text:
U.S. Preventive Services Task Force*
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Potential Conflicts of Interest: None disclosed.
Requests for Single Reprints: Reprints are available from the USPSTF Web site (www.preventiveservices.ahrq.gov).
This article has been corrected. The original version (PDF) is appended to this article as a supplement.
Reader Survey: Will the USPSTF Breast Cancer Screening Recommendations change what you do?
Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population.
The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.
The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation)
The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation)
The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement)
The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement)
The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)
The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement)
Screening for breast cancer using film mammography: clinical summary of USPSTF recommendation.
For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to www.preventiveservices.ahrq.gov.
Screening for breast cancer using methods other than film mammography: clinical summary of USPSTF recommendation.
Table 1. What the USPSTF Grades Mean and Suggestions for Practice
Table 2. USPSTF Levels of Certainty Regarding Net Benefit
The precise age at which the benefits from screening mammography justify the potential harms is a subjective judgment and should take into account patient preferences. Clinicians should inform women about the potential benefits (reduced chance of dying from breast cancer), potential harms (for example, false-positive results, unnecessary biopsies), and limitations of the test that apply to women their age. Clinicians should tell women that the balance of benefits and potential harms of mammography improves with increasing age for women between the ages of 40 and 70 (6).
Current evidence … does not suggest the inclusion of the manoeuvre in, or its exclusion from, the periodic health examination of women aged 40–49 years at average risk of breast cancer (grade C recommendation). Upon reaching the age of 40, Canadian women should be informed of the potential benefits and risk of screening mammography and assisted in deciding at what age they wish to initiate the manoeuvre (30).
Lewis ware MD
St Johns Regional Medical Center,Joplin,MO
November 17, 2009
The 40-50 age group.
As lead mammographer in my hospital, I can tell you that if we stop screening 40-50 yr. olds we will experience a giant step backward in detecting early cancer. Many of the cases that are detected at in situ or stage 1 will be seen later in her life as Stage 3 or 4 ; not much prevention there. I am sure women are much smarter than that. Shame on giving in on Government health care ideas.
None declared
philip s walter
No Affiliation
November 18, 2009
Re:The 40-50 age group.
This is one problem with what we do on a daily basis. Evidence has to be separated from the intuitive reactions we have. The response from the radiologist implies that he knows that all of the tumors he finds will have an impact on the life of the patient.
Victoria L. Seewaldt
Duke University
The U.S. Preventive Services Task Force (USPSTF) recently recommended against routine mammographic screening in women ages 40-49 (1). The recommendation was based on the relative probability of unscreened women dying of breast cancer and the reduction in mortality provided by mammographic screening. Based on these studies the USPSTF issued a blanket recommended against routine screening mammography in all women 40-49 years -of-age (1).
Lacking from the USPSTF study is evidence to support a reduction in mammography screening in African American and Latino women who are less than 50 years-of-age (1). The USPSTF study analyzed the risk/benefit mammography as a function of a woman's age but did not consider the potential contributions of race and ethnicity (1). Investigators did not state the racial and ethnic composition of study participants and there was no analysis of the risk/benefit of mammography in African-American and Latino women (1).
It is concerning that USPSTF issued a one-size-fits-all blanket breast cancer screening recommendation without considering whether the recommendation is appropriate for all women.
Our current recommendations for mammographic screening are based on studies in European, European-Canadian and European-American women. Eight reported randomized trials studied mammography's effectiveness in the United States, Sweden, Canada, and the United Kingdom (for a review, see reference 2). These studies balance the relative contributions of mammographic density (sensitivity and specificity of mammography) and the death rate from breast cancers (2). To our knowledge, there has been no large-scale analysis of the effectiveness of mammographic screening in African-American and Latino women.
Studies of mammographic screening in women ages 40-49 are complex because younger women have a lower incidence of breast cancer, denser breast tissue (which can lower sensitivity), and, on average, faster growing, biologically aggressive cancers. Relative to European-American women, African-American women have lower breast density, faster growing cancers, and a higher likelihood of dying from breast cancer (3-5). Since the death rate from breast cancer in African-American women is higher and mammographic density is typically lower, it is likely that the benefit from mammographic screening will be higher in African-American, and perhaps Latino women, than in European-American women.
So where's the evidence to recommend against routine mammography screening of African American and Latino women under 50 years-of-age?
We agree with the USPSTF that there is a need for change. But the change we call for is an end to one-size-fits-all recommendations and inclusion of African-American and Latino women in clinical trials testing the benefit of mammographic screening.
(1) Mandelblatt, J.S. et al. Effects of Mammography Screening Under Different Screening Schedules: Model Estimates of Potential Benefits and Harms (2009) Annals of Internal Medicine 151: 738-745
(2) Elmore, J.E., et al. Screening for Breast Cancer. (2005) JAMA 293:1245-1256.
(3) Stuedal, A., et al. Does Breast Size Modify the Association between Mammographic Density and Breast Cancer Risk? (2008) Cancer Epidemiol Biomarkers Prev 17:621-627.
(4) Ursin, G., et al. Mammographic Density and Breast Cancer in Three Ethnic Groups (2003) Cancer Epidemiol Biomarkers Prev 12:332-339..
(5) Elledge, R.M., et al. Tumor Biologic Factors and Breast Cancer Prognosis Among White, Hispanic, and Black Women in the United States (1994) JNCI 86:705-712.
The Editors
Annals of Internal Medicine
November 20, 2009
The Editors' Response
"In response to media reports that imply otherwise, Annals of Internal Medicine did not schedule the publication of the US Preventive Services Task Force recommendations about breast cancer screening to coincide with a particular date or event. The background papers (which underwent several rounds of revision over about 5 months based on independent peer review comments and Annals' statistical editor's comments) and the recommendation statement were all in final, accepted form by September 10, 2009. Annals scheduled them to appear in the next available print issue, which was the November 17th issue. Our routine print production process takes about 2 months from final acceptance to print." The Editors
Daniel B. Kopans
Harvard Medical School/Massachusetts General Hospital
The USPSTF Recommendations Are Not Scientifically Based - Underestimate the Benefit of Mammography and Admit That Lives Will Be Lost Unnecessarily
The US Preventive Services Task Force (USPSTF) acknowledges that mammography screening, beginning at the age of 40, significantly decreases breast cancer deaths. Their guidelines, however, ignore the science and direct measurements of benefit to limit access to screening.
1. None of the parameters of screening change abruptly at the age of 50 or any other age (1). The age of 50 is an arbitrary threshold. 2. The USPSTF correctly used the randomized, controlled trials (RCT) as scientific proof of benefit. However, since the RCT did not stratify by risk, there is no proof that screening based on risk will save lives, and no scientific support for recommending screening based on risk (2). Screening only women at high risk will miss the 75-90% of breast cancers that occur in women who are not at high risk. 3. The USPSTF chose the lowest possible reduction in breast cancer deaths (15%), unaware of the fact that the RCT underestimate benefit. Women allocated to be screened who refuse the invitation, and die of breast cancer, are still counted as having been screened (non-compliance). Women allocated to be controls whose lives are saved by mammograms that they obtain outside the trial, are still counted as unscreened controls (contamination). 4. The USPSTF recognizes a 30 % decrease in breast cancer deaths in the U.S. since 1990 but ignore it, and ignore the 40% decrease in breast cancer deaths reported in Sweden (3), predominantly due to screening, that applies to women in their forties. 5 Ignoring direct data they used a 15% reduction in deaths and estimated 1300 women needed to be screened (NTS) to save one life was a reasonable number to support recommending mammography. They would deny screening to women ages 40-49 because they estimated their NTS was 1900. In reality there is 30-40% decrease in deaths for women in their forties so, using their formula, the NTS is 950-705 for women in their forties putting them well below the threshold. 6 Most false positive mammograms are easily resolved with a few extra pictures. Most biopsies are needle biopsies. Over treatment is not the fault of mammography and should be addressed to the oncologists. 7. The Task Force admits that lives will be lost by increasing the time between screens to two years.
