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County offering breast exams for uninsured women

Original post made on Oct 26, 2012

Uninsured women in Contra Costa County can take advantage of free breast exams and mammograms at health centers throughout the county on Thursday as Breast Cancer Awareness Month draws to a close.

Read the full story here Web Link posted Monday, October 22, 2012, 3:14 PM

Comments (20)

Posted by Anna, a resident of Walnut Creek
on Oct 26, 2012 at 12:07 pm

Everyone knows from listening to Obama etc that we can get a free mammogram via planned parenthood ANYtime----another Obama lie.


Posted by Dave, a resident of Danville
on Oct 26, 2012 at 1:16 pm

Well, Anna, what "everyone knows" may not be what President Obama actually said. He didn't say that women can get free mammograms at Planned Parenthood. What he said was that many women rely on Planned Parenthood for mammograms. And that is true.

To be more precise, women can obtain breast exams at Planned Parenthood and, then, if necessary get a referral to a medical facility that does mammograms -- much like a doctor would make a referral to a radiology center for an x-ray. In addition, Planned Parenthood sometimes helps lower-income women find grants or other funding sources to help pay for the mammograms. Or sometimes it sponsors mammograms on a particular day with a mobile mammography van.

In any event, Planned Parenthood provides a worthy service in this area, one that many women undoubtedly rely on. Here's a link to the FactCheck.org page that sets the facts out: Web Link

Some news sources are careless about the facts. It's usually better to check the facts before just repeating misinformation.


Posted by JRM, a resident of Vista Grande Elementary School
on Oct 26, 2012 at 1:27 pm

To Anna-
The National Breast Cancer Prevention Act enabled all insured women to access screening mammograms without a physician's referral and without any out of pocket co-pay expenses. This was passed by Democrats as well as Republicans. The County is offering this service to UNINSURED women, or at least to the first 40 who show up.
It has nothing to do with Planned Parenthood or President Obama. All clinical research shows early detection is key to successful treatment and/or intervention. Your ignorant hateful rant is so far off base it is amazing, in particular coming from a female. All you tea party haters are going to have to find something else to rail against after the next election, I am sooo glad the tea party nit wits are losing support in almost every corner of the nation. Why you would knock a lifesaving health screening is beyond me and defies all logic.


Posted by Bayareamom, a resident of Danville
on Oct 26, 2012 at 5:00 pm

JRM,

You may want to do a bit more research:

Web Link

SNIP:

Mammography screening and breast cancer mortality in Sweden.
Autier P, Koechlin A, Smans M, Vatten L, Boniol M.
Source

International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France. philippe.autier@i-pri.org
Abstract

BACKGROUND:

Swedish women aged 40-69 years were gradually offered regular mammography screening since 1974, and nationwide coverage was achieved in 1997. We hypothesized that this gradual implementation of breast cancer screening would be reflected in county-specific mortality patterns during the last 20 years.

METHODS:

Using data from the Swedish Board of Health and Welfare from 1960 to 2009, we used joinpoint regression to analyze breast cancer mortality trends in women aged 40 years and older (1,286,000 women in 1995-1996). Poisson regression models were used to compare observed mortality trends with expected trends if screening had resulted in breast cancer mortality reductions of 10%, 20%, or 30% among women screened during 18 years of follow-up after the introduction of screening. All statistical tests were two-sided.

RESULTS:

From 1972 to 2009, breast cancer mortality rates in Swedish women aged 40 years and older declined by 0.98% annually, from 68.4 to 42.8 per 100,000, and it continuously declined in 14 of the 21 Swedish counties. In three counties, breast cancer mortality declined sharply during or soon after the implementation of screening; in two counties, a steep decline started at least 5 years after screening was introduced; and in two counties, breast cancer mortality increased after screening started. In counties in which screening started in 1974-1978, mortality trends during the next 18 years were similar to those before screening started, and in counties in which screening started in 1986-1987, mortality increased by approximately 12% (P = .007) after the introduction of screening compared with previous trends. In counties in which screening started in 1987-1988 and in 1989-1990, mortality declined by approximately 5% (P = .001) and 8% (P < .001), respectively, after the introduction of screening. Conclusion County-specific mortality statistics in Sweden are consistent with studies that have reported limited or no impact of screening on mortality from breast cancer."

