TORONTO – Most women age 40 to 49 should not have routine mammograms and those 50 to 69 can wait slightly longer between the tests than previously recommended, updated Canadian breast cancer screening guidelines advise.

And for the first time, the Canadian Task Force on Preventive Health Care that developed the guidelines says that women aged 70 to 74 should be getting mammograms on the same schedule as those 50 to 69.

The revamped guidelines, published Monday in the Canadian Medical Association Journal, apply to women with an average risk of developing the disease. They include those with no previous breast cancer, no history of the disease in a first-degree relative like a mother or sister, no known BRCA genetic mutation and no previous exposure to radiation of the chest wall.

In its previous set of guidelines penned in 2001, the expert panel made no recommendations for average-risk women in their 40s as to whether they should have routine screening or not.

But the task force now advises against the practice for that age group, saying the potential harms from false positives and unnecessary subsequent cancer treatment outweigh the possible benefit – a slight reduction in the number of deaths from the disease.

Story continues below

“Before there was no recommendation for or against, and clinical practice followed that lead,” said task force chair Dr. Marcello Tonelli of the University of Alberta. “Most organized screening programs don’t recruit women aged 40 to 49 years as a result.

“The biggest change of all is probably in the way in which we frame all of our recommendations, that breast cancer screening has risks and it has benefits, and how women weigh those up will influence their personal decision to be screened or not.”

In the 2001 guidelines, women 50 to 69 with an average risk of breast cancer were advised to have mammography every two years. But the new guide extends that period, saying such tests can be done every two to three years.

The panel now suggests women age 70 to 74 should also have mammograms every two to three years.

“In routine practice, one of the challenges in producing guidance and then implementing it in real life is that patients don’t turn up for screening or any other service on the anniversary of their last test,” said Tonelli.

“So the intent here was to give a range so that someone who is appearing for screening at two years and a day is still falling within recommended practice (and) even after two years and six months,” he said from Edmonton.

“We also wanted to signal that since the last set of guidelines were produced, there has been some evidence produced that longer screening intervals, like every three years, might be just as good as every year.”

The new guidelines have grown out of an intensive review of international clinical trials, which looked at the risk of developing breast cancer in the various age groups and the potential harms inherent in the breast X-ray that can arise from misdiagnosis.

“Specifically, the harms could range from a woman being told she has an abnormality on a mammogram and being asked to repeat the mammogram, being asked to go for a biopsy of her breast, being asked to have part or all of her breast removed, and all the way up to surgery and radiation and chemotherapy.

“These are the spectrum of possible harms, so if you don’t have breast cancer, but you have your breast removed and have surgery, I think we’d all agree that’s a harm of screening.”

The task force determined that screening 2,100 women every two to three years for about 11 years would prevent just one death from breast cancer. However, it also would result in 690 women having false-positives that would lead to unnecessary followup testing, including 75 women having unnecessary breast biopsies.

“For every woman that had cancer found with mammography, there are many more that have had a false positive result or a scare,” Tonelli said.

While no primary studies looked at the risk of overdiagnosis specifically among women 40 to 49 years, “data from our systematic review show that for every 1,000 women aged 39 years and older who are screened using mammography, five will have an unnecessary lumpectomy or mastectomy,” the authors write.

“In addition to unnecessary intervention, false-positive results can lead to fear, anxiety and distress.”

Dr. Cornelia Baines, an epidemiologist at the University of Toronto and one of the world’s foremost experts on breast cancer screening, lauded the task force’s recommendations, calling them “completely warranted.”

“All in all, I think it’s a superb set of guidelines that really are very, very carefully drawn, carefully thought out and totally justified on the basis of existing evidence.”

Still, she predicted they will be greeted with the same indignation and criticism that occurred in 2009 when the U.S. Preventive Services Task Force presented similar recommendations, which also advised women to defer routine mammograms until age 50.

The switch from the previous recommendation that American women in their 40s have a mammogram every year or two like their older sisters caused a firestorm of controversy.

If Baines has any criticism about the revamped Canadian guidelines, it is that they could have been clearer in illustrating the potential harms arising from false-positive results, which could “serve as a disincentive to wanting screening.”

“They don’t say it in a way that really hits home,” she said, noting that for women age 40 to 49, there is a one in three chance of having a false-positive result, and one in every 200 will be falsely diagnosed with breast cancer and unnecessarily treated.

“I had breast cancer,” said Baines. “I can’t imagine how I would feel if I thought there was a major chance that all the emotional upheaval, all the miseries of treatment, all the misery of followup, all the misery of diagnostic labelling was all useless because I didn’t really have breast cancer.

“I do know for a fact that only a minority of women who get breast cancer die of it.”

This year in Canada, an estimated 23,600 women overall will be diagnosed with breast cancer and an estimated 5,100 will die of the disease.

The College of Family Physicians of Canada has endorsed the new guidelines, as has the Canadian Cancer Society.

Gillian Bromfield, director of cancer control policy for the Canadian Cancer Society, said they reinforce the organization’s own breast-screening recommendations, which suggest women 50 to 69 should have a mammogram every two years.

“For women age 50 to 69, all the major health organizations are quite consistent that this is the age group that should be getting screened on a regular basis,” she said. “When you get outside of that age range, that’s where you start to see a bit more inconsistency.”

Among women in their 40s, for example, the evidence isn’t particularly strong that routine mammograms help to save lives, Bromfield said. Even so, some women will still want screening and should talk to their doctors about the benefits and risks.

Indeed, that is the overriding advice of the guidelines, Tonelli stressed.

