8/25/2016 #JACR Healthcare Social Media Transcript http://embed.symplur.com/twitter/transcript?hashtag=JACR&fdate=08%2F25%2F2016&shour=09&smin=00&tdate=08%2F25%2F2016&thour=10&tmin=30 1/28 #JACR transcript Healthcare Social Media Transcript From: Thu Aug 25 9:00:00 PDT 2016 To: Thu Aug 25 10:30:00 PDT 2016 change time period What is #JACR? Who were the influencers during this time period? #JACR analytics Healthcare Conference Healthcare Tweet Chats Healthcare Analytics roguerad Without further ado. Q1 (roughly 20 minutes): Are reports of overdiagnosis grossly exaggerated? #JACR Thu Aug 25 9:00:07 PDT 2016 jacrjournal Welcome to the #JACR tweet chat. Let’s start with intros. Thu Aug 25 9:00:26 PDT 2016 jacrjournal All tweets are assumed to be your own #JACR Thu Aug 25 9:00:50 PDT 2016 nxtstop1 The #JACR tweet chat starts now: The Topic Questions and References : >>Screening For Cancer https://t.co/jwDZJKZSvn Thu Aug 25 9:01:18 PDT 2016 jacrjournal Please include T1, T2, etc. in your tweets so we know which question you’re responding to #JACR Thu Aug 25 9:01:21 PDT 2016 roguerad Don't be scared to stick your neck above the parapet. No one will bite your head off. #JACR Thu Aug 25 9:01:26 PDT 2016 radiologyacr RT @RogueRad: Without further ado. Q1 (roughly 20 minutes): Are reports of overdiagnosis grossly exaggerated? #JACR Thu Aug 25 9:01:29 PDT 2016 sara_jiang RT @nxtstop1: The #JACR tweet chat starts now: The Topic Questions and References : >>Screening For Cancer https://t.co/jwDZJKZSvn Thu Aug 25 9:01:40 PDT 2016 drsxr #JACR hi everyone. Stephen from #SoFla here.
Transcript
8/25/2016 #JACR Healthcare Social Media Transcript
roguerad Without further ado. Q1 (roughly 20 minutes): Are reports of overdiagnosis grosslyexaggerated? #JACR Thu Aug 25 9:00:07 PDT 2016
jacrjournal Welcome to the #JACR tweet chat. Let’s start with intros. Thu Aug 25 9:00:26 PDT 2016
jacrjournal All tweets are assumed to be your own #JACR Thu Aug 25 9:00:50 PDT 2016
nxtstop1 The #JACR tweet chat starts now: The Topic Questions and References : >>Screening ForCancer https://t.co/jwDZJKZSvn Thu Aug 25 9:01:18 PDT 2016
jacrjournal Please include T1, T2, etc. in your tweets so we know which question you’re responding to#JACR Thu Aug 25 9:01:21 PDT 2016
roguerad Don't be scared to stick your neck above the parapet. No one will bite your head off. #JACRThu Aug 25 9:01:26 PDT 2016
radiologyacr RT @RogueRad: Without further ado. Q1 (roughly 20 minutes): Are reports ofoverdiagnosis grossly exaggerated? #JACR Thu Aug 25 9:01:29 PDT 2016
sara_jiang RT @nxtstop1: The #JACR tweet chat starts now: The Topic Questions and References :>>Screening For Cancer https://t.co/jwDZJKZSvn Thu Aug 25 9:01:40 PDT 2016
drsxr #JACR hi everyone. Stephen from #SoFla here.
pfanderson Patricia, medical librarian from Michigan, interested in topic but a tad offkilter today #jacr Thu Aug 25 9:02:35 PDT 2016
roguerad Is overdiagnosis a manufactured entity? #JACR Thu Aug 25 9:02:56 PDT 2016
fsodagari Hi, Faezeh, a research fellow from Northwestern. Happy to be here today. #jacr Thu Aug 25 9:03:08 PDT 2016
nxtstop1 Q1/T1 Please add T1 as preface to your answer RT @RogueRad: Q1 Are reports ofoverdiagnosis grossly exaggerated? #JACR Thu Aug 25 9:03:38 PDT 2016
roguerad I'll get to that. That's 2nd question. For now I want to focus on overdiagnosis. #JACRhttps://t.co/XaVIRXLTfd Thu Aug 25 9:04:35 PDT 2016
drsxr #JACR Q1: we know that %of population w/ CA will expire from other causes first beforeincidentally found CA causes death. (1/2) Thu Aug 25 9:04:38 PDT 2016
nxtstop1 Q1/T1 A supplementary question from moderator RE: overdiagnosis. RT @RogueRad: Isoverdiagnosis a manufactured entity? #JACR Thu Aug 25 9:04:44 PDT 2016
grebeccahaines Becky Haines, ACR staffer. Proud @JACRJournal is hosting this controversial convo #jacr Thu Aug 25 9:05:06 PDT 2016
drgmcginty . @MGHImaging Kopans T1 Yes greatly exaggerated. Handful of reports of disappearingbreast cancers al palpable & poorly documented. #JACR Thu Aug 25 9:05:32 PDT 2016
roguerad It's hard to believe that overdiagnosis is a manufactured entity when you see a graph likethis. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:05:54 PDT 2016
jenny_writer Join the discussion about #cancer screening in #radiology going on now #JACR Thu Aug 25 9:06:13 PDT 2016
zaidirad RT @DrGMcGinty: . @MGHImaging Kopans T1 Yes greatly exaggerated. Handful ofreports of disappearing breast cancers al palpable & poorly documented. #JACR Thu Aug 25 9:06:18 PDT 2016
zaidirad RT @grebeccahaines: Becky Haines, ACR staffer. Proud @JACRJournal is hosting thiscontroversial convo #jacr Thu Aug 25 9:06:21 PDT 2016
grebeccahaines @drsxr #JACR How do we figure out who's in which half? Thu Aug 25 9:06:21 PDT 2016
zaidirad RT @RogueRad: Is overdiagnosis a manufactured entity? #JACR Thu Aug 25 9:06:26 PDT 2016
drsxr T1: but predicting WHO that will happen to less straightforward. Patients always N=1 toselves (2/2) #JACR Thu Aug 25 9:06:36 PDT 2016
fsodagari T1: Overdiagnosis should be interpreted with age. Overdiagnosis in young patients can stillsave lives. #jacr Thu Aug 25 9:06:44 PDT 2016
nxtstop1 T1 From what I can tell, precise % of overdiagnosis are not known. In countries (like US)which screen more>increase OD suggested #jacr Thu Aug 25 9:06:45 PDT 2016
findlungcancer Hi sorry I'M late #JACR Thu Aug 25 9:06:49 PDT 2016
radiologyacr #JACR https://t.co/VXTgMwGeCY Thu Aug 25 9:06:51 PDT 2016
zaidirad RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:07:14 PDT 2016
findlungcancer T1 depends on type of cancer/disease screening for #JACR https://t.co/iBQpT46Mnp Thu Aug 25 9:07:28 PDT 2016
roguerad Reasonable point that regression of tumor, just because seen with neuroblastoma, will beseen in other tumors #JACR https://t.co/KBervGq1l2 Thu Aug 25 9:07:47 PDT 2016
chrisfilson RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:07:48 PDT 2016
nxtstop1 RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:07:57 PDT 2016
roguerad Is this a fair distinction? Overdiagnosis vs. Overtreatment? #JACR https://t.co/2UtjJ098c0 Thu Aug 25 9:08:33 PDT 2016
findlungcancer RT @drsxr: T1: but predicting WHO that will happen to less straightforward. Patients alwaysN=1 to selves (2/2) #JACR Thu Aug 25 9:08:36 PDT 2016
brianchiong RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:08:55 PDT 2016
sara_jiang T1 This is issue we've been dealing with in thyroid. Incidental thyroid nodules don't alwaysneed to be biopsied as often as they are #jacr Thu Aug 25 9:09:12 PDT 2016