Link: Web Link

SNIP:

"..."Our analysis found no or limited influence of mammography screening on breast cancer mortality," said Dr. Philippe Autier, at the International Prevention Research Institute in Lyon, France. The report is published July 17 in the Journal of The National Cancer Institute..."

Link: Web Link

SNIP:

..."Because the cumulative incidence among controls did not reach that of the screened group, we believe that many invasive breast cancers detected by repeated mammography screening do not persist to be detected by screening at the end of 6 years, suggesting that the natural course of many of the screen-detected invasive breast cancers is to spontaneously regress."

Link: Web Link

SNIP:

..."Why Getting a Mammogram Can be a Risky Decision

The long-held conventional medical advice has been for women to get an annual mammogram once they hit 40. A couple of years ago, the U.S. Preventive Services Task Force decided to alter their mammogram recommendation, advising women under the age of 50 to avoid mammograms, and limit them to every other year after the age of 50. The revision caused outrage among many cancer organizations. What was overlooked, however, was the reasoning behind the Task Force's decision to change their recommendation.

The prior advice was given in 2002, before a host of new research came out showing the problems of overdiagnosis, including false positives.

If a mammogram detects an abnormal spot in a woman's breast, the next step is typically a biopsy. This involves removing a small amount of tissue from the breast, which is then looked at by a pathologist under a microscope to determine if cancer is present. However, early stage cancer like ductal carcinoma in situ, or D.C.I.S., can be very hard to diagnose, and pathologists have a wide range of experience and expertise. There are actually NO universally agreed upon diagnostic standards for D.C.I.S., and there are no requirements that the pathologists doing the readings have specialized expertise...

Many conventional physicians view DCIS as "pre-cancerous" and argue that, because it could cause harm if left untreated it should be treated in the same aggressive manner as invasive cancer; however the rate at which DCIS progresses to invasive cancer is still largely unknown, with the weight of evidence suggesting it is significantly less than 50 percent -- perhaps as low as 2-4 percent.

This suggests that watchful waiting may be the more sensible approach, but most women are not informed of this option and instead go through invasive breast cancer treatments like surgery, radiation and toxic chemotherapy that often turns out to be unnecessary. As discussed above, it's really hard to justify harming 10 women with surgery and toxic chemotherapy treatment in order to possibly save the life of one woman ...

New York and Virginia followed the lead of Connecticut and Texas and recently passed laws requiring women with dense breasts to be informed they may need to seek alternative screening methods. The Federal Breast Density Bill is (HR 3102) is also currently being considered.

Mammography and its subsequent tests, such as MRIs and stereotactic (x-ray guided) biopsies, likely contribute to cancer because of the cumulative radiation exposure that occurs over a lifetime and the particularly radiation-sensitive nature of breast cells, e.g. BRCA1/2 genes confer greater risk for breast cancer, in part, because they interfere with the repair of radiation-induced DNA damage. Even the National Cancer Institute states that "repeated x-rays have the potential to cause cancer."


Posted by Diane, a resident of Danville
on Oct 26, 2012 at 6:01 pm

and yet, bayareamom, my sister's life was saved when a very small (unpalpable) tumor appeared on a mammogram. As she was very young when diagnosed, my sisters and I have been getting mammograms since we were 40, every year. This is supported by every breast cancer specialist I have meet with.

To me, the bottom line is that though the efficacy of annual mammograms may be unclear, shouldn't women (including low income women), have the right to make decisions for themselves regarding that risk?


Posted by Bayareamom, a resident of Danville
on Oct 26, 2012 at 6:37 pm

I've been doing medical research for some 20 years, now (I'm a former legal researcher). There is SO much I could say here re: this topic, but there's just not enough time (or space). Of COURSE, this is an issue women need to make for themselves. I don't believe I've stated anything to the contrary, in my above post.

The bottom line is, there ARE indeed, risks to repeated x-rays. X-rays DO have the POTENTIAL to cause cancer, as the National Cancer Institute states.

Diane, have you read ALL the articles relative to the links I've provided, above? There are other less damaging diagnostic tests that can be used, instead.

Example:

Link: Web Link

SNIP:

The Case Against Mammography

..."Health officials recommend that all women over 40 get a mammogram every one to two years, yet there is no solid evidence that mammograms save lives, and the benefits of mammograms are controversial at best.

