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Welcome! This is the place I write about Things I Notice in my daily walkabouts as well as what I might think about things in my world.

Dr. Welch from Dartmouth Says Mammograms Aren't Necessary - I Say - Bull Pucky To Him

DAY 17. Today I woke up at five (slept in!!) and started the day by getting the kids stuff ready for school and then I took today's photo out the back door. Then meds for Diane. Still lots of pain but throughout the day, she got much better. The doctors got together and for right now, we have a SAVI procedure planned for Thursday. I didn't hear properly when the surgeon's rep was talking about this yesterday. I thought she said, "Stabbie" but she really said SAVI which is med talk for Strut Adjusted Volume Implant. It looks like a whisk. Anyway, they put that inside where the catheter currently is and then use the SAVI for local radiation. We also go for an acupuncture treatment on Thursday (Diane, not me). Then on Friday, a radiation CT simulation (whatever that is) and a surgery post-op. Then on Monday, she starts radiation for five days in a row, twice a day.Early in the morning today, I opened the Wall Street Journal and found a half page op-ed about why women don't need mammograms. I was amazed. But then, I amaze easily and one of my colleagues thinks I may be a drama queen. Howsomever,  the author is Dr. H. Gilbert Welch from Dartmouth. I read his article, put the paper down and quietly thought for a while, and then...I wrote him at Dartmouth and I wrote the Wall Street Journal. This is what I wrote, feel free to comment.Sunrise In My Backyard Early This MorningDear Wall Street Journal,My first reaction when reading Dr. Welch’s editorial in the Wall Street Journal today (2/29/13) was saddened disbelief that a trained physician-educator in a world leadership position is doing his best to disrupt the education and treatment processes for breast cancer. His position, and I paraphrase here, is: mammograms are not necessary because treatment for breast cancer is now so good, early detection only serves a very small number of women.The numbers he uses to justify this position: only one death per 1,339 tests will be prevented by mammograms in women aged 50-59, and, only one death in 377 tests in women 60-69. Only one in 377? Only one in 1,339? He affirms his arguments based on the numbers of false positives: 86.6 out of a THOUSAND in women aged 50-59 and 79 out of a thousand in women aged 60-69. He tells us that 75-90% are over diagnosed or would have been successfully treated if caught later. Even as I write this I find myself in absolute disbelief and shock at the arrogance, insensitivity, and gender bigotry espoused in his essay. Probably his book, too. I haven’t read the book but I think I’ll head to the library to check out a copy.But what about the other side of the numbers? That means that 10-25% of diagnosed patients would have fared better had they been treated earlier. Most women, more than 90% do NOT have false positives. Mammograms have saved one woman for every 1,339 and 377 screenings (ages 50-69) and the number of women entering that age group is increasing logarithmically. Dr. Welch’s detractors say his numbers are outdated and don’t account for the time factor during treatment. I contend updated numbers aren’t required because his argument rings hollow even using his own numbers..Approximately 37 million women receive mammograms every year (Forbes.com, “Too Many Mammograms, Langreth, 11/16/09.)  Dr. Welch’s position is that the small number of breast cancers that are detected by a screening mammography, and, whose treatment outcome improves as a result of earlier detection, is only between 3% and 13%. He contends that screening mammograms produce no benefit to any of the remaining 87% to 97% of women. I read this to mean that given a population of 100 women whose cancer was discovered by mammogram, some number of them, between 3 and 13, would benefit from early detection. That seems like a large number.Yes there are false positives and yes the false positives cause angst and additional treatment and yes the follow up exams are inconvenient and uncomfortable. And yes, this is probably the heart of the matter, health care costs go up. Which, I posit, is probably why a policy wonk is trying to drive away the acceptance of routine mammograms that will eventually turn into a campaign to deny screenings except in known, high risk cases. Momentum is increasing in congress, health policy wonks, and the media to change the policy and eventually limit access to mammograms. I am sure some insurance company somewhere has done a cost-benefit-analysis and found that performing a mastectomy in later stage breast cancer is cheaper than the current process of early detection and treatment since only a fraction of women being screened actually are diagnosed with cancer. Does that position mean that most women should not have mammograms because most women that do the screening don’t have cancer?But this is is human science. Odds do make a difference. My wife is one whose cancer was aggressive but was detected early through a mammogram. From a world science, statistical standpoint, she was one of those in the “1 in 1377” who might have died without early detection. To her, to me, to her family and friends, that small number one is a huge human statistic.Breast cancer is certainly not just medical practice; because the occurrence of breast cancer is so high and the chances of survival are clearly enhanced by early detection—this cannot be just about the science. Raising public awareness is a process that includes campaigns for self-examination, routine mammograms, and medical consultation and most of all, educated communication among all peoples and disciplines. The science should not discourage or stop medical examinations that have some flaws but rather improve the technology, the diagnostics, the radiology training, the entire process.Dr. Welch comes off as a male-centric, statistics-oriented care provider whose first rush is to gamble someone else’s survival based on numbers that tell that tale he wants told--lower costs because the lives lost are statistically insignificant. My wife certainly may have been one of those statistics. Sad.

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