Let's reinvent the mammogram so it isn't effing torture!

Consider that “exclude” was a poster’s conclusion. Also, consider that they would want to identify any potentially confounding genetic factors as simply as possible.

For me it isn’t about a gap in the data, it’s about excluding people with breasts and the same hormones as ciswomen on what seems to me an inexplicable basis. I hope they do have a basis, but I can’t fathom it. It is inexplicable to me why they would screen out not just transmen, but also those who identify as nonbinary.

As far as data gaps go, I think it could be particularly interesting to see if an “individualized” approach worked better for folks who might be rubbed the wrong way by recommendations for women generally.

They specifically say the study is open to people who identify as female, don’t they?

What genetic factors are you referring to? Are you supposing there are ones that relate to transmen and nonbinary AFAB folks, but not ones that relate to transwomen?

I think I may have my terminology mixed up. They are including transwomen (women after transition) right? Those subjects would be more likely to have a Y chromosome.

I am likely just confused.

Probably not.

Men get breast cancer too, although it’s less common. I think the differences between breast cancer rates of cis men, trans men, cis women, and trans women might be illuminating and informative.

But men don’t generally get screened for breast cancer at all, unless they have some particular risk factor.

… and?

It’s not important to consider men who are at risk for breast cancer?

As I said, the information would be useful. That doesn’t mean this particular study has to include men - studies like this are free to pick and choose who they do and don’t include (and others are also free to criticize) - but it rubs me the wrong way to dismiss breast cancer in men as “it’s rare”.

My mom had breast cancer and mammograms saved her life.

She ultimately had a double mastectomy (one each, years apart).

IIRC she had that test done twice a year when she was older. She said it was not pleasant but she was my mom so didn’t go into a lot of detail.

Do we know if no one is bothering to find another means to test for this? They invented the painful version and just left it at that? (I really do not know.)

Anecdotal but the women I have known (other than my mom) who have talked to me about this have found the test to be unpleasant but not awful. Squished boob for a few moments which they did not like at all but was tolerable. There are loads of medical procedures that are uncomfortable or worse.

The question is can there be a better way? A Star Trek-like wand they wave at you that tells them all the need to know?

I agree it would be useful to better understand breast cancer in men. But I don’t think a study aimed at “what’s the best screening regimen” is the ideal place to examine that. And if the only information you are looking for is “how many men get breast cancer” I’m pretty sure that information is already being gathered. A lot of diseases are routinely reported to the CDC (i think it’s the CDC) along with very basic information (age and sex) and I’m pretty sure breast cancer is one of those.

Here, this says that 1/100 breast cancers in the US is found in men:

Unless your suggestion is that men should be regularly screened for breast cancer?

There are lots of things that could be screened for that aren’t. I know some people have advocated getting a full body cat scan/MRI from time to time to look for tumors before they produce symptoms. It’s controversial, and not just because it’s expensive. It’s likely to lead to over-treatment.

Anecdote time:
My best friend in high school was diagnosed with Hodgkin’s disease in the late 80s, and had a lot of scans as a result. They found an adrenal tumor. At the time, adrenal tumors had an extremely high risk of death, and her oncology team wanted to treat it aggressively. My father, who was a doctor, but not an oncologist, convinced her to have the tumor surgically removed but do nothing more. He said, “yes, adrenal cancers have historically been really bad news, but historically they’ve never been found before they advance to the point of causing problems. There’s growing evidence that cancers that are found accidentally, while scanning for other reasons, are a lot less dangerous. And the treatment is really rough on your body.” Decades later, he was right, she didn’t need treatment for that tumor. And the treatment might well have killed her by now. An acquaintance recently died of heart disease caused by the treatment of her breast cancer 15 years ago. Cancer treatment is not benign.

Now, you might say, sure, if we were all scanned we could treat all the resulting lumps and bumps conservatively. We could just watch them, or simply remove them and do no more. And maybe that IS what we’d do if MRIs and cat scans were nearly free. But some of us would be nervous enough to demand more aggressive treatment. And lots of doctors would be happy to have that revenue source, and support those decisions. It would lead to a lot more treatment. And maybe that treatment would do more harm than good.

Anyway, i assume that the reason men aren’t routinely screened for breast cancer is that it isn’t common enough in men to be considered worth the cost and the risk of false positives. But maybe it’s just bias.

I guess if men were advised to get regular mammograms we’d almost certainly have a less painful way of doing that.

But a study would need 100 times as many men to get comparably valid results regarding the best test regimen. That’s probably not feasible.

There’s the issue of what would be useful to learn;
The issue of what gets funded in general;
The issue of what this particular study was funded to study.

Honestly, I do not think that is either cost-effective nor in the best interests of men in general due to possibility of over-diagnosis and over-treatment.

It would be helpful to know which men might benefit from regular screenings, and how often that should be done because some men are at relatively higher risk than the majority.

Currently, the treatment of breast cancer in men is based on what works for women - the flip of the usual circumstances in medicine. A cursory bit of searching on male breast cancer while writing this post tells me that while ductal carcinoma is the most common in men (as it is in women), and inflammatory breast cancer and Paget’s disease have been found in men apparently there has not been an instance of lobular breast cancer recorded in men. Although lumps in male breasts are easier to find (essentially, less breast to look through/feel) tumors are usually found at a later stage in men (in part due ot lack of awareness that breast cancer can occur in men) and maybe they can start to metastasize quicker. We don’t know. As it is a rare disease (for men) randomized trials in men are, apparently, not being done. I’m not sure we really know which men are at risk, and how much, and how best to screen/approach this disease in men.

