Mammograms: Do they prevent or cause breast cancer?

This post includes a synopsis of a paper published in the British Journal of Cancer 2005 Sep 5;93(5):590-6  and a recipe for Sausage N’ Cabbage “Noodles”.

Study title and authors:
Mammographic screening before age 50 years in the UK: comparison of the radiation risks with the mortality benefits.
Berrington de González A, Reeves G.
Cancer Research UK Epidemiology Unit, University of Oxford, Gibson Building, Radcliffe Infirmary, Oxford OX2 6HE, UK. aberring@hsph.edu

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/16136033

Books:

In this study Berrington de González estimated how many breast cancer deaths could be caused and how many could be prevented by a decade of annual two-view mammographic screening starting before age 40 or starting age 40.

The study (i) extrapolated from a projected radiation risk to estimate the number of mammogram radiation-induced breast cancer deaths and (ii) assumed that screening would reduce the number of breast cancer deaths by 10-20%.

The study found that:
(a) The study estimates suggest that a decade of annual two-view mammographic screening before age 40 years would result in an increase in breast cancer deaths.
(b) The study estimates suggest that starting at age 40 years could result in a decrease only if breast cancer mortality is reduced by about 20% or more in women screened.

To conclude: Women under 40 having mammograms have a higher risk of breast cancer. For women over 40 the position is unclear whether it is beneficial to have mammograms.

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Recipe of the day

Sausage N’ Cabbage “Noodles”

Ingredients:

Food Mall: Italian Sausage

1 lb mild Italian pork sausage or other ground meat of your choice

1 red onion, thinly sliced
½ head or 5 cups thinly sliced green cabbage
2 tablespoons grass fed butter (or ghee, or coconut oil)
½ teaspoon caraway seeds
½ teaspoon paprika
Fresh ground black pepper and sea salt to taste

Instructions:
In a large skillet brown the sausage. Once the sausage is fully cooked, remove it from the pan and set aside. Add the butter to the same pan with the sausage drippings and add the onions and cook for about 5 minutes or until the onions start to brown a bit. Add the cabbage and cook for another 7-10 minutes or until the cabbage is soft and “noodle-y.” Add the sausage back to the pan, add the spices, mix well and serve.

Sausage N’ Cabbage “Noodles”



How doctors in the US actually get paid more for writing more statin prescriptions

This post features an article by Catherine Shanahan, a medical Doctor from Kalaheo, Hawaii

The following article by Catherine Shanahan describes how doctors actually get paid more for writing more statin prescriptions.

Statin Payments
Catherine Shanahan

You may have read that doctors receive payment or bonuses for prescribing statins, the cholesterol-lowering drugs. I'm a chapter leader in Kauai, and a family physician, so I'm in a good position to fill in some details about how doctors actually get paid more for writing more statin prescriptions. The mechanism is a little cumbersome to describe clearly, but I'll take a stab at it.

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We have a series of "quality measures" that are tracked by the insurance company. One quality measure is the number of mammograms we do on our patients between ages 40 and 69, another is that we send our diabetic patients to the eye doctor once a year for retinal exams. For our patients who carry a diagnosis of "coronary artery disease," we have to write them a prescription for a cholesterol-lowering drug. If any one doctor doesn't follow any one of these imperatives, he loses points toward a cash bonus, and the entire group is similarly penalized. As you can imagine, there is lots of peer pressure to prescribe!

Actually, we don't get our bonus unless the patient goes and buys the drug or gets the test or sees the eye doctor and so on, so it's not enough just to write the prescription, we have to talk up the drug enough to get them to go out and buy it. Currently, there are only a few means by which a person can be labeled as a patient with coronary artery disease. Having a heart attack is one, and having abnormal results on heart tests (like angiograms) is another. Diabetes is now considered a "coronary artery disease equivalent" and so, in the near future, doctors may be required to get all our patients who have type one or type two diabetes to take their statins, or lose more money.