tirathpatelmd @RogueRad If individual is diagnosed w cancer today, but dies of MI next week, they’reoverdiagnosed. Incidence unclear in many cases. #JACR Thu Aug 25 9:09:16 PDT 2016
pfanderson RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:09:34 PDT 2016
zaidirad @RogueRad It is, as we see many undiagnosed lung cancers come in through ER, needmore properly targeted screening, not less #JACR Thu Aug 25 9:09:45 PDT 2016
roguerad So we've established the invasive breast cancer doesn't disappear. Does that refuteoverdiagnosis? #JACR https://t.co/xEmN1iXSB4 Thu Aug 25 9:09:51 PDT 2016
nxtstop1 Must be addressed in the same breath RT @RogueRad:Is this a fair distinction?Overdiagnosis vs. Overtreatment? #JACR https://t.co/BZumC7el4W Thu Aug 25 9:10:10 PDT 2016
doctorfitz RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:10:10 PDT 2016
findlungcancer hard to separate but crucial to do RT @RogueRad: Is this fair distinction? Overdiagnosisvs. Overtreatment? https://t.co/Z1CWKau25W #jacr Thu Aug 25 9:10:13 PDT 2016
drgmcginty T1 Kopans: Two women whose breast cancers reportedly “disappeared” still died from theirmetastatic disease #JACR Thu Aug 25 9:10:31 PDT 2016
drgmcginty T1 Kopans: Papers suggesting major overdiagnosis of invasive cancers all been shown tobe scientifically flawed & not supportable. #JACR Thu Aug 25 9:10:31 PDT 2016
sara_jiang Forgot to introduce myself: Sara Jiang, pathologist @DukeHealth, no COI. #jacr Thu Aug 25 9:10:46 PDT 2016
zaidirad RT @DrGMcGinty: T1 Kopans: Papers suggesting major overdiagnosis of invasive cancersall been shown to be scientifically flawed & not supportable. #JACR Thu Aug 25 9:10:47 PDT 2016
zaidirad RT @DrGMcGinty: T1 Kopans: Two women whose breast cancers reportedly“disappeared” still died from their metastatic disease #JACR Thu Aug 25 9:10:50 PDT 2016
nxtstop1 RT @Sara_Jiang: T1 This is issue we've been dealing with in thyroid. Incidental thyroidnodules don't always need to be biopsied as often as they are #jacr Thu Aug 25 9:11:02 PDT 2016
nxtstop1 RT @TirathPatelMD: @RogueRad If individual is diagnosed w cancer today, but dies of MInext week, they’re overdiagnosed. Incidence unclear in many cases. #JACR Thu Aug 25 9:11:11 PDT 2016
findlungcancer YES when we get to 90% survival can discuss overdiagnosis RT @zaidirad: @RogueRadIt is, as we see many undiagnosed lung cancers #jacr Thu Aug 25 9:11:13 PDT 2016
zaidirad RT @findlungcancer: YES when we get to 90% survival can discuss overdiagnosis RT@zaidirad: @RogueRad It is, as we see many undiagnosed lung cancers #jacr Thu Aug 25 9:11:28 PDT 2016
pfanderson RT @TirathPatelMD: @RogueRad If individual is diagnosed w cancer today, but dies of MInext week, they’re overdiagnosed. Incidence unclear in many cases. #JACR Thu Aug 25 9:11:28 PDT 2016
pfanderson RT @RogueRad: Reasonable point that regression of tumor, just because seen withneuroblastoma, will be seen in other tumors #JACR https://t.co/KBervGq1l2 Thu Aug 25 9:11:40 PDT 2016
lowninstitute RT @findlungcancer: T1 depends on type of cancer/disease screening for #JACRhttps://t.co/iBQpT46Mnp Thu Aug 25 9:11:43 PDT 2016
roguerad Good question. How much overdiagnosis is too much? 10 %, 20 %, 30 %? #JACRhttps://t.co/c1X7qJmgVH Thu Aug 25 9:11:46 PDT 2016
sara_jiang #JACR https://t.co/fAovkTh7Wm Thu Aug 25 9:12:30 PDT 2016
pfanderson "We conclude 30% of invasive screendetected breast cancers in women age 4049 wereoverdiagnosed" https://t.co/EvKISWkmF6 #jacr Thu Aug 25 9:12:53 PDT 2016
pfanderson RT @Sara_Jiang: T1 This is issue we've been dealing with in thyroid. Incidental thyroidnodules don't always need to be biopsied as often as they are #jacr Thu Aug 25 9:13:14 PDT 2016
roguerad Are you talking about this? https://t.co/MssuTJposR Yes, it had assumptions. #JACRhttps://t.co/0yx3lK2r9V Thu Aug 25 9:13:16 PDT 2016
zaidirad @RogueRad @ethanjweiss Need more benchmarks as in mammography 10% recall rateacceptable, 30% is not #JACR Thu Aug 25 9:13:22 PDT 2016
pfanderson "no trial or population setting automatically permits unbiased estimation of overdiagnosis"https://t.co/E6nMByteh2 #jacr Thu Aug 25 9:13:43 PDT 2016
pfanderson RT @zaidirad: @RogueRad @ethanjweiss Need more benchmarks as in mammography10% recall rate acceptable, 30% is not #JACR Thu Aug 25 9:13:58 PDT 2016
mlsfleming2 RT @nxtstop1: T1 From what I can tell, precise % of overdiagnosis are not known. Incountries (like US) which screen more>increase OD suggested #jacr Thu Aug 25 9:14:10 PDT 2016
zaidirad @RogueRad @ethanjweiss Need more work on defining rates of recommendations forlung nodules and other findings #JACR Thu Aug 25 9:14:14 PDT 2016
tirathpatelmd @RogueRad @ethanjweiss Cannot ethically conduct a randomized controlled trial on thematter. #JACR Thu Aug 25 9:14:15 PDT 2016
marckemil RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:14:20 PDT 2016
pfanderson RT @RogueRad: Good question. How much overdiagnosis is too much? 10 %, 20 %, 30%? #JACR https://t.co/c1X7qJmgVH Thu Aug 25 9:14:24 PDT 2016
nxtstop1 T1 How much overdiagnosis is too much? If U don't love living in hospitals/endless RX fornaught, only low overdiagnosis tolerable. #jacr Thu Aug 25 9:14:24 PDT 2016
roguerad I'd be also inclined to shift the burden onto diagnosers (rads and path) #JACRhttps://t.co/7r8XXTJ0uJ Thu Aug 25 9:14:27 PDT 2016
nxtstop1 RT @RogueRad: Good question. How much overdiagnosis is too much? 10 %, 20 %, 30%? #JACR https://t.co/c1X7qJmgVH Thu Aug 25 9:14:32 PDT 2016
amykpatel @RogueRad don't forget to distinguish between the two as well. IDC vs DCIS #JACR@nxtstop1 @TirathPatelMD Thu Aug 25 9:14:38 PDT 2016
lowninstitute RT @RogueRad: I'd be also inclined to shift the burden onto diagnosers (rads and path)#JACR https://t.co/7r8XXTJ0uJ Thu Aug 25 9:14:42 PDT 2016
thinkalot RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:14:47 PDT 2016
tirathpatelmd RT @amykpatel: @RogueRad don't forget to distinguish between the two as well. IDC vsDCIS #JACR @nxtstop1 @TirathPatelMD Thu Aug 25 9:15:03 PDT 2016
roguerad I think we can all agree that invasive breast cancer doesn't become noninvasive. #JACRhttps://t.co/pYHdUMdfaz Thu Aug 25 9:15:13 PDT 2016
thinkalot RT @RogueRad: I'd be also inclined to shift the burden onto diagnosers (rads and path)#JACR https://t.co/7r8XXTJ0uJ Thu Aug 25 9:15:22 PDT 2016
sara_jiang .@RogueRad Yes, in path we're trying: Thyroid EFVPTC>NIFTP name changehttps://t.co/kwt6IC1qoK #jacr Thu Aug 25 9:16:39 PDT 2016
