Asymmetrical Information

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Future Right Wing Spin:
It wouldn't surprise me if this was a "Slick Edwards" ploy to get the sympathy vote.

Just wait. Someone is going to say it.

Brian, someone has very quickly made you a prophet. Indeed, if the time tag is right, they predated your prophecy. Check the comments here:

http://www.politico.com/blogs/bensmith/0307/Getting_It_Wrong.html

The most relevant one:

The only thing missing from this campaign stunt was Elizabeth saying "I will be cured if John is elected President." This is flat out one of the most shameful things I've seen a politician do. How pathetic.

Posted By: Steve A. | March 22, 2007 at 02:48 PM

Go get the mammogram, Megan. My wife (whose name really is Jane - oddly enough, my daughter's name is Megan) was diagnosed with breast cancer in October, and is currently going through chemotherapy after having had two surgeries. Fortunately, it was caught pretty early - but those tumors can grow fast. She was completely clean on her last mammogram, only one year earlier.

Yes, it's sad.

My mother beat breast cancer, a heart attack, raising me and my brother, and being married to my dad.

One of the remarkable things about the picture on the front page of CNN.com is the clear aging and weight loss of EE. Dunno if that's just a diet/exercise thing or a function of the cancer.

Sad indeed - my cousin's wifehad it & she lived six years after the late stage diagnosis though. Not sure if Edwards is being brave or stupid going thru with the campaign

Future Right Wing Spin: It wouldn't surprise me if this was a "Slick Edwards" ploy to get the sympathy vote.

I dunno know about that. What I remember though is in 2004 after Elizabeth Edwards made some rather hateful comments about Vice President and Mrs. Cheney’s relationship with their daughter and then went public that her cancer was returning, Mrs. Cheney responded with some rather graceful and classy wishes for her to make a full recovery.

Pity that you seem incapable of learning from her example.

"What I remember though is in 2004 after Elizabeth Edwards made some rather hateful comments about Vice President and Mrs. Cheney’s relationship with their daughter and then went public that her cancer was returning, Mrs. Cheney responded with some rather graceful and classy wishes for her to make a full recovery."

What remarks exactly? I didn't follow the candidates wives as closely as you apparently did.

Pity that you seem incapable of learning from her example.

Incapable of learning from whose example? Mrs. Cheney? As you might notice, I labelled that future right wing spin. It's not my opinion.

I predict that Brian Despain will say something negative about the right.

Just wait -- he will.

What? That's not my opinion, it's Brian Despain's.

It would be laughable if of course, if JMW hadn't linked to a post where people where saying that exact thing. Elizabeth Edward's chances of long term survival are slim to none. Survival of stage 4 beyond 5 years is less than 20%.

Thankfully Rush only posed it as "hypothetical."

"Hypothetical. Let's pretend that I were to, after hearing the press conference, come on with some comment about, "You know what, folks? This is purely political. This is just being done to set up this campaign. They're just trying to jump-start a sagging campaign. They're hoping to evoke a bunch of sympathy." Do you know what hell would fly over this? Nothing compared to the feud between me and the governator."

http://www.rushlimbaugh.com/home/daily/site_032207/content/01125112.guest.html

Incapable of learning from whose example? Mrs. Cheney? As you might notice, I labelled that future right wing spin. It's not my opinion.

That would fail an eighth grade composition exercise, assuming the US education system still knows what those are and how to grade them. Take your hate elsewhere; Jane's post was structured as a women's health notice and a generalized expression of sympathetic virtue. It doesn't need you vomiting political tripe all over it.

My best wishes go out to the Edwards family... I'd be more optimistic on this one than our lovely blogger Jane is. There are treatments that can keep some patients with bone mets alive for a lengthy period of time.

My mother (very similar age to Mrs. Edwards) was diagnosed with stage 4 breast cancer almost exactly 5 years ago and is, thank God, still doing well on these treatments, so I am very hopeful for EE and her family too.

My hate? What are you talking about? Is because I pointed out the some people will say pretty much anything?

I see - it was mentioning it in the comments? I am far more sympathetic to the Edwards' plight than you apparently think.

Is there nothing over which people won't play the 'we're good, you suck' game? Nothing? Good lord.

EE could go in a few months or several years. I wonder if people will think that JE would be compromised by having to worry about a sick wife, etc. I'm having a hard time understanding how he doesn't just suspend the campaign, but it's his (and her) life.

