Note - by reading this blog you agree to recognize that this site in no way attempts to recommend treatment or medical advice and that what it is designed to provide is medical information. You agree to be responsible for your own actions and medical care and that Dr. Harris does not take any responsibility for your medical care in the process of sharing medical information with you. Further more the opinions expressed here are the opinions of Dr. Harris and not necessarily those of the Royal New Zealand College of General Practioners or any other qualifying standards organizations from which Dr. Harris has gained under graduate or post graduate training.

Well welcome back!
I hope your day hasn't been quite as busy as mine. It ended with a person having an acute heart attack. This necessitated a trip down to hospital with them in the back of the ambulance. Fortunately the person made it and when I left them they were fine.
Emergency medicine is a lot of fun and very rewarding!

However I think that the most rewarding thing any of us could accomplish would be to see a dream we all share come true

- a reduction in the number of women developing and ultimately succumbing to breast cancer.

So lets summarize what was discussed yesterday.
- That at present the tactic we are taking to try and address the increase in breast cancer rates is to try to "prevent breast cancer deaths". To do this in medicine we try to diagnose breast cancer as early as possible to "prevent women from dying from it". This has lead to slightly muddled thinking that what we are doing is "preventing breast cancer". But actually we are waiting until women have already got it, not preventing it at all.

- Not only that but we seem to not be able to tell WHICH women actually needed our help when they do have it. Some have treatment they would never have needed as the recent Zahl paper confirms previously stated conclusions of the Cochrane review. The Cochrane review saying that 10 women per 2000 screened will under go unnecessary treatment.

Although I promised I would start to share the research pointing towards ways to truly prevent breast cancer, tonight I wanted to extend on the previous posting by sharing with you some information which I have looked into today for you.

Costs - what are the economic costs of the approach we are taking to breast cancer (early detection as the solution) here in New Zealand? If you are from overseas - don't worry, the costs would be in some vague ( fairly amazing as you will see) similar ballpark.

And so here are the results of today's investigation.
It turns out that the New Zealand mammography screening project has an annual budget of $NZ47.8million dollars. There are in the order of 600,000 women aged 45-70 who are eligible for screening here ( actually less but rounding up will decrease the cost per life saved and soften the stats in this case).

If the Cochrane estimates are correct and 1 in 2000 woman will have her life saved by screening over a ten year period the following calculation can be made....

Worst estimate....
600,000 divided by 2000 =300 women saved over 10 years, or 30 women every year.
$47.8million divided by 30 = 1.5million ( if rounded down)

If the Swedish studies are correct and 1 in 472 women will have their lives saved - then the cost per life is

Best estimate....
600,000 divided by 472 = 1271 over 10 years or 127 per year
$47.8million divided by 127 = roughly $370,000 per life saved.

Here in New Zealand we have people dying at times on our waiting lists for heart surgery due to inadequate funds - the sum needed being in the order of $20,000.
However a womans life is very precious. Often we are the king pin that holds a whole family together and so this is not a comment about whether this is a worthwhile sum. And economically it stacks up to fairly equivalent loss of life time earnings if the woman was to not be saved.

It is still a large sum! One that may surprise you. It is so large in fact, Australia is presently going through a major cost review on mammography.

But lets think further. So lets say at best and most generous guess ( in support of mammography) the cost per life saved is in the order of $370,000. BUT this does not include the costs of those women who are treated unnecessarily. Although I don't have the figures for this here in New Zealand, there is some published data on this topic such as that published by the California Breast Cancer Research Program. Click to go to this link Presumably everyone having unnecessary treatment would have low grade cancer and estimates of cost for this were around $16,000 per woman.
So now - if 10 women per 2000 were to have unnecessary breast cancer treatment over a 10 year period in new Zealand lets do the calculations...
600,000 divided by 2000 = 300 x 10 women = 3000 over 10 years or 300 each year.
300 x $16,000 = 4.8 million per year.

Now if we are ( at best estimate ) saving 127 women per year, the economic cost of women unnecessarily needing to be treated to save these women is $4.8million divided by 127 = $37,795.

So the total ( cheapest figure) might look something like $370,000 + $37,795 = lets just say in the $400,000 range.

