Let Us Ponder the Various Meanings of the Word “Boobs”

Boobs can be quite helpful in political protests as the Ukrainian group FEMEN demonstrates: http://andreasmoser.wordpress.com/2012/01/28/ukrainian-girls-show-us-how-to-protest/

This just confirms the shittiness of the Komen foundation. The President of the org helped Bush to water down the patient’s bill of rights, and in return Bush appointed her Ambassador to Hungary. Most of what they do seem to be ‘pinkwashing’ – letting people pretend that they are good-hearted for wearing something pink.

October is both domestic violence and breast cancer awareness month, and the NFL wears pink everything.Nothing is said about violence, even though it is a perfect opportunity to let the young males watching that violence against women is bad, because that would be ‘controversial’ or something.

And then there’s that save the tatas crap.

It is only partly on topic, but the current state of evidence-based medicine is that young women without specific risk factors should not, in fact, be encouraged to carry out regular self-examinations of their breasts[1] (let alone have regular, painful and largely counterproductive mammograms), and therefore people should also probably be aware that an awful lot of currently operating breast cancer charities are a massive waste of money.

[1] What? no? really? Yes. Breast self-examination has no effect on mortality. In general, it is no longer true for the majority of breast cancers that early detection makes much of a difference to treatment outcomes, and in large samples, any small effect is outweighed by the tendency of mammograms and self-examinations to lead to biopsies, which occasionally cause formerly benign tumours to turn malignant. This really, really is the current state of science.

@christian-h: Despite marketing themselves very effectively, Komen is hardly the only organization working on issues related to breast cancer. They do seem to have a very visible presence at many workplaces and corporations. I think we should keep an eye out for such efforts to raise money for Komen and, when possible, suggest that some other recipient might be a better idea.

Scott @8, this is along the same lines as a comment that somehow got into moderation hell, but: Google Karen Handel (their VP for Public Policy) and you may be less inclined to give them the benefit of the doubt.

Sending a Komen an emissive may be briefly satisfying but for longer lasting impact on their organization perhaps consider following the Canadian example and engage in a little forensic accounting to thank them for their political decision to harm women they were supposed to be championing. From the Globe and Mail reporting on the Canadian Cancer Society (who I have never seen buy a full page ad in InStyle):

“The CBC analyzed the charity’s financial reports and found “that each year, as the society raised more dollars, the proportion of money it spent on research dropped dramatically — from 40.3 per cent in 2000 to under 22 per cent in 2011.”
The pink-ribbon backlash
While the amount of money channelled toward research has increased slightly, as part of the charity’s overall increasing budget, spending on fundraising and administration has been on the steady rise, according to the CBC.

One Ontario cancer researcher said this should be a concern for those in the field:

“Most scientists don’t realize that the budget has been going up and up, and donations have been growing, but the budget for research has been shrinking,” Brian Lichty, a researcher at McMaster University who is looking into treating cancer with viruses that kill tumours, told the CBC”

Maybe its all fine here. Maybe not.
I have supported the Komen foundation through sponsorships and purchases. Too many friends have been impacted to ignore the cause. But Komens despicable decision will encourage me to find other ways to support research.

According to Ezra Klein: “Komen said it could not continue to fund Planned Parenthood because it has adopted new guidelines that bar it from funding organizations under congressional investigation. The House oversight and investigations subcommittee announced in the fall an investigation into Planned Parenthood’s funding. ”

This policy, innocuous as it sounds, seems to have been chosen particularly to justify defunding PP without even having to say it was about abortion. And “adopting new guidelines” is exactly the VP of Public Policy’s job.

the current state of evidence-based medicine is that young women without specific risk factors should not, in fact, be encouraged to carry out regular self-examinations of their breasts (let alone have regular, painful and largely counterproductive mammograms)

OT banking off OT, we really do need to get harping on the American Cancer Society about this; their recommendations are a decade behind the times now, and there are a hell of a lot of U.S. organizations (Planned Parenthood among them) who organize their whole cancer prevention service suite entirely around bad ACS recommendations.

And it’s worth mentioning it’s not just ACS dragging its heels due to caution and a desire for ‘more research’ or whatever. The relative ineffectuality of early-life mammograms was known by 2002 and was very well-reviewed by 2009, when the USPSTF announced its recommendation statement. (Seems worth noting this happened shortly after Obama took office.)

In fact, the ACS has been surprisingly pissy about reacting to this research and the corresponding USPSTF recommendation statements. Their line is political bullshit; I rememberthere was a news story (Associated Press or something) about the ACS’ refusal to adopt the 2009 USPSTF recommendations; the spokesperson quote was something like “they’re telling women that mammography saves lives, just not enough of them.” Which struck me at the time as a very bullshit way of representing the research, and strikes me now as utterly unconscionable.