Meanwhile, the health hazards of mammography have been well established.

John Gofman, M.D., Ph.D. – a nuclear physicist and a medical doctor, and one of the leading experts in the world on the dangers of radiation – presents compelling evidence in his book, Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease, that over 50 percent of the death-rate from cancer is in fact induced by x-rays.

Now consider the fact that the routine practice of taking four films of each breast annually results in approximately 1 rad (radiation absorbed dose) exposure, which is about 1,000 times greater than that from a chest x-ray."

Even the American Cancer Society lists high-dose radiation to the chest as a medium to high risk factor for developing cancer..."

SNIP:

Thermographic Breast Screening – A Safer, More Effective Alternative

..."Most physicians continue to recommend mammograms for fear of being sued by a woman who develops breast cancer after he did not advise her to get one. But I encourage you to think for yourself and consider safer, more effective alternatives to mammograms.

The option for breast screening that I most highly recommend is called thermographic breast screening.

Thermographic screening is brilliantly simple. It measures the radiation of infrared heat from your body and translates this information into anatomical images. Your normal blood circulation is under the control of your autonomic nervous system, which governs your body functions.

Thermography uses no mechanical pressure or ionizing radiation, and can detect signs of breast cancer as much as 10 years earlier than either mammography or a physical exam!

Whereas mammography cannot detect a tumor until after it has been growing for years and reaches a certain size, thermography is able to detect the possibility of breast cancer much earlier.

It can even detect the potential for cancer before any tumors have formed because it can image the early stages of angiogenesis -- the formation of a direct supply of blood to cancer cells, which is a necessary step before they can grow into tumors of size.

More men's lives could also be spared from the disease as mammography is not frequently used on men, which leads to most men with breast cancer being diagnosed at a very late stage..."


Posted by Diane, a resident of Danville
on Oct 26, 2012 at 8:56 pm

Bayareamom, I have not read all of the articles that you have provided links to. Honestly, you are losing me with your comments on thermography. I have heard of it and understand it is considered controversial at best, and not as accurate as a mammogram in breast cancer screening.

You clearly have put much energy in to posting your opinions around this subject and I appreciate that. However, for now I will stick with the advice of the clinical professionals that are part of my health care team. Back to the purpose of this article - I am grateful that low income women (at least 40 of them...) will have the opportunity to receive screening that may save their lives.


Posted by Citizen Paine, a resident of Danville
on Oct 27, 2012 at 6:51 am

Diane, you are a breath of fresh air in the Town dump.


Posted by Bayareamom, a resident of Danville
on Oct 27, 2012 at 1:49 pm

I understand your personal investment regarding this issue, really - I do.

But as I've learned in the past, it's best to keep your mind open like a parachute - it works best that way.

The fact that you have CHOSEN to refrain from reading my links, says a lot about your frame of reference. I realize it's a little frightening to do some of your own research and perhaps, find that small reality that may alter your framework of belief.

Physicians are fallible, just as with the rest of us. Science NEVER STOPS. Learning takes precedent - or should - as a rule of thumb. There was a time when the belief system held by most individuals was that the earth was flat. Later, much later, it was discovered that indeed, this was not the case.

I would encourage you to broaden your scope and breadth of knowledge and continue to do more research.

You may be glad you did.

My very best to you.


Posted by Bayareamom, a resident of Danville
on Oct 27, 2012 at 1:50 pm

Citizen,

Sometimes, jewels are found in those 'dumps.' But you are certainly free to your opinion.


Posted by Bayareamom, a resident of Danville
on Oct 27, 2012 at 1:58 pm

Here is a great link to the National Cancer Institute's statement regarding mammograms, etc.

Link: Web Link

SNIP:

..."What are some of the potential harms of screening mammograms?


Finding cancer early does not always reduce a woman's chance of dying from breast cancer. Even though mammograms can detect malignant tumors that cannot be felt, treating a small tumor does not always mean that the woman will not die from the cancer. A fast-growing or aggressive cancer may have already spread to other parts of the body before it is detected. Women with such tumors live a longer period of time knowing that they likely have a fatal disease.

In addition, screening mammograms may not help prolong the life of a woman who is suffering from other, more life-threatening health conditions.

False-negative results. False-negative results occur when mammograms appear normal even though breast cancer is present. Overall, screening mammograms miss about 20 percent of breast cancers that are present at the time of screening.

