User:Senra/Risks of too much awareness

Introduction
I have tried to help by pointing out some sourcing flaws in (part of) the  section. I am not familiar with the subject area, nor have I read the whole article, so my content help is limited. If it was me, I would want to know more about what Samantha King felt about the risks of too much awareness in King (2006) (which is cited in the article) and in King (2010a) and King (2010b) (both of which are not). I have access to none of those sources. For balance I would want to know what the corporate reaction, if any, was to King's writings in 2006, 2010a and 2010b. In addition, the 2011 documentary Pink Ribbon Inc., seemed to have beeninspired by King (2006), yet the documentary only gets a passing mention in the see also section of the article. I hope this helps-- Senra (talk) 19:48, 9 January 2013 (UTC)

Risks of too much awareness
Because breast cancer is a highly visible disease, most women significantly overestimate their personal risk of dying from it. The reality is that about eleven times as many women will die from heart disease than from breast cancer.
 * Ave (2006) actually says "One result of the pink movement is that many women have an undue fear of breast cancer, said Samantha King, an associate professor of kinesiology and health studies at Queen’s University in Ontario"


 * with my emphasis. Source says nothing about it being a highly visible disease. Thus saying so is WP:SYNTH
 * -- Senra (talk) 14:14, 9 January 2013 (UTC)
 * In addition, we must take care when reading sources. It is not the source that talks about the pink movement resulting in undue fear but "Samantha King, an associate professor of kinesiology and health studies at Queen’s University in Ontario", '' so the article has incorrectly attributed this anyway -- Senra (talk) 16:14, 9 January 2013 (UTC)


 * I'm not an expert in wikipedia source policy, but I have the feeling that this complicates the issue of primary/secondary/tertiary sources. I bet you'd know more about that than I. Is that an issue? Or what is the reason you are bringing this up? You think the article should say "Samantha King said..."? Charles35 (talk) 17:11, 9 January 2013 (UTC)
 * Currently, the article attributes Ave (2006) to this paragraph. One key sentence in Ave, especially in relation to this particular section, is "One result of the pink movement is that many women have an undue fear of breast cancer". Now, properly attributed, for example "Ave quoting Samantha King, associate professor of kinesiology and health studies at Queen’s University in Ontario says 'One result of the pink movement is that many women have an undue fear of breast cancer'" or even better, find the Samantha King source and attribute directly to her. You can of course paraphrase Ave but I am drawing your attention to the fact you cannot paraphrase Ave's quote of someone else (Samantha King) without attributing it to King (if you read it) or attributing to Ave quoting King. For the record, quoting King (providing you read her) is not relying on a primary source. Interpretation or bad paraphrasing of King (if you consider King as primary, which I do not in this context) should be done with extreme care (see WP:SCHOLARSHIP "When available, academic and peer-reviewed publications, scholarly monographs, and textbooks are usually the most reliable sources ...") -- Senra (talk) 18:43, 9 January 2013 (UTC)

Awareness has also led to increased anxiety for women. Early detection efforts result in overdiagnosis of precancerous and cancerous tumors that would never risk the woman's life (about one-third of breast cancers), and result in her being subjected to invasive and sometimes dangerous radiological and surgical procedures.
 * The first sentence is not in Aschwanden (2009) but is a decent paraphrase from Ave (2006) quoted by me above -- Senra (talk) 14:14, 9 January 2013 (UTC)


 * "(about one-third of breast cancers)" is not supported in the source which says "But screening poses another downside: A routine mammogram can find cancers that would never have become life-threatening, subjecting women to painful and toxic treatments they never actually needed. A new study calculates that this is just what happens in as many as one in every three breast cancers diagnosed by a screening mammogram"


 * The last sentence is not in the source and is thus WP:SYNTH
 * I think the synth part (the last clause about the invasive and dangerous procedures) should be removed. At first glance, it makes sense. But that's the problem with original research - there can always be something you haven't accounted for. I doubt that this is really true. I think that most adequate doctors (which are the majority) are smart enough to weigh the costs and benefits and are well aware that mammograms are not perfect. Charles35 (talk) 15:56, 9 January 2013 (UTC)


 * The source is reporting on a 9 July 2009 BMJ article which studied "rates of breast cancer in regions of the United Kingdom, Canada, Australia, Sweden and Norway before and after these countries instituted national mammography programs". I would therefore question whether or not this same research applies to a global audience. Specifically, this same result might not apply to the US which may have a different screening program


 * -- Senra (talk) 14:14, 9 January 2013 (UTC)

In recent years, the definition of breast cancer has expanded to include non-invasive, non-cancerous conditions like lobular carcinoma in situ (LCIS) and pre-cancerous or "stage 0" conditions like ductal carcinoma in situ (DCIS). Despite the now-regretted decision to use the word carcinoma in these relatively common conditions (almost a quarter of "breast cancer" diagnoses in the USA), they are not life-threatening cancers. Women with these conditions are promoted as breast cancer survivors due to the fear they experienced before they became educated about their condition, rather than in respect of any real threat to their lives. This effectively increases the market size for breast cancer organizations, medical establishments, pharmaceutical manufacturers, and the makers of mammography equipment.

An emphasis on educating women about lifestyle changes that may have a small impact on preventing breast cancer often makes women feel guilty if they do develop breast cancer. Some women decide that their own cancer resulted from poor diet, lack of exercise, or other modifiable lifestyle factor, even though most cases of breast cancer are due to non-controllable factors, like genetics or naturally occurring background radiation. Adopting such a belief may increase their sense of being in control of their fate. Increased awareness inadvertently increases victim blaming. Women who resist screening mammography or breast self-exams are subjected to social pressure, scare tactics, guilt, and threats from some physicians to terminate the relationship with the patient. Similarly, the emphasis on early detection results in many women wrongly blaming themselves if their cancer is not detected at an early stage.

The promotion of research to make screening programs find ever more cancers is also criticized. One-third of diagnosed breast cancers might recede on their own. In addition to efficiently finding most deadly cancers, screening programs also find most non-life-threatening, asymptomatic breast cancers and pre-cancers, and miss some fast growing, aggressive, dangerous cancers. According to H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice, "I'm certainly not asking anyone to stop getting mammograms. I am asking my profession to tell women the truth about overdiagnosis." Welch said that research on screening mammography has taken the "brain-dead approach that says the best test is the one that finds the most cancers" rather than the one that finds dangerous cancers.

Clinicians have responded that they are unwilling to consider the possibility of leaving potential deadly cancers alone because it is "far-riskier" than the alternative. Eric Winer, director of the breast cancer program at Dana-Farber Cancer Institute in Boston, says, "I don't know anyone who offers women the option of doing nothing." Further complicating the issue of early diagnosis is the fact that it is currently impossible to delineate malicious cancers from benign ones. Otis Brawley, a top official for the American Cancer Society, says that "even if we overdiagnose 1 in 5, we have numerous studies showing that by treating all these women, we save a bunch of lives". For instance, a 2011 Cochrane review showed a sample of mammogram screening programs resulted in a 15% reduction in mortality rate despite over-diagnosis, indicating that mammography programs save lives regardless of over-diagnosis.