grebeccahaines @zaidirad @RogueRad @ethanjweiss #jacr is this "unsexy" work? Seems like it wouldsave $ & lives > than new drug? Thu Aug 25 9:16:51 PDT 2016
roguerad But then there are these graphs, and they make you think. #JACR https://t.co/o4iKK4LUGu Thu Aug 25 9:16:56 PDT 2016
nxtstop1 To add to ongoing #JACR convo on Cancer Screening & I agree. https://t.co/dF1B3G56TF Thu Aug 25 9:16:56 PDT 2016
tirathpatelmd @amykpatel @RogueRad @nxtstop1 Absolutely. I wish medicine was at such a stagewhere only those who should be treated get treatment. #JACR Thu Aug 25 9:17:11 PDT 2016
lowninstitute RT @TirathPatelMD: @amykpatel @RogueRad @nxtstop1 Absolutely. I wish medicinewas at such a stage where only those who should be treated get treatment. #JACR Thu Aug 25 9:17:27 PDT 2016
findlungcancer RT @RogueRad: I'd be also inclined to shift the burden onto diagnosers (rads and path)#JACR https://t.co/7r8XXTJ0uJ Thu Aug 25 9:17:27 PDT 2016
roguerad Good point. #JACR https://t.co/SbGxrIz3fZ Thu Aug 25 9:17:34 PDT 2016
lowninstitute RT @RogueRad: Good point. #JACR https://t.co/SbGxrIz3fZ Thu Aug 25 9:17:45 PDT 2016
nxtstop1 RT @TirathPatelMD: @amykpatel @RogueRad @nxtstop1 Absolutely. I wish medicinewas at such a stage where only those who should be treated get treatment. #JACR Thu Aug 25 9:18:06 PDT 2016
tirathpatelmd @chrisfilson #JACR My suggestion entirely: https://t.co/ty4snQ0ucA Thu Aug 25 9:18:08 PDT 2016
roguerad It's information problem. But with partial information we make a choice do we err towardsover or under? #JACR https://t.co/VqmvvZ1cvh Thu Aug 25 9:18:22 PDT 2016
jacrjournal RT @TirathPatelMD: @amykpatel @RogueRad @nxtstop1 Absolutely. I wish medicinewas at such a stage where only those who should be treated get treatment. #JACR Thu Aug 25 9:18:40 PDT 2016
nxtstop1 RT @RogueRad: It's information problem. But with partial information we make a choice do we err towards over or under? #JACR https://t.co/VqmvvZ1cvh Thu Aug 25 9:18:55 PDT 2016
zaidirad @TirathPatelMD @RogueRad @ethanjweiss No need to do randomized trial, start withvariation in diagnosis and correlate to end outcomes #JACR Thu Aug 25 9:19:01 PDT 2016
tirathpatelmd @bodyradgal @RogueRad @amykpatel I’d agree but add this: Not everyone diagnosed wCa needs treatment for Ca. Onus on referrers too. #JACR Thu Aug 25 9:19:15 PDT 2016
zaidirad RT @grebeccahaines: @zaidirad @RogueRad @ethanjweiss #jacr is this "unsexy" work?Seems like it would save $ & lives > than new drug? Thu Aug 25 9:19:17 PDT 2016
pfanderson "USPSTF: evidence insufficient to assess benefits/harms of visual skin examination toscreen for skin cancer" https://t.co/CwT4sUP6BM #jacr Thu Aug 25 9:19:19 PDT 2016
roguerad It' nature of EBM. Even RCTs are flawed. But that's a separate discussion, probably forwhen we meet in person #JACR https://t.co/fxGiAiyAeg Thu Aug 25 9:19:20 PDT 2016
jacrjournal RT @RogueRad: I'd be also inclined to shift the burden onto diagnosers (rads and path)#JACR https://t.co/7r8XXTJ0uJ Thu Aug 25 9:19:29 PDT 2016
pfanderson RT @RogueRad: It's information problem. But with partial information we make a choice do we err towards over or under? #JACR https://t.co/VqmvvZ1cvh Thu Aug 25 9:19:30 PDT 2016
nxtstop1 @RogueRad T1 RE: Overdiagnosis & that's precisely where patient choice comes in RE:screening mammography. Patients have a choice~ #jacr Thu Aug 25 9:19:42 PDT 2016
amykpatel @bodyradgal @RogueRad It's a rad's job to participate in patient management #JACR Thu Aug 25 9:19:50 PDT 2016
fsodagari T1: A solution is in "riskstratification". If we tailor screening practices to each individual,overdiagnosis will be decreased. #jacr Thu Aug 25 9:19:50 PDT 2016
pfanderson RT @Sara_Jiang: .@RogueRad Yes, in path we're trying: Thyroid EFVPTC>NIFTP namechange https://t.co/kwt6IC1qoK #jacr Thu Aug 25 9:19:57 PDT 2016
sara_jiang @RogueRad Treatment decisions guided by docs convos with pts. Diagnosticians need tocommunicate effectively w/ treating team #jacr Thu Aug 25 9:19:57 PDT 2016
lowninstitute RT @nxtstop1: @RogueRad T1 RE: Overdiagnosis & that's precisely where patient choicecomes in RE: screening mammography. Patients have a choice~ #jacr Thu Aug 25 9:19:59 PDT 2016
nxtstop1 RT @TirathPatelMD: @bodyradgal @RogueRad @amykpatel I’d agree but add this: Noteveryone diagnosed w Ca needs treatment for Ca. Onus on referrers too. #JACR Thu Aug 25 9:20:15 PDT 2016
roguerad Ok, time for T2 (time flies fast when you're having fun) #JACR Thu Aug 25 9:20:22 PDT 2016
drgmcginty T2 Kopans: Women w breast cancer in RCT’s (to reflect treatment trials) have shown sigred in all cause mortality fr screening #JACR Thu Aug 25 9:20:25 PDT 2016
findlungcancer need SDM for all cancer screening RT @nxtstop1: @RogueRad T1patient choice comes inRE: screening mammography. Patients have choice #jacr Thu Aug 25 9:20:34 PDT 2016
tirathpatelmd @amykpatel @bodyradgal @RogueRad Agreed. Rads know limitations of their diagnosticstudies. #JACR Thu Aug 25 9:20:38 PDT 2016
drsxr RT @TirathPatelMD: @RogueRad If individual is diagnosed w cancer today, but dies of MInext week, they’re overdiagnosed. Incidence unclear in many cases. #JACR Thu Aug 25 9:20:45 PDT 2016
pfanderson @Sara_Jiang @RogueRad Friend who's MD was DX w/ ThyCa, refused Tx. Team wasupset, but data showed remission equal for Tx or not. #jacr Thu Aug 25 9:20:49 PDT 2016
zaidirad @grebeccahaines @RogueRad @ethanjweiss Raising drug prices by double digits everyyear at will is not a worthy business model for me #JACR Thu Aug 25 9:20:51 PDT 2016
nodesat RT @TirathPatelMD: @bodyradgal @RogueRad @amykpatel I’d agree but add this: Noteveryone diagnosed w Ca needs treatment for Ca. Onus on referrers too. #JACR Thu Aug 25 9:20:52 PDT 2016
zaidirad RT @RogueRad: I'd be also inclined to shift the burden onto diagnosers (rads and path)#JACR https://t.co/7r8XXTJ0uJ Thu Aug 25 9:21:06 PDT 2016
jacrjournal RT @amykpatel: @bodyradgal @RogueRad It's a rad's job to participate in patientmanagement #JACR Thu Aug 25 9:21:09 PDT 2016
drsxr @TirathPatelMD @RogueRad but are you willing to bet on it is question #JACR Thu Aug 25 9:21:16 PDT 2016
radiologyacr RT @Sara_Jiang: @RogueRad Treatment decisions guided by docs convos with pts.Diagnosticians need to communicate effectively w/ treating team #jacr Thu Aug 25 9:21:20 PDT 2016
roguerad T2/ Q2: What's the best way of measuring efficacy of screening? Cancerspecific mortality,allcause mortality, QALYs, etc #JACR Thu Aug 25 9:21:24 PDT 2016
