IOM DHSC & MANX CARE

[Cinderella]

1 hour ago, forestboy said:

Do we still have a breast care specialist/surgeon?

Screening doesn’t need surgeon. Anyone with something detected could be referred to UK if necessary (though not preferable). But removing routine screening is not acceptable. 

[Cinderella]

39 minutes ago, wrighty said:

Routine screening has, I believe, always been contracted out. The mammograms are carried out by radiographers here, but the reporting was done in the UK. At one point it was in Coventry - my information may not be current. 
 

There is still debate in academic circles as to the utility of breast screening. Something like 10 women are harmed unnecessarily for each invasive cancer detected. And of those cancers which seem to have a survival advantage if detected early, there is lead time bias to take into account. 
 

It’s not as clear cut that ‘screening=good, no screening=bad’ as people might imagine. 
 

To be clear though, I have absolutely no idea why the local programme is suspended. I found out about it here, this evening. 

Whilst respecting professional knowledge, having had friends had serious breast cancer averted by screening, I would choose to disagree.

[CallMeCurious]

45 minutes ago, wrighty said:

Routine screening has, I believe, always been contracted out. The mammograms are carried out by radiographers here, but the reporting was done in the UK. At one point it was in Coventry - my information may not be current. 
 

There is still debate in academic circles as to the utility of breast screening. Something like 10 women are harmed unnecessarily for each invasive cancer detected. And of those cancers which seem to have a survival advantage if detected early, there is lead time bias to take into account. 
 

It’s not as clear cut that ‘screening=good, no screening=bad’ as people might imagine. 
 

To be clear though, I have absolutely no idea why the local programme is suspended. I found out about it here, this evening. 

It is a difficult call when you factor in things like the probabilities of false postives and false negatives to both tests and treatments. That is why as much as any delay in diagnosis is considered bad, often best to have a 2nd test to confirm the initial finding because a lot of treatments have some harm associated with them. 
Fourtunately, medicine is advancing all the time and while it will never be black and white, both detection and treatment tend to give better outcomes. Sadly, usually at ever increasing cost in terms of money and resources but not always.

 

[snowman]

No money. No staff. Might as well turn off the lights. Joe Public is fucked. Meanwhile the high and mighty can jump on a plane and go private

 

[wrighty]

1 hour ago, Cinderella said:

Whilst respecting professional knowledge, having had friends had serious breast cancer averted by screening, I would choose to disagree.

It is complex. Anyone screened, who has a cancer found, and is then cured, will be eternally grateful. But, the facts are that most of those women would not have developed invasive cancer at all, and a few who undergo treatment may be harmed by it. The overall picture, at a population level, is still debated. 
 

So, to decide on the utility or otherwise of breast screening we should trust the public health specialists who know far more about this than either of us. I understand screening, but my specific knowledge of the breast screening debate is relatively low level. We certainly shouldn’t be swayed by anecdotal examples. 
 

This however is a side issue to the local suspension of services, which I’ll say again I have no information on. 

[hampsterkahn]

Unfortunately, we haven’t been given any details regarding why  the service being withdrawn.

A more frank and open announcement delivered at a better time than a Friday pm, would have helped avoid the  inevitable speculations and help prevent  some peoples’ worries.

Edited February 11, 2023 by hampsterkahn

[Gladys]

1 hour ago, wrighty said:

It is complex. Anyone screened, who has a cancer found, and is then cured, will be eternally grateful. But, the facts are that most of those women would not have developed invasive cancer at all, and a few who undergo treatment may be harmed by it. The overall picture, at a population level, is still debated. 
 

So, is it the case that mammogram screening identifies cancers, but not whether it is going to be invasive, and most aren't?

I did not know that and assumed that any cancer found would be invasive. 

Is it a matter of time if it is found to be invasive or is there a test which will indicate those that will, to avoid unnecessary and possibly damaging treatment?

ETA to add the whole post after getting the 'phone knocked by the cat! 

Edited February 11, 2023 by Gladys

[wrighty]

28 minutes ago, Gladys said:

So, is it the case that mammogram screening identifies cancers, but not whether it is going to be invasive, and most aren't?

I did not know that and assumed that any cancer found would be invasive. 

Is it a matter of time if it is found to be invasive or is there a test which will indicate those that will, to avoid unnecessary and possibly damaging treatment?

ETA to add the whole post after getting the 'phone knocked by the cat! 