Before denying women access to screening, anyone advising women needs to be aware of the facts.
1. Kopans DB. Informed decision making: age of 50 is arbitrary and has no demonstrated influence on breast cancer screening in women. Am J Roentgenology 2005;185:177-82
2. Kopans DB. Screening mammography for women age 40 to 49 years. Ann Intern Med. 2007;147:740-1.
3. Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev. 2006;15:45-51.
Cicero Urban
Breast Unit HNSG and Positivo University, Curitiba, Brazil
November 22, 2009
The USPSTF Recommendations should consider quality of life for breast cancer patients
The US Preventive Services Task Force (USPSTF) acknowledges that mammography screening, beginning at the age of 40, is not indicated for lower risk patients. Their guidelines, however, ignore the fact that breast cancer screening nowadays has two aims, from our point of view as breast surgeons. The first, of course, is regarding breast cancer deaths, which was discussed and can be easily calculated. But, the second one is related to the benefits of earlier diagnosis to breast surgery. We can preserve the breast and the axilla in most of patients with their breast cancer diagnosed in screening programs. Our current index of breast conservation surgery in a well selected population of brazilian patients in Curitiba (south of Brazil) who have access to screening today, is over 60%. Most of them (about 80%) had no axillary dissection, since the sentinel node was negative. These facts are directly related to quality of life in this group of patients. So there is a strong relation between screening and more conservative surgeries. I think that we can change our current recommendations in the future only if we consider the benefits to breast cancer patients in both aims. Mortality cannot be the only tool to be considered in the future guidelines. To save lifes is important, but to preserve quality of life is our current aim too in times of sentinel node and oncoplastic surgery.
Frank E. Stockdale
Stanford University School of Medicine
Elimination of mammographic screening and breast self examination in women 40-50
The USPSTF recommendation that women in the age group 40-50 not have screening mammograms comes from poor judgment about breast cancer data and clinical understanding of breast cancer. Coupling this recommendation to the recommendation that women in this age group not examine themselves clearly indicates that the panel members have limited understanding of breast cancer detection. To be sure there is no good evidence that breast self-examination lowers the risk breast cancer death. However, by limiting themselves to the impact of self-examination on mortality, they failed to address a second question raised by their recommendation that these women not have mammographic screening. Who is it that most often diagnoses breast cancer in the age group of 40-50 years? In unscreened women it is overwhelmingly the women themselves. If one follows the USPSTF recommendations that women in this age should not be screened and should not perform self-examination, how are breast cancers to be diagnosed? Certainly this will not come from annual clinical breast examination.
Richard A. Yoast, Ph.D.
November 24, 2009
US Preventive Services Task Force Recommendations on Screening for Breast Cancer
Although the Task Force breast cancer screening recommendations are meant to provide guidance to clinicians and their patients, these and many other Task Force recommendations are also released in a public health arena and because they address entire or large segments of a population may have unintended or unforeseen public health impacts. Unfortunately, the current research and communications methodologies of the Task Force seem not to take this into account.
For example, the recommendation against clinicians teaching Breast Self Examination (BSE) I assume was related to a particular form of BSE. This appears to be based on several assumptions that fail to take into account the possible impact of this recommendation. First, it assumes that most such education occurs through interactions with clinicians. While the recommendation is only to clinicians, the Task Force fails to explain how this might or might not apply to other settings or persons,for example, health educators, public health departments. Nor does the lack of specificity regarding this recommendation account for the possibility that women be taught how to be more self aware of and how to conduct self examinations of their breasts for other reasons.
In addition, the language utilized in the recommendations indicates that the only concern is for clinicians and their patients. However, the recommendations are also widely disseminated in the media to populations of women who do not have health care coverage or clinicians they interact with on a regular basis - or if they do, only in emergency situations. One could easily hypothesize that the recommendations as perceived by these populations could have the unintended effect of not only decreasing use of breast cancer detection services (including public health services) but also conveying the impression that these are not important issues for those without regular health care. Furthermore, there is little consideration about what the impact on other health behaviors may be at a time when the entire health community is trying to get people to be more aware of and take a more active role in their health and health behaviors,and to shift towards prevention and early intervention before tertiary interventions may be required. While the Task Force properly tries to address one clinical issue at a time, it operates in an arena in which clinical and public health concerns and impacts naturally intermingle, where individuals apply what they have learned about one health behavior to another. As much as it may assume otherwise, the recommendations go not only to clinicians who have patients but to many who might be patients but in reality have little regular interaction with clinicians, and to non-clinicians who regularly address the same or similar health concerns with the patients of others.
It may be an overstatement that the Task Force exemplifies the unfortunate, and I think harmful, gap between our health care/clinical and public health systems. However, the Task Force format needs to be revised so that research and data from the public health arena be factored in and that there be recognition that the recommendations also have public health connotations which must also be factored in when making and releasing clincal recommendations. Richard Yoast, PhD
James F. Ruiz
Woman's Hospital
November 25, 2009
Distressing Internal Inconsistencies
A primary source motivating the USPSTF to alter guidelines states that "conclusions about the optimal starting ages for screening depend more on the measure chosen for evaluating outcomes. If program benefits are measured in life-years, the measure most commonly used in cost- effectiveness analysis, then our results suggest that initiating screening at age 40 years saves more life-years... Starting annual screening at age 40 years (vs. 50 years) and continuing annually to age 69 years yields a median of 33 (range, 11 to 58) life-years gained per 1000 women screened. If the goal of a screening program is to efficiently maximize the number of life-years gained, then the preferred strategy would be to screen biennially starting at age 40 years (1)."
The USPSTF proceeds to ignore these comments to state "given that the age groups (40 to 49 years and 50 to 59 years) are adjacent, the Task Force elected to emphasize the mortality outcomes from the modeling studies." However, the USPSTF fails to describe how "adjacency" of the two age groups leads one to conclude that mortality outcomes is a better measure than life years gained. Further, the USPSTF does not counter the claim by their reference source that life years gained is "the measure most commonly used in cost-effective analysis."
Nelson's review, upon which the USPSTF relied to change their recommendations, states that "harms of mammography screening have been identified, but their magnitude and effect are difficult to measure. Mammography screening at any age is a tradeoff of a continuum of benefits and harms. The ages at which this tradeoff becomes acceptable to individuals and society are not clearly resolved by the available evidence (2)." However, the USPSTF chooses to emphasize the adverse consequences for most women and classifies harms for all age groups as "moderate."
The task force identifies false positives as the major harm in the younger age group. The task force indicates that it requires 565 more mammograms to save a life in the 40-49 year age group as compared to the 50-59 year group. Schell, et al, in evaluating the recall rate for 545,505 examinations in women aged 40-49, found that the rate is on the order of 9% which would lead to a "harm" of approximately 51 instances of additional views and/or ultrasound, 5 percutaneous biopsies under local anesthesia and the discovery of one cancer (at a rate of 3 cancers/1000 mammograms)(3). In order to conclude that the harm overshadows the life saved, the task force must find that the value of a human life is something less than the combined negative value of 616 imaging exams, 5 biopsies under local anesthesia, and the discovery of one new cancer.
