Sunday, April 13, 2014


Today I read the NY Times article VAST STUDY CASTS DOUBT ON THE VALUE OF MAMMOGRAMS.  It gave me a few confused moments.  

It credits the BMJ editorial published with the study with saying that earlier pro-mammogram studies were done "before the routine use of drugs like Tamoxifen sharply reduced the breast cancer death rate."  

My research didn't impress me with a huge Tamoxifn reduction in eventual death rate.  Also, I was in a room with a small group of strangers for a hospital edu/lunch when one woman announced:  "I took the Tamoxifen and my cancer came back."   Since I was just starting Tamoxifen, that didn't make me want my lunch.

Of course my main interest is DCIS treatment.  The Times also quotes Dr. Anthony B. Miller, the lead author of the paper.  He insisted that there would have been more false diagnosis if the study had included DCIS.  The one thing I learned from Dr. Miller is, "' ...D.C.I.S. is found only with mammography,"'   

 Yes, I've read about autopsied women found with DCIS that had never grown or metastasized.  We don't know their ages.  We don't know what would have happened in the breast in a year, if something else hadn't killed them.  

But there are some things we do know.  Including what I saw in my pathology report after lumpectomy:

Margins of resection - negative

Number of blocks with DCIS 3 - (I checked with my surgeon; it was in more than one duct)
Estrogen receptor
Nuclear grade 3    

Nuclear grade 3, how the nucleus looks, is the punch line! Mayo Clinic Breast Books says:  ". . . 3 represents marked variation between normal and cancerous cells."  They also say, "High grade tumors have a higher rate of recurrence."

As I've said before, grade 3 plus hormone receptor made me sure I'd be getting radiation and years of pills.  Or else?  The doctor recommended talking to the radiation oncologist and the medical oncologist.  I talked.  I got radiated.  I take the Tamoxifen pills.  They aren't wonderful - my feet are swelling, and I'm not a bundle of energy or cheer.  

I'm alive.  And thanks to that pathology report, I don't think my mammogram was a mistake.

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