Robert M. Centor, MD; Reem A. Mustafa, MD, MPH, PhD
Disclosures: Dr. Centor has disclosed the following: Honoraria: Medscape. Dr. Mustafa has disclosed the following: Employment: University of Kansas Medical Center. Research grants/contracts: Patient-Centered Outcomes Research Institute, American Society of Hematology, American College of Radiology. Honoraria: Institute for Clinical and Economic Review.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Audio. Annals On Call - Making Sense of Breast Cancer Screening Guidelines: Dr. Centor discusses screening for breast cancer with Dr. Reem A. Mustafa of the University of Kansas.
Other Audio Options: Download MP3
Richard M Fleming, PhD, MD, JD
October 17, 2019
Does someone have cancer? – This really isn’t a yes-no question.
For decades we have been running screening tests looking for cancer, allowing physicians to make an educated guess as to whether we think you do or don’t have cancer. If we think the patient might have cancer, then we run more tests to find out. Alternatively, if we think the patient probably doesn’t have cancer, we wait –so too does the patient and their family. The entire concept of using screening tests is archaic and anything but comfortable if you’re the patient. The acceptance of screening tests is primarily based on the use of qualitative tests – tests that we look at, or blood tests. Is there something on the stool guaiac? Is it blood, iron, too much pepto bismol? Is the PSA elevated? Is it prostate cancer, prostatitis, BPH, too much exercise? In keeping with October - Breast Cancer Awareness month – the question becomes, just what is that questionable area on the mammogram – is it calcium, dense tissue, inflammation, cancer or nothing?The process of developing cancer is not an overnight, yes - no phenomena; although that is how we’ve been treating it . Cancer is the result of the interaction between the genetics of a cell – which is unique for each individual – and the cellular environment. That cellular environment is similarly unique and is the result of the air you breathe, the food you eat, the oxidative stress your body is experiencing at the moment, is there infection, et cetera . Rather than using a qualitative screening approach, with the associated problems with sensitivity (we missed your disease) and specificity (we told you there was a problem when there wasn’t), and the resulting personal, psychological, physical, financial, family, work costs – if we’re really interested in informed decision making, we should be focusing less on screening and more on actually measuring what’s happening in the body. It turns out that the changes which happen in the body leading to the development of both cancer and coronary artery disease, can now be measured by looking at changes in metabolism and regional blood flow . By being able to measure what’s actually happening, we can tell someone where on the health-spectrum he or she actually is [1,2]. We can measure whether their treatment is working – saving time, money and lives – thus providing true patient-specific, patient-guided treatment. By actually measuring what’s happening in each individual, we can do better than guess – we can make a truly informed decision and so can the patient.Acknowledgment: FMTVDM is issued to first author.References:1. Fleming RM, Fleming MR, Chaudhuri TK, McKusick A. Cancer: Our Body’s Global Warming Warning. Biomed Research. Open Acc J Oncol Med 2019;3(1):238-239. DOI: 10.32474/OAJOM.2019.03.000154 2. Fleming RM, Fleming MR. The Importance of Thinking about and Quantifying Disease like Cancer and Heart Disease on a “Health-Spectrum” Continuum. J Compr Cancer Rep 2019;3(1):1-3 (Article ID 100011). 3. Fleming RM, Fleming MR, Chaudhuri TK. The Similarities in Coronary Artery Disease and Cancer. Acta Scientific Med Sci. 2019;Special Issue 1:03-04. DOI:10.31080/ASMS.2019.S01.0002.
Centor RM, Mustafa RA. Annals On Call - Making Sense of Breast Cancer Screening Guidelines. Ann Intern Med. 2019;171:OC1. doi: https://doi.org/10.7326/A19-0015
Download citation file:
Published: Ann Intern Med. 2019;171(8):OC1.
Breast Cancer, Cancer Screening/Prevention, Hematology/Oncology, Prevention/Screening.
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use