This may also have implications for trans men. I’m sure we know even less about breast cancer in trans men although, presumably they have at least as much risk as cis men, and likely more due to hormonal influence. Certainly, “top” surgery will not completely eliminate the risk as it does not completely remove all breast tissue.

Again, I don’t think we really know the actual risks in trans women. This is probably a higher priority than either cis or trans men but I expect no one has really studied this. Presumably they’re at higher risk than men - are they at greater or less risk than cis women? Does it matter at what age they transitioned?

And, finally, for everyone I wish we could definitively say which tumors/cancers/conditions actually need aggressive treatment to either put into remission or extend meaningful life, which only require monitoring (and the schedule of that monitoring), and which we really can’t do anything for and for which aggressive treatment only prolongs sickness and suffering so patients can make the decisions that are best for them.

Yeah, I know - why don’t I ask for world peace and a pony, too. Hey, I’m an idealist. I also understand that there is only so much funding to go around and there are good arguments for funding that which will benefit the greatest number of people. Right now, that’s women.

If it were a study of how to treat breast cancer it would make sense to include men. (And attempt to oversample them, to get enough data to be meaningful.) But this is a study about monitoring for breast cancer, specifically, how often to have mammograms. I don’t see much point in including men in this study.

Thank you for following up on this.

If they’re taking your assigned sex at birth into account, then they can still use the data because they can filter for people who were not assigned female at birth. It does require everyone to be honest, but so do most medical trials.

I hope the eventual overall results will only include people assigned female at birth rather than everyone who potentially participated in the study, and they did ask, so they can filter the data in that way.

Including a few extra people who were assigned male at birth but now identify as female is not that big a deal if they’re filtered out of the overall results - they will still be followed up, and their data could potentially be used for other studies (if they agree to their anonymised data being used for other studies, which I think is standard?)

It still misses out anyone was assigned female at birth but doesn’t identify as female. They could be a missed group for breast cancer, same as with lesbians and cervical cancer.

Did they ask anything more about medications, btw?

I wish people addressing the gender issue would remember that there are more than just transmen and transwomen. Nonbinary is a thing. And a lot of non-cisgendered people who were assigned female at birth don’t take hormones and don’t have surgery. But they also don’t identify as female.

It just seems to me that the “identifies as female” criterion might have been created with an incomplete view of who would be included or excluded.

I assume they won’t be “filtered out” but rather, “analyzed separately”.

They asked a lot of questions about hormone use, but that’s all I remember. They again asked about some health conditions i don’t have. Perhaps if I’d said i had those, they would have asked about other medications.

That’s possible. I agree that non-binary people with breasts would seem like valid participants.

Men who have had breast cancer certainly should be monitored going forward, but I agree that would probably be a different study.

The non-binary issue is another complication.

However, studies generally need some limitations to be manageable.

I think the a priori chance for a male to get breast cancer, since it’s much lower than in women, means that with the test being used right now the chance of a false positive outcome exceeds by far the chance of catching a tumor. Mammograms are in the 70% range of sensitivity (iirc, med school has been a while :wink:), and that’s only in women older than 30. Below that age the tissue is too dense to get an accurate image by mammography. I’m not an oncologist, but I seem to recall this from my clinical decision making classes. At least in the Netherlands, ultrasound is recommended in women younger than 30 or who are pregnant, but that’s in symptomatic cases, not for screening purposes.

The radiation from repeated mammograms can also cause cancer. It’s a relatively low risk, and it is outweighed for women by the benefits of catching cancer early. For men, that calculus would be different, though.

Interesting development. Researchers (one of whom has had breast cancer) have developed AI that can read mammograms in greater detail than the human eye. This would not do away with mammograms, but could lead to more wise and strategic use.

Here are a few snippets to give you the idea, but they are by no means, the whole picture. This is a 2,800-word story. I used the share link, so it should not be paywalled.


As she and her team laid out in an article in the Journal of Clinical Oncology last month and explore further in an upcoming piece set to be published in Nature Medicine, by analyzing a mammogram’s set of byzantine pixels and then cross-referencing them with thousands of older mammograms, the AI — known as Mirai — can predict nearly half of all incidences of breast cancer up to five years before they happen.

The mammogram is a little bit like Winston Churchill’s democracy: It’s the worst screening method, except for all the others. The approach — which uses low-grade radiation to examine breast tissue from multiple viewing angles — has become the gold standard over the past several decades, and many medical professionals swear by it as an uncomfortable but important safeguard. It also has drawn its share of critics in the oncology and women’s health communities who say it has led to unnecessary radiation exposure, overtesting, false positives and all the stress that comes with them.

Many radiologists in the field are enthusiastic too. Katerina Dodelzon, Katzen’s colleague at Weill Cornell, noted the technology’s ability to take radiology “from diagnostic to prognostic” functions.

There is, of course, resistance in the medical community…

The same optimism may not yet have taken hold with breast cancer surgeons or oncologists, who most directly advise patients on breast cancer risk. Requests for comment to such doctors at four high-level hospitals were declined, and one hospital staffer described an ambivalence among that group. Mathematical models are common in cancer treatments such as chemotherapy dosages, but that is more familiar to physicians than outsourcing a prognosis to a computer.

Even some radiologists are conflicted, fearing automation could take their jobs.

While emphasizing that these technologies are meant merely as a tool for the human reader, Tobias Rijken, chief technological officer and co-founder of Kheiron Medical, also pointed to a machine’s comparative advantage in the life-or-death effort of breast cancer imaging. “An AI works 24/7, it doesn’t get tired, and it doesn’t have personal problems at home,” he said.