Now these figures are just playing with numbers. They are not accurate, they take American estimated sums and mix them with New Zealand figures. They make many assumptions.
However.... they give us a rough ball park figure to ask.....

If we were going to actually truly prevent breast cancer what could we achieve with an incredible sum like $47.8 million per year.
What could we do that might actually make a saving

so that the cost per life saved was less than $400,000 per woman?

This site proposes - isn't this the question that we should be asking?

Stay tuned!

live empowered,

and know that you have a right to know

Dr. Elizabeth Harris

MBChB, Dip Obs, Dip MSM, MACNEM, FRNZCGP

New Zealand

Welcome

Note - by reading this blog you agree to recognize that this site in no way attempts to recommend treatment or medical advice and that what it is designed to provide is medical information. You agree to be responsible for your own actions and medical care and that Dr. Harris does not take any responsibility for your medical care in the process of sharing medical information with you. Further more the opinions expressed here are the opinions of Dr. Harris and not necessarily those of the Royal New Zealand College of General Practioners or any other qualifying standards organizations from which Dr. Harris has gained under graduate or post graduate training.

Summary of todays entry
- this dialog begins to question our present approach to preventing breast cancer deaths.

-It points out there are some problems with using mammographic screening as the only solution we are offering to women

-It suggests that we need to start working in the area of true prevention - stopping women getting it in the first place

-It lets you know that there will be upcoming information on research suggesting areas to address in breast cancer prevention.

So Welcome! This site has been developed with you in mind! If you are looking for a place where you can go to find out how to prevent breast cancer; to access what the greatest medical minds are talking about in this field; you have come to the right place.

If you are looking for a community of people who are interested in helping each other to discover the way forward in reducing our staggering rates of breast cancer here in the western world, we are glad that you have joined us.

So many women today are looking for more answers than we as doctors are giving them.

Are you sick of being told that the only thing

that you can do to

prevent the development of breast cancer

is to have regular mammograms?

You like many of us, may have figured out the not so subtile mistake in this concept. Mammography in no way "prevents" breast cancer development. To have a positive mammogram the idea is that you will already have developed breast cancer. Sadly - research released just this last month in the Archives of Internal Medicine (Click here to read latest medical news release on this)confirms previous statements by the world renouned Cochrane review (Click here to read the Cochrane review on mammography)- that there are many women who are inaccurately picked up as having breast cancer and under go unnecessary treatment following a mammogram.

This site will gently introduce you to medical literature. Research that has been published and up until now you have been relying on medical professionals to interpret and feed to you. Be empowered! Just as in the middle ages it was thought that only the monks could have access to and understand the bible, today many lay people feel the same about medical studies.

So now its time to start - let me introduce you to the Cochrane reviews.

The Cochrane library is a world renowned database respected by doctors and scientists. One of its functions is to look at many studies at once and to come to a conclusion. Now there are research reviews which are positive and say that mammography saves lives. There are others that are negative.

In fact the Cochrane review is so staggering in what it tells us about the idea of relying on mammographic screening as our only defense against breast cancer, that the summary is provided below. Following this I have included a positive research review.

Screening for breast cancer with mammography - from the Cochrane review

Screening uses a test to check people who have no symptoms of a particular disease, to identify people who might have that disease, to identify people who might have that disease and to allow it to be treated at an early stage when a cure is more likely. Mammography uses X-ray to try to find early breast cancers before a lump can be felt. Many countries have introduced mammography screening for women aged 50 to 69. The review includes seven trials involving a total of half a million women. The review found that mammography screening for breast cancer likely reduces breast cancer mortality, but the magnitude of the effect is uncertain and screening will also result in some women getting a cancer diagnosis even though their cancer would not have led to death or sickness. Currently, it is not possible to tell which women these are, and they are therefore likely to have breasts and lumps removed and to receive radiotherapy unnecessarily. Based on all trials, the reduction in breast cancer mortality is 20%, but as the effect is lower in the highest quality trials, a more reasonable estimate is a 15% relative risk reduction. Based on the risk level of women in these trials, the absolute risk reduction was 0.05%. Screening also leads to overdiagnosis and overtreatment, with an estimated 30% increase, or an absolute risk increase of 0.5%. This means that for every 2000 women invited for screening throughout 10 years, one will have her life prolonged. In addition, 10 healthy women, who would not have been diagnosed if there had not been screening, will be diagnosed as breast cancer patients and will be treated unnecessarily. It is thus not clear whether screening does more good than harm.

