SMOKINCHOICES (and other musings)

April 24, 2015

Blood test better than mammograms

Most women really dislike mammograms.  There’s the worry, the discomfort or pain of doing them, and then the angst which follows when  something suspicious arises.  No woman can escape this anxiety. . there is too much threat, hype and discussion out there to ignore it.  For this can undo everything we’ve built in our lives, we can die.  And what other option is there?  With most experts disagreeing on almost everything,  women pretty much have to do this choosing on our own based on hope, what we’ve learned and how informed we actually are.  

Now, most fortunately, science has brought us something new — and it looks pretty darned encouraging.  For this reason, I am putting two articles into this one post.   The first one is the encouraging new technique which is only now becoming available.  It is good news on all levels, [discomfort, anxiety, cost factor and immediacy]. Must read it to fully understand – you’re gonna like it!   The second article, also recently published, is trying to implement  a more cautious and reasonable approach, advising as it has since 2009, lesser mammograms and hoping to dilute the damage factors (false positives and unnecessary treatments for otherwise non-threatening issues).  This can go a long way to allowing women to live without the distraction of all those things which can go wrong with our health . . to be freer and enjoy happier thoughts,  for this is what can keep us healthier as well as happier.    Jan     


Blood test may make biopsies unneeded, study shows

Gina Kolata The New York Times >Sunday April 19, 2015 

In the usual cancer biopsy, a surgeon cuts out a piece of the patient’s tumor, but researchers in labs across the country are testing a potentially transformative innovation: the liquid biopsy.It’s a blood test that has only recently become feasible with the latest exquisitely sensitive techniques, and it’s showing promise in finding tiny snippets of cancer DNA in a patient’s blood.

The hope is that a simple blood draw — far less onerous for patients than a traditional biopsy or CT scan — will enable oncologists to quickly figure out whether a treatment is working and, if so, to continue monitoring the treatment in case the cancer develops resistance. Failing treatments could be abandoned quickly, sparing patients grueling side effects and allowing doctors to try alternatives.

“This could change forever the way we follow up not only response to treatments but also the emergence of resistance, and down the line could even be used for really early diagnosis,” said Dr. Jose Baselga, physician in chief and chief medical officer at Memorial Sloan Kettering Cancer Center in New York.

Researchers caution that more evaluations of the test’s accuracy and reliability are needed. So far, there have been only small studies in particular cancers, including lung, colon and blood cancer. But early results are encouraging.

A National Cancer Institute study published this month in The Lancet Oncology involving 126 patients with the most common form of lymphoma found the test predicted recurrences more than three months before they were noticeable on CT scans. The liquid biopsies also identified patients who are unlikely to respond to therapy.

“Every cancer has a mutation that can be followed with this method,” said Dr. David Hyman, an oncologist at Sloan Kettering. “It is like bar coding the cancer in the blood.”

The blood tests also allow frequent monitoring of tumors as they spread and mutate or develop resistance to treatment. The only other way to know is with biopsies.

  • “I cannot do a weekly liver biopsy and see how things are going,” Baselga said. “But I can do a blood test every week.”



Panel reinstates caution over annual mammograms


By Misti Crane – The Columbus Dispatch  

A vast divide remains on when and how often women should have mammograms.

In a draft of its newest recommendations released 4-20-15, the U.S. Preventive Services Task Force isn’t veering far from its 2009 guidance that didn’t recommend routine mammography for women in their 40s and said every other year was often enough for women 50 to 74 years old.The task force concluded that while mammography does save younger women’s lives, women in their 40’s who aren’t at high risk should weigh whether finding a deadly cancer is worth finding and treating a cancer that might not harm them or undergoing diagnostic tests for suspicious but benign spots.

  • In that age group, the task force said, it’s a delicate balance between risk and benefit.

“Mammography is good. It’s useful, but it has its limits. It has its harms, and we need to balance those benefits and harms,” said Dr. Michael LeFevre, immediate past chairman of the task force and a current member.

Although there has not been widespread retooling of the usual mammography recommendations (every year, 40 or older) since 2009, LeFevre said he’s optimistic that the national climate is shifting in terms of considering risks alongside benefits.