In the newly passed Senate health reform bill, the USPSTF has been given a prominent role in determining what kind of care will and will not be allowed in a health care system. Under the new administration, this first effort by the USPSTF does not inspire confidence.
1. Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, et al. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med. 2009;151:738-47.
2. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:727-37.
3. M. J. Schell, B. C. Yankaskas, R. Ballard-Barbash, B. F. Qaqish, W. E. Barlow, R. D. Rosenberg, and R. Smith-Bindman Evidence-based Target Recall Rates for Screening Mammography Radiology, June 1, 2007; 243(3): 681 - 689.
Hari H. Dayal
UNTHSC, Fortwoth TX
November 30, 2009
Cost of preventing one breast cancer death for women in their 40's
The Editor Annals of Internal Medicine
Dear Editor,
The US Preventive Service Task Force (USPSTF) revised recommendations on mammography have understandably stirred fierce debate. The research cited by USPSTF in support of their recommendation for women in their 40's seems compelling.
We assume in our calculation that the average cost of a mammogram is $250, about 1% of those screened will need a biopsy at an average cost of $1,000, and about 10% will need some other less expensive testing. If indeed 1,900 women in their 40's have to be screened annually for a decade to avert one breast cancer death, the associated cost comes to approximately $5 million.
The USPSTF revised guidelines recommend against performing mammography on women in their 40's on a population basis. However, for those in their 40's at high risk, they recommend mammography on a case by case basis in consultation with the physician.
Every penny of the $5 million will be well-spent if the one breast cancer death averted is of my 45-year old daughter with no known risk factor. That is where the debate gets personal and emotional- an area where science, data, and analyses become irrelevant. And, that is where the debate gets political, seemingly making all the science, all the data, and all the analyses irrelevant.
Somewhere, somehow, someone must find a middle ground so we as a society can make efficacious use of a viable early detection method for averting breast cancer deaths. It also behooves us as a society to look into other ways to avert breast cancer deaths, such as primary prevention using dietary modification. Perhaps the policy makers in addition to early detection can play a proactive role in prevention, providing a multi- pronged strategy to fight breast cancer mortality.
Vickie L Ledford
Murphy Medical Center
I can not believe this is happening!! We have come so far with our outreach to women everywhere to encourage them and assure them that early detection was the best protection to keep from dying with breast cancer. I have been a mammographer for 15 years and I have too many memories of young women in their 40's being diagnosed with breast cancer. If these women waited to come in when they were 50 the cancer could have spread to their lymph nodes and would be more complex to treat. I don't know what these people were thinking when they came out with this recommendation. Mammographers need to continue to encourage women not to wait until their 50 to get a mammogram.
Colin B. Begg
Memorial Sloan-Kettering Cancer Center
December 3, 2009
Mammography Screening Guidelines
TO THE EDITOR: In their recent evaluation of mammography, the US Preventive Services Task Force recommends screening for breast cancer bi- annually starting at age 50 (1). The Task Force has stressed that this recommendation depends solely on the trade-off between medical benefits and harms, with no consideration of costs. Editorials in both the Wall Street Journal (2) and the New England Journal of Medicine (3), however, suggest that the recommendation was in fact motivated by cost considerations. A careful examination of the data analyses by Mandelblatt et al. (4), presented in support of the recommendations, would appear to confirm the view that costs were indeed pivotal in informing the Task Force recommendation.
The Task Force states that its recommendation involves trading off the mortality benefit of screening against medical "harms" such as provoked anxiety, the adverse consequences of false positive tests including unnecessary biopsies and treatment, and the adverse effects of "over-diagnosis". But how did they use the evidence about these effects to reach their recommendation? There are no analyses in the report nor in the supporting articles (4,5) that simultaneously consider both benefits and harms and that lead directly to the specific recommendation to begin screening at age 50, and to do it bi-annually. The only analysis provided that aligns clearly with the Task Force recommendation is the analysis displayed in the Figure in Mandelblatt et al. (4) This Figure presents the results from independent analyses by six investigative groups of the projected mortality reduction for a range of screening strategies, covering various starting ages, and including options to screen annually or bi-annually. The critical feature of these analyses is that the population mortality benefit is contrasted solely with the numbers of mammograms required, a surrogate for resource utilization, and thus for costs. The authors do not utilize "harms". These analyses search for an optimal strategy at the point where the graphs plateau, representing a point of diminishing returns from additional screening. Bi-annual screening strategies starting at age 50 are close to the "optimal" inflection point in all 6 of these analyses, and this would appear to be the crucial finding that motivated the Task Force recommendation. The number of mammograms in these analyses does not represent "harm". Rather, it is a measure of the societal investment in mammography, i.e. the societal cost. In other words, this is, in effect, a thinly disguised assessment of cost relative to effectiveness, something most experts would label a cost-effectiveness analysis.
1. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26. PubMed PMID: 19920272.
2. Editorial. Liberals and mammography: Rationing? What rationing? Wall Street Journal 2009, November 24 [cited 2009 December 2]. Available from: http://online.wsj.com/public/search/page/3_0466.html?KEYWORDS=liberals%20and%20mammography&mod=DNH_S
3. Truog RD. Screening mammography and the "R" word. N Engl J Med. Epub 2009 Nov 25. doi: 10.1056/NEJMp0911447; PubMed PMID: 19940292.
4. Mandelblatt JS, Cronin KA, Bailey S, Berry DA, de Koning HJ, Draisma G, et al. Effects of mammography screening under different screening schedules: model estimates of potential harms and benefits. Ann Intern Med. 2009;151:738-47. PubMed PMID: 19920274.
5. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the US Preventive Services Task Force. Ann Intern Med. 2009;151:727-37.
Jessica T. DeFrank
Dept. of Health Behavior and Health Education, UNC Gillings School of Global Public Health
December 8, 2009
False-positive mammography results cause breast cancer-related distress
Two recent U.S. Preventive Services Task Force (USPSTF) statements on screening for breast cancer identify harms of false-positive mammography screening test results, including psychological distress (1,2). Unfortunately, the reports drift away from published evidence about psychological distress from false-positive mammograms. The summary report dismisses the problem: "Anxiety, distress, and other psychosocial effects can exist with abnormal mammography results but fortunately are usually transient (1)." We believe this statement mischaracterizes the empirical literature, and indeed what the USPSTF reports to an extent in its own detailed concurrent report (2), which more correctly states that "False-positive mammography results had no consistent effect on most women's general anxiety and depression but increased breast cancer specific distress, anxiety, apprehension, and perceived breast cancer risk for some (2)." This statement is consistent with our own recent research where we found that false-positive mammography results cause small but reliable elevations in breast cancer-specific distress (3).
The USPSTF summary also comes to a different conclusion about transience of the effects of false-positive mammograms (1,2) than two previous systematic reviews (4,5). Brett et al. state that "women who have further investigations following their routine mammogram experience significant anxiety in the short-term, and possibly in the long-term (4)." Brett et al. did not emphasize the transience of false-positive's effects as a general finding. Similarly, our own systematic review concluded that the effects of false-positive mammography results endure over the long-term, well after cancer has been ruled out (5). We believe the correct conclusion is that false-positive mammography results cause small but reliable distress that endures for months and years.
1. US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2009; 151(10):716-26.
2. Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L; U.S. Preventive Services Task Force. Screening for breast cancer: An update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009; 151(10):727-37.
