H. Gilbert Welch is an American academic physician and cancer researcher. He was an internist at the Veterans Administration Medical Center in White River Junction, Vermont, as well as a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice. [1] In September 2018, Welch resigned from Dartmouth College after a 20-month long research misconduct investigation at Dartmouth concluded he had committed plagiarism. [2]
Welch received his BA from Harvard University in 1976, his MD from the University of Cincinnati in 1982, and his MPH from the University of Washington in 1990. [1]
Welch joined Dartmouth Medical School as an assistant professor in 1990. [3] He was promoted to associate professor there in 1995, and to full professor in 2000. [3]
Welch is known for his research into cancer screening. In 2012, Welch co-authored a study which found that mammography was having little to no impact on breast cancer death rates. The study also concluded that substantial overdiagnosis was associated with mammographic screening, "accounting for nearly a third of all newly diagnosed breast cancers." [4] [5] In 2014, Welch and two other researchers published a perspective piece in the New England Journal of Medicine examining trends in thyroid cancer incidence and mortality in South Korea. The piece found that thyroid-cancer mortality has not changed appreciably there from 1993 to 2011, despite the rate of diagnoses for this type of cancer increasing by a factor of 15 during the same time period. [6] [7]
In 2016, he led a study which concluded that women were more likely to be diagnosed with a small tumor that will never increase in size through mammography than they are to have a dangerous tumor detected through the practice. [8] [9] This 2016 study, which included two staff members of the National Cancer Institute (Barnett Kramer and Philip Prorok), was found to have contained uncredited data from a colleague, Samir Soneji. [10] In 2018, after a 20-month investigation, Dartmouth College determined that Welch had "engaged in research misconduct, namely, plagiarism, by knowingly, intentionally, or recklessly appropriating the ideas, processes, results or words of Complainants without giving them appropriate credit, and that these actions represented a significant departure from accepted practices of the relevant research community." Welch disputed the investigation's finding, telling Retraction Watch that "the underlying data are publicly available — all the analyses, all the figures and all the writing in the article are my co-authors' and mine." [11] Dartmouth College considered Welch's claims in a formal appeal process before concluding he engaged in research misconduct, specifically plagiarism. [12]
Welch is critical of the concept of early detection in medicine, [13] [14] stating that "we have exaggerated the benefits of medical care, and we've underplayed — or ignored entirely — the harms. This is particularly true when it comes to early detection." [15] He has also argued that mammograms tend to detect abnormalities that are "not destined to cause them [women who undergo screening] any problems" but are still labeled cancer in these women. [16]
Breast cancer is a cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a red or scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.
Mammography is the process of using low-energy X-rays to examine the human breast for diagnosis and screening. The goal of mammography is the early detection of breast cancer, typically through detection of characteristic masses or microcalcifications.
Screening, in medicine, is a strategy used to look for as-yet-unrecognised conditions or risk markers. This testing can be applied to individuals or to a whole population without symptoms or signs of the disease being screened.
Overdiagnosis is the diagnosis of disease that will never cause symptoms or death during a patient's ordinarily expected lifetime and thus presents no practical threat regardless of being pathologic. Overdiagnosis is a side effect of screening for early forms of disease. Although screening saves lives in some cases, in others it may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm. Given the tremendous variability that is normal in biology, it is inherent that the more one screens, the more incidental findings will generally be found. For a large percentage of them, the most appropriate medical response is to recognize them as something that does not require intervention; but determining which action a particular finding warrants can be very difficult, whether because the differential diagnosis is uncertain or because the risk ratio is uncertain.
Philip Strax was an American radiologist who pioneered the use of mammography to screen for early breast cancer. With his co-investigators, the statistician Sam Shapiro and the surgeon Louis Venet, he conducted a randomized controlled trial comparing outcomes of over 60,000 women who received either mammogram and clinical breast exam or standard medical care. The first results of this study were published in the Journal of the American Medical Association (JAMA) in 1966. The study demonstrated that screening mammograms, which are routine periodic mammograms of asymptomatic women, could find breast cancer at an early enough stage to save lives. For this research Strax and Shapiro shared the Kettering Prize for outstanding contributions to cancer diagnosis or treatment in 1988.
The United States Preventive Services Task Force (USPSTF) is "an independent panel of experts in primary care and prevention that systematically reviews the evidence of effectiveness and develops recommendations for clinical preventive services". The task force, a volunteer panel of primary care clinicians with methodology experience including epidemiology, biostatistics, health services research, decision sciences, and health economics, is funded, staffed, and appointed by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality.
Breast cancer screening is the medical screening of asymptomatic, apparently healthy women for breast cancer in an attempt to achieve an earlier diagnosis. The assumption is that early detection will improve outcomes. A number of screening tests have been employed, including clinical and self breast exams, mammography, genetic screening, ultrasound, and magnetic resonance imaging.
