Chance News 81

Quotations

Eminence based medicine—The more senior the colleague, the less importance he or she placed on the need for anything as mundane as evidence. Experience, it seems, is worth any amount of evidence. These colleagues have a touching faith in clinical experience, which has been defined as “making the same mistakes with increasing confidence over an impressive number of years.” The eminent physician's white hair and balding pate are called the “halo” effect.

from Seven alternatives to evidence based medicine, British Medical Journal, 18 December 1999

Submitted by Paul Alper

Question of significance

“Ultrasounds Detect Cancers That Mammograms Missed, Study Finds”
by William Weir, The Hartford Courant, January 13, 2012

A 2009 CT law requires that “all mammogram reports include the patients' breast density information, and that women with greater than 50 percent density be recommended for additional ultrasound testing.”

For the period October 2009-October 2010, the radiologist collected data on more than 70,000 cases, of which about 8,600 involved ultrasound screenings, and she found that the screenings “detected 3.25 cancers per 1,000 women that otherwise would have been overlooked.”

"When you think about it, we find four or five per thousand breast cancers in an overall screening population. So, then you add that extra three on," she said. "I think that's not insignificant."

She also stated:

[M]ore data was needed to know whether ultrasound tests actually did a better job detecting tumors in breasts with high density. Ultrasounds typically cost patients more than a mammogram (particularly if their insurance has a high deductible), require skilled technologists and take longer to perform than a mammogram. .... [S]he called [the bill] a case of "putting the cart before the horse," [but that] the law presented a "golden opportunity."

The radiologist’s study has been accepted by publication in The Breast Journal.

Discussion

(to come ...)

Submitted by Margaret Cibes