Again, I’m somewhat out of my depth here, but I think that’s right. The mammogram identifies a pattern of calcification which could be cancer or DCIS (ductal carcinoma in situ). It gets cut out, these days with lumpectomy rather than full mastectomy, and sent to the lab for analysis.  Those that are DCIS had a lowish chance of turning bad. 
 

It’s similar with prostate cancer in men. If we live long enough most of us get it on a cellular level but have no problem with it.  Some however do. It’s not a simple case of a blood test and find out like some believe, and at the moment screening is not supported by evidence. Some will still have it though, and it causes headaches as to what to do with some of the positives, and some men are harmed by surgery that in hindsight was unnecessary. 

[Gladys]

1 hour ago, wrighty said:

Again, I’m somewhat out of my depth here, but I think that’s right. The mammogram identifies a pattern of calcification which could be cancer or DCIS (ductal carcinoma in situ). It gets cut out, these days with lumpectomy rather than full mastectomy, and sent to the lab for analysis.  Those that are DCIS had a lowish chance of turning bad. 
 

It’s similar with prostate cancer in men. If we live long enough most of us get it on a cellular level but have no problem with it.  Some however do. It’s not a simple case of a blood test and find out like some believe, and at the moment screening is not supported by evidence. Some will still have it though, and it causes headaches as to what to do with some of the positives, and some men are harmed by surgery that in hindsight was unnecessary. 

That is interesting, thanks Wrighty.  It, possibly, comes back to one of the challenges facing healthcare atm, and that is to target treatment (resources and money) effectively.

In the 90s, my Gran had a suspect lump in her breast in her latter years, and the decision based on the medical advice was that because of her age, it was unlikely to progress or become invasive, so no treatment or real investigation.  Putting it very bluntly, she was more likely to succumb to time than cancer.  

Had the same with my Mum, almost 30 years later.  To be honest, the process of her going through a mammogram when in a wheelchair and biopsy (a large needle into the lump), all done in a morning,  was really unnecessary and quite distressing, because there was no way she could have dealt easily with any treatment, she had many other health issues.   

TBH, it was a pointless exercise.  As she was not in any pain and after a discussion with the consultant, we agreed that regardless of the outcome of the biopsy, any cure was likely to be worse than the thing it was intended to cure, so no further action. 

A different matter if she was a young woman otherwise healthy, but that investigation pushed someone else down the queue. 

Within a year she passed away peacefully and not from any cancer.

Healthcare, IMO, has to be better targeted. 

Edited February 11, 2023 by Gladys

[GD4ELI]

7 hours ago, Cinderella said:

Whilst respecting professional knowledge, having had friends had serious breast cancer averted by screening, I would choose to disagree.

Same here - two friends, ~50 years old, early detection and all clear after treatment. Without the detection who knows?

[Moddey Dhoo]

11 hours ago, Ringy Rose said:

Nah, they spent all their money on that bellend Jonathan Michael. Which is why DESC are out to humiliate Dr Ranson rather than pay her off quietly.

JM chaired the interview panel that appointed RR..........

[Banker]

Doesn’t help backlogs when 500+ don’t turn up for hospital appointments c10% !! Be interesting to know what they were for eg colonoscopy, cataract etc where the wait can be long.

[Gladys]

1 hour ago, Banker said:

Doesn’t help backlogs when 500+ don’t turn up for hospital appointments c10% !! Be interesting to know what they were for eg colonoscopy, cataract etc where the wait can be long.

More to the point, why they didn't attend.  That is the only way the problem will be addressed.  There could be numerous reasons some of which could be sorted with tweaks in the processes.  There will, however, always be a hard core of people who, for whatever reason ranging from CBA to not capable, will not turn up. 

[Two-lane]

4 minutes ago, Gladys said:

More to the point, why they didn't attend

More to the point, why has no analysis been done to find out why (I assume none has been)?

So, let's say, 10 % of all the money due to be paid to managers disappears but no-one bothers to find out why. That's not going to happen.

It seems to me to be poor management to not know why.

Maybe some MHK could ask a pointed question.

[Banker]

37 minutes ago, Two-lane said:

More to the point, why has no analysis been done to find out why (I assume none has been)?

So, let's say, 10 % of all the money due to be paid to managers disappears but no-one bothers to find out why. That's not going to happen.

It seems to me to be poor management to not know why.

Maybe some MHK could ask a pointed question.

Hooper was asked this question & said that if they had to contact 500 people every month then it would take up to much staff time which is a fair point if they’re calling them but maybe a text to them asking for reasons & giving 3/4 possible reasons