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Mammograms don't reduce cancer death rates, study finds

Written By Umair Ali on Wednesday, 12 February 2014 | 20:56

Mammograms don't reduce cancer death rates, study finds

Mammograms don't reduce cancer death rates, study finds
LONDON: The research, published Tuesday in the British Medical Journal, is the latest in a series of studies that question the value of annual breast X-rays for pre-menopausal women and whether too many women are being "overdiagnosed" by the popular test.
 
"We found absolutely no benefit in terms of reduction of deaths from the use of mammography," said study leader Dr. Anthony Miller, an epidemiologist at the University of Toronto's Dalla Lana School of Public Health.
 
The controversial finding is unlikely to trigger an immediate change in national screening policies, although it will enliven an already heated debate over screening. Experts have been arguing the merits of breast X-rays since 2009, when a government panel recommended that most women under 50 could safely skip the test. The U.S. Preventive Services Task Force determined that the chances a 40-year-old woman would be diagnosed with invasive breast cancer in the next 10 years was 1.44% and that her odds of dying from it were just 0.19%.
 
However, the breast cancers that strike women in their 40s are often more aggressive, and they account for about 17% of deaths from the disease, according to the American Cancer Society.
 
The ACS and the American College of Obstetricians and Gynecologists recommend annual mammograms for women beginning at age 40, and the National Cancer Institute advises women in their 40s to have the test once every year or two. The Canadian Task Force on Preventive Health Care advises women to have mammograms every two to three years between the ages of 50 and 74.
 
The British Medical Journal report, based on data from the Canadian National Breast Screening Study, argues that mammography all too often finds small cancers that would never become dangerous if left alone. Roughly half of all cancers found by mammography — yet undetected through physical examination — fell into this category, the study authors wrote.
 
The researchers examined the medical records of 89,835 women in six Canadian provinces between the ages of 40 and 59. All of the trial participants received annual physical breast examinations, while half of them also had yearly mammogram screenings for five years, beginning in 1980.
 
Over the next 25 years, 3,250 of the 44,925 women in the mammography arm of the study were diagnosed with breast cancer, along with 3,133 of the 44,910 women in the control group. In addition, 500 patients in the mammography group died of breast cancer, as did 505 women in the control group.
 
The researchers found that women who got mammograms were more likely to be diagnosed with breast cancer, but that the test did not reduce their risk of dying from the disease.
 
The research team calculated that 22% of the cancers found on mammograms were overdiagnosed. That means that for every 424 women who were screened, one received unnecessary cancer treatment.
 
The study did not address the use of mammography as a diagnostic tool, which most experts agree is valuable.
 
In light of their findings, Miller and his colleagues concluded, "The rationale for screening by mammography should be urgently reassessed by policymakers."
 
The American College of Radiology, one of the leading critics of the task force recommendations, was quick to denounce the study's conclusions. The group said in a statement that the Canadian National Breast Screening Study was "deeply flawed" and "incredibly misleading." Among other problems, the study relied on "second-hand" mammography equipment that was operated by poorly trained technicians, the group said.
 
"It would be an outrage for women if access to screening was curtailed because of the poor results in the Canadian National Breast Screening Study," said Dr. Daniel Kopans, a senior breast imager at Massachusetts General Hospital in Boston. "It has been known for years that the trial was compromised from the start."
 
The study authors said they stood by their conclusions and challenged the critics to produce data showing that mammograms reduced deaths. Other recent studies have found that advances in breast cancer treatment have eroded some of the benefits of early detection.
 
"Modern treatment is so much more effective now that the lead time gained by mammography has little impact on the outcome," Miller said.
 
Dr. H. Gilbert Welch, an epidemiologist and biostatistics professor at Dartmouth College's Geisel School of Medicine, said the study offered the highest-quality evidence yet on the prevalence of overdiagnosis.
 