zaidirad @RogueRad @chrisfilson Agree, rads can do better with defining diagnostic rates andrecommendations as well as helping with followup #JACR Thu Aug 25 9:21:42 PDT 2016
nxtstop1 @TirathPatelMD @bodyradgal @RogueRad @amykpatel T1Once word "cancer"intro'dsome ppl have nightmares if don't RX>Angelina Jolie effect #jacr Thu Aug 25 9:21:43 PDT 2016
findlungcancer don't agree RT @TirathPatelMD: @RogueRad If individual is diagnosed w cancer today,but dies of MI next week, they’re overdiagnosed. #jacr Thu Aug 25 9:21:50 PDT 2016
grebeccahaines RT @findlungcancer: need SDM for all cancer screening RT @nxtstop1: @RogueRadT1patient choice comes in RE: screening mammography. Patients have choice #jacr Thu Aug 25 9:21:59 PDT 2016
nxtstop1 RT @findlungcancer: need SDM for all cancer screening RT @nxtstop1: @RogueRadT1patient choice comes in RE: screening mammography. Patients have choice #jacr Thu Aug 25 9:22:08 PDT 2016
radiologyacr RT @RogueRad: T2/ Q2: What's the best way of measuring efficacy of screening? Cancerspecific mortality, allcause mortality, QALYs, etc #JACR Thu Aug 25 9:22:14 PDT 2016
pfanderson RT @RogueRad: T2/ Q2: What's the best way of measuring efficacy of screening? Cancerspecific mortality, allcause mortality, QALYs, etc #JACR Thu Aug 25 9:22:17 PDT 2016
grebeccahaines @findlungcancer @nxtstop1 @RogueRad Then we need MUCH > training 4 docs &#patients #jacr Thu Aug 25 9:22:49 PDT 2016
sara_jiang @pfanderson @RogueRad For cancers that generally indolent like WD Thy Ca, issue ofoverdx/overtx esp pertinent #jacr Thu Aug 25 9:22:59 PDT 2016
roguerad I'm no longer indulging anyone on Q1! Stick to Q2 #JACR Thu Aug 25 9:23:05 PDT 2016
nodesat RT @findlungcancer: need SDM for all cancer screening RT @nxtstop1: @RogueRadT1patient choice comes in RE: screening mammography. Patients have choice #jacr Thu Aug 25 9:23:06 PDT 2016
pfanderson "Too much chemo. Too much radiation. And way too many mastectomies"https://t.co/laxPEHpBvW #jacr Thu Aug 25 9:23:08 PDT 2016
zaidirad RT @RogueRad: T2/ Q2: What's the best way of measuring efficacy of screening? Cancerspecific mortality, allcause mortality, QALYs, etc #JACR Thu Aug 25 9:23:15 PDT 2016
findlungcancer All RT @RogueRad: T2/ Q2: What's the best way of measuring efficacy of screening?Cancerspecific mortality, allcause mortalit #jacr Thu Aug 25 9:23:15 PDT 2016
pfanderson RT @findlungcancer: don't agree RT @TirathPatelMD: @RogueRad If individual isdiagnosed w cancer today, but dies of MI next week, they’re overdiagnosed. #jacr Thu Aug 25 9:23:16 PDT 2016
lowninstitute RT @pfanderson: "Too much chemo. Too much radiation. And way too manymastectomies" https://t.co/laxPEHpBvW #jacr Thu Aug 25 9:23:28 PDT 2016
grebeccahaines Where's @economeer when we need him? @NeimanHPI #jacr https://t.co/nAUohXFcC3 Thu Aug 25 9:23:47 PDT 2016
pfanderson The changing incidence of thyroid cancer. https://t.co/myskQoJs8g #jacr Thu Aug 25 9:23:50 PDT 2016
lowninstitute RT @findlungcancer: All RT @RogueRad: T2/ Q2: What's the best way of measuringefficacy of screening? Cancerspecific mortality, allcause mortalit #jacr Thu Aug 25 9:23:51 PDT 2016
nxtstop1 @anish_koka @RogueRad @TirathPatelMD @amykpatel T1 As woman (former acadrads)downside>getting full court press for disease never had! #JACR Thu Aug 25 9:24:01 PDT 2016
roguerad Should we use allcause mortality? Or is that statistical splitting hairs? #JACR Thu Aug 25 9:24:03 PDT 2016
nxtstop1 @nxtstop1 @anish_koka @RogueRad @TirathPatelMD @amykpatel Re: Cancer overdiagnosis leads to overtreatment >the majority of the time #jacr Thu Aug 25 9:24:31 PDT 2016
thyroidmary RT @pfanderson: The changing incidence of thyroid cancer. https://t.co/myskQoJs8g #jacr Thu Aug 25 9:24:31 PDT 2016
pfanderson @Sara_Jiang @RogueRad That was my friend's argument. 20+ years later, she's still fine,no recurrence. #jacr Thu Aug 25 9:24:36 PDT 2016
roguerad That's not the question! The question: how do we measure? #JACR https://t.co/lEgI3kSVue Thu Aug 25 9:24:37 PDT 2016
whaaf RT @nxtstop1: @RogueRad T1 RE: Overdiagnosis & that's precisely where patient choicecomes in RE: screening mammography. Patients have a choice~ #jacr Thu Aug 25 9:24:38 PDT 2016
findlungcancer RT @grebeccahaines: @findlungcancer @nxtstop1 @RogueRad Then we need MUCH >training 4 docs & #patients #jacr
pfanderson RT @Sara_Jiang: @pfanderson @RogueRad For cancers that generally indolent like WDThy Ca, issue of overdx/overtx esp pertinent #jacr Thu Aug 25 9:24:45 PDT 2016
findlungcancer Agree let's get started #jacr https://t.co/PKGJWpm2o8 Thu Aug 25 9:25:13 PDT 2016
drgmcginty T2 Kopans: 15,000 lives saved by seatbelts is a tiny fraction of “all cause” mortality (0.6 %of all deaths). Why bother? #JACR Thu Aug 25 9:25:18 PDT 2016
zaidirad @RogueRad would start with rate of path proven cancers, and cancerspecific mortality#JACR Thu Aug 25 9:25:23 PDT 2016
hswapnil RT @RogueRad: T2/ Q2: What's the best way of measuring efficacy of screening? Cancerspecific mortality, allcause mortality, QALYs, etc #JACR Thu Aug 25 9:25:34 PDT 2016
nxtstop1 RT @RogueRad: T2/ Q2: What's the best way of measuring efficacy of screening? Cancerspecific mortality, allcause mortality, QALYs, etc #JACR Thu Aug 25 9:25:46 PDT 2016
katennp and too many mammograms, which is how it allllll starts....#JACR https://t.co/xqvSVSnO9H Thu Aug 25 9:25:53 PDT 2016
roguerad Imagine being saved from Al Qaida only to be decapitated by ISIS. I think allcausemortality is helpful #JACR https://t.co/EcK3rOoG0o Thu Aug 25 9:26:09 PDT 2016
pfanderson @lowninstitute @DrDkopans I tweeted two article back to back with 180 degree oppositeviews. Challenging! #jacr Thu Aug 25 9:26:24 PDT 2016
tirathpatelmd @nxtstop1 @anish_koka Yes. It’s an information problem. Can’t separate those whoshouldn’t be treated from those who should be. #JACR Thu Aug 25 9:26:37 PDT 2016
pfanderson RT @KatenNP: and too many mammograms, which is how it allllll starts....#JACRhttps://t.co/xqvSVSnO9H Thu Aug 25 9:27:13 PDT 2016
findlungcancer Maybe but dangerous except in obvious cases of frailty/limited life expectation #jacrhttps://t.co/2fZ8yz1baK Thu Aug 25 9:27:14 PDT 2016
roguerad Well done. I think you've identified the problem with allcause mortality. Hard to measure.Underpowered #JACR https://t.co/afitCbicyS Thu Aug 25 9:27:22 PDT 2016
nxtstop1 T2 Allcause mortality is the best way to measure efficacy of a screening program (whiletaking into account patient medical history) #jacr
