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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]<mailto:[log in to unmask]>> Date: Wed, 21 Dec 2011 19:19:38 +0000 To: Klim McPherson <[log in to unmask]<mailto:[log in to unmask]>>, "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[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]<mailto:[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]<mailto:[log in to unmask]>> Reply-To: "Dr. Amy Price" <[log in to unmask]<mailto:[log in to unmask]>> Date: Wed, 21 Dec 2011 00:39:20 +0000 To: "[log in to unmask]<mailto:[log in to unmask]>" <[log in to unmask]<mailto:[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