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Some background info on mammograms (x-rays of the breast). For whatever reason breast cancer is highly political in the US. As a result there are federal laws r
by honksillet 5y ago
Some background info on mammograms (x-rays of the breast). For whatever reason breast cancer is highly political in the US. As a result there are federal laws regarding communication of results and scheduling follow-up exams that apply to mammograms only and no other radilody or other medical test. To comply with these laws radiologists set up a uniform grading system with highly specific jargon. As a result the formatting and language used in mammogram reads by radiologist will be much more consistent than, say, a chest x-ray screening for lung cancer. This makes mammograms the ideal studies to be tackled by AI
- Calloutman 5y agoI'm puzzled at how breast cancer could be a political issue. How so?
- kaesar14 5y agoAmericans have a weird relationship with breasts. Also issues that only affect women (mostly, I know men can get it in rare cases?)
- ars 5y agoBreast cancer is the cancer that raises the most money (that pink ribbon you see everywhere). That money goes somewhere..... This is not a "weird relationship" thing, rather women got organized and: https://en.wikipedia.org/wiki/Breast_cancer_awareness https://en.wikipedia.org/wiki/Breast_cancer_awareness
- ben_w 5y agoWhile all that is true, America absolutely has a weird relationship with breasts.
- lostlogin 5y ago> While all that is true, America absolutely has a weird relationship with breasts. It’s more broad than that, it’s the relationship with women’s health as a whole.
- gweinberg 5y agoThat depends on what you think a normal relationship with breasts would look like, I suppose.
- ben_w 5y agoIn particular, the pearl-clutching gender-specific moralising: it is absurd that an organ whose specific purpose is to feed infants by being inserted into their faces is censored specially from minors, whereas the non-functional copy of the organ in men which can’t even do that is apparently acceptable (modulo dress code, weather, etc, but you can walk around or swim or sunbathe topples as man, not as a woman).
- darkhorse13 5y agoWhat is exactly a "normal" relationship with breasts for a country to have?
- teekert 5y agoThings like: It's normal to breast feed in public. Or the nation does not go bananas when a nipple is exposed on TV. Or how normal it is to sunbathe topless. Arguably this also relates to how normal it is for kids to walk around naked and families to be naked around each other. If you're really interested, watch some older Dutch movies to see the normalness of naked, like Turkish Delight [0]. Or even have a closer look at the relation between the Professor and Raquel in the recent Casa the Papel. It's different from US series. More respectful, mature wrt women if you ask me. More emphasis on intelligence. Or on a beautiful woman in her 40s with normal wrinkles. The US, like on many other topics, seems to be polarized, caught between the hyper sexuality of Cardi B and the prude nature of American culture in general. [0]: https://en.wikipedia.org/wiki/Turkish_Delight_(1973_film) https://en.wikipedia.org/wiki/Turkish_Delight_(1973_film)
- thomasjudge 5y agoAlso the largest and best known breast cancer fundraising organization, Susan G Komen, has, in the words of wikipedia, "been mired by controversy over pinkwashing, allocation of research funding, and CEO pay." https://en.wikipedia.org/wiki/Susan_G._Komen_for_the_Cure https://en.wikipedia.org/wiki/Susan_G._Komen_for_the_Cure
- cwmma 5y agomale doctors have not historically treated female patients great.
- ars 5y agoThat's not really true in this case. There was no effective treatment for a long time, until suddenly there was. See: https://en.wikipedia.org/wiki/William_Stewart_Halsted https://en.wikipedia.org/wiki/William_Stewart_Halsted
- cratermoon 5y agoWe're not even talking about treatment: just regular screening and detection, the same as you get when you go to your doctor and he sticks a finger up your butt and tells you to cough.
- mrguyorama 5y ago>sticks a finger up your butt and tells you to cough You may want to consider finding a different medical professional!
- cratermoon 5y agoNot at the same time! Referring to the two common tests that doctors routinely perform on men, every physical checkup
- CyberDildonics 5y agoWhoever did that to you was not a medical doctor
- cratermoon 5y agoNot at the same time! Referring to the two common tests that doctors routine perform on men, every physical checkup
- SpicyLemonZest 5y agoI don’t think “political” is meant to mean “controversial” here. There were just some extremely successful awareness campaigns for it in the 80s and 90s (to the point where it’s the stereotypical example of an awareness campaign for many of us), so people care a lot about it.
- tialaramex 5y agoOne thing that will cause mammograms to be political, in several countries, is that there's a difference in perception of the downsides vs upsides of such screening programmes, and we're bad at communicating the trade to a population who lack the statistical literacy to understand it intuitively. So our best shot from a public health perspective is to say "Here's what we recommend for everybody" and pay for that. All screening programmes have two difficulties, which must be balanced against the benefit, and this trade is somewhat personal, so when the balance is quite fine the arguments can be vociferous as a result. 1. The screening itself may seem unpleasant. One woman may find it a very mild annoyance, a drive ten minutes out of her way, the staff are very pleasant, the scan itself is far less traumatic than a bra fitting, and she receives easy to understand results after not very long and isn't anxious about them; but for another maybe it's an hour's bus journey to the city hospital, the staff there are short-tempered and say she has the wrong paperwork, then another hour in a queue, she feels like she's just meat, squashed around for the convenience of the machine for what seems like forever, and then after anxiously waiting for what seems to be too long the results are confusing to her and she has to have a friend interpret them. 2. Over-treatment is always a problem. Screening by definition detects something that isn't causing noticeable symptoms. If you have a noticeable lump, or mysterious bleeding, you don't need screening you need a doctor's appointment. So a positive screening result might be nothing important. However either you've now got the burden of a diagnosis you ignored or, you accept the medical advice and are treated, even though it's possible (not likely, but possible) that you would have been just fine without treatment. So, screening programmes are set up based on guessing how to trade these factors plus a third, how much should we spend on this medical intervention? After all, in some sense every dollar doing breast cancer screening is a dollar you don't have to cure blindness in poor orphans (or of course, to bomb somewhere) If your experience of a screening programme is that it's a minor inconvenience at most, and yet you know people who died of undetected disease, more screening seems like a no brainer. Particularly if you live somewhere where screening stops at age 50, and somebody you know died of undetected disease aged 54, you might reason that the screening should go to age 55 or 60 to detect such cases, no matter the public cost. On the other hand if your experience is that it's an awful ordeal even when negative, and you know people who spent their last years horribly scarred by surgery as a result of suspected disease but then they died in their sleep from something else anyway, you may feel that there's already too much screening and it should be trimmed back, not to save money but the extra money for other programmes is welcome.