On the OT OT topic: I did my national service in a leading German gynecological hospital. At the time we were part of a study that was supposed to prove that yearly (!) mammograms should be had by women over 40. The people involved were quite clearly either consciously massaging the data, or lacked knowledge of statistics and subconsciously steered towards the result they desired (more mammograms).

Sebastian – IIRC the evidence points towards screening over 50s around once every one or two years. To the extent that cutting off funding for PP affects screening for that group of women then it’s likely to cost lives.

Komen always rubbed me the wrong way because of how much money they spent on marketing and “awareness” and how little they spent on research or treatment. or that was my perception, anyway.

I like TBogg’s suggestion:

but you can make a donation to Planned Parenthood and request a thank you card be sent to

Karen Handel
Senior VP of Fail
c/o Susan G. Komen Foundation
P.O. Box 650309
Dallas, TX 75265-0309

biopsies, which occasionally cause formerly benign tumours to turn malignant. This really, really is the current state of science.

Really? Says nothing about that in the linked article. What’s the source?

As a local art critic put it, she rejects the idea that her breasts are innocent and her vagina guilty. May the wrath of the Internet descend upon this cowardly and brain dead organization.

leederick;

(1) Screening activities, like self-examination or mammography, are population health exercises rather than treatment of individuals. The pros and cons are worked out not just on the personal but systemic costs. The obvious risk to the system is to be drowned in low yield biopsies. The risks to the individual are less obvious but still substantial. Once a procedure like a biosy is sufficiently low-yield the small risks (infection, anaesthetic risks) become relatively high. Also, pathology can be wrong, not necessarily through anyone’s error, leading to unnecessary operations.

If the recommendation of self-exam does not work in practice, it should not be made. Having said that, the evidence or self-exam was always weak. It has mainly been pushed, as far as I can tell, to make sure breast cancer awareness was started early and compliance with (high-yield) mammography was raised. Publicity, basically.

Interestingly, with the introduction of Gardasil (the HPV vaccine) the yield of Pap smears is dropping so that the screening recommendations are being revised there as well.

(2) I think the implication is that the charity is becoming less focused on it’s core work and more a self sustaining corporate entity, managed for the benefit of the senior staff. This may or may not be true but decisions like this do suggest it.

(3) No comment. I have never lived in the land of the free so must admit I find such questions…odd.

I think dsquared and Steve Labonne are only partly right. A Swedish scientist has just released a book on the breast screening controversy and I think his opinion is that all screening should be stopped, and that self-examination is sufficient. There’s a big controversy brewing internationally over breastscreening.

Certainly, though, current guidelines shouldn’t be recommending screening for women under 50 and if the US is doing that then that’s just another example of stupid and counter-productive over-treatment. As far as I know the guideline is for women between 40 and 50 to seek screening if they have a family history (mother or Aunt, I think) of breast cancer before 50.

OT OT OT, in my opinion NICE exaggerates the threat of false negatives, and is too conservative in its screening strategies, possibly for cost-cutting reasons. The British cervical screening recommendations are imo too weak.

Not so OT, this is another example of the sucky-ness of not having universal health care. In Australia and the UK breastscreening is provided free by the govt to people who fit into the categories (over 50, or over 40 + doctor’s recommendation). We don’t rely on stupid charities to fund essential health services, and decisions about the appropriateness of the program are made on the basis of evidence and clear guidelines that are set by a democractically elected (well, not in the UK) govt.

In Japan and the USA there is a tendency to overprescribe these screening procedures because the doctor/hospital gets paid for it. While in Australia and the UK the incentive is not to screen if possible (since the screening is arranged separately to any GP service and is done for free).

This is one of the reasons for the USA’s ballooning medical care costs. In Australia, you would only be recommended a mammogram at 42 if you had a strong family history of early breast cancer, but here in Japan it’s a pretty routine part of medical checks (I know a woman in her 30s who is subjected to a mammogram at her annual workplace health check!)

There’s been a long debate about the effectiveness and cost-effectiveness of breast screening. In the 90s and early ‘noughties the evidence tended to fall on the side of screening, but it was always borderline, and the new evidence coming out appears to be against screening. Especially because most breast cancers are slow-growing and modern treatments are improving, the chance that early detection will make any difference to outcomes is declining. This pushes up the number-needed-to-treat, and thus makes the screening less and less worthwhile. The book I linked to seems to include evidence that there is a lot of political pushback going on, but that in the next few years we’re going to see radical changes to the breast screening programs of several nations.