"I think there's growing realization that all is not well with mammography," said Welch, who co-wrote the book "Overdiagnosed: Making People Sick in the Pursuit of Health." "People in the cancer community and the cancer surgery community are aware of the problem of overdiagnosis. They're aware that mammography was oversold, that its benefits were exaggerated and its harms were kind of downplayed."
 
In an editorial that accompanied the study, three breast cancer experts from the University of Oslo who have studied the effects of screening in Europe said Miller and his colleagues made a convincing case that current policies should be reconsidered.
 
"This is not an easy task, because governments, research funders, scientists and medical practitioners may have vested interests in continuing activities that are well established," they wrote.
 
Similar studies on mammography screening have been conducted in Europe, and critics have said that they don't apply to American women. The Canadian researchers said that their results are highly pertinent to the United States, and that their study is probably the largest we will ever see.
 
"Many people believe you do not adopt policy on the result of one trial, and yet there's not likely to be another trial like this," Miller said. "It takes too long."

Shabana Azmi says Javed Akhtar never wrote poetry for her

Shabana Azmi says Javed Akhtar never wrote poetry for her

Shabana Azmi says Javed Akhtar never wrote poetry for her
KARACHI: The Indian film, TV and theatre actress, Shabana Azmi has smilingly protested that her husband Javed Akhtar never wrote any song or poetry for her.
 
Today, Shabban Azmi graced Media studio with her presence and talked to the anchor Najia Ashar.
 
When asked whether Javed Akhtar wrote the song ‘Aik Larki Ko Dekha Tau Aisa Laga’ keeping her in mind, Shabana Azmi said it was written for Manisha Koirala – the Bolllywood actress who co-starred with Anil Kapoor in ‘1942 A Love Story’. “He never wrote any couplet for me.”
 
She said her husband justified it by saying: “If someone works in a circus, would you expect him to remain suspended upside down in his home too.”
 
Shabana Azmi, to a question if she feels there was anything her life lacked, said she cannot cook and even today she considered it as a deficiency.
 
Shabana Azmi is in Karachi to participate in the 1st Sindh International Film Festival being held in collaboration with the UK-based Raindance Film Festival and Independent Film Trust. The two-day event is being held as part of the two-week Sindh Culture Festival.

Pakistan to get $900mn from ADB for Jamshoro coal power project

Pakistan to get $900mn from ADB for Jamshoro coal power project

Pakistan to get $900mn from ADB for Jamshoro coal power project
ISLAMABAD: The Asian Development Bank (ADB) will provide $900 million to Pakistan for completion of Jamshoro coal power project.
 
Pakistan and ADB signed an agreement in this regard on Wednesday. Secretary Economic Affairs Division Nargis Sethi and ADB Country Director signed the pact. The project will be completed in 4 years.
 
Finance Minister Ishaq Dar was also present on the occasion.
 
Dar said the government is taking concrete measures to generate cheap electricity to overcome power crisis in the minimum possible time.
 
Under the agreement‚ the ADB will assist Pakistan to complete two units of 660 megawatt each at Jamshoro power plant which will generate electricity through imported coal.

IHC judge refuses to hear plea against appointment of PCB chief

IHC judge refuses to hear plea against appointment of PCB chief

IHC judge refuses to hear plea against appointment of PCB chief
ISLAMABAD: Justice Shaukat Aziz Siddiqui of Islamabad High Court (IHC) has refused to hear plea against appointment of Pakistan Cricket Board (PCB) interim chairman Najam Sethi, Media reported.
 
Justice Shaukat Aziz Siddiqui, while refusing to hear the plea, said as the same court had given verdict for the dismissal of Zaka Ashraf, therefore, it would refer the case to Chief Justice IHC Justice Anwar Kasi.
 
A man, namely Abdullah Tahir, had filed plea against appointment of Najam Sethi as PCB chairman.
 
In his petition, the applicant had pleaded that Sethi should be stopped from performing his duties as cricket board chief and that the PCB chairman be appointed through election.