zaidirad RT @RogueRad: Well done. I think you've identified the problem with allcause mortality.Hard to measure. Underpowered #JACR https://t.co/afitCbicyS Thu Aug 25 9:28:11 PDT 2016
pfanderson RT @DrGMcGinty: T2 Kopans: 15,000 lives saved by seatbelts is a tiny fraction of “allcause” mortality (0.6 % of all deaths). Why bother? #JACR Thu Aug 25 9:28:15 PDT 2016
roguerad Probably true for US. Not true for other countries where the economics is different. #JACRhttps://t.co/BYx47Mk8yq Thu Aug 25 9:28:20 PDT 2016
jedipd Disease specific &All Cause both helpful in delineating confounding factors methinks#JACR Thu Aug 25 9:28:33 PDT 2016
anish_koka @RogueRad as patient I'd like control of how i die #JACR Thu Aug 25 9:28:33 PDT 2016
findlungcancer consider powering some trials 4 all cause too RT @RogueRad: Well done. I think you'veidentified the problem with allcause mortality #jacr Thu Aug 25 9:28:35 PDT 2016
zaidirad @RogueRad @curatorius Good to be specific with causes and take targeted approach tosubsets of at risk population #JACR Thu Aug 25 9:28:53 PDT 2016
tirathpatelmd @DrDkopans @findlungcancer @RogueRad Of course not. Like I said, incidence isunclear, could be negligible. #JACR Thu Aug 25 9:29:04 PDT 2016
curatorius @RogueRad then again ppl who undergone screening are often among the worried well,have better access to health care/insurance etc. #JACR Thu Aug 25 9:29:05 PDT 2016
lowninstitute RT @nxtstop1: T2 Allcause mortality is the best way to measure efficacy of a screeningprogram (while taking into account patient medical history) #jacr Thu Aug 25 9:29:06 PDT 2016
roguerad A reasonable pointbut there are off target effects. Radiation can cause stenosis of left maincoronary artery #JACR https://t.co/oNWpzrFOCX Thu Aug 25 9:29:47 PDT 2016
findlungcancer it's patient value/decision RT @curatorius: @RogueRad then again ppl who undergonescreening are often among the worried well, #jacr Thu Aug 25 9:29:55 PDT 2016
pfanderson I've seen flipside, too. Friend Dx with mast cell lung cancer, told it wdnt be problem in herlifespan. Died of it 2 years later. #jacr Thu Aug 25 9:29:56 PDT 2016
Good luck with that! I think we humans imagine we have more control than we do. #JACRhttps://t.co/uQjqZ44knG Thu Aug 25 9:30:08 PDT 2016
pfanderson RT @curatorius: @RogueRad then again ppl who undergone screening are often amongthe worried well, have better access to health care/insurance etc. #JACR Thu Aug 25 9:30:18 PDT 2016
anish_koka @RogueRad @amykpatel @DrGMcGinty false equivalence assumes all deaths areequal. Sudden cardiac arrest better than head and neck ca #JACR Thu Aug 25 9:30:19 PDT 2016
tirathpatelmd @DrDkopans @nxtstop1 @bodyradgal @RogueRad @amykpatel Agreed. But how manyare truly informed on benefits *and risks* of screening. #JACR Thu Aug 25 9:30:29 PDT 2016
zaidirad @RogueRad @curatorius Agreed, always have to weigh the risks,should not overradiateyoung women looking for PE if risk factors are low #JACR Thu Aug 25 9:31:06 PDT 2016
roguerad So from policy perspective (if there's still something called evidencebased policy) shd useallcause or not? #JACR https://t.co/X9lZZBc3XU Thu Aug 25 9:31:07 PDT 2016
zaidirad RT @RogueRad: A reasonable pointbut there are off target effects. Radiation can causestenosis of left main coronary artery #JACR https://t.co/oNWpzrFOCX Thu Aug 25 9:31:11 PDT 2016
nxtstop1 T2 Seat belt argument mentioned does not apply at all. There is no downside to wearingseatbelts. There is a ton of downside to overdx #jacr Thu Aug 25 9:31:22 PDT 2016
grebeccahaines What scale works? Public, open process rather than secretive trials fueling tenure & drugdiscovery? #JACR https://t.co/NbnMXrCMjp Thu Aug 25 9:31:31 PDT 2016
shannonbrownlee RT @nxtstop1: T2 Seat belt argument mentioned does not apply at all. There is nodownside to wearing seatbelts. There is a ton of downside to overdx #jacr Thu Aug 25 9:31:40 PDT 2016
lowninstitute RT @nxtstop1: T2 Seat belt argument mentioned does not apply at all. There is nodownside to wearing seatbelts. There is a ton of downside to overdx #jacr Thu Aug 25 9:31:40 PDT 2016
vilavaite RT @RogueRad: Join me for #JACR Tweetchat. Thursday August 25th. 121 pm, EST."Screening. Is it worth it? The Fight of the Century." Thu Aug 25 9:31:44 PDT 2016
jacrjournal RT @TirathPatelMD: @DrDkopans @nxtstop1 @bodyradgal @RogueRad @amykpatelAgreed. But how many are truly informed on benefits *and risks* of screening. #JACR Thu Aug 25 9:32:02 PDT 2016
jacrjournal RT @ShannonBrownlee: Good luck with that! I think we humans imagine we have morecontrol than we do. #JACR https://t.co/uQjqZ44knG Thu Aug 25 9:32:13 PDT 2016
findlungcancer key point morbidity often NOT considered RT @anish_koka: @RogueRad @amykpatel@DrGMcGinty assumes all deaths are equal. #jacr Thu Aug 25 9:32:17 PDT 2016
sara_jiang RT @nxtstop1: T2 Seat belt argument mentioned does not apply at all. There is nodownside to wearing seatbelts. There is a ton of downside to overdx #jacr Thu Aug 25 9:32:30 PDT 2016
roguerad So now death is unequal! That'll throw a spanner in the works of modern health economics#JACR https://t.co/Ojm5qsOgPT Thu Aug 25 9:32:30 PDT 2016
zaidirad @DrDkopans @RogueRad @curatorius Agreed, I was referring more to lung cancerexamples or developing new screening strategies #JACR Thu Aug 25 9:32:33 PDT 2016
nxtstop1 RT @TirathPatelMD: @DrDkopans @nxtstop1 @bodyradgal @RogueRad @amykpatelAgreed. But how many are truly informed on benefits *and risks* of screening. #JACR Thu Aug 25 9:32:49 PDT 2016
prof_goldberg RT @pfanderson: "Too much chemo. Too much radiation. And way too manymastectomies" https://t.co/laxPEHpBvW #jacr Thu Aug 25 9:33:06 PDT 2016
curatorius @zaidirad @DrDkopans @RogueRad OMG yes, some prefer a screening CT to smokingcessation & it shouldnt be either/or #JACR Thu Aug 25 9:33:22 PDT 2016
findlungcancer SDM needed RT @TirathPatelMD: @DrDkopans @nxtstop1 @bodyradgal @RogueRad@amykpatel Agreed. But how many are truly informed #jacr Thu Aug 25 9:33:30 PDT 2016
roguerad Should we use cancer free survival days as a metric, rather than cancerspecific or allcause mortality? #JACR Thu Aug 25 9:33:30 PDT 2016
zaidirad RT @curatorius: @zaidirad @DrDkopans @RogueRad OMG yes, some prefer a screeningCT to smoking cessation & it shouldnt be either/or #JACR Thu Aug 25 9:34:09 PDT 2016
pfanderson RT @ShannonBrownlee: Good luck with that! I think we humans imagine we have morecontrol than we do. #JACR https://t.co/uQjqZ44knG Thu Aug 25 9:34:22 PDT 2016