These HMOs are insurance companies like Blue Cross, which offer their clients (employers and patients) HMO programs. The HMO plan we have is offered by HMSA (Hawaii Medical Something Something). For whatever reason, HMSA wants to offer an HMO program for people, and doctors who participate as providers must comply with the rules of the program and accept payments according to the rules. There are clear benefits to pharmaceutical companies in this structure but no obvious reason why HMSA would want to encourage people to buy expensive drugs that HMSA must pay for. One might speculate that there are some quid-pro-quo relationships between the insurance companies and the pharmaceutical companies, but I have no idea what they are. However the ties are structured, I feel, as do many other scientists, that these kinds of business relationships lead to behaviors that pose real threats to patient care, and to human health in general. Because industrial connections like this fund most research, they distort the scientific process and are far more insidious, invisible, and totalitarianistic than expensive dinners and trips to Hawaii, which are what the media would have us believe is the sum total of the problem.

By the way, the bonus is actually not a bonus at all. This is where it gets Orwellian. We give up a certain percentage of the payment for accepting HMO patients, and we get it all back, in theory, if we meet all of our quality measures. We never do because of computer glitches which continually fail to track our prescribing, testing, and referring patterns accurately. Nobody can explain why we've agreed to accept HMO insurance plans, but we seem to feel we have no choice. And we will have less choice before long; Medicare is planning to begin similar programs. Each of these programs takes more money away from the doctors and gives it to middle managers, ensures that drug companies get more money, and that expensive tests of limited value are done more often.

These are some reasons why savvy business people are going into "alternative" medicine where they benefit from cash payments and total autonomy. Several here on Kauai are making millions.

Catherine Shanahan MD

Kalaheo, Hawaii

This article can be accessed at: http://www.westonaprice.org/letters/754-letters-winter-2006?qh=YTozOntpOjA7czo5OiJjYXRoZXJpbmUiO2k6MTtzOjg6InNoYW5haGFuIjtpOjI7czoxODoiY2F0aGVyaW5lIHNoYW5haGFuIjt9

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Are mammograms safe and effective?

This post includes a synopsis of a paper published in the Cochrane Database of Systematic Reviews 2011 Jan 19;(1):CD001877 and a recipe for bacon, spinach and sweet potato salad.

Study title and authors:
Screening for breast cancer with mammography.
Gøtzsche PC, Nielsen M.
The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, 3343, Copenhagen, Denmark, DK-2100.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/21249649

Books:

The objective of the review was to assess the effect of screening for breast cancer with mammography on death rates and disease. 600,000 women were included in the analyses.

The review found:
(a) For every 2000 women invited for screening throughout 10 years, only one will have her life prolonged.
(b) For every 2000 women invited for screening throughout 10 years, 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily.
(c) For every 2000 women invited for screening throughout 10 years, more than 200 women will experience important psychological distress for many months because of false positive findings.

To conclude: It is thus not clear whether screening does more good than harm. To help ensure that the women are fully informed of both benefits and harms before they decide whether or not to attend screening, Cochrane have written an evidence-based leaflet for lay people that is available in several languages on http://www.cochrane.dk/.

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Recipe of the day

Bacon, Spinach and Sweet Potato Salad

Ingredients:

3 cups peeled and diced sweet potatoes

Food Mall: Bacon

1 tbsp coconut oil

1 apple diced
8 strips of bacon, diced
2 leeks, thinly sliced
6 oz of fresh baby spinach
Handful of sliced almonds for garnish

Dressing:
¼ cup olive oil
1 tbsp apple cider vinegar
1 tsp spicy brown mustard
Fresh ground black pepper to taste
1 tbsp of dried basil
Pinch of cayenne pepper

Instructions:
Preheat your oven to 400. Toss the diced sweet potatoes with the coconut oil and spread evenly on a baking sheet. Bake in your preheated oven for 20 minutes. While the sweet potatoes are baking, cook the diced bacon in a large skillet. Once the bacon is crispy, add the sliced leeks in with the bacon and saute for another 4-5 minutes. Put your spinach in a large salad bowl and add the bacon and leek mixture. Toss well, letting the warm bacon wilt the spinach. Add the apples and sweet potatoes to the salad and toss together. In a separate bowl whisk together the salad dressing ingredients. Pour over the salad, mix well and garnish with the sliced almonds.

Bacon, Spinach and Sweet Potato Salad