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Great Debate Live: Breast cancer screening

A discussion between Reuters and cancer screening specialists

Please join us at 12pm ET on Tuesday for this live discussion. Full details at blogs.reuters.com

by Reuters_Health 11/16/2009 9:26:23 PM
Reader comment: These guidlines just go to show that as our governemnt take a step towards socialized medicine those with money will get the test and those who do not will not. These preventative guidelines just give the governement and insurance industry a reason not to pay for tests. Those with money will continue to receive those without will not. All research that comes out of countries with government run healthcare focus on disproving diagnostic testing. Not because it harms patients or not needed, it because they want to save money(just like the UK). To elimated or discourage self breast exams becasue we don't want to do unnecessary testing is unreal. You can take numbers arrange and interpret them on paper anyway you want to manipulate people in to believe something. How is this good patient care?

by Chastity McCleary edited by Reuters_Health 11/17/2009 4:28:02 PM
@Reuters_Health Are there other tests or screenings that younger women can get for breast cancer? #mammography #breastcancer

by RMZFarrell via twitter 11/17/2009 4:40:07 PM
We'll be opening up the call line shortly if you want to listen in

by Reuters_Health 11/17/2009 4:56:01 PM
Or you can follow the live blog here

by Reuters_Health 11/17/2009 4:56:40 PM
Reuters Health editor Ivan Oransky is welcoming everyone to the call

by Reuters_Health 11/17/2009 5:01:52 PM
Sweeping new breast cancer guidelines released yesterday. Story is here: www.reuters.com

by Reuters_Health 11/17/2009 5:02:52 PM
On the call today is Heidi Nelson, who led the review

by Reuters_Health 11/17/2009 5:03:11 PM
Also Daniel B. Kopans, professor of radiology at Harvard Medical School and director of breast imaging at the Massachusetts General Hospital.

by Reuters_Health 11/17/2009 5:03:40 PM
Maggie Fox, Reuters editor for health & science, is also on the call

by Reuters_Health 11/17/2009 5:04:02 PM
Ivan: What do these new guidelines say?

by Reuters_Health 11/17/2009 5:04:15 PM
Nelson: The big change is the age. What we're talking about here is the mammograms for women who have no symptoms or findings. That's different from someone coming to physician with findings.

by Reuters_Health 11/17/2009 5:04:57 PM
What has changed is the understanding of when to start that routine of screening.

by Reuters_Health 11/17/2009 5:05:18 PM
The language has changed to a discussion of the benefits and harms

by Reuters_Health 11/17/2009 5:05:32 PM
Kopans says guidelines are more emphatic: don't get screening

by Reuters_Health 11/17/2009 5:05:50 PM
Kopans: There was no-one on taskforce that has any direct experience of screening. I would point out that the taskforce said no screening for women in their 40s.

by Reuters_Health 11/17/2009 5:06:25 PM
What I would like to know is what are they advising women in their 40s? It sounds like they're saying wait until they have a cancer they can no longer ignore.

by Reuters_Health 11/17/2009 5:06:48 PM
Nelson: I'm not on the taskforce, I'm trying to help you read what they've written. Regarding clinical breast exam, that a clinician does on a routine basis, they gave that rating an "i". That's not a yes or a no, but a placeholder.

by Reuters_Health 11/17/2009 5:08:10 PM
Oransky: Tell us about the taskforce and how what you do feeds into what they do.

by Reuters_Health 11/17/2009 5:08:28 PM
Nelson: They're not a government panel. They rotate every three years. They systematically review the evidence looking at the effectiveness of different ...

by Reuters_Health 11/17/2009 5:09:28 PM
Nelson: We lay out the evidence and then step back. I have nothing to do with actual recommendations..

by Reuters_Health 11/17/2009 5:09:43 PM
The evidence I hope isn't too controversial

by Reuters_Health 11/17/2009 5:10:03 PM
Kopans: You can show me no trial to show that something changes at age 50

by Reuters_Health 11/17/2009 5:10:31 PM
The task force actually stated that there is a clear benefit for screening women in their 40s. I can find nowhere that they looked at evidence from Netherlands and Sweden that when you introduce screening there are clear data that the death rate goes down

by Reuters_Health 11/17/2009 5:11:37 PM
The task force doesn't even mention that data. They use computer modeling. There are other models that disagree with the models they use.

by Reuters_Health 11/17/2009 5:12:04 PM
Fox suggesting this is getting too technical. Let's discuss how we got to the recommendations.

by Reuters_Health 11/17/2009 5:12:31 PM
Fox: Does anything change at 50? Why 50?

by Reuters_Health 11/17/2009 5:12:50 PM
Nelson: We force the data into those decade groups and those for the 40s are the same for the 50s. We get a 15 pct reduction in mortality for women in 40s and 50s.

by Reuters_Health 11/17/2009 5:13:35 PM
So we do see strong effect across all ages

by Reuters_Health 11/17/2009 5:13:45 PM
Kopans: the conservative estimate you've used is the lowest of the lows. randomized control trials underestimate benefits of screening. women in control group can only be invited to be screened.

by Reuters_Health 11/17/2009 5:14:17 PM
such trials give you lowest estimate of benefit of screening. what happens when you go outside the trials? where it has been introduced into the general population, the death rate has dropped dramatically.

by Reuters_Health 11/17/2009 5:15:07 PM
Death rate in US down 30 percent. Task force admits in its paper that death rate has declined highest among women in their 40s.

by Reuters_Health 11/17/2009 5:15:37 PM
Interesting dynamic: Nelson, woman, against vs. Kopans, man, for routine mammo in 40-yo #mammography

by murzee via twitter 11/17/2009 5:16:06 PM
Nelson: I think randomized control trials strengthen the finding.

by Reuters_Health 11/17/2009 5:16:17 PM
The task force went on to commission modelling studies.

by Reuters_Health 11/17/2009 5:17:40 PM
The reason for taking it on to a model is because a lot of questions weren't answered in the trials

by Reuters_Health 11/17/2009 5:17:55 PM
Kopans: We still haven't had an answer on why use computer models not studies showing benefits when introduced in general population?

by Reuters_Health 11/17/2009 5:18:40 PM
Oransky: last guidelines were 2002. We're getting to some meaty questions of evidence. We need for our users to ask is there something that has changed since then? Is it a regular review?

by Reuters_Health 11/17/2009 5:19:39 PM
Nelson: This is an update of that work. They wanted to focus on fuzzy issues of when to stop and when to start. New trial in UK on women in their 40s.

by Reuters_Health 11/17/2009 5:20:05 PM
Kopans: Age trial in UK was shown to be nonsense. Author has repudiated it.

by Reuters_Health 11/17/2009 5:20:38 PM
It missed 25 pct of breast cancers.

by Reuters_Health 11/17/2009 5:21:03 PM
They basically missed a huge number of cancers. The age trial adds nothing.

by Reuters_Health 11/17/2009 5:21:20 PM
Nothing has actually changed since 1997 when National Cancer Institute recognized the data clearly showed a benefit for women in their 40s.

by Reuters_Health 11/17/2009 5:21:44 PM
Now we're going back to 1993 with the same arguments.

by Reuters_Health 11/17/2009 5:21:51 PM
Fox: What should women in their 40s be doing?

by Reuters_Health 11/17/2009 5:22:06 PM

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