“They say: ‘Here is what you can expect to get in the way of benefits from screening and here’s what you might expect in the way of harms. And based on what you, yourself, feel about your trade-off of those risks and those benefits, you together with your doctor can make a decision that’s right for you.’”

In a related commentary, Dr. Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen, calls the new guidelines “more balanced and more in accordance with the evidence than any previous recommendations.”

Gotzsche writes that scientific evidence does not support mammography screening and he argues that it could even be harmful because it can lead to unnecessary mastectomies.

“The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening.”

NEW YORK, N.Y. – The mother of a “lone wolf” accused of plotting to attack police stations and post offices with homemade bombs apologized to New Yorkers on Monday, even as questions arose about why federal authorities – who typically handle terrorism cases – declined to get involved in what city officials called a serious threat.

The mother of Jose Pimentel spoke to reporters outside her upper Manhattan home the day after her son was arraigned in state court on terrorism-related charges.

“I didn’t raise my son in that way,” Carmen Sosa said.

Officials with the NYPD, which conducted the undercover investigation using a confidential informant and a bugged apartment, said the department had to move quickly because Pimentel was about to test a pipe bomb made out of match heads, nails and other ingredients bought at neighbourhood hardware and discount stores.

Federal authorities were aware of the probe, but under the circumstances, “it was appropriate to proceed under state charges,” District Attorney Cyrus Vance said in announcing the arrest late Sunday.

Story continues below

Two law enforcement officials said Monday that the NYPD’s Intelligence Division had sought to get the FBI involved at least twice as the investigation unfolded. Both times, the FBI concluded that he wasn’t a serious threat, they said.

The FBI thought Pimentel “didn’t have the predisposition or the ability to do anything on his own,” one of the officials said.

The officials were not authorized to speak about the case and spoke on condition of anonymity. The FBI’s New York office and the U.S. attorney’s office in Manhattan both declined to comment on Monday.

Pimentel’s lawyer, Joseph Zablocki, said his client was never a true threat.

The arrest marked the second time this year that the police department took the unusual step of working with a state prosecutor to bring a terrorism case. In May, two men were indicted on charges they told an NYPD undercover detective about their desire to attack synagogues.

A grand jury declined to indict Ahmed Ferhani and Mohamed Mamdouh on the most serious charge initially brought against them – a high-level terror conspiracy count that carried the potential for life in prison without parole. They were, however, indicted on lesser state terrorism and hate crime charges, including one punishable by up to 32 years behind bars.

Attorneys for Ferhani said hate crime charges and a rarely used state terrorism law were misapplied to what they have called a case of police entrapment.

State prosecutors insist that there’s ample evidence that Pimentel went well beyond merely talking about terrorism – and that he was acting on his own initiative.

At an arraignment where Pimentel was ordered held without bail, prosecutors said investigators have “countless hours” of audio and video in this case. And in a criminal complaint, an intelligence division detective alleges Pimentel told him after the arrest that he was about an hour away from finishing the bomb and felt Islamic law obligates all Muslims to wage war against Americans to avenge U.S. military action in their homelands.

TORONTO – Most women age 40 to 49 should not have routine mammograms and those 50 to 69 can wait slightly longer between the tests than previously recommended, updated Canadian breast cancer screening guidelines advise.

And for the first time, the Canadian Task Force on Preventive Health Care that developed the guidelines says that women aged 70 to 74 should be getting mammograms on the same schedule as those 50 to 69.

The revamped guidelines, published Monday in the Canadian Medical Association Journal, apply to women with an average risk of developing the disease. They include those with no previous breast cancer, no history of the disease in a first-degree relative like a mother or sister, no known BRCA genetic mutation and no previous exposure to radiation of the chest wall.

In its previous set of guidelines penned in 2001, the expert panel made no recommendations for average-risk women in their 40s as to whether they should have routine screening or not.

But the task force now advises against the practice for that age group, saying the potential harms from false positives and unnecessary subsequent cancer treatment outweigh the possible benefit – a slight reduction in the number of deaths from the disease.

Story continues below

“Before there was no recommendation for or against, and clinical practice followed that lead,” said task force chair Dr. Marcello Tonelli of the University of Alberta. “Most organized screening programs don’t recruit women aged 40 to 49 years as a result.

“The biggest change of all is probably in the way in which we frame all of our recommendations, that breast cancer screening has risks and it has benefits, and how women weigh those up will influence their personal decision to be screened or not.”

In the 2001 guidelines, women 50 to 69 with an average risk of breast cancer were advised to have mammography every two years. But the new guide extends that period, saying such tests can be done every two to three years.

The panel now suggests women age 70 to 74 should also have mammograms every two to three years.

“In routine practice, one of the challenges in producing guidance and then implementing it in real life is that patients don’t turn up for screening or any other service on the anniversary of their last test,” said Tonelli.

“So the intent here was to give a range so that someone who is appearing for screening at two years and a day is still falling within recommended practice (and) even after two years and six months,” he said from Edmonton.

“We also wanted to signal that since the last set of guidelines were produced, there has been some evidence produced that longer screening intervals, like every three years, might be just as good as every year.”

The new guidelines have grown out of an intensive review of international clinical trials, which looked at the risk of developing breast cancer in the various age groups and the potential harms inherent in the breast X-ray that can arise from misdiagnosis.

“Specifically, the harms could range from a woman being told she has an abnormality on a mammogram and being asked to repeat the mammogram, being asked to go for a biopsy of her breast, being asked to have part or all of her breast removed, and all the way up to surgery and radiation and chemotherapy.