Yes, it's their life and their decision. It occurred to me that going on with one's routines is a great distraction when horrible luck like this strikes. For JE and EE, campaigning is their routine, their normal life. I could easily see that being their preference to merely shuttling between home and hospital, focused on the disease 24/7.

I'm having a hard time understanding how he doesn't just suspend the campaign, but it's his (and her) life.

I think they actually believe in what they are doing and do not want to go gentely into that good night

The Edwards have a nice life in Chapel-Hill. He has a center at UNC, his office is right behind mine. They really have no reason to do this but the fact that they want to change the mood in America.

My sense is that they would rather fight the good fight than sit on the sidelines. Besides she could live to see her husban president, that is motivation in and of itself.

Yeah, you guys are right - go on with your life. If things get bad, they'll deal with that thing then. Good for them.

I just want to confirm something: No one here really thinks commenter Brian Despain was genuinely saying this is a ploy to get the sympathy vote, do they? If so, wow.

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I think you're still a bit too young to get a mammogram. As hard as this is for some to believe, premature testing can be dangerous. At a certain point, you're much more likely to get a false positive than a true positive, which can be followed by potentially painful and/or harmful exploration.

A question in regard to Larry's point:

Is a mammogram still the only non-invasive way to detect breast cancer? It would seem like there would be other methods by now.

Monthly breast self exam and mammogram is still essentially the only cost-effective way to diagnose breast cancer as of 2007. MRI is very sensitive but it has major down sides. Firstly it's TOO sensitive leading to lots of painful and expensive negative biopsies. Second it's CRAZY expensive (like $1000 per) so the cost per life year gained doesn't make the cut. MRI only makes sense as a screening exam in very high risk individuals (such as a positive genetic profile (BRCA1 or 2) or in high risk people (big family history but no or negative genetic profile) who are difficult mammography candidates (implants, small, dense breasts). Hope this wasn't too technical.

Assuming JE were elected, EE would most likely be getting very ill (read hospice, pain, radiation therapy to brain, vomiting, etc.) halfway through his presidency. Could he work like he needed to during that time? Would we want him to? Just because he wants to "keep fighting the good fight" doesn't mean we should let him.

Thanks BladeDoc. That wasn't too technical at all, though "dense breasts" does raise other questions...

Actually a search on the topic didn't help much. Does body tissue actually vary in density across the population? I can see how bone would, but I would think tissue would not. Then again, I'm not a doctor.

Steve,

Not a doctor, but here's how I understand it (I have both breast cancer and "dense breasts" in the family, but no breasts of my own):

There are different types of tissue in the breast (some is fat, some is glandular tissue, some is connective tissue, etc.). Each different type of tissue has different characteristics (density, firmness, x-ray transparancy, etc.). Each type of tissue is fairly consistant from person to person, but the composition of the breast varies- a most smaller breasts will be mostly glandular & connective tissue, while a larger breast might be dominated by fatty tissue. Maybe a doc can confirm this?

My sympathy goes to the Edwards family, but its not going to sway my politics. It's a sad commentary that political implications are the first thing some on the left and right think of.

Between this and Cathy Seipp's passing, this must be Cancer-Asserting-Its-Power Week. Bite me, cancer.

I just want to confirm something: No one here really thinks commenter Brian Despain was genuinely saying this is a ploy to get the sympathy vote, do they? If so, wow.

No, but evidently some of us think he’s a jerk who tried to turn a non-political thread in which Jane and others expressed their sympathy for the plight of another human being into an “us versus them” political fight.

I read a few years back that mammograms are one of the least reliable tests in terms of false positives and negatives. A quick GIS revealed the following links, with key quotes:

False positives: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=PubMed&list_uids=9545356&dopt=medline

The estimated cumulative risk of a false positive result was 49.1 percent

False negatives:
http://www.cancer.gov/cancertopics/factsheet/Detection/screening-mammograms

Overall, mammograms miss up to 20 percent of the breast cancers that are present at the time of screening.

Admittedly, I have not investigated this subject too awfully much. (And Mrs. Fan has had her baseline and one or two follow-up mammograms, FWIW)

Can anyone give a medically reasoned answer or link as to why a not "at-risk" woman should go ahead and get a test with such dismal accuracy rates?

