Kathy Merrell


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Why is breast cancer detection technology so primitive?

While Komen v. Planned Parenthood has us all fired up about access to breast cancer screening let's talk about the pathetic state of the actual screening technology. Why is that in the 50 years that mammography has been in use there's been no progress in improving the experience of having a mammogram and relatively little progress in improving the accuracy of detection? Perhaps more importantly, why is it that new and better technologies are ignored or left underfunded?

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    Feb 4 2012: The cynic in me also goes with the "because there's too much money in the status quo" option.

    Then again, I know several women whose breast cancer was caught by ultrasound, not mammography - one of whom had to override her own doctor and check the "ultrasound" box herself when she was getting tested because he thought she was being a hypochondriac when she said she knew something was wrong.
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    Feb 10 2012: Thanks for your comments. The technology that is the focus of Dr. Deborah Rhode's TED talk to which this discussion is attached is precisely about a scanning technology that tags tumors for detection. Using gamma rays, it is far more accurate at detecting tumors in dense breast tissue. What's great about the technology is it doesn't require the type of tissue compression that is the focus of this discussion. The question is why does the routine scanning technology have to hurt so much? The pain of getting a mammogram is something I am sure your wife will agree is less than optimal. Sorry if you felt gender bias in the discussion. It's guys like you willing to speak up that can help bridge the divide.
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    Feb 10 2012: Great comments. I wish you well!
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    Feb 9 2012: First - disclosure. I am a physician of 30 years but not an oncologist, though trained at MD Anderson in Houston. And my wife was diagnosed with breast cancer at age 37, with 2 distant recurrances (metastasis) since - currently disease free.
    I refute the cynical claims of gender bias made below. Almost half of physicians are now women, and the people I know in this area are good, passionate, intelligent people agressively searching for answers on multiple fronts.

    First "prevention" - this term is usually misused to mean early detection. But in that area agressive search for the genetic markers is rapidly ongoing - still expensive but the cost is dropping as technology improves and volume goes up to cover the fixed cost such as a gene sequencing analyzer costing > 500K each. These advances are made more difficult by the fact that there is not one, but multiple genetic mutations shown to lead to development. Additional research on ways to optimize the immune system ranging from vitamins such as Vit d, effects of glucose control (Prediabetes & Diabetes) and many others are ongoing.

    Detection technology has also advanced remarkably in the last 10 years, with digital mammography, and MRI as well as much better ultrasound (all with better computers and software as the foundation) One major limitation for premenopausal women, is that there is not much difference in tissue density between some tumors and the surrounding tissue - and just like photography - medical imaging all depends on contrast - so if no contrast, then no tumor seen. Ultrasound can show masses in premenopausal, as can MRI but on a public health level, the cost per additional diagnosis gets exponentially higher the younger and lower risk a lady is. One area of research is using monoclonal antibodies (MCA) to label tumor cells with a marker that is then seen on imaging. But with variation in tumors, again there are multiple MCA needed with increaed cost and lower sensitivity.
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    Feb 9 2012: Excellent questions, and as one who is surviving stage IV head/neck cancer, I would ask them in regard to all forms of this killer. Early detection is the key. As for underfunded research, here's my thought (ripping off a famous line), "The need of the many outweighs the greed of the few." Sadly, too few health industry bigwigs don't seem to agree.

    Just a thought: I wonder if a prediliction to cancer is possibly to be found in our DNA? If that were the case, perhaps DNA might be altered early in life as a preventative? Admittedly, I'm no scientist...perhaps this thought is misinformed.
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    Feb 7 2012: My opinion is, that breast technology is primitive because of gender bias. There are other female diseases and problems that have not been researched in past years...due to most past researchers and doctors being male.
    Times have changed...but we are still behind in comparison to research that has been done on female vs. male diseases.
  • Feb 4 2012: There are a lot of other technologies than just a mammogram to find cancer. However the other tests cost sh*tloads more to do.
    It is just a cost vs value thing. Ofcourse for the women getting it and being left undetected this is a horrible experience (actually when it's found it's also not a happy occasion I assure you). But we also can't charge everyone 10k$ each year to test whether they have breast cancer or not.

    You could argue that there should be a more accurate test that is more cost-efficient. That would make a large impact.
    But I actually doubt if that is possible. Because everything that works with radiation can be pretty lethal by itself and strong magnetism / electronical devices just cost a lot to build.