As long as sexual health is seen as a moral issue and not purely a health issue, we will continue to be having these conversations.

ehrenreich article:

http://www.guardian.co.uk/lifeandstyle/2010/jan/02/cancer-positive-thinking-barbara-ehrenreich

there was also a presentation online somewhere where she elaborated on this for some foundation – can;t remember the names, but i remember being pretty impressed by her.

d

MPAVictoria @30: I don’t think PP does abortions in Canada, just referrals. But yeah, I imagine that young women might not want to see their GP (who also treats their mother) for stuff like STD tests, pregnancy tests, birth control, and sexual and reproductive health.

This is not only a political decision, it is a marketing/development one as well. My wife is a breast cancer survivor, and we were supporters of our local Komen until yesterday. Many, many small donors will quit giving to Komen, but the counter-backlash will occur when a handful of wealthy, conservative women decide to “make-up” the missing small donations. There’s no doubt in my mind the Komen board has already weighed these factors in making their decision. They are, like many “mainstream” charities calculating that the future lies with fewer, wealthier donors rather than a broader base of smaller donors. They are counting on the economic trends of the past 30 years remaining the same.

Gack, so does this mean that cutting off PP isn’t actually likely to cost any lives?

It’ll cost lives, and possibly ameliorate a lot of agony spent over false positives. But then, if men were likewise encouraged to get an annual colonoscopy and perform self-exam prostate exams, that would save lives, at the expense of a lot of agony. And if all adults were encouraged to submit themselves to an annual MRI and EEG, who knows what could be detected and nipped in the bud, but it’s not sensible to recommend that even if it strictly speaking would save lives.

One important point is that breast self-exams can be, potentially, awfully counterproductive. Swollen lymph nodes happen all the time and can occasionally manifest basically as a lump. The ‘breast cancer awareness’ SBK movement has, perhaps with good intentions, introduced a huge amount of anxiety over something that (a) happens to a huge number of women and (b) is nothing to worry about because (c) it’s only very rarely indicative of a serious cause for concern, and the serious causes for concern are indistinguishable from the nothing-to-worry-about in self-examination. This is one of the times where I pretend to be utilitarian long enough to agree with the USPSTF conclusion that a lot of 20th-century breast cancer screening procedures are ‘not worth it’ in terms of utility.

OTOH it should be emphasized, mammograms *are* recommended for women 50+, and there’s quite a span between that and Medicare eligibility for Planned Parenthood to fill. I haven’t ever heard before that benign tumors can turn malignant when biopsied, so I set that claim aside, but having an unnecessary mammogram sucks and having an unnecessary biopsy sucks. I didn’t mean to suggest we should be anything less than pissed at SBK, which has just abandoned the main thing that kept it from being an utterly awful charity, or anything less than concerned about Planned Parenthood’s future, which has just been provably compromised by the bullshit Congressional investigation.

“some kind of probe thing into a nipple duct”

If your goal today was to make me wince at my desk mission accomplished. That sounds just awful. My sympathies.

Was the probe thing a consequence of an uncertain mammography or breast exam? (or for that matter, any other kind of screening activity?)

Years ago I knew a woman whose job was teaching doctors to administer pap smears in a way that didn’t hurt. Apparently, with pap smears the pain is largely a function of poor technique.

well then there are no lessons about screening to be learnt from your unfortunate nipple experience. zannen! As you were!

They can’t unshit the bed with a bit of insincere damage control. A lot of executive heads- starting with Brinker and Handel- will need to roll for them to recover even a portion of their former standing. And their even bigger problem is that they’ve been a particularly sucky charity for years in terms of serving their corporate interest vs. serving the cause they claim to support (and in terms of being a Republican front group basically all along), but few dared to question their bona fides. That immunity is over for good.

@17

The people involved [in the mammogram study] were quite clearly either consciously massaging the data . . .

Hi-yooooooooo!

I don’t really know about the whole self-exam/screening issue for young women, but I do know that of the three women I know to have been through breast cancer treatment, one was in her 20s and had (I believe) a double mastectomy; one was in her 30s and had a double mastectomy; one is in her early 40s, and I believe is going with radiation and a lumpectomy.

I don’t know if the two younger women went through it due to genetic testing, or because a lump was found in an examination.

Statistics may well suggest that self-exam and screenings for young women are useless, but that isn’t very persuasive when you’re more concerned about keeping particular individuals healthy.

I mean, we’re not talking about biopsies to screen for Kreutzfeld-Jakob or annual invasive tests of 30-somethings to check for early-onset Alzheimers. Breast cancer strikes young people pretty often.

The “early” breast cancer screening story I heard which saved a life was about something that happened in the late 50’s/ early 60’s from a woman now in her 90’s. A local hospital had found a tumor and said to watch it for a while. (My guess is that it wasn’t that small by modern standards). One of the people at her job was the son of an HMS professor in gynecology or something who told him to “tell that woman to get herself down to the Brigham hospital”. They were working on an early-detection program, since breast cancer was mostly a death sentence then by the time it was caught. I think that if she’d waited the six months to a year the first doctor recommended she probably would have died. I think she got it in her other breast a decade later and had to have a mastectomy. As I said above, I don’t know whether the first tumor would have been seen as an early detection by today’s standards.