The main cause of false-negative results is high breast density. Breasts contain both dense tissue (i.e., glandular tissue and connective tissue, together known as fibroglandular tissue) and fatty tissue. Fatty tissue appears dark on a mammogram, whereas fibroglandular tissue appears as white areas. Because fibroglandular tissue and tumors have similar density, tumors can be harder to detect in women with denser breasts.

False-negative results occur more often among younger women than among older women because younger women are more likely to have dense breasts. As a woman ages, her breasts usually become more fatty, and false-negative results become less likely. False-negative results can lead to delays in treatment and a false sense of security for affected women.

False-positive results. False-positive results occur when radiologists decide mammograms are abnormal but no cancer is actually present. All abnormal mammograms should be followed up with additional testing (diagnostic mammograms, ultrasound, and/or biopsy) to determine whether cancer is present.

False-positive results are more common for younger women, women who have had previous breast biopsies, women with a family history of breast cancer, and women who are taking estrogen (for example, menopausal hormone therapy).

False-positive mammogram results can lead to anxiety and other forms of psychological distress in affected women. The additional testing required to rule out cancer can also be costly and time consuming and can cause physical discomfort.

Overdiagnosis and overtreatment. Screening mammograms can find cancers and cases of ductal carcinoma in situ (DCIS, a noninvasive tumor in which abnormal cells that may become cancerous build up in the lining of breast ducts) that need to be treated. However, they can also find cancers and cases of DCIS that will never cause symptoms or threaten a woman's life, leading to "overdiagnosis" of breast cancer. Treatment of these latter cancers and cases of DCIS is not needed and leads to "overtreatment." Overtreatment exposes women unnecessarily to the adverse effects associated with cancer therapy.

Because doctors often cannot distinguish cancers and cases of DCIS that need to be treated from those that do not, they are all treated.

Radiation exposure. Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is extremely low, but repeated x-rays have the potential to cause cancer. The benefits of mammography, however, nearly always outweigh the potential harm from the radiation exposure.."

AND:

"What other technologies are being developed for breast cancer screening?


NCI is supporting the development of several new technologies to detect breast tumors. This research ranges from methods being developed in research labs to those that are being studied in clinical trials. Efforts to improve conventional mammography include digital mammography, magnetic resonance imaging (MRI), positron emission tomography (PET) scanning, and diffuse optical tomography, which uses light instead of x-rays to create pictures of the breast.

Selected References

Mandelblatt JS, Cronin KA, Bailey S, et al. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Annals of Internal Medicine 2009;151(10):738-747. [PubMed Abstract]
Pisano ED, Gatsonis C, Hendrick E, et al. Diagnostic performance of digital versus film mammography for breast-cancer screening. New England Journal of Medicine 2005; 353(17):1773-1783. [PubMed Abstract]
Kerlikowske K, Hubbard RA, Miglioretti DL, et al. Comparative effectiveness of digital versus film-screen mammography in community practice in the United States: a cohort study. Annals of Internal Medicine 2011;155(8):493-502. [PubMed Abstract]


Posted by Diane, a resident of Danville
on Oct 27, 2012 at 6:30 pm

Bayareamom, I wish you the best as well. I haven't read all your links because I'm a busy working mom, and they are just too long and one sided. In earlier posts you advocated the use of thermography, but that screening modality is not one of those listed as supported by the NCI in your own recent post. I'm not sure where you stand, other than perhaps thinking that standard mammograms are not something you would choose to pursue for your own screening. I'm so glad you have the opportunity to make that decision, that I am free to make my decisions, and that other woman are given an opportunity to do the same regardless of their ability to pay (and I hope this opportunity in particular is expanded).

Citizen Paine, as always, right back at you. You know I'm your fan.


Posted by Bayareamom, a resident of Danville
on Oct 30, 2012 at 10:25 am

As with any medical procedure, everything carries risk. Simply put, weigh the benefits versus the risks re: mammograms, as you would with any other procedure.

Here is an article which I just found on mainstream news, this morning.