Molecular breast imaging (MBI), also known as scintimammography, is a type of breast imaging test that is used to detect cancer cells in breast tissue of individuals who have had abnormal mammograms, especially for those who have dense breast tissue, post-operative scar tissue or breast implants.
Daniel B. Kopans, MD, FACR is a radiologist specializing in mammography and other forms of breast imaging.
Cancer screening aims to detect cancer before symptoms appear. This may involve blood tests, urine tests, DNA tests, other tests, or medical imaging. The benefits of screening in terms of cancer prevention, early detection and subsequent treatment must be weighed against any harms.
Breast cancer awareness is an effort to raise awareness and reduce the stigma of breast cancer through education about screening, symptoms, and treatment. Supporters hope that greater knowledge will lead to earlier detection of breast cancer, which is associated with higher long-term survival rates, and that money raised for breast cancer will produce a reliable, permanent cure.
Positron emission mammography (PEM) is a nuclear medicine imaging modality used to detect or characterise breast cancer. Mammography typically refers to x-ray imaging of the breast, while PEM uses an injected positron emitting isotope and a dedicated scanner to locate breast tumors. Scintimammography is another nuclear medicine breast imaging technique, however it is performed using a gamma camera. Breasts can be imaged on standard whole-body PET scanners, however dedicated PEM scanners offer advantages including improved resolution.
Dynamic angiothermography (DATG) is a technique for the diagnosis of breast cancer. This technique, though springing from the previous conception of thermography, is based on a completely different principle. DATG records the temperature variations linked to the vascular changes in the breast due to angiogenesis. The presence, change, and growth of tumors and lesions in breast tissue change the vascular network in the breast. Consequently, through measuring the vascular structure over time, DATG effectively monitors the change in breast tissue due to tumors and lesions. It is currently used in combination with other techniques for diagnosis of breast cancer. This diagnostic method is a low-cost one compared with other techniques.
The Canadian National Breast Screening Study, sometimes abbreviated as CNBSS or NBSS, was a randomized trial conducted with the aim of evaluating whether mammography reduced breast cancer incidence or mortality among women who underwent screening. The trial was initiated in 1980, and was conducted in fifteen screening centers in six different Canadian provinces. It was the first study designed to determine whether mammography was effective among women between the ages of 40 and 49.
In medicine, breast imaging is a sub-speciality of diagnostic radiology that involves imaging of the breasts for screening or diagnostic purposes. There are various methods of breast imaging using a variety of technologies as described in detail below. Traditional screening and diagnostic mammography uses x-ray technology and has been the mainstay of breast imaging for many decades. Breast tomosynthesis is a relatively new digital x-ray mammography technique that produces multiple image slices of the breast similar to, but distinct from, computed tomography (CT). Xeromammography and galactography are somewhat outdated technologies that also use x-ray technology and are now used infrequently in the detection of breast cancer. Breast ultrasound is another technology employed in diagnosis and screening that can help differentiate between fluid filled and solid lesions, an important factor to determine if a lesion may be cancerous. Breast MRI is a technology typically reserved for high-risk patients and patients recently diagnosed with breast cancer. Lastly, scintimammography is used in a subgroup of patients who have abnormal mammograms or whose screening is not reliable on the basis of using traditional mammography or ultrasound.
Fiona Jane Gilbert is a Scottish radiologist and academic.
Elisa Rush Port FACS is Associate Professor of Surgery at the Icahn School of Medicine at Mount Sinai Hospital, as well as cofounder and director of the Dubin Breast Center at the Tisch Cancer Institute at Mount Sinai Health System, since 2010. She has received four research grants, has served as an investigator or co-investigator on 15 clinical trials, published 44 peer-reviewed articles, and published a total of 12 book chapters and books. She has specialized in sentinel-node biopsy, a diagnostic method that determines cancer stages based on spread to regional lymph nodes, nipple sparing mastectomy, and the use of MRI for breast cancer.
HB 2102, also known as "Henda's Law", is a breast density (BD) notification law approved in 2011 by the FDA that mammography patients be provided educational materials on dense breast tissue can hide abnormalities, including breast cancer, from traditional screening. Henda's Law aims to promote patient–doctor discussion as well as reduce the rate of false negatives, as mammography may not detect abnormalities in dense breasts.
Dense breast tissue, also known as dense breasts, is a condition of the breasts where a higher proportion of the breasts are made up of glandular tissue and fibrous tissue than fatty tissue. Around 40–50% of women have dense breast tissue and one of the main medical components of the condition is that mammograms are unable to differentiate tumorous tissue from the surrounding dense tissue. This increases the risk of late diagnosis of breast cancer in women with dense breast tissue. Additionally, women with such tissue have a higher likelihood of developing breast cancer in general, though the reasons for this are poorly understood.
Mary E. Costanza is a retired doctor and professor at the University of Massachusetts Amherst medical school. She is known for her research in the field of cancer, cancer prevention, and leadership of the American Cancer Society in Massachusetts.
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