“These are the spectrum of possible harms, so if you don’t have breast cancer, but you have your breast removed and have surgery, I think we’d all agree that’s a harm of screening.”

The task force determined that screening 2,100 women every two to three years for about 11 years would prevent just one death from breast cancer. However, it also would result in 690 women having false-positives that would lead to unnecessary followup testing, including 75 women having unnecessary breast biopsies.

“For every woman that had cancer found with mammography, there are many more that have had a false positive result or a scare,” Tonelli said.

While no primary studies looked at the risk of overdiagnosis specifically among women 40 to 49 years, “data from our systematic review show that for every 1,000 women aged 39 years and older who are screened using mammography, five will have an unnecessary lumpectomy or mastectomy,” the authors write.

“In addition to unnecessary intervention, false-positive results can lead to fear, anxiety and distress.”

Dr. Cornelia Baines, an epidemiologist at the University of Toronto and one of the world’s foremost experts on breast cancer screening, lauded the task force’s recommendations, calling them “completely warranted.”

“All in all, I think it’s a superb set of guidelines that really are very, very carefully drawn, carefully thought out and totally justified on the basis of existing evidence.”

Still, she predicted they will be greeted with the same indignation and criticism that occurred in 2009 when the U.S. Preventive Services Task Force presented similar recommendations, which also advised women to defer routine mammograms until age 50.

The switch from the previous recommendation that American women in their 40s have a mammogram every year or two like their older sisters caused a firestorm of controversy.

If Baines has any criticism about the revamped Canadian guidelines, it is that they could have been clearer in illustrating the potential harms arising from false-positive results, which could “serve as a disincentive to wanting screening.”

“They don’t say it in a way that really hits home,” she said, noting that for women age 40 to 49, there is a one in three chance of having a false-positive result, and one in every 200 will be falsely diagnosed with breast cancer and unnecessarily treated.

“I had breast cancer,” said Baines. “I can’t imagine how I would feel if I thought there was a major chance that all the emotional upheaval, all the miseries of treatment, all the misery of followup, all the misery of diagnostic labelling was all useless because I didn’t really have breast cancer.

“I do know for a fact that only a minority of women who get breast cancer die of it.”

This year in Canada, an estimated 23,600 women overall will be diagnosed with breast cancer and an estimated 5,100 will die of the disease.

The College of Family Physicians of Canada has endorsed the new guidelines, as has the Canadian Cancer Society.

Gillian Bromfield, director of cancer control policy for the Canadian Cancer Society, said they reinforce the organization’s own breast-screening recommendations, which suggest women 50 to 69 should have a mammogram every two years.

“For women age 50 to 69, all the major health organizations are quite consistent that this is the age group that should be getting screened on a regular basis,” she said. “When you get outside of that age range, that’s where you start to see a bit more inconsistency.”

Among women in their 40s, for example, the evidence isn’t particularly strong that routine mammograms help to save lives, Bromfield said. Even so, some women will still want screening and should talk to their doctors about the benefits and risks.

Indeed, that is the overriding advice of the guidelines, Tonelli stressed.

“They say: ‘Here is what you can expect to get in the way of benefits from screening and here’s what you might expect in the way of harms. And based on what you, yourself, feel about your trade-off of those risks and those benefits, you together with your doctor can make a decision that’s right for you.’”

In a related commentary, Dr. Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen, calls the new guidelines “more balanced and more in accordance with the evidence than any previous recommendations.”

Gotzsche writes that scientific evidence does not support mammography screening and he argues that it could even be harmful because it can lead to unnecessary mastectomies.

“The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening.”

—

Online:

Guidelines: 杭州桑拿按摩论坛杭州夜生活cmaj.ca/lookup/doi/10.1503/cmaj.110334

Commentary: 杭州桑拿按摩论坛杭州夜生活cmaj.ca/lookup/doi/10.1503/cmaj.111721

Canadian Cancer Society: 杭州桑拿按摩论坛杭州夜生活cancer.ca

Note to readers: This is a corrected story. A previous version had an incorrect spelling for Bromfield

TORONTO – Most women age 40 to 49 should not have routine mammograms and those 50 to 69 can wait slightly longer between the tests than previously recommended, updated Canadian breast cancer screening guidelines advise.

And for the first time, the Canadian Task Force on Preventive Health Care that developed the guidelines says that women aged 70 to 74 should be getting mammograms on the same schedule as those 50 to 69.

The revamped guidelines, published Monday in the Canadian Medical Association Journal, apply to women with an average risk of developing the disease. They include those with no previous breast cancer, no history of the disease in a first-degree relative like a mother or sister, no known BRCA genetic mutation and no previous exposure to radiation of the chest wall.

In its previous set of guidelines penned in 2001, the expert panel made no recommendations for average-risk women in their 40s as to whether they should have routine screening or not.

But the task force now advises against the practice for that age group, saying the potential harms from false positives and unnecessary subsequent cancer treatment outweigh the possible benefit – a slight reduction in the number of deaths from the disease.

Story continues below

“Before there was no recommendation for or against, and clinical practice followed that lead,” said task force chair Dr. Marcello Tonelli of the University of Alberta. “Most organized screening programs don’t recruit women aged 40 to 49 years as a result.

“The biggest change of all is probably in the way in which we frame all of our recommendations, that breast cancer screening has risks and it has benefits, and how women weigh those up will influence their personal decision to be screened or not.”

In the 2001 guidelines, women 50 to 69 with an average risk of breast cancer were advised to have mammography every two years. But the new guide extends that period, saying such tests can be done every two to three years.

The panel now suggests women age 70 to 74 should also have mammograms every two to three years.

“In routine practice, one of the challenges in producing guidance and then implementing it in real life is that patients don’t turn up for screening or any other service on the anniversary of their last test,” said Tonelli.

“So the intent here was to give a range so that someone who is appearing for screening at two years and a day is still falling within recommended practice (and) even after two years and six months,” he said from Edmonton.

“We also wanted to signal that since the last set of guidelines were produced, there has been some evidence produced that longer screening intervals, like every three years, might be just as good as every year.”

The new guidelines have grown out of an intensive review of international clinical trials, which looked at the risk of developing breast cancer in the various age groups and the potential harms inherent in the breast X-ray that can arise from misdiagnosis.

“Specifically, the harms could range from a woman being told she has an abnormality on a mammogram and being asked to repeat the mammogram, being asked to go for a biopsy of her breast, being asked to have part or all of her breast removed, and all the way up to surgery and radiation and chemotherapy.

“These are the spectrum of possible harms, so if you don’t have breast cancer, but you have your breast removed and have surgery, I think we’d all agree that’s a harm of screening.”

The task force determined that screening 2,100 women every two to three years for about 11 years would prevent just one death from breast cancer. However, it also would result in 690 women having false-positives that would lead to unnecessary followup testing, including 75 women having unnecessary breast biopsies.

“For every woman that had cancer found with mammography, there are many more that have had a false positive result or a scare,” Tonelli said.

While no primary studies looked at the risk of overdiagnosis specifically among women 40 to 49 years, “data from our systematic review show that for every 1,000 women aged 39 years and older who are screened using mammography, five will have an unnecessary lumpectomy or mastectomy,” the authors write.

“In addition to unnecessary intervention, false-positive results can lead to fear, anxiety and distress.”

Dr. Cornelia Baines, an epidemiologist at the University of Toronto and one of the world’s foremost experts on breast cancer screening, lauded the task force’s recommendations, calling them “completely warranted.”

“All in all, I think it’s a superb set of guidelines that really are very, very carefully drawn, carefully thought out and totally justified on the basis of existing evidence.”

Still, she predicted they will be greeted with the same indignation and criticism that occurred in 2009 when the U.S. Preventive Services Task Force presented similar recommendations, which also advised women to defer routine mammograms until age 50.

The switch from the previous recommendation that American women in their 40s have a mammogram every year or two like their older sisters caused a firestorm of controversy.

If Baines has any criticism about the revamped Canadian guidelines, it is that they could have been clearer in illustrating the potential harms arising from false-positive results, which could “serve as a disincentive to wanting screening.”

“They don’t say it in a way that really hits home,” she said, noting that for women age 40 to 49, there is a one in three chance of having a false-positive result, and one in every 200 will be falsely diagnosed with breast cancer and unnecessarily treated.

“I had breast cancer,” said Baines. “I can’t imagine how I would feel if I thought there was a major chance that all the emotional upheaval, all the miseries of treatment, all the misery of followup, all the misery of diagnostic labelling was all useless because I didn’t really have breast cancer.

“I do know for a fact that only a minority of women who get breast cancer die of it.”

This year in Canada, an estimated 23,600 women overall will be diagnosed with breast cancer and an estimated 5,100 will die of the disease.

The College of Family Physicians of Canada has endorsed the new guidelines, as has the Canadian Cancer Society.

Gillian Bromfield, director of cancer control policy for the Canadian Cancer Society, said they reinforce the organization’s own breast-screening recommendations, which suggest women 50 to 69 should have a mammogram every two years.

“For women age 50 to 69, all the major health organizations are quite consistent that this is the age group that should be getting screened on a regular basis,” she said. “When you get outside of that age range, that’s where you start to see a bit more inconsistency.”

Among women in their 40s, for example, the evidence isn’t particularly strong that routine mammograms help to save lives, Bromfield said. Even so, some women will still want screening and should talk to their doctors about the benefits and risks.

Indeed, that is the overriding advice of the guidelines, Tonelli stressed.

“They say: ‘Here is what you can expect to get in the way of benefits from screening and here’s what you might expect in the way of harms. And based on what you, yourself, feel about your trade-off of those risks and those benefits, you together with your doctor can make a decision that’s right for you.’”

In a related commentary, Dr. Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen, calls the new guidelines “more balanced and more in accordance with the evidence than any previous recommendations.”

Gotzsche writes that scientific evidence does not support mammography screening and he argues that it could even be harmful because it can lead to unnecessary mastectomies.

“The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening.”

—

Online:

Guidelines: 杭州桑拿按摩论坛杭州夜生活cmaj.ca/lookup/doi/10.1503/cmaj.110334

Commentary: 杭州桑拿按摩论坛杭州夜生活cmaj.ca/lookup/doi/10.1503/cmaj.111721

Canadian Cancer Society: 杭州桑拿按摩论坛杭州夜生活cancer.ca

Note to readers: This is a corrected story. A previous version had an incorrect spelling for Bromfield

TORONTO – Most women age 40 to 49 should not have routine mammograms and those 50 to 69 can wait slightly longer between the tests than previously recommended, updated Canadian breast cancer screening guidelines advise.

And for the first time, the Canadian Task Force on Preventive Health Care that developed the guidelines says that women aged 70 to 74 should be getting mammograms on the same schedule as those 50 to 69.

The revamped guidelines, published Monday in the Canadian Medical Association Journal, apply to women with an average risk of developing the disease. They include those with no previous breast cancer, no history of the disease in a first-degree relative like a mother or sister, no known BRCA genetic mutation and no previous exposure to radiation of the chest wall.

In its previous set of guidelines penned in 2001, the expert panel made no recommendations for average-risk women in their 40s as to whether they should have routine screening or not.

But the task force now advises against the practice for that age group, saying the potential harms from false positives and unnecessary subsequent cancer treatment outweigh the possible benefit – a slight reduction in the number of deaths from the disease.

Story continues below

“Before there was no recommendation for or against, and clinical practice followed that lead,” said task force chair Dr. Marcello Tonelli of the University of Alberta. “Most organized screening programs don’t recruit women aged 40 to 49 years as a result.

“The biggest change of all is probably in the way in which we frame all of our recommendations, that breast cancer screening has risks and it has benefits, and how women weigh those up will influence their personal decision to be screened or not.”

In the 2001 guidelines, women 50 to 69 with an average risk of breast cancer were advised to have mammography every two years. But the new guide extends that period, saying such tests can be done every two to three years.

The panel now suggests women age 70 to 74 should also have mammograms every two to three years.

“In routine practice, one of the challenges in producing guidance and then implementing it in real life is that patients don’t turn up for screening or any other service on the anniversary of their last test,” said Tonelli.

“So the intent here was to give a range so that someone who is appearing for screening at two years and a day is still falling within recommended practice (and) even after two years and six months,” he said from Edmonton.

“We also wanted to signal that since the last set of guidelines were produced, there has been some evidence produced that longer screening intervals, like every three years, might be just as good as every year.”

The new guidelines have grown out of an intensive review of international clinical trials, which looked at the risk of developing breast cancer in the various age groups and the potential harms inherent in the breast X-ray that can arise from misdiagnosis.

“Specifically, the harms could range from a woman being told she has an abnormality on a mammogram and being asked to repeat the mammogram, being asked to go for a biopsy of her breast, being asked to have part or all of her breast removed, and all the way up to surgery and radiation and chemotherapy.

“These are the spectrum of possible harms, so if you don’t have breast cancer, but you have your breast removed and have surgery, I think we’d all agree that’s a harm of screening.”

The task force determined that screening 2,100 women every two to three years for about 11 years would prevent just one death from breast cancer. However, it also would result in 690 women having false-positives that would lead to unnecessary followup testing, including 75 women having unnecessary breast biopsies.

“For every woman that had cancer found with mammography, there are many more that have had a false positive result or a scare,” Tonelli said.

While no primary studies looked at the risk of overdiagnosis specifically among women 40 to 49 years, “data from our systematic review show that for every 1,000 women aged 39 years and older who are screened using mammography, five will have an unnecessary lumpectomy or mastectomy,” the authors write.

“In addition to unnecessary intervention, false-positive results can lead to fear, anxiety and distress.”

Dr. Cornelia Baines, an epidemiologist at the University of Toronto and one of the world’s foremost experts on breast cancer screening, lauded the task force’s recommendations, calling them “completely warranted.”

“All in all, I think it’s a superb set of guidelines that really are very, very carefully drawn, carefully thought out and totally justified on the basis of existing evidence.”

Still, she predicted they will be greeted with the same indignation and criticism that occurred in 2009 when the U.S. Preventive Services Task Force presented similar recommendations, which also advised women to defer routine mammograms until age 50.

The switch from the previous recommendation that American women in their 40s have a mammogram every year or two like their older sisters caused a firestorm of controversy.

If Baines has any criticism about the revamped Canadian guidelines, it is that they could have been clearer in illustrating the potential harms arising from false-positive results, which could “serve as a disincentive to wanting screening.”

“They don’t say it in a way that really hits home,” she said, noting that for women age 40 to 49, there is a one in three chance of having a false-positive result, and one in every 200 will be falsely diagnosed with breast cancer and unnecessarily treated.

“I had breast cancer,” said Baines. “I can’t imagine how I would feel if I thought there was a major chance that all the emotional upheaval, all the miseries of treatment, all the misery of followup, all the misery of diagnostic labelling was all useless because I didn’t really have breast cancer.

“I do know for a fact that only a minority of women who get breast cancer die of it.”

This year in Canada, an estimated 23,600 women overall will be diagnosed with breast cancer and an estimated 5,100 will die of the disease.

The College of Family Physicians of Canada has endorsed the new guidelines, as has the Canadian Cancer Society.

Gillian Bromfield, director of cancer control policy for the Canadian Cancer Society, said they reinforce the organization’s own breast-screening recommendations, which suggest women 50 to 69 should have a mammogram every two years.

“For women age 50 to 69, all the major health organizations are quite consistent that this is the age group that should be getting screened on a regular basis,” she said. “When you get outside of that age range, that’s where you start to see a bit more inconsistency.”

Among women in their 40s, for example, the evidence isn’t particularly strong that routine mammograms help to save lives, Bromfield said. Even so, some women will still want screening and should talk to their doctors about the benefits and risks.

Indeed, that is the overriding advice of the guidelines, Tonelli stressed.

“They say: ‘Here is what you can expect to get in the way of benefits from screening and here’s what you might expect in the way of harms. And based on what you, yourself, feel about your trade-off of those risks and those benefits, you together with your doctor can make a decision that’s right for you.’”

In a related commentary, Dr. Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen, calls the new guidelines “more balanced and more in accordance with the evidence than any previous recommendations.”

Gotzsche writes that scientific evidence does not support mammography screening and he argues that it could even be harmful because it can lead to unnecessary mastectomies.

“The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening.”

—

Online:

Guidelines: 杭州桑拿按摩论坛杭州夜生活cmaj.ca/lookup/doi/10.1503/cmaj.110334

Commentary: 杭州桑拿按摩论坛杭州夜生活cmaj.ca/lookup/doi/10.1503/cmaj.111721

Canadian Cancer Society: 杭州桑拿按摩论坛杭州夜生活cancer.ca

Note to readers: This is a corrected story. A previous version had an incorrect spelling for Bromfield

TORONTO – Most women age 40 to 49 should not have routine mammograms and those 50 to 69 can wait slightly longer between the tests than previously recommended, updated Canadian breast cancer screening guidelines advise.

And for the first time, the Canadian Task Force on Preventive Health Care that developed the guidelines says that women aged 70 to 74 should be getting mammograms on the same schedule as those 50 to 69.

The revamped guidelines, published Monday in the Canadian Medical Association Journal, apply to women with an average risk of developing the disease. They include those with no previous breast cancer, no history of the disease in a first-degree relative like a mother or sister, no known BRCA genetic mutation and no previous exposure to radiation of the chest wall.

In its previous set of guidelines penned in 2001, the expert panel made no recommendations for average-risk women in their 40s as to whether they should have routine screening or not.

But the task force now advises against the practice for that age group, saying the potential harms from false positives and unnecessary subsequent cancer treatment outweigh the possible benefit – a slight reduction in the number of deaths from the disease.

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“Before there was no recommendation for or against, and clinical practice followed that lead,” said task force chair Dr. Marcello Tonelli of the University of Alberta. “Most organized screening programs don’t recruit women aged 40 to 49 years as a result.

“The biggest change of all is probably in the way in which we frame all of our recommendations, that breast cancer screening has risks and it has benefits, and how women weigh those up will influence their personal decision to be screened or not.”

In the 2001 guidelines, women 50 to 69 with an average risk of breast cancer were advised to have mammography every two years. But the new guide extends that period, saying such tests can be done every two to three years.

The panel now suggests women age 70 to 74 should also have mammograms every two to three years.

“In routine practice, one of the challenges in producing guidance and then implementing it in real life is that patients don’t turn up for screening or any other service on the anniversary of their last test,” said Tonelli.

“So the intent here was to give a range so that someone who is appearing for screening at two years and a day is still falling within recommended practice (and) even after two years and six months,” he said from Edmonton.

“We also wanted to signal that since the last set of guidelines were produced, there has been some evidence produced that longer screening intervals, like every three years, might be just as good as every year.”

The new guidelines have grown out of an intensive review of international clinical trials, which looked at the risk of developing breast cancer in the various age groups and the potential harms inherent in the breast X-ray that can arise from misdiagnosis.

“Specifically, the harms could range from a woman being told she has an abnormality on a mammogram and being asked to repeat the mammogram, being asked to go for a biopsy of her breast, being asked to have part or all of her breast removed, and all the way up to surgery and radiation and chemotherapy.

“These are the spectrum of possible harms, so if you don’t have breast cancer, but you have your breast removed and have surgery, I think we’d all agree that’s a harm of screening.”

The task force determined that screening 2,100 women every two to three years for about 11 years would prevent just one death from breast cancer. However, it also would result in 690 women having false-positives that would lead to unnecessary followup testing, including 75 women having unnecessary breast biopsies.

“For every woman that had cancer found with mammography, there are many more that have had a false positive result or a scare,” Tonelli said.

While no primary studies looked at the risk of overdiagnosis specifically among women 40 to 49 years, “data from our systematic review show that for every 1,000 women aged 39 years and older who are screened using mammography, five will have an unnecessary lumpectomy or mastectomy,” the authors write.

“In addition to unnecessary intervention, false-positive results can lead to fear, anxiety and distress.”

Dr. Cornelia Baines, an epidemiologist at the University of Toronto and one of the world’s foremost experts on breast cancer screening, lauded the task force’s recommendations, calling them “completely warranted.”

“All in all, I think it’s a superb set of guidelines that really are very, very carefully drawn, carefully thought out and totally justified on the basis of existing evidence.”

Still, she predicted they will be greeted with the same indignation and criticism that occurred in 2009 when the U.S. Preventive Services Task Force presented similar recommendations, which also advised women to defer routine mammograms until age 50.

The switch from the previous recommendation that American women in their 40s have a mammogram every year or two like their older sisters caused a firestorm of controversy.

If Baines has any criticism about the revamped Canadian guidelines, it is that they could have been clearer in illustrating the potential harms arising from false-positive results, which could “serve as a disincentive to wanting screening.”

“They don’t say it in a way that really hits home,” she said, noting that for women age 40 to 49, there is a one in three chance of having a false-positive result, and one in every 200 will be falsely diagnosed with breast cancer and unnecessarily treated.

“I had breast cancer,” said Baines. “I can’t imagine how I would feel if I thought there was a major chance that all the emotional upheaval, all the miseries of treatment, all the misery of followup, all the misery of diagnostic labelling was all useless because I didn’t really have breast cancer.

“I do know for a fact that only a minority of women who get breast cancer die of it.”

This year in Canada, an estimated 23,600 women overall will be diagnosed with breast cancer and an estimated 5,100 will die of the disease.

The College of Family Physicians of Canada has endorsed the new guidelines, as has the Canadian Cancer Society.

Gillian Bromfield, director of cancer control policy for the Canadian Cancer Society, said they reinforce the organization’s own breast-screening recommendations, which suggest women 50 to 69 should have a mammogram every two years.

“For women age 50 to 69, all the major health organizations are quite consistent that this is the age group that should be getting screened on a regular basis,” she said. “When you get outside of that age range, that’s where you start to see a bit more inconsistency.”

Among women in their 40s, for example, the evidence isn’t particularly strong that routine mammograms help to save lives, Bromfield said. Even so, some women will still want screening and should talk to their doctors about the benefits and risks.

Indeed, that is the overriding advice of the guidelines, Tonelli stressed.

“They say: ‘Here is what you can expect to get in the way of benefits from screening and here’s what you might expect in the way of harms. And based on what you, yourself, feel about your trade-off of those risks and those benefits, you together with your doctor can make a decision that’s right for you.’”

In a related commentary, Dr. Peter Gotzsche of the Nordic Cochrane Centre in Copenhagen, calls the new guidelines “more balanced and more in accordance with the evidence than any previous recommendations.”

Gotzsche writes that scientific evidence does not support mammography screening and he argues that it could even be harmful because it can lead to unnecessary mastectomies.

“The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening.”

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Online:

Guidelines: 杭州桑拿按摩论坛杭州夜生活cmaj.ca/lookup/doi/10.1503/cmaj.110334

Commentary: 杭州桑拿按摩论坛杭州夜生活cmaj.ca/lookup/doi/10.1503/cmaj.111721

Canadian Cancer Society: 杭州桑拿按摩论坛杭州夜生活cancer.ca

Note to readers: This is a corrected story. A previous version had an incorrect spelling for Bromfield

FLORHAM PARK, N.J. – Rex Ryan’s mouth really cost him this time.

The brash New York Jets coach will not appeal a US$75,000 fine issued by the NFL on Monday for using profanity while angrily responding to a fan at halftime of New York’s 37-16 loss to New England last Sunday. Ryan received an official notice from Commissioner Roger Goodell in the morning.

“The commissioner’s got a tough enough job,” Ryan said. “I’m an NFL lifer. I know I represent the NFL and I know I represent the Jets, so I’m accountable for my actions.”

Ryan spoke to Goodell a few days ago to discuss the matter, and to apologize to him.

“Quite honestly, the man’s made a decision, and if his decision is that I should be fined $75,000, then that’s the way it is,” Ryan said, when asked if the punishment was excessive. “I just want to get it behind me.”

A 49-second video shot by a fan at MetLife Stadium shows the Jets walking off the field and when Ryan appears, someone is heard yelling, “Hey, Rex, Belichick is better than you,” referring to Patriots coach Bill Belichick. Ryan looks up and tells the fan to “shut up” while also using an obscenity.

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Ryan apologized a day later for what he called “a mistake,” saying he “was full of emotion and just popped off.” Moments earlier, the Jets had just allowed the Patriots to take a 13-9 lead into halftime. He reiterated Monday that he has owned up to what he did since the incident became public last week.

It’s not the first time Ryan is in trouble because of his mouth, which likely contributed to the hefty punishment. He was fined $50,000 by the Jets in February 2010 after he was caught on a cellphone camera giving the middle finger to a fan during a mixed martial arts event in Florida.

“I know that to coach in the National Football League is an honour,” he said. “I don’t want to be the guy to put a black eye on this or whatever. I just want to get it behind me and move forward.”

The Jets will not further discipline Ryan for the latest incident, saying it was a game-related matter.

General manager Mike Tannenbaum said in a statement last week that he and Ryan discussed what happened and the coach “knows that his behaviour was not acceptable.”

OTTAWA – The Harper government appears to be getting a free pass from Canadians for backtracking on a key campaign promise to balance the federal budget by 2014.

The most recent survey by The Canadian Press-Harris Decima suggests that not only are Canadians not surprised the campaign pledge would not be fulfilled, most agree that it shouldn’t.

Overall, about 62 per cent of respondents to the survey taken earlier this month said they believed the government should not take extraordinary steps to try to meet the 2014 deadline.

The result is understandable given that Canadians are still largely divided on the issue of the most appropriate policy direction the government should take in the next year.

A slight majority of those surveyed – 53 per cent – said they believed Ottawa should control spending, while 43 per cent said the government should continue spending to create jobs. That’s almost a reverse of the results to an identical question asked in October.

“Canadians are clearly of two minds (on the issue),” said Doug Anderson, senior vice president of Harris Decima.

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“So, are they upset another year or two is being added to the balanced budget timeline? No. They are not saying don’t balance it, they are saying the idea of taking at least four years is most appropriate.”

The poll of 1,000 adult Canadians was conducted Nov. 10-13, and is considered accurate to within 3.1 points up or down, 19 times in 20.

The timing of the survey is significant because it comes a few days after Finance Minister Jim Flaherty released his fall economic update, warning that Canada faces a more sluggish recovery than previously thought, given the risks to the global outlook.

As a result, the update largely took a balanced budget in the fiscal year 2014-15 off the table, pencilling in 2015-16 as the new goal.

The extended timeline made headlines, but Canadians took the announcement in stride. According to the poll results, 87 per cent said they were not surprised by the change.

And 63 per cent agreed with Flaherty that “instability of the international economy” was more to blame for the missed deadline than any policies taken by the government. Even majorities among opposition NDP and Liberal supporters said the government is not primarily to blame.

“Canadians appear to agree that the global economic turmoil is a clear and valid reason for reducing the urgency of tackling the deficit, and their preferred timeline tends to match the one targeted by the federal government,” Anderson said.

Previous polling suggests that Canadians trust the Conservatives more than any other party to manage the economy during this period of uncertainty and elevated risk.

The survey did show a degree of partisan division in some of the questions, but not as strongly as might be supposed, noted Anderson.

On the question of stimulus versus cost-cutting, a clear majority of Conservatives said they favoured the spending-restraint option. But even so, NDP and Liberal supporters were not in radical disagreement.

Among New Democrats, 48 per cent said they favoured more spending as opposed to 47 per cent for restraints; while among Liberals, the split was 50 per cent to 44 per cent favouring stimulus measures.

OTTAWA – The Harper government appears to be getting a free pass from Canadians for backtracking on a key campaign promise to balance the federal budget by 2014.

The most recent survey by The Canadian Press-Harris Decima suggests that not only are Canadians not surprised the campaign pledge would not be fulfilled, most agree that it shouldn’t.

Overall, about 62 per cent of respondents to the survey taken earlier this month said they believed the government should not take extraordinary steps to try to meet the 2014 deadline.

The result is understandable given that Canadians are still largely divided on the issue of the most appropriate policy direction the government should take in the next year.

A slight majority of those surveyed – 53 per cent – said they believed Ottawa should control spending, while 43 per cent said the government should continue spending to create jobs. That’s almost a reverse of the results to an identical question asked in October.

“Canadians are clearly of two minds (on the issue),” said Doug Anderson, senior vice president of Harris Decima.

Story continues below

“So, are they upset another year or two is being added to the balanced budget timeline? No. They are not saying don’t balance it, they are saying the idea of taking at least four years is most appropriate.”

The poll of 1,000 adult Canadians was conducted Nov. 10-13, and is considered accurate to within 3.1 points up or down, 19 times in 20.

The timing of the survey is significant because it comes a few days after Finance Minister Jim Flaherty released his fall economic update, warning that Canada faces a more sluggish recovery than previously thought, given the risks to the global outlook.

As a result, the update largely took a balanced budget in the fiscal year 2014-15 off the table, pencilling in 2015-16 as the new goal.

The extended timeline made headlines, but Canadians took the announcement in stride. According to the poll results, 87 per cent said they were not surprised by the change.

And 63 per cent agreed with Flaherty that “instability of the international economy” was more to blame for the missed deadline than any policies taken by the government. Even majorities among opposition NDP and Liberal supporters said the government is not primarily to blame.

“Canadians appear to agree that the global economic turmoil is a clear and valid reason for reducing the urgency of tackling the deficit, and their preferred timeline tends to match the one targeted by the federal government,” Anderson said.

Previous polling suggests that Canadians trust the Conservatives more than any other party to manage the economy during this period of uncertainty and elevated risk.

The survey did show a degree of partisan division in some of the questions, but not as strongly as might be supposed, noted Anderson.

On the question of stimulus versus cost-cutting, a clear majority of Conservatives said they favoured the spending-restraint option. But even so, NDP and Liberal supporters were not in radical disagreement.

Among New Democrats, 48 per cent said they favoured more spending as opposed to 47 per cent for restraints; while among Liberals, the split was 50 per cent to 44 per cent favouring stimulus measures.

NORWOOD, N.J. – Gregory Papalexis, whose Sabrett hot dogs have become a part of the New York City experience, has died. He was 86.

Papalexis was president, CEO and chairman of Englewood-based Marathon Enterprises, a supplier of hot dogs, buns, onion sauce and other products, and the owner of the Sabrett trademark.

He died Friday in Rockleigh, N.J., according to the Barrett Funeral Home in Tenafly, N.J., which is handling arrangements.

Sabrett hot dogs are sold nationwide. On the streets of New York, they are sold from stainless-steel pushcarts with instantly recognizable blue-and-yellow umbrellas. Marathon also supplies franks to Papaya King and Gray’s Papaya restaurants, and sells more than 35 million pounds of hot dogs a year.

His son-in-law, Mark Rosen, Marathon Enterprises’ vice-president of sales, told The Record of Bergen County that Papalexis was “the single biggest hot dog lover in the world.”

And Papalexis, who retired two years ago, practiced what he preached: He ate Sabrett hot dogs four or five days a week, relatives said. Mark Rosen said franks-and-beans casserole was part of the Papalexis family’s Christmas table each year.

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The son of a baker, Papalexis grew up next door to a hot dog factory in upper Manhattan. He earned a bachelor of science degree in industrial relations from New York University in 1948, and then entered the food business.

With a $2,500 G.I. loan, Papalexis bought his father’s bakery and sold rolls to clients throughout New York City, making deliveries in a Cadillac because it had the biggest trunk he could find.

He soon began selling hot dogs as well, manufacturing a pushcart brand called House O’ Weenies. He formed Marathon Enterprises in 1964 and acquired a series of competitors, including Sabrett Food Products in 1989.

His daughter, Nikki Rosen, also a company executive, said her father gave great detail to the buns his company sold, insisting they be “light, airy and fluffy,” she said. His reasoning was simple: If customers fill up on the bun, they won’t have room for a second hot dog.

The Sabrett company got its name in 1926 when its two co-founders wanted to call it the Sabre Meat Company, only to find that another firm was already using the name.

“So the two owners said, ‘We’re a small company, so we’ll call ourselves Sabre-ette, which soon became Sabrett,” said the company’s new president, Boyd Adelman.

The company’s facilities include two manufacturing plants and a distribution centre in the Bronx and a corporate office in Englewood, N.J.

Its customers include retail supermarkets, wholesale clubs, independent distributors, movie theatres, amusement parks, pushcart vendors, convention centres, ballparks and stadiums. In addition to hot dogs, the company also sells hot sausage, kielbasa, salami, pastrami, corned beef and garlic rings.

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Information from: The Record, 杭州桑拿按摩论坛杭州夜生活northjersey杭州夜网