A Canadian study published Wednesday suggests that mammograms do not lower the risk of dying of breast cancer while finding many tumors that do not need treatment. Is atheism rational? Later, Gravity production designer Andy Nicholson joins Larry to discuss how he created outer space for the film.
New large-scale study casts more doubt about necessity of mammograms
By Marilynn Marchione, AP Chief Medical Writer
A Canadian study that many experts say has major flaws has revived debate about the value of mammograms. The research suggests that these screening X-rays do not lower the risk of dying of breast cancer while finding many tumors that do not need treatment.
The study gives longer follow-up on nearly 90,000 women who had annual breast exams by a nurse to check for lumps plus a mammogram, or the nurse's breast exam alone. After more than two decades, breast cancer death rates were similar in the two groups, suggesting little benefit from mammograms.
It's important to note that this study did not compare mammograms to no screening at all, as most other research on this topic has. Many groups have not endorsed breast exams for screening because of limited evidence that they save lives.
Critics of the Canadian study also say it used outdated equipment and poor methods that made mammograms look unfairly ineffective.
The study was published Wednesday in the British journal BMJ.
Breast cancer is the leading type of cancer and cause of cancer deaths in women worldwide. Nearly 1.4 million new cases are diagnosed each year. Many studies have found that mammography saves lives, but how many and for what age groups is debatable. It also causes many false alarms and overtreatment of cancers never destined to become life-threatening.
In the U.S., a government-appointed task force that gives screening advice does not backmammograms until age 50, and then only every other year. The American Cancer Society recommends them every year starting at age 40. Other countries screen less aggressively. In Britain, for example, mammograms are usually offered only every three years.
The Canadian study has long been the most pessimistic on the value of mammograms. It initially reported that after five years of screening, 666 cancers were found among women given mammograms plus breast exams versus 524 cancers among those given the exams alone.
After 25 years of follow-up, about 500 in each group died, suggesting mammograms were not saving lives. The similarity in the death rates suggests that the 142 "extra" cancers caught by mammograms represent overdiagnosis — tumors not destined to prove fatal, study leaders concluded.
The work was immediately criticized. The American College of Radiology and Society of Breast Imaging called it "an incredibly misleading analysis based on the deeply flawed and widely discredited" study. Mammograms typically find far more cancers than this study did, suggesting the quality was poor, the groups contend.
In a letter posted by the medical journal, Dr. Daniel Kopans, a radiologist at Harvard Medical School, described outdated machines and methods he saw in 1990, when he was one of the experts asked to review the quality of mammograms used in the study.
"I can personally attest to the fact that the quality was poor," he wrote. "To save money they used secondhand mammography machines" that gave poor images, failed to properly position breasts for imaging, and did not train radiologists on how to interpret the scans, he wrote.
The study leader, Dr. Anthony Miller of the University of Toronto, said it was "completely untrue" that inferior equipment or methods were used.
Still, the study highlights the fact that mammograms are an imperfect tool that lead to many false alarms, needless biopsies and treatment of many tumors that would never threaten a woman's life.
"Overdiagnosis is not an anomaly in the study from Canada. This has been compellingly demonstrated in research from the U.S. and Europe," said another study leader, Dr. Cornelia Baines of the University of Toronto.
Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in New Hampshire, spoke on the issue at the San Antonio Breast Cancer Symposium in December.
"Screening is a choice, not a public health imperative. There are trade-offs here," he said.
"The people who stand to gain the most from screening are the people at greatest risk of the disease" — older women who are more likely to have breast cancer and those not too old that they are likely to die of something else, he said.
Death rates from breast cancer have fallen mostly because of dramatic improvement in treatments, he and other doctors have said.
"The better we are at treating clinically evident disease, the less important it becomes to find it early," Welch said.
A big caveat: The Canadian study was on routine mammograms to screen healthy women. No one doubts the value of diagnostic mammograms — more detailed X-rays when a problem is suspected or after a lump has been found.
WEIGH IN:
Are doctors changing breast cancer screening in response to studies such as this? If you’re a woman in your 40s or 50s, what’s your plan for breast cancer screening?
GUESTS:
Dr. Joanne Mortimer, Vice Chair and Professor, Medical Oncology & Therapeutics Research, Director and Women's Cancer Programs, Co-director, Breast Cancer Program at City of Hope
Dr. M. William Audeh, medical director of the Wasserman Breast Cancer Risk Reduction Program at the Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute
Theists or atheists: Who is more rational?