LINK: Web Link

SNIP:

"LONDON (AP) — Breast cancer screening for women over 50 saves lives, an independent panel in Britain has concluded, confirming findings in U.S. and other studies.
But that screening comes with a cost: The review found that for every life saved, roughly three other women were overdiagnosed, meaning they were unnecessarily treated for a cancer that would never have threatened their lives.
The expert panel was commissioned by Cancer Research U.K. and Britain's department of health and analyzed evidence from 11 trials in Canada, Sweden, the U.K. and the U.S.
In Britain, mammograms are usually offered to women aged 50 to 70 every three years as part of the state-funded breast cancer screening program.
Scientists said the British program saves about 1,300 women every year from dying of breast cancer while about 4,000 women are overdiagnosed. By that term, experts mean women treated for cancers that grow too slowly to ever put their lives at risk. This is different from another screening problem: false alarms, which occur when suspicious mammograms lead to biopsies and follow-up tests to rule out cancers that were not present. The study did not look at the false alarm rate.
"It's clear that screening saves lives," said Harpal Kumar, chief executive of Cancer Research U.K. "But some cancers will be treated that would never have caused any harm and unfortunately, we can't yet tell which cancers are harmful and which are not."


Posted by Momwithapurpose, a resident of Danville
on Oct 30, 2012 at 3:36 pm

As a 41 year old female with no family history of breast cancer, who just had the initial (first) mammogram, which found a stage 2 tumor in my breast and after surgical removal, the cancer was also in my lymph nodes, I support all forms of radiological means as early detection. I had put off getting my mammogram at 40 yrs, as I didn't think I was at risk. I am not overweight, eat a balanced diet and exercise regularly...everything one is supposed to do. Thus, to BayAreaMom and all of the folks on this string who don't support early detection at any rate, why don't you go to chemotherapy and radiation treatments with me!!!! The cost alone of my treatments plus a hospital stay due to neutropenia from the first round of chemotherapy far outweigh the cost of one mammogram every year. Plus, had I did get my first mammogram at 40 yrs, I may have had to endure less treatment. Thus, to all women out there, get a mammogram as you don't know until you are screened (even then screening doesn't find all cancers and may not find them for years)!! I wish the county could give more free screenings to uninsured women!


Posted by Derek, a resident of Danville
on Oct 30, 2012 at 3:47 pm

Dave, Diane, JRM, and Citizen Paine:

Please, Do Not Feed the Trolls. They keep coming back for more. Look above. See what I mean?


Posted by JRM, a resident of Vista Grande Elementary School
on Oct 30, 2012 at 4:51 pm

Derek....note I never responded to "Bayareamom" as it would have been a waste of time. As a 30 year healthcare veteran and one who has more experience with breast cancer than I care to expand upon here her suggestion that I need to do more research was incredibly condescending and not worthy of a response. If she can find a physician that does not recommend a screening mammogram for her because of risk of radiation I would be shocked. The new breakthrough is Tomosynthessis 3 Dimensional mammography (approved by the FDA in early 2011) and I'm sure she finds that troubling as well. To "Momwithapurpose" take heart...stage 2 is highly treatable and there is absolutely light at the end of the tunnel! I send you and yours my prayers of support and please know you are not alone in this fight!!


Posted by Diane, a resident of Danville
on Oct 30, 2012 at 6:27 pm

JRM, as usual you are the voice of reason (and experience - I remember your story). I got hooked in yet again. I need to remember Derek's advice!

momwithapurpose: Hang in there! The treatments are so effective (and yes, brutal) and I have high hopes that you will live a long life, thanks to your early screening and aggressive treatment. You will be in my thoughts!


Posted by JRM, a resident of Vista Grande Elementary School
on Oct 30, 2012 at 7:56 pm

Momwithapurpose (MWAP)
We are sooo behind you, you perhaps now have a new informal support group beyond your immediate circle of friends just so you know. Not to be inappropriately personal, but your post will generate a lot of helpful and supportive prayers and I hope that is okay with you. You will feel weaker from each successive treatment and that only means it is working!!
You will get through this I am certain! Here's to MWAP--
JRM


Posted by American, a resident of Danville
on Oct 30, 2012 at 8:10 pm

I lost my mother in law to breast cancer, but do to an early mamogram, she lived over 20 years, and got to be a wonderful grandma to my son. You are right JRM, please, get early mammograms and listen to the board certified medical specialist.


Posted by cardinal, a resident of Diablo
on Oct 31, 2012 at 3:26 pm

Free Mammograms, today only! weblink: Web Link


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