3. Salz T, Richman A, Brewer NT. The long-term consequences of false- positive mammograms on outcomes specific to breast cancer. Pyscho- oncology. Forthcoming.
4. Brett J, Bankhead C, Henderson B, Watson E, Austoker J. The psychological impact of mammographic screening. A systematic review. Psycho-Oncology. 2005; Nov 14(11):917-938.
5. Brewer NT, Salz T, Lillie SE. Systematic review: The long-term effects of false-positive mammograms. Annals of Internal Medicine. 2007; 146(7):502-510.
Mitchell H. Gail
Division of Cancer Epidemiology and Genetics, National Cancer Institute
December 16, 2009
Risk Models for Breast Cancer Screening of Women in Their Forties
The U.S. Preventive Services Task Force recommended "against routine screening mammography in women aged 40 to 49 years," writing that the decision should be based on "patient context, including the patient's values regarding specific benefits and harms." These criteria do not explicitly include risk assessment. Indeed, the report (1) seems to dismiss risk assessment based on "demographic, physical or historical risk factors for breast cancer", stating that "none conveys clinically important absolute increased risk for cancer."
Although age is the most important risk factor over long age intervals, it is not as important as other risk factors over the age range 40 to 50 years. In 1998, Gail and Rimer (2) suggested that a woman in her forties should consider mammographic screening if her absolute risk was as great as that of a fifty year old women without other risk factors, because benefits are thought to outweigh risks for such a fifty year old woman, and, as argued in (2), the same should be true for a younger woman with comparable risk. The ratio of incidence rates of a fifty year old white woman with no risk factors to a forty year old white women with no risk factors is 2.46 (2). If the forty year old has risk factors that increase her risk at least 2.46 times above baseline, she has at least the absolute risk of the fifty year old. Many risk factors, such as two affected first-degree relatives, atypical hyperplasia, and at least 75% dense tissue on a mammogram have relative risks that exceed 2.46, as do many combinations of weaker risk factors (2, 3). For a 48 year old woman, risk factors need to increase baseline risk by only 6% to put her at the risk of a 50 year old with no risk factors (2).
Recent data (1) that screening reduces breast cancer mortality by 15% in women aged 39-49 and by 14% in women aged 50-59 only strengthen arguments (2) that a woman in the age range 40-49 years with the same absolute risk as a fifty year old woman has a similar ratio of benefits to adverse effects, such as false positive results requiring further evaluation. Thus, risk factors in addition to age should be considered when counseling a woman in her forties whether or not to have screening mammograms. Of course, "the patient's values regarding specific benefits and harms" should also be considered, as recommended by the Task Force (1).
1.U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services task Force Recommendation Statement. Ann Intern Med. 2009;151:716-726 [PMID: 19920273]
2.Gail M, Rimer B. Risk-based recommendations for mammographic screening for women in their forties. J Clin Oncol. 1998 Sep;16:3105-14. [PMID: 9738582]
3.Gail MH, Brinton LA, Byar DP, Corle DK, Green SB, Schairer C, Mulvihill JJ. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81:1879-86. [PMID: 2593165]
Peter B. Dean
University of Turku Faculty of Medicine and Turku University Hospital, Turku, Finland
December 18, 2009
Mammography Screening Guidelines Should Reflect Reliable Data
The data search for published evidence from the RCTs used by the USPSTF ended in December 2008. In June 2009 Holmberg et al. (1) published a review of the data from the Swedish Two-County Trial, which showed that the methodology used in the previous overview (2) "resulted in a reduction of the estimate of the effect of screening." Data from this previous overview (2) were used for both the 2002 and 2009 USPSTF evaluations. Although this latest Swedish overview (1) did not present results specific to age categories, the material is available for such an analysis. It is unfortunate that none of the members of the USPSTF were aware of these recently revealed flaws in their database at the time when they were in the lengthy process of deciding that the benefits of mammography screening were less than previously calculated. A more concerted effort to communicate with individuals currently working with breast cancer screening could easily have brought this newer information to their attention.
The USPSTF evaluation (3) and supporting articles are plagued with ambiguity over the use of the terms "screen" and "screening" when used alone or in conjunction with the term "mammography." Whereas the evidence of benefit has been drawn exclusively from "intention to treat" publications, the numerical conclusions have been directly applied by the USPSTF to the case of the individual woman seeking advice from her physician. If the USPSTF evaluation is taken at face value, women will be told the estimated benefit of receiving an invitation to participate in a mammography screening program, a benefit considerably lower, by a factor of approximately 1.4, than the benefit of her actually getting mammograms (4).
The harms, on the contrary, are not calculated on an "intention to basis," so the USPSTF has introduced a considerable bias into their benefit/risk calculations.
The USPSTF purports to determine, in its own words,"benefits...potential harms...and limitations of the test"(3)." The additional benefits of actually getting a mammogram have been measured in Sweden using the ongoing service screening programs (5), and results specific for women aged 40-49 have been submitted for publication. It does not appear to make good sense for the USPSTF to intentionally ignore such publications when attempting to answer their own question, since the analysis of benefit is jeopardized by exclusive reliance upon historic RCT data that were designed to answer a different question.
1. Holmberg L, Duffy SW, Yen AM, Tabar L, Vitak B, Nystrom L, Frisell J. Differences in endpoints between the Swedish W-E (two county) trial of mammographic screening and the Swedish overview: methodological consequences. J Med Screen. 2009;16(2):73-80.
2. Nystrom L, Andersson I, Bjurstam N, Frisell J, Nordenskojld B, Rutqvist LE. Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet. 2002 Mar 16;359(9310):909-19. Erratum in: Lancet 2002 Aug 31;360(9334):724.
3. US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2009; 151(10):716-26.
4. Duffy SW, Tabar L, Chen HH, Holmqvist M, Yen MF, Abdsalah S, Epstein B, Frodis E, Ljungberg E, Hedborg-Melander C, Sundbom A, Tholin M, Wiege M, Akerlund A, Wu HM, Tung TS, Chiu YH, Chiu CP, Huang CC, Smith RA, Rosen M, Stenbeck M, Holmberg L. The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish counties. Cancer. 2002 Aug 1;95(3):458-69.
5. Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev. 2006 Jan;15(1):45-51.
Anita Ho
Centre for Applied Ethics, University of British Columbia
January 10, 2010
The Social Context and Values Behind the Breast Cancer Screening Controversy
Regarded by many medical professionals as a premier source of information on preventive services (1), the US Preventive Services Task Force (USPSTF) was blind-sided by the recent controversy regarding its recommendation against routine screening mammography for asymptomatic women under the age of 50 (2). While the evidence-based panel prides itself on being independent of advocacy groups or managed care organizations, the controversy can be better understood if we consider the socio-political context of women's health and health-care reform. Historically, women have significantly less access to some of the major diagnostic and therapeutic interventions compared to men (3), are more likely to delay or go without necessary medical care, and express more concerns about the quality of health care they receive (4). The panel's recommendations may have prompted many to perceive, rightly or wrongly, the guidelines to be a setback in promotion of women's health.
In the midst of health-care reform discussions, the public's response may also reflect its scepticism of scientists' claim of value neutrality in evidence-based medicine and their social authority based therein. After all, even if scientific evidence is the most important factor in the panel's recommendation, what conditions are considered to create a large enough burden of suffering for society to warrant the USPSTF's investigation is partly a value judgment (5). As the USPSTF's ratings influence insurance coverage of various preventive services, the public's flat-out rejection of the panel's conclusion may be a result of its distrust in the social authority of expert opinion, confusion about the panel's decision-making process, and concerns about how rationing and funding priorities are determined by these experts.