nxtstop1 OR Quality of Life days MT @RogueRad: Q:Use cancer free survival days as a metric,rather than cancerspecific or allcause mortality? #JACR Thu Aug 25 9:34:31 PDT 2016
curatorius Now we're using stats that cancer treatment folks use, rigors for evidence for screeningneed to be different #JACR https://t.co/LpOPvJIda5 Thu Aug 25 9:34:33 PDT 2016
roguerad Yes, since we're arguing about the numbers. This adds to confusion #JACRhttps://t.co/ifzmLwsxIm
findlungcancer no bc possible good QOL with cancer RT @RogueRad: Should we use cancer free survivaldays as a metric, #jacr Thu Aug 25 9:35:05 PDT 2016
jedipd Between normal living, chronic long suffering and a quick grim reaper's scythe lies theperfect QALY #JACR Thu Aug 25 9:35:11 PDT 2016
tirathpatelmd @DrDkopans @bodyradgal @RogueRad @amykpatel Concur 100%!!! But many docs whorefer even themselves don’t know limitations. Educate! #JACR Thu Aug 25 9:35:22 PDT 2016
amykpatel RT @TirathPatelMD: @DrDkopans @bodyradgal @RogueRad @amykpatel Concur100%!!! But many docs who refer even themselves don’t know limitations. Educate! #JACR Thu Aug 25 9:35:36 PDT 2016
nxtstop1 T2 Re:Screening RT @RogueRad: Should we use cancer free survival days as a metric,rather than cancerspecific or allcause mortality? #JACR Thu Aug 25 9:35:38 PDT 2016
pfanderson RT @nxtstop1: T2 Seat belt argument mentioned does not apply at all. There is nodownside to wearing seatbelts. There is a ton of downside to overdx #jacr Thu Aug 25 9:35:43 PDT 2016
pfanderson RT @grebeccahaines: What scale works? Public, open process rather than secretive trialsfueling tenure & drug discovery? #JACR https://t.co/NbnMXrCMjp Thu Aug 25 9:35:54 PDT 2016
sara_jiang @nxtstop1 @RogueRad Yes, if we're worried about downsides of overtx impact on qualityof life needs consideration. #jacr Thu Aug 25 9:35:56 PDT 2016
roguerad Thus, the intractability of the measuring problem. I rest my case (briefly) #JACRhttps://t.co/i568N8fIqo Thu Aug 25 9:36:07 PDT 2016
pfanderson RT @JediPD: Between normal living, chronic long suffering and a quick grim reaper'sscythe lies the perfect QALY #JACR Thu Aug 25 9:36:07 PDT 2016
drkyliesmith RT @pfanderson: "Too much chemo. Too much radiation. And way too manymastectomies" https://t.co/laxPEHpBvW #jacr Thu Aug 25 9:37:02 PDT 2016
nxtstop1 @TirathPatelMD @findlungcancer @DrDkopans @bodyradgal @RogueRad @amykpatelShared decision making #SDM #JACR Thu Aug 25 9:37:07 PDT 2016
roguerad A compelling point but wd need a massive RCT & 30 yr followup during which time, txand diagnosis changes #JACR https://t.co/BApSS7ecfh Thu Aug 25 9:37:14 PDT 2016
clareeile RT @RogueRad: Imagine being saved from Al Qaida only to be decapitated by ISIS. I thinkallcause mortality is helpful #JACR https://t.co/EcK3rOoG0o Thu Aug 25 9:37:48 PDT 2016
zaidirad RT @RogueRad: A compelling point but wd need a massive RCT & 30 yr followup duringwhich time, tx and diagnosis changes #JACR https://t.co/BApSS7ecfh Thu Aug 25 9:37:56 PDT 2016
radiologyacr RT @grebeccahaines: https://t.co/FOjSWI6VOR if u r trying 2 keep up #JACRhttps://t.co/vODCRKJ6RF Thu Aug 25 9:38:01 PDT 2016
tirathpatelmd @nxtstop1 @findlungcancer thanks. #JACR (never seen it abbreviated) Thu Aug 25 9:38:20 PDT 2016
amykpatel @DrDkopans @nxtstop1 @RogueRad @DrGMcGinty Exactly. The point I also made.#JACR Thu Aug 25 9:38:30 PDT 2016
roguerad I'm always innovating, and deinnovating, instantly #JACR https://t.co/TN9FF1NOqw Thu Aug 25 9:38:45 PDT 2016
grebeccahaines Asking hopefully...what role can modeling play? #JACR https://t.co/XcJc71sZxA Thu Aug 25 9:38:51 PDT 2016
andrewfoy82 RT @ShannonBrownlee: Good luck with that! I think we humans imagine we have morecontrol than we do. #JACR https://t.co/uQjqZ44knG Thu Aug 25 9:39:25 PDT 2016
findlungcancer Gr8 point predictive risk models in #lungcancer helpful RT @grebeccahaines: Askinghopefully...what role can modeling #jacr Thu Aug 25 9:39:38 PDT 2016
nxtstop1 @curatorius @zaidirad @DrDkopans @RogueRad This is a big problem imo. Patients whocontinue to smoke despite diagnosis& RX do poorly #JACR Thu Aug 25 9:39:49 PDT 2016
zaidirad RT @nxtstop1: @curatorius @zaidirad @DrDkopans @RogueRad This is a big problemimo. Patients who continue to smoke despite diagnosis& RX do poorly #JACR Thu Aug 25 9:40:10 PDT 2016
roguerad I assume you don't mean Trump's girl friends? Modelling leads to even more arguing bclots of assumptions #JACR https://t.co/QUqFvbsZ1O Thu Aug 25 9:40:11 PDT 2016
pfanderson RT @JediPD: Or shall we say QALY by any other name is not QALY & doesn't smell assweet? #JACR Thu Aug 25 9:40:12 PDT 2016
pfanderson @JediPD Very clever, and appropriate! #jacr Thu Aug 25 9:40:28 PDT 2016
vilavaite RT @RogueRad: A compelling point but wd need a massive RCT & 30 yr followup duringwhich time, tx and diagnosis changes #JACR https://t.co/BApSS7ecfh Thu Aug 25 9:40:53 PDT 2016
roguerad That incidence is itself subject to a lot of debate (APC) #JACR https://t.co/hE8ijvAdqP Thu Aug 25 9:41:02 PDT 2016
learnmath4us RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:41:12 PDT 2016
findlungcancer screening can help motivate to quit RT @nxtstop1: @curatorius @zaidirad @DrDkopans@RogueRad Patients who continue to smoke#JACR #jacr Thu Aug 25 9:41:42 PDT 2016
tirathpatelmd @curatorius @ercowboy @RogueRad @amykpatel @nxtstop1 The usual “if it’s me doeverything” vs societal/economic costs dilemma. #JACR Thu Aug 25 9:41:47 PDT 2016
curatorius Given screening chat, I must add this week's @NEJM special report on Body Fatness andCancer (assoc study) https://t.co/bEVpGZEIbY #JACR Thu Aug 25 9:42:25 PDT 2016
pfanderson Benefits and Harms of Breast Cancer Screening: A Systematic Review.https://t.co/nBN2JUrCGh #jacr Thu Aug 25 9:42:43 PDT 2016
jacrjournal RT @TirathPatelMD: @curatorius @ercowboy @RogueRad @amykpatel @nxtstop1 Theusual “if it’s me do everything” vs societal/economic costs dilemma. #JACR Thu Aug 25 9:42:59 PDT 2016
tirathpatelmd @curatorius @DrDkopans @nxtstop1 @bodyradgal @RogueRad @amykpatel That’s whatI’ve read, but not everyone is fully informed, sadly. #JACR Thu Aug 25 9:43:04 PDT 2016
nxtstop1 @ercowboy @curatorius @RogueRad @TirathPatelMD @amykpatel T2 ..yes, & fearunderlies way too muchmedical care. Awful 4decision making #jacr Thu Aug 25 9:43:14 PDT 2016
nxtstop1 RT @pfanderson: Benefits and Harms of Breast Cancer Screening: A Systematic Review.https://t.co/nBN2JUrCGh #jacr Thu Aug 25 9:43:45 PDT 2016