She is a remarkable woman.

I suspect she will face this test with dignity and courage--her example should inspire us all.

That's quite rich coming from you, Thorley.

If Despain breached any rules of etiquette with his first post, which post was soon substantiated by the way, then you certainly breached the same rules with your response to him.

Or perhaps I missed your expression of sympathy for another human being as you pointed out Elizabeth Edwards "hateful" commentary about the Cheneys. Just compassion, no politics in your words, right?

Cheers,

Bite me, cancer.

It may jsut be superstition, but I don't think I'll join Jessica in that statement.

Shelby,

I just found out yesterday that the cancer of the wife of a friend has just returned. It's something about this week, I swear. Wishing you and yours good health.

Mrs Edwards has my prayers. Lost my mother to bone mets 10 years after lumpectomy. What she has gone through and will go through will far transcend politics.

Scott -- exactly correct on the breast density issue. Breast glandular tissue absorbs more Xray radiation (is more radio-opaque) than fatty tissue and therefore looks "white" on xray film. The younger you are, the less fatty replacement the breast has and the harder it is to differentiate tumor (which is usually denser than fat) or calcifications (which are related to some breast tumors) from the surrounding breast. That's one of the reasons that screening mammography is not recommended for young women (the other is that the risk of cancer is low and you're much more likely to have a false positive than find a cancer).

Not to get into the stats too deeply (which I had to memorize for a test, but as a trauma surgeon let fall into disuse and slip into the same morass that swallowed calculus whole) -- although mammogram is a pretty lousy test it is just sensitive and specific enough that when applied across a large population improves mortality from breast cancer. It took about 15 years for this to occur (lag time) and there were huge fights in the medical literature about the cost effectivity thereof. For example see http://jnci.oxfordjournals.org/cgi/content/abstract/85/20/1644 To summarize the summary -- Screening mammography is one of the most highly studied tests we have -- and we're STILL not sure that it is effective in the 40-50yr decile while in the 50-70 yr age group it definitely lowers breast cancer deaths. That's why in the US we recommend it's use starting at age 40 (i.e. it COULD work and we have the money) and in most of Europe they recommend starting at 50.

Some misconceptions here....

I'm a doctor and also a stage 4 breast cancer patient who has lived for 11 years with NO symptoms, currently with undetectable cancer but still considered a stage 4. (It was in my lung---far more deadly than bone metastases like EE.)

I continue to work, run, hike, travel, garden, do volunteer work, write books, and take care of my 93 year old mother. I am 55 years old and I look like I'm 40.

Breast cancers are not all alike. Some are more indolent, others very aggressive. I know a woman who has lived for 22 years with bone metastases, and you would never guess it from looking at her and watching her life.

Those of you who seem to have crystal balls and pronounce Mrs. Edwards' cancer as being so deadly as to give her only a few years at most, would thereby know more than any scientist or doctor on the face of the earth! When I was diagnosed with metastatic breast cancer (and I have the "deadly" one, the HER2+ tumor, which Mrs. Edwards does not have), the oncologist told me to imagine holding my grandchildren, knowing that my daughter was only 7 then and would not be having grandchildren for a long time!

Mrs. Edwards should also be thinking about holding grandchildren. It is not an unreasonable quest, based on today's treatment of metastatic breast cancer.

As for mammograms---they are the best screening tool we have right now, but will miss 5-15% of all tumors depending on what type of breast cancer it is. (Again, not all breast cancers are alike.) They work better in fatty breast tissue. Dense breasts (which are more common in younger patients, but we have plenty of older patients with very dense breasts) are harder to visualize with mammograms. I do send some of my high risk patients (Ashkenazi Jews, women who have family histories of ovarian or breast cancer in their 20s/30s/40s) for MRIs of the breast. It is always an insurance battle, but an important battle for doctors to fight for for their patients. A thermogram is NOT sensitive enough, nor is an ultrasound, for most cancers.

Also it's important to remember than ALL technology has its limits (chest Xrays, CT scans, MRIs, ultrasounds, and blood tests included). I too had a mammogram that was negative and then covered with cancer only 6 months later. It didn't necessarily mean it was an aggressive cancer and that I would die soon. It just meant that the cancer had grown to a point where it could finally be seen by the naked eye of a radiologist.

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