In responding to accusations that their recommendations were politically and economically driven, the Task Force adamantly denied any financial considerations. Instead of convincing the public of its neutral stance, the USPSTF may have inadvertently perpetuated the impression that financial considerations in health care are always illegitimate. As the country continues its debate on health-care reform, the Task Force and government officials may want to use this controversy as a new opportunity to facilitate more informed and responsible discussions among citizens regarding health-care program planning and funding. Rather than simply denying that economic or social context plays any role in scientific review, it may be more fruitful for the panel to clearly explain what values were part of the consideration, and furthermore, how such values were chosen, and why such values were appropriate in determining their guidelines.
I would like to thank Dave Unger, MD, and Suze Berkhout, PhD(c), for their critical and constructive comments on an earlier draft.
1. Eisenberg JM, Kamerow DB. The Agency for Healthcare Research and Quality and the U.S. Preventive Services Task Force: Public support for translating evidence into prevention practice and policy. Am J Prev Med 2001;20(3S)1-2.
2. U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force. Recommendation Statement. Ann Intern Med. 2009;151:716-726.
3. Segev DL, Kucirka LM, Oberai PC, Parekh RS, Boulware LE, Powe NR, et al. Age and Comorbidities Are Effect Modifiers of Gender Disparities in Renal Transplantation. J Am Soc Nephrol. 2009; 20: 621-628.
4. Salganicoff A, Beckerman JZ, Wyn R, Ojeda V. 2002. Women's Health in the United States: Health Coverage and Access to Care. Washington, DC: The Henry J. Kaiser Family Foundation. Accessed at http://www.kff.org/womenshealth/20020507a-index.cfm on 24 November 2009.
5. Harris RP, Helfand M, Woolf SH, Lohr KN, Mulrow CD, Teutsch SM, et al., for the Methods Work Group, third U.S. Preventive Services Task Force. Current methods of the U.S. Preventive Services Task Force: a review of the process. Am J Prev Med 2001;20(suppl 3):21-35.
Saika Kumiko
Center for Cancer Control and Information Services, National Cancer Center
July 16, 2010
Screening for breast cancer: following the analysis conducted by the U.S. Preventive Services Task Force
In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended that the decision to start regular screening mammography (SC. MMG) before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (1, 2). As a metric, they calculated the number needed to invite (NNI) to screening to prevent 1 death from breast cancer by a meta-analysis of several trials previously published (3). They concluded that the net benefit is smaller for women aged 40 to 49 years with a larger NNI compared to the value for women aged 50-59. However, they did not consider different follow-up periods when comparing NNI by age group. For women aged 40 to 49 years, the average follow-up varied from 10.7 to 16.8 years in 8 trials included in the meta-analysis, while follow-up varied from 12.9 to 18.1 years for women aged 50-59 years in 5 trials and from 14.3 to 15.5 years for women aged 60-69 years in 2 trials. Shorter follow-up periods for women aged 40-49 will lead to lower cumulative mortality, which results in an overestimation of NNI.
We aimed to estimate NNI adjusted by the follow-up period in each available study in order to compare NNI between different age groups.
Methods and Findings We estimated the NNI by applying similar methods and including similar studies to those used in the USPSTF (3). A meta-analysis of mammography trials was conducted to estimate the pooled relative risk (RR) from a random-effect model under a Bayesian analysis using the WinBUGS package (4). We included 8, 5, 2 and 1 trials for women aged 40-49, 50-59, 60-69 and 70-74 years, respectively. The NNI for screening to prevent 1 death from breast cancer reported by USPSTF was defined as the inverse of the absolute risk reduction. Here, the risk was the mortality rate during the follow-up period (death/person). In taking into account the follow-up period of studies, the estimates of NNI were calculated using the mortality rate per year (death/person-year). The estimated NNI was that based on a one-year follow-up. Thus, when we compared the NNI on the assumption that the follow-up period was x years, the estimated NNI was divided by x. In this study we tried to estimate the NNIs on the assumption of 10-year, 15-year and 20-year follow-up period.
The pooled RRs and NNIs for reducing breast cancer mortality in the USPSTF report, and our estimates calculated using the same condition are shown in Table 1. Pooled RRs with adjustment for the follow-up period were similar for all age groups. On the contrary, the NNIs were different depending on the assumed follow-up periods, i.e. 10-years, 15-years, and 20-years. On the assumption of a 10-year follow-up, the NNIs for women aged 40-49 and 50-59 were estimated to be 2399 (CI, 1195 to 8550) and 1708 (CI, 452 to 10215), respectively. The longer the assumed follow-up period, the smaller the estimates of NNIs for all age groups. More importantly, the differences in NNIs between women aged 40-49 and 50-59 were smaller in our analysis than those from the USPSTF report.
When comparing NNIs, the follow-up period directly affects the results. The NNIs are necessarily greater in shorter follow-up period, which means the NNI can be overestimated for younger age group with relatively shorter follow-up periods if not adjusted for the follow-up. The recommendations for mammography screening by USPSTF stated that an NNI of 1904 for women aged 40-49 years was too high, yet an NNI of 1339 for women aged 50-59 years was adequate (2). However, when we adjusted for the follow-up period of the trials, the estimated NNIs for women aged 40-49 were 1599 with a 15-year follow-up and 1199 with a 20-year follow-up. Whatever the conclusion, it should not be based on biased estimates of NNIs for reducing breast cancer mortality by age group.
1) U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151:716-26.
2) U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement, 2009. Accessed at http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm on 17 June 2010.
3) Heidi DN, Kari T, Arpana N, Christina B, Benjamin KC, Linda H. Screening for breast cancer: An update for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151:727-37.
4) Lunn DJ, Thomas A, Best N, Spiegelhalter D. WinBUGS -a Bayesian modeling framework: concepts, structure, and extensibility. Stat Comput. 2000;10:325-37.
Table l. Pooled RRs and NNIs for breast cancer mortality from mammography screening trials for all ages
RR for breast cancer mortality (95% CI)
NNI to prevent 1 breast cancer death (95% Cl)
Reported value by USPSTF
0.85 (0.75-0.96)
1904 (929-6378)
0.86 (0.75-0.99)
1339 (322-7455)
0.68 (0.54-0.87)
377 (230-1050)
1.12 (0.73-1.72)
Not available
Our estimates under the same condition as that by USPSTF
1908 (957-7339)
0.83 (0.69-0.99)
1229 (299-7490)
0.69 (0.54-0.87)
388 (64-4438)
1.2 (0.71-2.09)
Adjusted by follow up period
10 years follow-up
2399 (1195-8550)
0.82 (0.69-0.98)
1708 (452-10215)
0.68 (0.53-0.86)
520 (36-2907)
1.23 (0.71-2.14)
15 years follow up
1599 (797-5700)
1139 (302-6810)
347 (24-1938)
Not available
20 years follow up
1199 (598-4275)
854 (226-5107)
260 (18-1453)
70 74
Six trials including Canadian National Breast Screening Study-2 were used.
U.S. Preventive Services Task Force*. Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2009;151:716–726. doi: https://doi.org/10.7326/0003-4819-151-10-200911170-00008
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Published: Ann Intern Med. 2009;151(10):716-726.
Breast Cancer, Cancer Screening/Prevention, Guidelines, Hematology/Oncology, Prevention/Screening.
