Breast Screening – Core Needle Biopsy of Breast Cancer Tumours Increases Distant Metastases in a Mouse Model.

Excerpt from authors’ conclusion:

Our experimental findings demonstrate for the first time that in the setting of malignant breast cancer, performance of a CNB is associated with a significantly increased incidence of pulmonary metastases. We also show that an additional impact of CNB includes creation of a distinctly immunosuppressive and pro-metastatic tumor microenvironment with elevated TGF-β/SOX-4associated EMT and significantly higher CTC levels. In this era of digital mammography when smaller breast cancers are being detected, presumably in a pre-metastatic state, biologic knowledge of the potential harms associated with the traditional work-up of breast cancer through the application of a CNB needs to be considered…’ Edward Gitau Mathenge, Cheryl Ann Dean, Derek Clements et al. Neoplasia, Vol 16, No 11, pp950-960.

Also

‘Circulating tumour cells increased immediately after the taking of biopsies from human squamous cell, prostate, breast and hepatocellular carcinomas. Although no increased risk of biopsy-induced distant metastasis has been reported for any type of tumour, this is inconclusive due to a lack of non-biopsied control groups in human studies. Reports of biopsy-induced metastasis in animal tumours indicate that the taking of transcutaneous biopsies from urogenital tumours may be associated with a risk of NTM. However, there is no evidence of a general increase in risk of distant metastases in any tumour type in people or animals. The overall risk therefore appears to be negligible when compared to the valuable information obtained from biopsies in veterinary practice.’ – ‘Does the taking of biopsies affect the metastatic potential of tumours? A systematic review of reports on veterinary and human cases and animal models’ – Klopfleisch R, Sperling C, Kershaw O, Gruber AD. Vet J. 2011 Nov, 190(2):e31-42

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Breast screening – Wounding from biopsy and breast cancer progression

Surgical wounding associated with the extirpation of experimental primary cancers can trigger angiogenesis in previously dormant micrometastatic tumour deposits, which can result in the acceleration ofrelapse and death….’ ‘The uniform incapacity of randomised controlled studies of screening mammography to show early surgical advantage of screened populations aged 40–49 years might relate to this biology..

The lack of mammographic benefit…’ (in the Canandian study) …’can be explained by the extra 550 biopsies done in year 1 in the intervention group if 14 of these biopsies showed false-negative results and caused lymphangiogenesis and stage progression…’

‘…Our hypothesis is that stage progression associated with excessive biopsies in young women with abnormal mammograms offsets any long-term benefit for the screened populations. Michael Retsky, Romano Demicheli, William Hrushesky. The Lancet, Correspondence: Vol 357; 1048 (March 31, 2001).

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Breast screening: overdiagnosis in Denmark

Yet more proof of overdiagnosis: a paper estimating overdiagnosis in Denmark, published in the Annals of Internal Medicine, concluded:

‘Breast cancer screening was not associated with a reduction in the incidence of advanced cancer. It is likely that 1 in every 3 invasive tumors and cases of DCIS diagnosed in women offered screening represent overdiagnosis.’

Breast Cancer Screening in Denmark: a Cohort Study of Tumor Size and Overdiagnosis. Karsten Juhl Jorgensen, Peter C Gotzsche, Mette Kalager, Per-Hendrik Zahl

http://annals.org/aim/article/2596394/breast-cancer-screening-denmark-cohort-study-tumor-size-overdiagnosis

An editorial by Otis Brawley, Chief Medical Officer for the American Cancer Society covers this important paper.

http://annals.org/aim/article/2597574/accepting-existence-breast-cancer-overdiagnosis

Posted in breast screening, Campaigns, citizen safety, Compassion in healthcare, harms, healthcare modernisation, information, informed consent, medicine's flaws, Over-medicalisation, overdiagnosis, overtreatment, personal autonomy, Public safety, Screening, Screening Mammography, Uncategorized | Tagged , | Leave a comment

How libraries can help to humanise healthcare

‘The Health/Art/Libraries (HAL) project was founded in 2015 by Somerset based GP, Dr Malcolm Rigler and Liverpool artists John Campbell and Moira Kenny: THE SOUND AGENTS.