'Dangerous' Afghans to be released in 24 hours: US

'Dangerous' Afghans to be released in 24 hours: US

'Dangerous' Afghans to be released in 24 hours: US
KABUL: The Afghan government plans within 24 hours to start releasing from a former American detention facility a group of 65 inmates that the U.S considers highly dangerous, the NATO-led coalition said late Wednesday.
U.S. forces in Afghanistan have repeatedly registered strong concerns about releasing the detainees, who it says have the blood of international and Afghan soldiers on their hands - plus strong evidence against them, from DNA linking them to roadside bombs to explosive residue on their clothing.
When President Hamid Karzai ordered their release several weeks ago from the Parwan Detention Facility, it prompted angry denunciations from the U.S. and strained relations between the two countries ahead of the year-end withdrawal of most international combat troops.
The international coalition on Wednesday issued the latest in a string of statements condemning the release, which it said would begin early Thursday morning and include detainees directly linked to attacks that have killed or wounded 32 U.S. or coalition personnel and 23 Afghan security personnel or civilians.
The U.S. has stressed it wants the detainees to face trial in Afghanistan, but Kabul has cited insufficient proof to hold them - despite U.S. claims it has strong evidence against the prisoners.
Karzai, too, has referred to the Parwan Detention Facility as a "Taliban-producing factory" where innocent Afghans are tortured into hating their country.
Among those expected to walk free Thursday morning are Mohammad Wali, who the U.S. military says is a suspected Taliban explosives expert who allegedly placed roadside bombs targeting Afghan and international forces. The military said Wali had been biometrically linked to two roadside explosions and had a latent fingerprint match on another improvised explosive device - plus tested positive for explosives residue.
Others in the group include Nek Mohammad - who the U.S. says was captured with extensive weapons, and a man identified as Ehsanullah, who is claimed to have been biometrically matched to a roadside bomb and tested positive for explosive residue.
The U.S. military had formally disputed the prisoners' release, but an Afghan review board had effectively overruled those challenges.
The detainees' release has been in the works for weeks, and comes as Karzai's government has taken an increasingly hostile tone towards the U.S. ahead of the withdrawal of NATO combat troops at the end of 2014.
Elsewhere in Afghanistan on Wednesday, two international troops and two Afghan service members were killed in an apparent insider attack, according to officials.
The NATO-led force confirmed the deaths of its service members, saying they were killed by two men in Afghan uniforms. The coalition gave no further information, saying there would be an investigation.
A senior Afghan military official meanwhile said two Afghan army personnel were killed in the incident, which came after a heated dispute on a base in the east of the country. The official but had no further information, saying a joint NATO-Afghan team had been dispatched to investigate. He added that several other personnel were wounded in the incident in an Afghan base in the Pagab district of Kapisa province, east of Kabul.
He could not be identified because he was not authorized to release the information.
Insider attacks in the past have been claimed by Taliban insurgents as proof they can infiltrate Afghanistan's Western-trained security forces. Other cases have involved personal quarrels between Afghan forces and their trainers.
The Taliban earlier Wednesday issued a statement claiming that a "battle" between Afghan forces and foreign trainers had resulted in several deaths and injuries, but the insurgents did not claim its infiltrators were responsible.


Man sets his brother house on fire over land dispute; 3 kids dead

Man sets his brother house on fire over land dispute; 3 kids dead

Man sets his brother house on fire over land dispute; 3 kids dead
DERA GHAZI KHAN: A man set his brother’s house on fire in Dera Ghazi Khan over a land dispute, killing three kids and injuring six others including a woman, in the wee hours of Thursday.
 
According to police, the accused, Suleman, managed to flee after setting his brother Muhammad Qasim’s house on fire.
 
A one-year old Hassan, five-year old Zehra and fifteen-year old Samreen burnt to death while Qasim, his wife Musarrat Mai, and two sons and two daughters sustained injuries.
 
Qasim’s mother said that her son Suleman had threatened to kill all of them if they wouldn’t give him a big share of land.
 
The bodies and injured people are shifted to hospital.
 
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Published by Umair Ali Sajid