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The roundabout is a particularly awful traffic solution in the age of cars and stoplights. It's as if a bunch of city planners were sitting around wondering if perhaps people wouldn't drive better if they were dizzy. Alas, we wonder if the whole thing wasn't the ingenious invention of the owner of a RWD car.
Also, we wonder if horrible music wasn't a prerequisite for Eastern European videos of BMW drifting. It's the price you pay for E28 hoonage.


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Childhood in New York; high school experience at Horace Mann; Harvard undergraduate at the age of 15. Impressions of ordeal with Harlow Shapley. Depression years in the family business, return to a very changed Harvard in 1934. Thesis work on Interstellar Absorption (Bart Bok), Ph.D. 1937. Postdoc at Yerkes Observatory (Otto Struve) working on Upsilon Sagittarius. Develops the 140-degree camera (the Greenstein-Louis G.
Early life in Mexico; Civil Engineering school, 1938, physics in Mexico; University of Mexico; study group; visitors from the United States, 1941; McDonald and Yerkes Observatories, 1942; work with Otto Struve; modern physics at University of Mexico; contact with Subrahmanyan Chandrasekhar; Solomon Lefshetz's influence on mathematics in Mexico; Yerkes courses and general atmosphere after 1944; Struve's administration; work with Chandrasekhar; postdoctoral work in Mexico; return to Yerkes, staff reorganization; research at Yerkes, including radiative transfer, stellar envelopes, and Jupiter


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CHILDREN from a Tyldesley school have read their own poems at a commemorative service.
The poems were written after the Tyldesley branch of the Royal British Legion visited St George's Central Primary School in November to launch their annual Poppy Appeal.
The children were moved to write the poems which have now been printed in a book and each pupil read their own at a service at St George's Church.
Head teacher Mark Grogan said: "What started out as a way of saying thank you to our visitors has now turned into a book and we have received letters of appreciation from Michael Gove and the Queen.
"The children read their poems with pride."
Leigh MP Andy Burnham MP attended the service on Sunday and was so impressed he has arranged a further visit to the school to meet the children again.
The children were presented with a certificate and a copy of the book.


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Tricks, Traps and Tips for better Problem Solving
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Although you're more than welcome to send me a note of appreciation and/or order some books as a way to support the costs of providing this service.
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If you work for a living, then you solve problems of all types.This session will explore some simple PS concepts and explain how we can use formal, and informal, PS techniques in every day Life.
Peter believes very much in the idea that we learn by doing, more precisely? That we learn by failing at doing.
So??? This presentation WILL be interactive.
1) Make sure you have a deck of playing cards handy.
2) Peter will take 'questions' via e-mail as he presents.
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Haynes Lab:Notebook/Investigating Photo-Switchable Synthetic Nucleosomes/2012/11/23
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Dephosphorylation (11/23/12)
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Proceed directly to Transformation. See http://openwetware.org/wiki/Haynes:Assembly101
Results of the enzyme digests are shown, with four H2B bands on the left, and three LOV bands on the right. The gel was loaded with 30 μL samples. The bands are at 2000 bp, confirming the vector self ligated and there is no insert.


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Hong Kong Airport Ferrari Store Opening
Hong Kong, 10 June – A new Ferrari store inaugurates today at the Unit 6V510 on the 6th Level of the Terminal 1 Hong Kong International Airport. Travellers will discover a selection of products dedicated to Ferrari fans, enthusiasts, children and collectors in the tifosi, lifestyle and luxury collections , including the memorabilias, unique and certified original pieces of present and past Ferrari GT and sinlgeseaters. This store joins prestige Ferrari retail locations around the world, including those in Milan, Rome and Venice (Italy), London (UK), Barcelona (Spain), New York (USA), and Johannesburg (South Africa), to name a few.


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You are the TANGO! You are full of lust and emotion. You love to have a partner and you flirt a lot. Your sexy are you bring the temperature up. Sometimes you leave people breathless and you never disapoint, This is why you are the tango. The tango branched out from jazz. It was very interesting to people of the sexuality of it. Its really hard to achomplish but i think it would come natural to you ;)Retake Quiz
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OKC's Metro is the 27th largest city in the United States! There are plenty of options when you are trying to decide where to live. The quiz answers include... 1. Central OKC 2. Edmond 3. Norman 4. Moore 5. Mustang or Yukon 6. Nichols Hills. Enjoy!
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The Pentek 158643 3G housing has 3/8-inch inlet/outlets. The Pentek 3G IB 158643 water filter housing has an integrated bracket so a separate bracket does not need to be purchased. The slim design of the housing reduces space required for installation without sacrificing capacity. The Pentek 158643 housing includes a pressure-relief/bleed button. The 158643 water filter housing has leak-proof sealing with a top-seated Buna-N o-ring. The Pentek 158643 housing accepts proprietary Seal-Safe double o-ring sealing cartridges as well as standard Double Open End (DOE) cartridges. The Pentek 3G IB 158643 filter housing can use any 10-inch L x 2.5-inch W water filter. Two number 10 Standard housings can be connected with a pipe nipple or pipe union. There are several pipe nipples available that can be used to connect two number 10 Standard Housings. Use the NP-38 pipe nipple to connect two number 10 Housings with 3/8-inch inlet/outlets.
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NASHVILLE, Tenn. – Mollie Mitchell, Lipscomb's graduate assistant softball coach, went to the land of William Wallace in June for a mission trip.
It was a family trip for Mitchell. She was joined by her parents, Lou Ann and Mike, along with her brother, Jake, and her sister, Ann Marie; on the 10-day trip. They were joined by 30 others on the trip.
They worked at the Church of Christ in East Kilbride, a congregation of approximately 40 people under the direction of Alex Gear.
"They only have two teenagers in the congregation," Mitchell said. "They are the youngest people that go there. They told me they have a real problem of getting children into the church because their parents won't take them."
The Church of Christ is not that well-known in Scotland. The Church of Scotland and the Catholic church are the main religious bodies.
"Someone asked me if you can worship freely in Scotland," Mitchell said. "You can, but the Church of Christ is frowned upon."
In an effort to make a connection with the children in the area the group invited students from elementary schools in the area and held a Vacation Bible School. Students, aged five to 12 years old, met at a designated school.
"They are allowed to have clubs so we called it Vacation Bible Club," Mitchell said. "We had classes, a skit and then we would play with them.
"We were just trying to get the church into the schools and help the church grow that way. We brought the Mars Hill jazz band with us and they played at the schools. After the band played we invited the kids to come to the Vacation Bible School."
Mitchell said the biggest attendance was 50.
The group also visited a special needs school and performed.
"That was pretty cool," Mitchell said. "The kids really enjoyed it."
Mitchell spoke to the women in the church about encouragement.
"I talked about using encouragement in hard times," Mitchell said. "Here everyone goes to church. We are in the `Bible Belt'.
"In Scotland it is harder to get people to go to church. The church is very small with only 30 or 40 people. They meet in a community center."
Gear is Scottish, but he attended school at Heritage Bible College in Florence, Ala. The school used to be known as International Bible College.
My parents go to Sherrod Avenue Church of Christ in Florence. Gear has connections there.
"It was definitely a different type of mission trip," Mitchell said. "I have been to Mexico and I have been to Honduras. Those are more about hard labor.
"This was so much more about developing relationships and encouraging people to stay strong. After I spoke this woman came up to me crying because she had been having such a hard time. I realized I was accomplishing something."
In places like Mexico and Honduras mission trip members can see their results. A new wall is built. A house is constructed. Walls are painted.
