftly by, What’s wrong with you for thinking this way? Aren’t you a proponent for gay rights? Aren’t you thrilled that gays can now get legally married in California if they really want to jump in the crucible with the rest of us? Yes and yes. Then what the hell is wrong with you? Are you suddenly an anti-gay born-again bigot? No, no and no.

Months earlier my gay friend Mark, who came out in his early twenties, told me he wasn’t ashamed anymore of being gay, but he was still ashamed of keeping it a secret from his family and closest friends for so long. He said the feeling of being a fraud and of feeling he had lied by omission was devastating. At the time I didn’t get it. What did his being gay have to do with his parents and friends? Why was it any of their business? But now, sitting across from Maggie, I got it.

I couldn’t help feeling that Maggie had betrayed me. That our friendship, if not a lie, had somehow not been entirely true. That our trust was breached.

Since Maggie’s gone home our history together passes before my eyes in dreams at night, as though my subconscious brain is knitting together the rupture in things as I thought they were and things as they really are. In waking moments I rewind the tapes of our friendship again and again, looking for something.

I don’t even know exactly what I’m looking for. The truth? I suspect I won’t find it in the past. I’ll have to find the right time and place to talk to Maggie about my feelings in the future. Which seems narcissistic and self-involved when I consider that she’s grappling with the more serious problem of the future of her marriage.

But I think being willing to have awkward conversations with the people you love is a sure sign of how committed you are to the relationship. And that sometimes these awkward conversations can lead to more honest and closer friendships.

Has a friend ever divulged information you didn’t quite know how to handle? And what did you finally do?

Read More:  http://www.huffingtonpost.com/shannon-colleary/what-do-you-do-when-your-best-friend-tell-you-she-might-be-gay_b_3908531.html?utm_hp_ref=women&ir=Women?utm_hp_ref=women&ir=Women

A Message From The Creator


%d bloggers like this: