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'1 in 1,900' T-shirts protest policy and personalize odds in breast cancer screening

To me, what Monday's announcement from the U.S. Preventive Services Task Force (suggesting that women under the age of 50 don't need regular mammograms) seemed to lack was personal perspective. Anyone who has suffered through breast cancer -- or had a loved one who has -- will probably tell you that performing 1,900 preventive mammograms to save the life of one woman isn't too big a hurdle. 

IRage_1900f you feel otherwise, save your vitriol for someone else. I'm not a scientist, an economist or a government flack. What I am, however, is someone who appreciates how quickly the wheels of commerce (even charitable commerce) can turn in the Internet age.

About 15 minutes ago, my sister-in-law sent me a link to cafepress.com/1in1900, where T-shirts are already for sale that hammer home what those odds really mean. White T-shirts emblazoned with the pink ribbon that's become the symbol of the battle against breast cancer, the shirts bear the words: "I Am the One in 1900 " at the top and the words "My life was saved by preventative breast cancer screening."

Other versions personalize the odds with "My Friend Is the 1 in 1900," "My Mother Is the 1 in 1900," "My Sister Is the 1 in 1900," "My Daughter Is the 1 in 1900" and "My Wife Is the 1 in 1900."

All proceeds from the $19.99* T-shirts benefit the American Cancer Society, which quite publicly continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40.

What do you think the odds are they'll sell a heck of a lot better than the "I Followed the New Screening Guidelines and All I Got Was This Lousy Breast Cancer" shirts?

-- Adam Tschorn

*[UPDATED 11/19/2009: In an early version of this post, the price of the T-shirts was incorrectly listed as $14.99.]

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I understand, but I've read the reasoning behind the decision and I believe it's sound. If we truly believe that decisions should be made by the exception to the best medical advice for the majority of people, then why don't we start screenings at 2o years old, and do them every year? And why don't we provide regular mammograms free of charge to all the women who don't have health coverage to pay for them? In medicine, we choose what to screen based on our best judgment for the general population, and increase our vigilance if an individual has relevant risk factors.

Only the beginning. This presages the rationed health care that some so vigorously desire. I saw this better when I understood that 'coverage' for a majority of Americans does not translate to 'quality health treatment' for a majority of Americans. Only the rich will have access to high end care. This issue transcends republicans and democrats. It strikes at our freedom and quality of life as Americans. Please wake up and oppose this.

My wife is the 1 in 1900, she was diagnosed two days after turning 35. What's worse, typically these cancers are the most aggressive and recurrent. I wish we had known about this 3 years ago and had done mammograms. No replacement for mammograms, cancer can sometimes be too fast-growing even for your doctor to detect with physical exams.

It is a mistake to think "nowadays we have beaten this thing", or to place the burden of cure in the patient. My wife's original tumor doubled size every month and a half.

Go get your mammogram done today.

Let's make t-shirts that say "I am one in 1900 misdiagnosed breast cancers." Many women who don't have breast cancer end up undergoing chemo-therapy. Seriously, women, anything that is designed to cause you pain, no matter what the purported cause, is probably just that: pain.

do ya think this has something to do with obamacare? what about the stop smoking campains, do you think this has a link with the new obieseity problems?
studies have shown most gain weight when they stop smoking. if you stop screening for breast cancer it will lead to more incureable cases i think but just think of the money the insurance companies will be saving. if the govt. is paying for it as with obamacare they would want to save as much as possible by dropping the screening at the younger age. when you get older and go to the nursing home, you loose your teeth, hearing,eyesight, but as far as i know you dont loose your feelings. those ppl need love and care too, just remember when you were small your parents took good care of you, now its payback time. i used to work in nursing homes, even the smallest gesture like giving them a birthday card will generate the biggest smiles you have ever seen, whats it cost ya the price of a coke, what a sweet deal!

What I find shockingly irresponsible about this post and some of the comments is the emotional "they are taking my mammograms away!" response. There are risks to mammograms. Does the 1 in 1900 refer to the additional cancer caused by mammogram radiation exposure or the life saved? The benefit and the harm were found to cancel each other out in the study. The recommendation makes complete sense to any rational person.

The point is that the radiation from the mammograms is also a risk. We shouldn't give mammograms to detect a 1/1900 cancer chance if there is a greater than 1/1900 that the radiation will cause a cancer. In older women, cancer detection is more probable so this outweighs the radiation risk. In younger women, it's more dangerous to get routine mammograms. This isn't new data either; we've known it for years.

This seems a consequence of the latest studies in which they've found that early detection and treatment doesn't necessarily change the ultimate outcome. The majority of breast cancers are found in women with no obvious risk factors. Smaller tumors are not by definition less lethal (as had been previously thought). Breast cancer progression & recurrence - & being able to predict how a given tumor will progress - is still not understood well by the medical community. Treatment is prescribed, at best, based on odds, the doctor's best guess, & the individual woman's comfort level with the options.

Well, hemotherapy shouldn't be administered as carelessly as you Cecile suggest. It is incredible that chemo will be not only recommended but paid for (by health insurance companies) without concluding tests. These drugs and related treatments are very expensive and full of risks, and it is a real liability to be administering it based on a lump and pain alone.

It usually takes not only a simple biopsy but at least a tru-cut one paired with an immunohistochemical analysis. Otherwise oncologists really wouldn't have an idea of how to target the treatment.

I suggest you (or whoever was dignosed and given chemo) sue your doctors. That is gross malpractice.

Still the T-Shirt is a great way to raise awareness of the fact that it is a grand lie that physical self examination is a safe way to go. My wife had regular obgyn visits (3-4 a year), weights 110 lb., never smoked, exercised regularly, and eat healthy. By the time her tumor was caught it had already spread to the underarm lymph nodes. Even her gynecologist couldn't detect it up until that point. This thing still kills, it is a false assumption to think we are beyond breast cancer.

I think this problem should be given serious thought, maybe the economics of it can be worked around (invest in developing new simpler machines and tests), or compare the statistical costs of giving the mammograms versus treatment and surgery. Come on, it is a freaking X-ray. It is not a CT-PET.


Just a quick correction - it is NOT true that the risks and benefits of screening women 40-49 cancel each other out.

Per the task force's study, screening these women resulted in a 3% reduction in overall mortality in this age group, and a 15% reduction in breast cancer mortality in this age group.

That is net of all risks of screening. Other studies show significantly higher reductions.

The number of screenings to save one life is very similar in 40-49 (1904) to 50-59 (1339).

Also, no one on the panel considered anything about the ability to avoid chemo with early detection, the ability to lose fewer lymph nodes and avoid lymphedema, the ability to have a longer cancer-free survival.

The false positives result primarily in followup screenings (extra mammograms and possibly an MRI.) About 33 of the 1900 will need a biopsy, which is usually a needle biopsy. Very few will need surgical biopsies. So the treatment that is being avoided are extra scans, a needle (had one, not that unpleasant), and a very occasional surgical biopsy (had one, outpatient, didn't even get a general.)

THAT's why this is so controversial - because the science is not clearcut and many people disagree with how the study was done.

And yes, I'm one of the 1900.



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