nxtstop1 RT @curatorius: Given screening chat, I must add this week's @NEJM special report onBody Fatness and Cancer (assoc study) https://t.co/bEVpGZEIbY #JACR Thu Aug 25 9:43:48 PDT 2016
pfanderson RT @curatorius: Given screening chat, I must add this week's @NEJM special report onBody Fatness and Cancer (assoc study) https://t.co/bEVpGZEIbY #JACR Thu Aug 25 9:43:50 PDT 2016
grebeccahaines RT @pfanderson: Benefits and Harms of Breast Cancer Screening: A Systematic Review.https://t.co/nBN2JUrCGh #jacr Thu Aug 25 9:43:59 PDT 2016
tirathpatelmd Both. Only Screen those who should be screened; only treat those who should be treated.#JACR https://t.co/iAL30XulcI Thu Aug 25 9:44:11 PDT 2016
roguerad Screening will always be a tradeoff. Can we select wisely to reduce slope of tradeoff?#JACR Thu Aug 25 9:44:15 PDT 2016
findlungcancer need to have individualized risk with genetic screening to help guide screening & treatmentdecisions. #jacr Thu Aug 25 9:44:17 PDT 2016
tirathpatelmd @amykpatel @RogueRad @jacr Tailoring BOTH treatment and screening to those who’dbenefit is key. #JACR Thu Aug 25 9:45:04 PDT 2016
pfanderson Costeffectiveness of quantitative pretest probability to < radiation exposure in ED ptsw/chest pain&dyspnea. https://t.co/3wWuUCoddR #jacr Thu Aug 25 9:45:16 PDT 2016
grebeccahaines RT @findlungcancer: need to have individualized risk with genetic screening to help guidescreening & treatment decisions. #jacr Thu Aug 25 9:45:28 PDT 2016
drgmcginty T3 Kopans Q: “Why not just screen women who will develop breast cancer!” Ans: Becausewe do not know who they are! #JACR Thu Aug 25 9:45:29 PDT 2016
findlungcancer T3 genetic testing, modeling & informed patients will be key to screening & treating the rightfolks #jacr Thu Aug 25 9:45:46 PDT 2016
roguerad Of course, it depends what you mean by "works." No threshold will be precisely right#JACR https://t.co/TxZwdxSHzA Thu Aug 25 9:45:50 PDT 2016
nxtstop1 @TirathPatelMD @curatorius @ercowboy @RogueRad @amykpatel T2 Note: The "If medo everything" decision may kill! cf The VIP syndrome #jacr Thu Aug 25 9:46:01 PDT 2016
findlungcancer RT @DrGMcGinty: T3 Kopans Q: “Why not just screen women who will develop breastcancer!” Ans: Because we do not know who they are! #JACR Thu Aug 25 9:46:04 PDT 2016
pfanderson @RogueRad @jacr Are we prepared for this? Needs lots more data than just the screeningresults, & diff data sources. Yes? #jacr Thu Aug 25 9:46:09 PDT 2016
jacrjournal RT @TirathPatelMD: @amykpatel @RogueRad @jacr Tailoring BOTH treatment andscreening to those who’d benefit is key. #JACR Thu Aug 25 9:46:24 PDT 2016
roguerad How? (I agree it's key) #JACR https://t.co/KMFMZ8M6TJ Thu Aug 25 9:46:26 PDT 2016
pfanderson RT @DrGMcGinty: T3 Kopans Q: “Why not just screen women who will develop breastcancer!” Ans: Because we do not know who they are! #JACR Thu Aug 25 9:46:34 PDT 2016
findlungcancer by definition screening is in asymptomatic group RT @DrGMcGinty: T3 Kopans Ans:Because we do not know who they are #jacr Thu Aug 25 9:46:55 PDT 2016
sara_jiang RT @nxtstop1: @TirathPatelMD @curatorius @ercowboy @RogueRad @amykpatel T2Note: The "If me do everything" decision may kill! cf The VIP syndrome #jacr Thu Aug 25 9:46:56 PDT 2016
zaidirad RT @findlungcancer: screening can help motivate to quit RT @nxtstop1: @curatorius@zaidirad @DrDkopans @RogueRad Patients who continue to smoke#JACR #jacr Thu Aug 25 9:46:56 PDT 2016
pfanderson Benefits and harms of mammography screening after age 74 years: model estimates ofoverdiagnosis. https://t.co/PBwom4gvGk #jacr Thu Aug 25 9:47:03 PDT 2016
tirathpatelmd @DrGMcGinty @DrDkopans “Information problem” is present in all cancer screening. Iwish we didn’t have it, but it’s a fact of life. #JACR Thu Aug 25 9:47:12 PDT 2016
jacrjournal RT @RogueRad: Screening will always be a tradeoff. Can we select wisely to reduceslope of tradeoff? #JACR Thu Aug 25 9:47:20 PDT 2016
roguerad For example, LungRads excludes ground glass opacities. This is example of greaterprecision #JACR Thu Aug 25 9:47:33 PDT 2016
pfanderson Collaborative Modeling of Benefits & Harms Associated With Different U.S. Breast CancerScreening Strategies https://t.co/gQbkLv8EMG #jacr Thu Aug 25 9:47:40 PDT 2016
grebeccahaines What @ #patients who want 2 b screened? Who pays? #markcubaneffect #jacr Thu Aug 25 9:47:47 PDT 2016
pfanderson RT @findlungcancer: T3 genetic testing, modeling & informed patients will be key toscreening & treating the right folks #jacr Thu Aug 25 9:47:52 PDT 2016
findlungcancer need to do best assessment individualized risk RT @RogueRad: Screening will always bea tradeoff. #jacr Thu Aug 25 9:48:11 PDT 2016
roguerad Bronchoalveolar cell cancer has a lead time of 33 years (longer than some marriages) excluding reduces overdiagnosis #JACR Thu Aug 25 9:48:16 PDT 2016
grebeccahaines RT @DrGMcGinty: T3 Kopans Q: “Why not just screen women who will develop breastcancer!” Ans: Because we do not know who they are! #JACR Thu Aug 25 9:48:25 PDT 2016
tirathpatelmd @RogueRad Screening: Define population as small as possible. Treatment: Genomics,etc. Still much work to do. #JACR Thu Aug 25 9:49:21 PDT 2016
pfanderson @RogueRad We need info on patient view of QoL, genetics, behaviors, resources,environment, support, Ca specific predictors tests etc #jacr Thu Aug 25 9:49:38 PDT 2016
drsxr RT @DrGMcGinty: T3 Kopans Q: “Why not just screen women who will develop breastcancer!” Ans: Because we do not know who they are! #JACR Thu Aug 25 9:49:41 PDT 2016
zaidirad RT @TirathPatelMD: @RogueRad Screening: Define population as small as possible.Treatment: Genomics, etc. Still much work to do. #JACR Thu Aug 25 9:49:43 PDT 2016
zaidirad RT @RogueRad: For example, LungRads excludes ground glass opacities. This isexample of greater precision #JACR Thu Aug 25 9:49:48 PDT 2016
pfanderson RT @TirathPatelMD: @DrGMcGinty @DrDkopans “Information problem” is present in allcancer screening. I wish we didn’t have it, but it’s a fact of life. #JACR Thu Aug 25 9:49:49 PDT 2016
pfanderson RT @RogueRad: Bronchoalveolar cell cancer has a lead time of 33 years (longer thansome marriages) excluding reduces overdiagnosis #JACR Thu Aug 25 9:50:04 PDT 2016
roguerad But policy makers need to look at net benefits, even though screening is individual choice#JACR https://t.co/vabhw3y0D5 Thu Aug 25 9:50:12 PDT 2016
drgmcginty T3 Kopans: If only screen high risk women, 75% of diagnosed w breast cancer will nothave access to & will not benefit fr screening #JACR Thu Aug 25 9:50:24 PDT 2016