In plain english? If 2000 women have regular mammograms over a 10 year period, 1 of them will live longer. For this one woman to live longer, on average.... 10 will be unnecessarily told they have cancer and treated for it. 10 women who would never have been affected by breast cancer. To be dramatic, 10 will have to be cut, irradiated and or undergo dangerous treatment in the form of chemotherapy. A side-effect of which can at times be death itself.

Ok - the other side - some studies conclude that mammography does save lives.

There have been a number of studies going on in Sweden showing a benefit. The conclusion from the following study

Click here says

"These results indicate a reduction in breast cancer mortality [people dying of breast caner] of between 40% and 45% in association with screening, after adjustment for self-selection bias. These results were obtained with modest human costs: the number needed to screen to save one life was estimated as 472."

If indeed the Cochrane estimates are correct and that 10 out of 2000 women are undergoing unnecessary breast cancer treatment however - the human costs may not be quite so modest, even if, at best estimate one life out of every 472 women undergoing mammography is saved.

Put another way - would you enter a lottery where you were told that you had a 1 in 472 odds of living longer, but by taking part you had a 1 in 200 odds of undergoing unnecessary cancer treatment? Tough decision!

Maybe one of the ways to answer this difficult question is to concentrate on a different tactic.

Maybe concentrating on not getting the breast cancer in the first place, rather than trying to pick it up as early as possible is the better way to go.

We are told by the medical establishment that there is no way to do this. That we don't know how to prevent breast cancer. However it turns out that we know and awful lot about what a population of women who have GOT breast cancer look like compared to a population of women who don't. For example we know that they have lower vitamin D levels. That they have lower iodine levels. That they don't exercise as much and that they tend to not look after their sleep routines making sure that they get enough sleep. And these are just some of the many pointers available in the research. And these are the research clues that this site will share with you as the weeks and months go by.

Is it time to start using these clues to try a different tactic?

Don't get me wrong. This is in NO WAY a comment as to whether you should have a mammogram today. But it IS a comment on how likely it is, given a population of women, that we will see a reduction in breast cancer rates with this approach without possible significant harm to an even higher number of women.

SO! What can we do to prevent breast cancer?

Are there any clues in the literature to tell us things that we can actively be doing that might really make a difference?

What if I was to tell you that the exciting answer is YES!

So what has this blog covered so far?

- That women are told that the best way to prevent breast cancer is to have regular mammograms.

-That this does not prevent breast cancer. It is aimed at reducing numbers dying in those who have already got it.

- That there are questions around whether this is the best way to help women. That one of the worlds leading authority sites on medical research results sums up by saying "it is thus not clear whether screening does more harm than good"

- That we can intelligently begin to look at other research to answer the question "how do we actually prevent breast cancer "?( not get it in the first place).

Join me tomorrow as I begin to share with you news from many different branches of medicine -

cell biology, molecular biology, epidemiological studies.

And don't worry if you don't understand the lingo as you read through this site - you will slowly and naturally upgrade your knowledge. Just like the lay people who began to read the bible and discovered that they didn't have to pay the monks (read medico's) to save themselves from eternal damnation ( read avoidable health crises) so you too can become empowered by knowledge.

Together as women by sharing our knowledge, we can learn and grow and make a difference to each others health.

You can be empowered today.

You can gain access to the knowledge which is sitting around the world in studies pointing to the way forward. You can become your own preventive health care source.

Like a light passed from one to many,

and as we as women start to take steps towards our own wellness....

just watch us.....

and see if the breast cancer rates.....

don't begin to drop!

Until tomorrow

live empowered,

and know that you have a right to know

Dr. Elizabeth Harris

MBChB, Dip Obs, Dip MSM, MACNEM, FRNZCGP

New Zealand