The aim of the project is to design and deliver a series of Arts Projects, Events, Publications, Workshops and Training Sessions to offer help to patients and carers in their search for information and understanding about health, social care and life changes from 0 to 100 years, working along the theme of “ Libraries on Prescription”…’ http://librariesandhealth.com/

The link to the full BMJ editorial, ‘Humanising Healthcare’, mentioned in my earlier post (Robin Youngson & MB, Christmas edition 2016) can be found there under the ‘READ’ heading – http://librariesandhealth.com/recommended-reading.php

On the same page is the link to ‘Redundant Subjectivity’ by Professor Stephen Pattison, Hon Fellow RCGP : ‘…instead of attending to my concerns, the GP…insists on taking my blood pressure and interrogating me on my lifestyle before giving me unasked for advice about how I could live a healthier and better life (as if I didn’t know that I could do that, and were not ashamed of the fact that I don’t). I leave the surgery edified but effectively deafed out, both guilty and demoralised…’

How many of us have had similar encounters? We are all individuals. We need healthcare to take account of that individuality, not treat us according to guidelines and generalisations.

Posted in Campaigns, Compassion in healthcare, guidelines, medicine's flaws, open access, Uncategorized | Tagged | 3 Comments

Christmas message from Hearts in Healthcare

For all those wishing to make healthcare more humane and compassionate, here’s two gifts for you this Christmas

1. “From HERO to HEALER – Awakening the inner activist” – a free book just for you!

If you are feeling ground-down by the craziness of the healthcare system, and wondering how you can possibly make a difference, here’s inspiration from Hearts in Healthcare co-founder Robin Youngson. His new book is offered to you FREE (or you can choose to pay a ‘donation’ price).

  • Learn how the traditional Western ideas about leadership and success actually prevent us from building a better world.
  • Find out how you can be an ‘inner activist’ in your workplace, inspiring positive change around you.
  • Powerfully align your work with your deepest values and ideals

To access your copy of ‘From HERO to HEALER‘ order here:

https://herotohealer.org/?mc_cid=3a6605dd04&mc_eid=be3cb102e3

2. Great news about our cause!

Each year, the international medical journal the BMJ publishes a special Christmas edition. We’re absolutely thrilled that the BMJ invited us to write an Editorial on the subject of ‘Humanising Healthcare‘ for this Christmas edition, which reaches 1.5 million subscribers worldwide. The editorial is already published online in advance of the print edition. This is an open-access, full-text article so anyone can read the editorial or respond in the comments section.

Here’s your chance to support the cause – please click on the link to ‘Respond to this article‘ on the BMJ page and post your comments. Let’s thank and encourage the editors for their support by making this the most discussed editorial of the year. And don’t forget to ‘like’ the article too!

Wishing you all a happy and relaxing time for the festive season and best wishes for the New Year!

 

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Humanising healthcare: Robin Youngson

“We need people who do not doubt our good intentions, but are prepared to tell us things others are not” – Dr Helen Williamson, RCPath, p 185 in ‘Nothing Personal, disturbing undercurrents in cancer care’. I was fortunate to have worked alongside Dr Williamson in the Royal College of Pathologists’ Lay Advisory Council which comprised 6 doctors and 6 lay people. ‘No tokenism’ was the rule – the LAC was fully integrated into College working due to Dr Willamson’s efforts and leadership, and that of her colleagues.

And now I am fortunate once again, having been invited to join Dr Robin Youngson in the bmj editorial of the Christmas edition.

Compassionate doctors are the Great ‘Men’ of Medicine.

BMJ Editorial: Humanising healthcare. Dr Robin Youngson is an anaesthetist in New Zealand.

http://www.bmj.com/content/355/bmj.i6262.full

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Breast screening: one woman’s successful fight against compulsory screening programme

“Uruguay’s government is being challenged to end its compulsory breast screening programme, after a court ruled that one woman with concerns about possible harms caused by mammography should be exempt.”

Uruguay’s compulsory policy was introduced in 2006 under President Tabaré Vázquez, a practising oncologist. It made it a requirement for  women aged 40-59 have to have a mammogram every two years or they could not get the health card  (“carné de salud”) required by employers.

Ana Rosengurtt spoke out against compulsory breast screening and gained the support of her MP and former GP to successfully win her case. But the court ruling applies only to her individual case.

This is a very worrying situation in light of harms of screening mammography, in particular overdiagnosis and overtreatment. A policy based on belief instead of science, held together by vested interests.

MP and former GP challenges Uruguay’s compulory breast screening programme. Sophie Arie. BMJ 2016;355:i6624  (Published 8 December 2016)

http://www.bmj.com/content/355/bmj.i6624

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