- cratermoon 5y agoThere's a lot of literature about the systematic biases in medicine that exclude a lot of women's health care from serious consideration.
- hellbannedguy 5y agoIt's definitely not brest cancer now. It's very well funded now.
- randcraw 5y agoBreast cancer isn't political. But there's continuing debate in the US medical establishment over the proper way to screen for it -- how to test, how frequently, at what age range, what constitutes a positive result, and how should the doctor follow up if the test is positive? The recommended answers to these questions seem to change every few years, and the substantiation behind the answers is often inconsistent. The same issues bedevil prostate cancer screening.
- deleted 5y ago[deleted]
- 317070 5y agoWhile Ronald Reagan was in office, he had a colectomy for a colon tumor in 1985 (turned out it was not cancer) [0], and his wife had a mastectomy for breast cancer in 1987 [1]: While Reagan did a lot to try to defund cancer research regardless, the first lady's mastectomy drew a lot of attention to a previously taboo topic. [0] https://www.nytimes.com/1985/07/16/us/reagan-s-illness-medical-outlook-cancer-of-the-colon-a-leading-killer.html https://www.nytimes.com/1985/07/16/us/reagan-s-illness-medic... [1] https://www.latimes.com/archives/la-xpm-1987-10-18-mn-15261-story.html https://www.latimes.com/archives/la-xpm-1987-10-18-mn-15261-...
- dekhn 5y agoIt kills large numbers of middle-to-rich people who are highly motivated and make advocacy groups that are effective lobbyists. Back when I was a life scientist the best advice I got was to work on diseases the family members of congresspeople had.
- himinlomax 5y agoThe science is pretty well established on *generalized* breast cancer screening not improving health outcomes despite being costly. (In short: cancer is rare, tests have false positives that trigger biopsies, biopsies are invasive and can be harmful, overall biopsies and pointless surgery on slow growth cancers do as much harm as cancer.) But since screening has been framed as caring for women, pointing out the flaws with screening is automatically seen as hating women.
- rhcom2 5y agohttps://en.wikipedia.org/wiki/Mammography_Quality_Standards_Act https://en.wikipedia.org/wiki/Mammography_Quality_Standards_...
- crazygringo 5y agoIs this what you're referring to? https://en.wikipedia.org/wiki/Mammography_Quality_Standards_Act https://en.wikipedia.org/wiki/Mammography_Quality_Standards_...
- caycep 5y agoalso, maybe there's more number of scans, so higher N datasets to train on? Our hospital bought an AI stroke detector (viz.ai). The "AI" part is laughable but it allows the hospital to collect some extra HHS/medicare fee for using "imaging algorithms" or something. I suspect that company is potentially using anonymized scans to continue training their data, because the initial product was trained on some tiny sample of brain CT scans, like under 500. The one plus for actual physicians and nurses is that at least they wrote a non-sucky PACS imaging interface for the iPhone so we can just pull up the plain scans and view them easier.
- cratermoon 5y agoWow, so a medical device which doesn't work is being used in what is essentially an unsupervised, non-random, non-blind trial? Why would that even pass the FDA smell test?
- inter_netuser 5y agonon-invasive devices are way easier to get approved, they are a lot less tightly regulated. you'd be surprised.
- tedivm 5y agoThis is actually why it isn't ideal for AI to tackle. The fact is there's no market for the product. Right now much of the mammogram reading is extremely straight forward. Radiologists can fly through those exams with high quality, especially when you consider the macros they have setup that allow them to write most of the report with with a two second voice command. This is one of the biggest things radiologists complain about- from their perspective most AI is solving problems that aren't actually useful to radiologists. I think the companies that will do best are the ones that augment radiologists with a focus on making them more accurate and efficient, rather than trying to cut them out of the loop (I'm a bit bias though as my previous company, Rad AI, is taking the augmentation approach and it has worked out rather well).
- kn1ght 5y agoHey I've also worked in a previous company that was doing exactly this for DK, UK, etc. As far as I remember one of the bigger things there was tissue density and masking effects where it might become not as clear cut for a radiologist. We saw a lot of opportunity in that area and in prognosis- the whole health economics aspect of frequency of visits.
- jacquesm 5y ago> tissue density and masking effects But those are also harder for software based systems.
- bob33212 5y agoGood point. Similar to intellisense while coding.
- 908B64B197 5y agoBut coding is a creative task. Breast cancer screening is more like classifying breeds of dogs or determining if there's a fire hydrant in the picture.
- version_five 5y ago
- TravelPiglet 5y agoIsn’t most science political in the US?
- 256lie 5y agoAdditionally, breast cancer screening is a high-volume and low-prevalence task and CAD applications has been developed for decades (although not with the performance of latest CNN algorithms).
- ska 5y ago> This makes mammograms the ideal studies to be tackled by AI This looks good from 70,000 ft, but in practice you need labels much more specific than BIRADS.
- deleted 5y ago[deleted]