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Dear Grace, Thank you for what you have shared, my daughter is also threatened by the predictors. I would like to see your publication. I appreciate the wisdom and grace with which you have shared and the accuracy with which you have captured the threat and yet have moved forward in science, simply and elegantly stating things as they are. I hope that that the answers are explicated and put into practice in your lifetime. Be Well Amy From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Willard, Grace Sent: 21 December 2011 03:59 PM To: [log in to unmask] Subject: Re: Breast tumours Hello all, I am going to speak from three foci. One as a registered nurse who has taken care of patients who are diagnosed with and treated for breast cancer. Two, as a nurse scientist who studies all aspects of breast cancer, as well as other areas of healthcare concern. And three, and probably most importantly to me, right now, as a person with a recurrence of advanced stage breast cancer. And, interestingly, both diagnoses were found serendipitously - not because I didn't have mammograms done, but because I had "interim" tests done for another screening, when the cancerous cells were "seen". I have many comments about this thread, but have received some interest in a publication related to this, so am not going to bore you with ALL my thoughts and info; besides this response would be way tooo long by then. Primarily, my comment relates to all three of these roles: it isn't so much the discovery of the breast cancer nodes that is as important as the importance of recognizing that each of those discovered nodes very likely has yet to be undiscovered cells, and those cells grow to be discovered - and that is when we are diagnosed, treated, and scared. It is akin to the "just noticeable difference" that we discuss in some measurement methods. We have to look in different ways, and harder for those cells - or other markers - that are not yet seen but that could be predictors. We absolutely need more specific and precise methods of discovery of all kinds of cancer cells. FYI for those of you that may not know, there is a large scale study going on right now in the US called "The Sister Study". The study examines number of variables that would help identify people who have a higher probability of "getting" cancer; hopefully, some markers may be identified from this project. The study follows a large cohort of women who are sisters of women who have been diagnosed with BC. This has been ongoing for some time now, and we may see some preliminary results soon. Klim, I strongly agree - we need to garner the support for erring on the side of over testing, (as opposed to over diagnosis). Folks, let's keep talking about this issue from both a scientific approach as well as a patient-centered approach. Thanks for the thread, and for listening. Everyone, have a wonderful Holiday season. Grace //Dr. W. In the process of knowledge discovery, what is known about a concept must be qualified to ensure understanding before that concept can be used for making judgements or conclusions. Thus, concepts must be examined for their characteristics and usage, with the goals of common understanding, consistent communication and theory development in mind (Rodgers & Knafl, 2000). Senior Research Scientist Academic Center for Evidence-Based Practice School of Nursing University of Texas Health Science Center at San Antonio 210-567-5879 www.isrn.net Plan to attend: SUMMER INSTITUTE ON EVIDENCE-BASED PRACTICE July 19-21, 2012; Pre-Conferences: July 18, 2012 at the Grand Hyatt Hotel, San Antonio, TX IMPROVEMENT SCIENCE SUMMIT July 17-18, 2012 at the Grand Hyatt Hotel, San Antonio, TX Knowledge workers spend up to 2.5 hours each day looking for information... but find what they are looking for only 40% of the time. KS Taylor, 2002 From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Dr. Amy Price Sent: Wednesday, December 21, 2011 2:20 PM To: [log in to unmask] Subject: Re: Breast tumours Klim, I see what you mean...Do you think if women were more accurately informed to build acceptance along with the screenings as a public health service for 2-3 years and if RR etc was taught in school health classes and a public information with decision aids was offered that this could build a bridge. I think once women get past the emotion they would want to know and would be more accepting of improved diagnostics? Amy From: Klim McPherson [mailto:[log in to unmask]] Sent: 21 December 2011 03:10 PM To: Dr. Amy Price; [log in to unmask] Subject: Re: Breast tumours Amy, I am sure a research protocol to render a test more specific about intrinsic malignancy could be devised. However the basic problem here is that screening carries so much face validity and therefore so much 'emotional' support that to devise and institute such a protocol is hindered by the need to explicitly acknowledge the possible existence of over diagnosis, over and above the issues associated with DCIS. Thus to do so has a certain heretic component that does not, and will not, help. First we need a greater degree of acceptance of the need to do so. Klim From: "Dr. Amy Price" <[log in to unmask]> Date: Wed, 21 Dec 2011 19:19:38 +0000 To: Klim McPherson <[log in to unmask]>, "[log in to unmask]" <[log in to unmask]> Subject: RE: Breast tumours Klim, It was your initial response that kept me thinking and returned me to the land of reason. I wonder if it would be worth using markers and tracking the cells overtime with a segment of the population. Klim what would you envision as strategies to solving this complexity? Andy, I really appreciate both the breast and prostate decision aids, these are the best I have seen...great work I like how you have explained the risk factors and the graph is outstanding without being overwhelming. Paul, these papers are excellent and I learned a lot from reading them that I hope to apply later! Jo, The lawyers information site was surprisingly informative maybe it is time to merge all for a blog article Thanks to all for your help and understanding, You are awesome Best, Amy From: Evidence based health (EBH) [mailto:[log in to unmask]] On Behalf Of Klim McPherson Sent: 21 December 2011 06:02 AM To: [log in to unmask] Subject: Re: Breast tumours Amy, The whole current controversy surrounding mammography centres on the issue of overdiagnosis. Does it exist if so how common is it? Without doubt removing tumours is much better than not and the earlier the clinical stage the better the survival experience - again without doubt. The evidence is overwhelming. But the question is are there some tumours for which treatment is unnecessary - to which the answer is probably yes, and there may be many. But deciding which is not anywhere near reliable enough right now. Hence the controversy. In my view the guidelines are woefully inadequate and I think women are not given anything like enough information to take proper decisions on an impossible question. That however is no excuse in my view. Klim Klim McPherson MA Phd FFPH FMedSci Visiting Professor of Public Health Epidemiology Nuffield Dept Obstetrics & Gynaecology Emeritus Fellow of New College University of Oxford Mobile 07711335993 From: "Dr. Amy Price" <[log in to unmask]> Reply-To: "Dr. Amy Price" <[log in to unmask]> Date: Wed, 21 Dec 2011 00:39:20 +0000 To: "[log in to unmask]" <[log in to unmask]> Subject: Breast tumours Dear all, Does anyone know how to find out if people who have breast cancers removed have a higher longer survival rate than those who do not? The question was raised that perhaps those with lesions and successful surgery could have perhaps left them in there with no ill results? The thinking was that if it is cancer within a set number of years they will die anyway with or without intervention. I was too emotionally invested to look at this clearly initially however wilful ignorance does not solve problems but can be a source of alienation. What evidence is there that screening and consequent treatment is not helpful? I do understand that mass screening may be a waste of resources in terms of numbers needed to treat but it seems that the suggested guidelines seem to be evidence starved as well. Many thanks if someone could direct me to helpful links in this area. Best, Amy Amy Price PhD Http://empower2go.org Building Brain Potential