But Mitchell and the rest of the mission group will have to wait and see what the results of their trip will be.
"This trip was about planting seeds in those kids," Mitchell said. "We hope that more and more people will work with those kids. You never know what kind of life you are going to affect.
"Parents were starting to come to the VBS towards the end of the week. You never know what kinds of seeds were planted."
Mitchell, however, did immediately feel the effects of the mission trip.
"Any mission trip I go on has an immediate effect on me," Mitchell said. "You come back with a different perspective on the world.
"I feel so blessed that I am in an area with so many churches within 10 miles of here. It is easy to be a Christian when you are surrounded by Christians."
NASHVILLE, Tenn. – Mollie Mitchell, Lipscomb's graduate assistant softball coach, went to the land of William Wallace in June for a mission trip.


text:
Thursday, October 13, 2011
History or Genealogy?
How can you understand how your ancestor lived if you don't know what events he witnessed or which events played a part in the decisions he made? Do you just forget that he served in the Civil War and suffered from his wounds the rest of his life? Do you forget that he was a minister and helped establish a new church?
On the other hand, how can you understand history if you don't research the people who participated in the events? Do you study the Civil War as a series of conflicts without looking at the men who fought the battles?
Where does one stop and the other begin? In my mind, history and genealogy support each other and must be studied and researched together to get a more complete picture of our ancestors. What do you think?
9 comments:
- Susan Clark said...
Oh my (substituting for my more colorful response to this)! I agree wholeheartedly. I've never understood the concept of filling a pedigree chart with names but having no interest in the lives those ancestors lived. I probably go deeper into the history than others - that was my first love - but it seems genealogy must involve historical context.
As to what history must involve - volumes have been written. I believe it must examine the lives of the people who lived it.
- October 13, 2011 at 7:54 AM
- LSW said...
I was a good history student, but never fully appreciated what studying history meant until I started placing my ancestors into the time lines. Likewise, I was oblivious to the need to study geography until I started plugging the ancestors into the world map. Now I find that history, geography and ancestry all blend to make a great 3D picture of where I come from. Remove any of the elements and you go back to a flat picture.
- October 13, 2011 at 2:46 PM
- Brenda Joyce Jerome said...
Well said, ladies!
- October 13, 2011 at 2:50 PM
- owlhart said...
In school, history was a favorite subject of mine. Of course, the history taught in school is much about governments, laws, wars, etc.
My love of history has increased many times more as a result of my genealogy research; town histories, profiles of individuals, development of counties - more about the lives of real people; of course, I get even more excited when my direct ancestors are mentioned. I am an accountant by day, putting dates and numbers into spreadsheets and accounting programs. But at night, I thrive on being able to put sentences and paragraphs into my genealogy program, not just dates. For me, this brings the individuals to life.
- October 13, 2011 at 9:43 PM
- Nanakat said...
I realized the importance of history in connection with genealogy when I first looked at a pedigree chart showing ancestors of mine who lived in New England in the 1600s. Almost all of them had estimated birthdates before 1620, and birthplaces given as if they had been born in New England (and no "of New England" type birthplaces, either!). I was appalled.
One thing I would very much like to know more about is the Trail of Tears that, as I understand it, went through Western Kentucky. I have ancestors who may have known some of the Cherokee who were on that journey, since my ancestors came from northwestern South Carolina to Western Kentucky only about 30 years before.
I found a Lyon County history that did not even mention the Trail of Tears, and I thought that was rather strange.
Or am I confused about where the Trail actually went?
- October 16, 2011 at 8:40 PM
- Brenda Joyce Jerome said...
These websites might be of interest to you: http://www.trailoftears.org/
Lyon County wasn't created until 1854. The Trail of Tears went through Caldwell County and Livingston County.
- October 16, 2011 at 9:05 PM
- Nanakat said...
Thank you so much, I'll check those websites out.
I realize that Lyon County, as a county, wasn't there during the Trail of Tears, but it was created from the counties that were, and the book purported to cover pre-Lyon County history. And that's what perplexed me, because even though it went back to 1800, there was no mention of the Trail of Tears, as if that wasn't important to the history of the area.
Was it ignored on purpose?
- October 17, 2011 at 10:29 AM
- Nanakat said...
I've visited the websites you recommended, and it's good to know that attention is now being paid to places along the Trail.
I'm wondering if there are any records from that time that are from the point of view of the Kentuckians living in the area through which the Trail passed.
It would be very interesting to know what the people thought of the whole thing, especially those from northwestern South Carolina who might have lived near and known the Cherokee in their original homeland.
- October 17, 2011 at 10:38 AM
- Brenda Joyce Jerome said...
Nanakat: A good many of the settlers in this part of western Kentucky came from the upstate in South Carolina.
If you will email me at firstname.lastname@example.com I will give you the contact info for someone who might be able to answer your questions.
- October 17, 2011 at 11:14 AM


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Dominick's stores and Safeway company they really don't care about there employees they have had several. Class action law suit against them and quite a few settled with the board of labor in Illinois I'm sure it is public records for unfair treatment of there employees maybe people should know how dirty that company really treated there employees I just hope they will get hired by other companies that would treat there employees better
ed Gibbons
I live in Green Bay Wisconsin,and tried to DVD a show on Time Warner Cable called Bozo Gar and Ray..three shows I remember from my childhood…it is on their menu.. I can schedule it but it comes up as null 1 on my DVR..And says it won't record because the channel doesn't exsist..having my sisters up and promised them some serious Garfield Goose…you should fix this
Geraldine M. Pajkos
Can someone tell me why there has not been anything on the news about TPP. This is scary to me. I don't really understand the whole concept of this action but I don't think I like it. I found TPP on Google. What do you think about this "Fasttrack" stuff???
It is deliberate . This is an attempt to give free reign to Foreign trade and keep you in slavery to the system. Do we need any trade agreements? No of course not what do we make here? It is a sellout of our country without our consent of course so they want to "Fast Track "it right by you because of course you would say Go$$@$$ yourself. But you are not supposed to have any say in the matter.
Pat Campbell Moseley
I think rebroadcasts of the Middle is one of the best things on TV. I am a new viewer. I am not so fond of hours of news. It is tiring. Could we do something about all the popups and advertising? There are at least 32 commercials during the Middle, a half hour shows. Thanks
Pretty! This has been an incredibly wonderful article. Thanks
for supplying this info.
JAG please please continue/return JAG to your lineup. Buds leg amputated…you stop series. I especially liked extras on Saturdays.


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thanks barry, i knew i could trust you.
rader, by 'different than the run of the mill', for me, it means that i have tended not to follow prescribed ways of doing things when it comes to my career and personal pursuits.
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text: In terms of size Cairo is not a big city. You quickly arrive at its edges in the desert or the green agricultural fields of the delta. According to official figures there are 17 million people living in greater Cairo city, a city big enough to accommodate two million. The density of people is only comparable to the Indian cities of Bombay and Delhi. Apart from that, nowhere else do so many people live so close together.The population of the Netherlands is just as large as that of the city of Cairo. In this respect, the Netherlands is a dull suburb instead of a densely populated country.


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Hurricane Sandy was devastating my neighborhood, and it was time to obey the warnings and leave. High winds and pounding rain made it very dangerous for everyone, and fireman and police officers were mostly using flares at intersections because of power outages and their flashlights dying in the downpour. I gave my two SureFire E1B (now EB1) Backup® flashlights and a 12 pack of SureFire batteries to two officers helping cars get past some downed, sparking power wires. They wanted to pay me for them, but I, of course, refused and told them to stay safe. I was leaving the area for safety, but the police had to stay and keep things safe. I knew there was no way those lights would fail them, not even in a hurricane.
