New cancer drugs, survival, and quality of life –

A retrospective cohort study in the bmj to determine the availability of data on overall survival and quality of life benefits of cancer drugs approved in Europe concluded that

‘…most drugs entered the market without evidence of benefit on survival or quality of life…’ and ‘when there were survival gains over existing treatment options or placebo, they were often marginal’

“Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13”. Courtney Davis et al.

http://www.bmj.com/content/359/bmj.j4530

BMJ 2017;359:j4530

Editorial: http://www.bmj.com/content/359/bmj.j4528

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Breast cancer screening – short video explains reality

TIME FOR HONESTY – This short video presents the true picture of breast screening programmes in a very easy to understand format. How shocking that this harmful ‘industry’ is allowed to continue (NHS BSP) and the age limit extended at both ends (due to massive charity pressures on parliament) – and the extension used as ‘the biggest randomissed controlled trial in the world’. How many women realise that – or what they are voluntarily subjecting their bodies to…all without full information or written consent? With GPs being paid to encourage women to attend breast screening…Sisters – spread the word if you value your breasts: Click on the gear wheel below the video for optional language subtitles: (or here’s the direct english link: https://www.youtube.com/watch?v=WokeeihfCnw)

Diagnostic shades of grey

How many patients (and doctors) are unaware of the range of variability in diagnoses that can derive from the same pathology sample? How much accepted ‘certainty’ is, in fact, ‘uncertain’? Read on, and you may never want to accept a diagnosis without getting a second opinion – or a third.

When Diagnostic Uncertainty Hits Home. Joann Elmore. BMJ Opinion, 28 June 2017.

http://blogs.bmj.com/bmj/2017/06/28/joann-elmore-when-diagnostic-uncertainty-hits-home/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bmj%2Fblogs+%28Latest+BMJ+blogs%29&g=w_bmj-com

The article includes some useful links eg http://www.nejm.org/doi/full/10.1056/NEJM199412013312206

‘Variability in Radiologists’ Interpretations of Mammograms. Joann G. Elmore, Carolyn K. Wells, Carol H. Lee, Debra H. Howard, and Alvan R. Feinstein

N Engl J Med 1994; 331:1493-1499 December 1, 1994 – which calls for efforts to improve accuracy and reduce variability in interpretations of mammography.

GP Payments

In my rapid response to this BMJ article I should have mentioned GP payments that were given for not referring patients. Does anyone else have the sense that there are also cut-off points for referral, diagnostic investigations or treatments at say age 75? Or above? That’s certainly the impression I’m getting from friends and colleagues.

Prescribing incentives feel grubby because they are. Margaret McCartney. BMJ 2017;357:j2695

http://www.bmj.com/content/357/bmj.j2695?

Are wealthier people at extra risk of harm?

In this New England Journal of Medicine paper, Welch and colleagues discuss whether wealthier people receive too much care – ie more than is good for them. “Excessive testing of low-risk people produces real harm, leading to treatments that have no benefit (because there is nothing to fix) but can nonetheless result in medication side effects, surgical complications, and occasionally even death.’

Income and Cancer Overdiagnosis – When Too Much Care is Harmful. H Gilbert Welch, Elliott S Fisher. N Engl J Med 376;23, 2208-2209. June 8 2017. http://www.nejm.org/doi/pdf/10.1056/NEJMp1615069

 

Breast cancer screening – DCIS and the COMET trial

Women diagnosed with Ductal Carcinoma in Situ (DCIS) are usually offered lumpectomy or mastectomy as standard treatment, although DCIS is not usually recognised as an actual cancer, but rather cell changes which may or may not become cancerous in the future. In an attempt to combat overtreatment of women diagnosed with DCIS, the prospective, randomised clinical trial, COMET, (Comparison of Operative to Medical Endcrine Therapy) will test whether or not active surveillance (as offered in prostate cancer) with close monitoring would be a safe option.

Laurie McGinley. Waiting and watching with ‘Stage O’ cancer put to nationwide test.

https://www.washingtonpost.com/national/health-science/waiting-and-watching-with-stage-0-breast-cancer-put-to-nationwide-test/2017/04/29/60e47bde-1f8f-11e7-ad74-3a742a6e93a7_story.html?utm_term=.682cd66f5e6e

Breast cancer screening – why do physicians continue to ignore national guidelines?’

When research shows breast cancer screening participants are more likely to experience more harms than benefits, why do physicians continue to ignore national guidelines and recommend screening mammography?

“There have been many explanations over the years for why physicians perform tests and procedures for which there is no evidence of benefit – or, in this case, where there is actual evidence of harm.’

Physician Adherence to Breast Cancer Screening Recommendations

Deborah Grady, Rita F. Redberg.

http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2617273