The Opinion Pages in the New York Times on Sunday had an intriguing feature, asking whether atheism is a rational belief. A theologian argues in the piece that there's an absence of evidence to support atheism as a logical position, that the best atheists could prove is that God might not exist.
Atheists, on the other hand, would say that burden of proof in this debate rests on the believers, because the amount of evil in the world contradicts the existence of God.
Guests:
William Lane Craig, Research Professor of Philosophy at the Talbot School of Theology at Biola University, a private Christian University based in La Mirada, California
Michael Shermer, founder of Skeptic Magazine
Challenging Alcoholics Anonymous as the model for substance abuse treatment
The 12-step model of alcohol addiction treatment has been the status quo in rehabilitation centers for well over fifty years. Alcoholics Anonymous was formed in the 1930s and by 2000, the 12 steps were the program of choice for 90 percent of American addiction treatment programs.
The success of these rehab programs is now under extra scrutiny since the Affordable Care Act now requires that substance misuse be covered by insurance in the same way as physical illnesses. Several prominent physicians have come out to challenge the dominance of the 12-step model.
A new book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, by former professor of psychiatry at Harvard Medical School Dr. Lance Dodes is the latest to criticize the AA model.
He argues that some studies find that people mandated into AA programs aren't any more successful, and sometimes do worse, than those who are simply left alone.
Is the abstinence-based AA model the most successful treatment program? Should it be the dominant program for the vast majority of American treatment centers? Does one method of treatment work better than another?
Guest:
Dr. Lance Dodes, MD, former director of Harvard’s substance abuse treatment unit at McLean Hospital and co-author of the upcoming book, The Sober Truth: Debunking the Bad Science Behind Twelve-Step Programs and the Rehab Industry
Marc Mahoney, director of operations at SOBA Recovery Center in Malibu, a treatment center rooted in the 12-step philosophy.
Gay man files complaint after Catholic school reneges on job offer
Matthew Barrett was elated when offered a job last year as food services director of Massachusetts Catholic school, Fontbonne Academy. As reported on NPR, Barrett started to prepare new-hire forms including listing his husband as an emergency contact.
Two days later, the school called him in to say the Catholic Church does not recognize same-sex marriage and he could not be hired. In a statement, the Academy explained it "does not discriminate based on sexual orientation but that Church doctrine against same-sex marriage drives policy at Fontbonne and other catholic schools." Federal law exempts religious groups from most employment discrimination laws, but those exemptions tend to be used for leadership or teaching hires.
How much latitude should the school have? How does the Supreme Court decision on same-sex marriage interact with discrimination exemptions for religious organizations? Does a cafeteria manager's same-sex marriage choice affect the teaching of the a Catholic school?
Guest:
Brad Dacus, President of Pacific Justice Institute, a non-profit organization that defends religious liberties and parental rights
Sarah Warbelow, State Legislative Director at Human Rights Campaign
‘Gravity’ production designer Andy Nicholson on taking audiences to space
Alfonso Cuarón’s stunning sci-fi drama ‘Gravity’ earned 10 Oscar nominations this year. Among them, a nod for the film’s production design—which includes a meticulously-crafted Space Shuttle and striking simulation of the zero-gravity environment beyond earth’s atmosphere. Transporting audiences so convincingly to a far-off place they’ve never been was the job of production designer Andy Nicholson.
Nicholson has spent the last two decades working in the art departments of Hollywood films—including Tony Scott’s ‘Spy Game,’ Paul Greengrass’ ‘The Bourne Ultimatum’ and Tim Burton’s ‘Frankenweenie.’ ‘Gravity’ is just Nicholson’s second time in the production designer role—and this space suspense drama was no ordinary job. So much of the interstellar scenes were digitally created.
In addition to real sets, Nicholson built proxy ones—and worked with computer animators upfront to meticulously design the materials and sets that were added in post-production.
How much research did designing ‘Gravity’ require? What went into the creation of scenes like the one below?
Guest:
Andy Nicholson, Oscar-nominated production designer of director Alfonso Cuaron’s “Gravity;” Nicholson’s other credits include art direction on “Sleepy Hollow,” “Troy,” “The Bourne Ultimatum,” “The Golden Compass” and more.