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Breast Cancer Rate in the U.S. is No Longer Declining

A wor­risome report on breast cancer trends in the U.S. appeared on-​​​​line today, ahead of print in an AACR journal, Cancer Epi­demi­ology, Bio­markers & Prevention.

The analysis, based on the NCI’s SEER data from 2000 — 2007, shows that the inci­dence of breast cancer in the U.S. is no longer declining. (A drop after 2002 in BC inci­dence is gen­erally attributed to an abrupt reduction in HRT around that time.)

Since 2003 the overall BC rate has been steady overall, with a few exceptions:

The inci­dence of BC in non-​​​​Hispanic white women ages 60–69 rose by 4.8% in this period. “It remains to be seen if this trend will con­tinue,” according to the study authors.

Among white women ages 40–49 rates of estrogen receptor (ER) pos­itive (ER+) breast cancer sig­nif­i­cantly increased by an average of 2.7% per year during this period. In con­trast, the rate of ER– breast tumors decreased,

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New Numbers Should Factor Into the Mammography Equation

On Friday the New York Times reported that sur­geons are per­forming far too many open breast biopsies to evaluate abnormal mam­mogram results. A new American Journal of Surgery article ana­lyzed data for 172,342 out­pa­tient breast biopsies in the state of Florida. The main finding is that between 2003 and 2008, sur­geons per­formed open biopsies in an oper­ating room – as opposed to less invasive, safer biopsies with needles — in 30 percent of women with abnormal breast images.

I was truly sur­prised by this should-​​be out­dated sta­tistic, which further tips the mam­mog­raphy math equation in favor or screening.

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A Bit More on False Positives, Dec 2009, Part 1

Why bother, you might ask — wouldn’t it be easier to drop the subject? “Make it go away,” sang Sheryl Crow on her radi­ation ses­sions. I’ll answer as might a physician and board-​​certified oncol­ogist who happens to be a BC sur­vivor in her 40s: we need establish how often false pos­i­tives lead, in current practice, to addi­tional pro­ce­dures and inap­pro­priate treatment…These numbers matter. They’re essential to the claim that the risks of breast cancer screening out­weigh the benefits.

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Getting the Math on Mammograms

But con­sider — if the expert panel’s numbers are off just a bit, by as little as one or two more lives saved per 1904 women screened, the insurers could make a profit! By my cal­cu­lation, if one addi­tional woman at a cost of, say, $1 million, is saved among the screening group, the provider might break even. And if three women in the group are saved by the pro­cedure, the decision gets easier… Now, imagine the tech­nology has advanced, ever so slightly, that another four or five women are saved among the screening lot. How could anyone, even with a profit motive, elect not to screen those 2000 women?

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