BTW, I’ve heard that one of the problems with a biopsy on a possibly malignant tumor is that the very act will spread tumor cells around.

I should perhaps explain to anyone reading this that I bear no personal animus against Mr squared, have enjojyed variuos of his contributions, share a number of opinions and interests with him, etc.

But he recently nailed his colours to the mast and started defending a variety of things which we’ll designate by the term ‘bankers’, thgus joining a bloc which includes the Chipping Norton set, Goldman Sachs etc, and which I consider enemies to me, my family, the NHS and pretty much all I hold dear.

Since then, not only have his bad habits got worse, but even if they hadn’t they are now harmful and not to be tolerated, where previously there was little reason to spoil jokes and get into scraps by challenging them. If people can be encouraged to be considerably more critical of, and less deferential toward, this increasingly pernicious output, that’s a good thing.

Also – far be it from me to take the P out of PPE, but I can’t resist a quick namecheck for Thomas “St Thomas” Aquinas. ‘Heresy’, in those so very ex cathedra italics, snigger.

Note also the use of the term ‘pre-emption’ where ‘disproportionate retaliation’ would probably be more appropriate.

But he recently nailed his colours to the mast and started defending a variety of things which we’ll designate by the term ‘bankers’, thgus joining a bloc which includes the Chipping Norton set, Goldman Sachs etc, and which I consider enemies to me, my family, the NHS and pretty much all I hold dear.

Tim, do you not see how if you are going to accuse me of vile intellectual dishonesty for making small errors on matters of theology (and then, villainy upon villainy, not monitoring every thread I comment on and so not noticing that someone had corrected me! Infamy!), then it kind of reduces your own credibility to post something like the italicised passage above? It’s kind of … well, intellectually dishonest.

Anyway, yes, banned from my threads. It’s perfectly clear that you don’t want to have a polite or good-faith debate on these issues with me, so you shouldn’t be surprised that you aren’t going to get one.

No, basically, I think you have quite a bit of influence and get a bit of an easy ride, partly as a consequence of making use of a battery of techniques for defecting criticism, which includes allowing the witty and amusing presentation to obscure flaws in the underlying argument – which when you’re openly trolling about Bud or something is one thing, but when it’s something more serious, not so. One of those techniques – apart from banning people, e.g. JWMason/’Lemuel Pitkin’, and being shall we say pretty robust in meeting critics (not by trading floor standards, but) – is that ex cathedra kind of tone. It hustles people – who already tend to treat you as the golden boy, deservedly in mnay ways – into accepting what you’re saying. So examples where it’s been used to present false propositions are pretty germane.

That’s all really. Except to point out that you’re providing a tu quoque rather than very susbtantive argument even here, with It’s kind of … well, intellectually dishonest. The point is that I’d perviously been h9olding my tongue because it’s difficult, troublesome, ban-inviting and (previously) unnecessary to start trying – rather quixotically – to right a subtly skewed balance, as I see it.

It’s perfectly clear that you don’t want to have a polite or good-faith debate on these issues with me, so you shouldn’t be surprised that you aren’t going to get one.

But you’ve probably seen enough of my contributions here and elsewhere to realise that I’m not especially unreasonable and in fact generally pretty earnest about topics of any seriousness. This line is almost exactly the same one I’ve already pointed to. And I actually took issue with the description of you as ‘intellectually upright’ where that clearly meant not to be suspected of ever failing to volunteer self-corrections or use similar very slightly dubious techniques’. You are not going to deny you have a fair bit of ego – you wouldn’t, as they say, be where you are now. And everyone has a tendecny to get protective of their rep, treat things as a sparring match rather than pure disinterested pursuit of truth, etc. My pesky little contribution – which I did quite honestly explain – was to try and counteract yours.

I dunno, whatever. You’ll be OK I reckon.

I am apparently wrong about biopsies turning benign tumours malignant – I had just assumed that when NICE referred to them as “harmful”, that’s what they meant.

Good to have that cleared up. Thanks.

It’s good to forthrightly admit mistakes, and that should be encouraged. At the same time, tho, most people would not write that it “really, really is the current state of science” that biopsies cause tumors to become malignant, if what they actually meant was that they’d read that biopsies might be a bad idea and were wildly guessing that might be the reason. So that’s something to file for future reference.

(DSquared, if you’re reading this: You’ve already preemptively banned me, so you needn’t again. You are welcome to comment on my blog any time tho, if you want.)