“Women are beginning to say, ‘Maybe we should talk about this,’” he said. “I hope that physicians will learn the science and not just have this knee-jerk reflex that annual mammography is the best thing for everybody from 40 until they die.”

For every 10,000 women 40 to 49 who are screened with repeated mammography for 10 years, an estimated four breast cancer deaths are avoided. That number jumps to eight for women in their 50s, 21 for women in their 60s and 13 for women 70 to 74, according to the task force.

The toll of harm per 10,000 women screened one time goes down with age. For instance, 100 biopsies are needed to find a single case of invasive breast cancer in women in their 40s. That number drops to 60 for women in their 50s and 30 for women 60 to 74.

There continues to be plenty of opposition, particularly in the radiology community, which largely has supported annual exams for all women 40 or older.

“When you find a cancer early, it’s more treatable, and the longer it’s in there the more likely it is to spread and become invasive,” said Dr. Mitva Patel, a radiologist at Ohio State University’s Stefanie Spielman Comprehensive Breast Center.

Although some cancers that are found with routine mammography might not become deadly, medical science hasn’t advanced to a point that determines which will and which won’t, so overtreatment is unavoidable, she said.

The American Cancer Society’s chief cancer control officer expressed concern that the recommendation for younger women could lead to obstacles to coverage. The recommendation carries a “C” rating, which means coverage is not mandated under the Affordable Care Act, according to a Cancer Society statement.

Others said the recommendations are reasonable and reflect a good analysis of the available science.

“The decades that we’ve spent drumming into women’s heads and doctors’ heads that once-a-year for a lifetime, early detection saves lives — the amount of money that has been spent marketing that message — it’s very difficult to overcome that, but we need to overcome it,” said Frances Visco, a breast-cancer survivor and president of the National Breast Cancer Coalition, an advocacy group.

The U.S. Preventive Services Task Force, which advises the government on the risks and benefits of screening, reviewed scientific studies of mammography and newly commissioned modeling studies conducted by the Cancer Intervention and Surveillance Modeling Network.

Women in their 40s with a first-degree relative who had breast cancer (mother, sister or daughter) appear to be at a two-fold increased risk of developing breast cancer, bringing the risk of harm vs. the potential for benefit in line with women in their 50s, the draft recommendations say.

Mammography’s benefits grow with time, the group stressed. And it emphasized the risks of overdiagnosis: treating cancers, including localized ductal carcinoma, in situations that otherwise would not threaten a woman’s health with surgeries, chemotherapy and radiation.

Clinical trials that have shown that mammography saves lives have included screening intervals from 12 to 33 months, and there’s no clear evidence that annual mammograms are the way to go, the task force’s draft recommendations say.

  • Modeling studies showed a small increase in the number of deaths averted when moving from biennial to annual mammography, but a large increase in harm.

The task force found insufficient evidence to recommend routine mammography after age 74.

It also looked at three-dimensional mammography (tomosynthesis) and additional approaches for screening women with dense breasts and found there was not enough scientific evidence to issue guidance.

Dr. Guillermo Arbona, a radiologist with the group that provides radiology services to the Mount Carmel Health System, said he’s interested in following the evolving science and accepts that recommendations could change with time. But for now, he stands by routine mammography every year starting at 40.

“We see quite a few women in the 40-to-49 age group who do get benefit,” Arbona said.

Over-diagnosis is real, and it’s a legitimate concern, but it’s hard to see how that eclipses the benefit when you do find cancer that could have ended a woman’s life, he said.

Patel said women ultimately should make their own choices about what is best for them, but she worries that conflicting advice will be confusing.

Dr. Lauren Miller, of Riverside Radiology and Interventional Associations, also objects to the draft task-force guidance and expressed similar worries about confusion. She said plenty of science supports mammograms earlier and every year.

Arbona agreed that confusion is bound to arise, but that differing opinions are bound to increase conversations that in the long term can advance medicine.

Said Visco: “We shouldn’t be worried about confusing women. We should be worried about whether we’re telling them the truth or not.”

The public has four weeks to offer input to the task force before the group begins to finalize its recommendations.

To read the full recommendations, go


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