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East Syracuse, NY


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Rachel Hunter (born 9 September 1969) is a New Zealand model, actress and reality TV show host who now resides in the U.S. She is best known for her appearance in Sports Illustrated Swimsuit Issues and her longtime marriage to singer Rod Stewart, which ended in 2006. She also appeared in the music video for the Fountains of Wayne song "Stacy's Mom".
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text: Hey guys, my brother and I are planning on going out to Wyoming to do some archery antelope hunting this upcoming August. We were looking into units 68, 72, or 73 to apply for. I know there is quite a bit of public ground in these areas, but I was wondering if any of you guys have been in any of those areas and have any thoughts about hunting out there and the odds of us drawing a tag for one of those units? This will be our first time goat hunting, trying do as much research as possible before hand. We were also looking at units 26,27, and 29, I know there is not as much public ground but is it pretty hard to get access on private ground for archery? Thanks


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REAL JUNE (not Mock this time; I really am writing this in June, honest!) June—whew! Just made it in under the deadline here, didn't I?
If you waste time on Google, you may've come across this. If not, I was part of an art project that my pal, Carl Wyckaert, put together for an art book/gallery showing in Paris and Belgium in May. Here's a link to my friend Carl who organized it the gallery show, and is putting out a book of all the cards in the tarot deck.
My old buddy Josh Hagler was there, David Mack, Baron Storey, Mike Dringenberg and a bunch of other artists i haven't met in person so i won't feel to guilty if i flake on mentioning them here. I couldn't BE there for the show, but I asked to have my art burned at the show, and to my surprise and delight, they happily obliged!
(note sinister lighter in Carl's left hand as he smiles down at them!)
Now, before this freaks any of you out (IF it does), please read this, which i wrote for the show and was printed on the back of some prints of the art they sold at the show:
Still horrified? Then just hear me out: Lots of artists often throw out or otherwise destroy stuff they don't like. It's fact. Nothing personal. It's our right. Or stupidity. (If it helps, I don't burn everything I do; some I give away, some I burn, some I keep or sell in galleries for more than my comic book art goes for.
I have not sold any comic book art in about three years and have discontinued doing so. Why? Because much of my art is so digital, there IS no art to speak of TO sell anymore. I never have or will look down on comic art, but I also don't wish to hide my respect for illustrators and contemporary art— which I don't talk about much publicly, only because I hate the elitist baggage that often accompanies it. I don't mean the artists, I mean the fine folks who speculate and profit off it like crabs feasting off rotting fish. Not to seem bitter…
I still remain friends with my old comic art dealer, Albert Moy, a true pal. But as I've told him, my focus now is increasingly gallery-focused, meaning, for lack of a better word, the art I do outside of comics is what my old pal Alex Pardee calls;
'...personal art ',
Like weird crap i build or sculpt by hand, like this Box i made. dozens of magic boxes made of clay, toilet seats, feathers, something that makes ZERO sense at all...
Like this big-ass panting of yet another asian woman, which dwarfs my usual original art size and stimulates different parts of my brain to work so BIG and use mixed media so DIFFERENTLY than i do in comics.
So i make crap, so what right? Lots of people do. If i use rope, cords, fur, rusty old crap and cobble together.. i'd not be the first one to do it -- so why call it personal art?
I just mean as opposed to work for hire, meaning art I do for ME.
To keep me Happy and Stupid. Foolish fun. This is the kinda stuff that pollutes more and more of my sketchbooks, unapologetically so. My feeling is, if only ONE person wants to buy a piece of this art, cool. If not, that's fine too. I know that fewer fans 'per square inch' will like, or follow, or care about this stuff and most will pine away for Maxx and Julie, little bitty hairs on Wolverine's arms, or Batman looking his usual melodramatic self or… (insert favorite mindless superhero's name here). That's cool too. I STILL love that stuff or I wouldn't be doing comics anymore, would I?
An imaginary friend of mine (who doesn't exist except as an excuse to ask me something in the third person) asked me, "Hey Sam, why should us fans buy a gallery painting for thousand of bucks, if he can get a comic page for so much less?"
No reason, and I say, if you're looking for a deal, or a Zero Girl or Wolverine comic page inspires you, GO for it. I drew it for you to enjoy. But just respect my right to ALSO paint things of a personal nature too. Stuff that may take more time and sweat, as well as inspire me on a personal level. If such work takes more out of me, then yes, I AM willing to either ask more for it or, in some cases, give it away, or, yes—sometimes burn it and give it back to the earth.
So I ask your patience and support as I branch out into this, for lack of a better word 'gallery' or 'personal art' side of stuff. And I bet most of my fans are already open to this, given how I mix styles and media, even in my superhero work nowadays.
Remember as R. Crumb once said, "It's only lines on paper, folks."


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Take a look at Halloween in Florida through the years!
Local restaurateur Pam Maneeratana displays three intricately crafted pumpkins carved using a technique called Kae-Sa-Luk, a 700 year-old art carving method from Thailand.
Photographer Roy Erickson chronicled life in Fort Lauderdale, Florida from the late 1960s to the early 1980s.
Photographer Donn Dughi grew up in St. Petersburg, Florida. This is his daughter, Leslie.
Tags: Halloween


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Posted this on the comment wall as well since I don't know where it is best to post things.
Would like to get back into tennis and find some playing partners. I played in college and used to be 5.0 - 5.5 I would guess. Now, am very rusty but am somewhere near 4 - 4.5 . . . will be better once I play regularly. I haven't played much in the past 5 years as golf has pulled me away.
Let me know if you are up for hitting. My time is pretty flexible but I prefer mornings and lunch hour on weekdays or mornings on Saturdays. I am in North Roseville (65/Washington) and have played at Rocklin High and Woodcreek. Those seem to be the most convenient public courts based on where I live.
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Hi Cory,
That's great you're getting back to it! I workout in the mornings but can hit with you any weekday during your lunch hour. I live in Rocklin. We wouldn't be able to hit during the week at the highschools. There's Woodbridge Park off Blue Oaks or we could play at my apt complex.
I'm free on Mondays, Tuesdays and some Wednesdays in the mornings or early afternoon. I live by the Galleria.
Same here Andrew; let's hit. I live like 2mi from the Galleria.
Michele, do you still play?
Yes, I'm still playing! Do you want to hit? My e-mail is email@example.com....thanks.
Let's play. My e-mail is email@example.com. I live near Rocklin High.
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Grand Finale | Preview
Preview: Episode 8 | 30s
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DeRuyter settling in at A&M
COLLEGE STATION, Texas — The only person at Texas A&M with close to as much pressure as head coach Mike Sherman is Tim DeRuyter, the new defensive coordinator he pilfered from Air Force. He's merely in charge of saving Sherman's job.
I met him here yesterday, and he doesn't look at it like that, but stats say otherwise. The Aggies have arguably the best quarterback in the league in Jerrod Johnson but their defense gave up 33.5 points and 426.3 yards a game, and topped 40 points in five games.
"I think professionally this place, especially for a defensive coach and the tradition they've had at Texas A&M, has always been a place in the back of my mind, 'Man, could I ever work at a place like that?'" he said.
He's changing from a 4-3 to a 3-4 and has the best pass rusher in the nation in Von Miller, who led college football with 17 sacks last year.


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