findlungcancer RT @TirathPatelMD: @RogueRad Screening: Define population as small as possible.Treatment: Genomics, etc. Still much work to do. #JACR Thu Aug 25 9:50:26 PDT 2016
roguerad Can DCIS be managed with watchful waiting, like that brave surgeon from California isadvocating? #JACR Thu Aug 25 9:50:59 PDT 2016
jedipd No hard & fast metrics Earths drifts closer to the sun Metrics are the human opium Feelhappy w/2+2=4 Health...well, unmeasurable #JACR Thu Aug 25 9:51:03 PDT 2016
grebeccahaines RT @pfanderson: @RogueRad We need info on patient view of QoL, genetics, behaviors,resources, environment, support, Ca specific predictors tests etc #jacr Thu Aug 25 9:51:04 PDT 2016
curatorius .@RogueRad 1/ yes, that's why quintiles of risk (Tammemagi et al), biannual screening(NELSON trial pending results), GGO surveillance #JACR Thu Aug 25 9:51:11 PDT 2016
zaidirad RT @TirathPatelMD: Both. Only Screen those who should be screened; only treat thosewho should be treated. #JACR https://t.co/iAL30XulcI Thu Aug 25 9:51:22 PDT 2016
grebeccahaines RT @DrGMcGinty: T3 Kopans: If only screen high risk women, 75% of diagnosed w breastcancer will not have access to & will not benefit fr screening #JACR Thu Aug 25 9:51:28 PDT 2016
findlungcancer RT @curatorius: .@RogueRad 1/ yes, that's why quintiles of risk (Tammemagi et al),biannual screening (NELSON trial pending results), GGO surveillance #JACR Thu Aug 25 9:51:40 PDT 2016
amykpatel @RogueRad @jacr @DrGMcGinty Is this about $$$ or saving lives? #JACR Thu Aug 25 9:51:41 PDT 2016
roguerad I wouldn't assume! Ask @JeanneLenzer1 @cragcrest #JACR https://t.co/wkKAGMghOn Thu Aug 25 9:51:48 PDT 2016
pfanderson "Compared w/ PSAonly screening, the use of a PHI test can reduce negative biopsies,improve #PCSM detection" https://t.co/55dppGRjeH #jacr Thu Aug 25 9:51:53 PDT 2016
nxtstop1 Should beimo, #SDM RT @RogueRad: Can DCIS be managed with watchful waiting, likethat brave surgeon from California is advocating? #JACR Thu Aug 25 9:52:36 PDT 2016
roguerad Once you decide you won't spend the entire GDP to save one life, the rest is merelyquibbling about the price #JACR https://t.co/MhOBRDTX7m Thu Aug 25 9:52:41 PDT 2016
vilavaite RT @RogueRad: Once you decide you won't spend the entire GDP to save one life, therest is merely quibbling about the price #JACR https://t.co/MhOBRDTX7m Thu Aug 25 9:53:05 PDT 2016
benmazer @RogueRad Anything can be managed by waiting. Doctors are always surprised whenpatients don't immediately drop dead from inaction. #JACR Thu Aug 25 9:53:10 PDT 2016
findlungcancer many women don't want any screening RT @RogueRad: I wouldn't assume! Ask@JeanneLenzer1 @cragcrest https://t.co/k0YjRqGFkB #jacr Thu Aug 25 9:53:14 PDT 2016
jedipd DCIS 98% 10 yr survival But & the kicker 2%? 2% of 40% of 1,000,000 is substantial #sNo? #JACR Thu Aug 25 9:53:23 PDT 2016
pfanderson RT @curatorius: .@RogueRad 1/ yes, that's why quintiles of risk (Tammemagi et al),biannual screening (NELSON trial pending results), GGO surveillance #JACR Thu Aug 25 9:53:27 PDT 2016
abrahamnussbaum RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 9:53:39 PDT 2016
nxtstop1 @RogueRad @JeanneLenzer1 @cragcrest @amykpatel @jacr @DrGMcGinty Personallyprefer under screen to over screen patient choice #JACR Thu Aug 25 9:53:46 PDT 2016
roguerad That was the idea :) #JACR https://t.co/HVNkNiU501 Thu Aug 25 9:53:47 PDT 2016
findlungcancer body often heals itself #amazing RT @BenMazer: @RogueRad Anything can be managedby waiting. #jacr Thu Aug 25 9:53:47 PDT 2016
tirathpatelmd @DrDkopans @drmcginty Agreed! Journals shouldn’t have an “agenda,” but many do andtheir peerreviewers tow the party line. #JACR Thu Aug 25 9:53:56 PDT 2016
pfanderson RT @nxtstop1: @RogueRad T1 RE: Overdiagnosis & that's precisely where patient choicecomes in RE: screening mammography. Patients have a choice~ #jacr Thu Aug 25 9:54:00 PDT 2016
roguerad ok, we're nearing the end. Some closing thoughts #JACR Thu Aug 25 9:54:29 PDT 2016
jacrjournal RT @BenMazer: @RogueRad Anything can be managed by waiting. Doctors are alwayssurprised when patients don't immediately drop dead from inaction. #JACR Thu Aug 25 9:54:31 PDT 2016
theraltweet RT @RogueRad: Once you decide you won't spend the entire GDP to save one life, therest is merely quibbling about the price #JACR https://t.co/MhOBRDTX7m Thu Aug 25 9:55:02 PDT 2016
vilavaite RT @RogueRad: Can DCIS be managed with watchful waiting, like that brave surgeonfrom California is advocating? #JACR Thu Aug 25 9:55:07 PDT 2016
drgmcginty T3 Kopan RCT’s proved screening saves lives among women in general. No proof thatscreening only high risk women will save any lives. #JACR Thu Aug 25 9:55:21 PDT 2016
pfanderson Addressing overtreatment of screen detected DCIS; the LORIS trial.https://t.co/teSz8DXU6m #jacr Thu Aug 25 9:55:29 PDT 2016
theraltweet RT @RogueRad: Join me for #JACR Tweetchat. Thursday August 25th. 121 pm, EST."Screening. Is it worth it? The Fight of the Century." Thu Aug 25 9:55:31 PDT 2016
roguerad My closing thoughts ( x 2): Lung cancer is the model of screening bc they excluded groundglass opacities #JACR Thu Aug 25 9:55:38 PDT 2016
findlungcancer we will soon have data re:overdiagnosis w/prostate cancer screening incidence down survival data will be key #jacr Thu Aug 25 9:55:45 PDT 2016
pfanderson RT @findlungcancer: body often heals itself #amazing RT @BenMazer: @RogueRadAnything can be managed by waiting. #jacr Thu Aug 25 9:55:46 PDT 2016
jedipd Stopping PSA screening reduced the "incidence" don't see won't know But raised theaggressive Prostate Cancer numbers? Huh? #JACR Thu Aug 25 9:55:57 PDT 2016
nxtstop1 Note: I will "Storify" this tweet chat & disseminate it under the hashtag #JACR ~ Thu Aug 25 9:56:13 PDT 2016
grebeccahaines What would u tell your Mom? Screen or not? #jacr Thu Aug 25 9:56:17 PDT 2016
tirathpatelmd @amykpatel @RogueRad @DrGMcGinty Ageold debate. Policy makers & insurers mustlook at former while we wish they’d focus on latter. #JACR Thu Aug 25 9:56:21 PDT 2016
nxtstop1 RT @pfanderson: Addressing overtreatment of screen detected DCIS; the LORIS trial.https://t.co/teSz8DXU6m #jacr Thu Aug 25 9:56:31 PDT 2016
roguerad You may have point there. Alternative inference: NNT is too many. I do agree USPSTF shdbe more upfront #JACR https://t.co/C3qnKWeb9Z Thu Aug 25 9:57:05 PDT 2016
zaidirad RT @RogueRad: My closing thoughts ( x 2): Lung cancer is the model of screening bc theyexcluded ground glass opacities #JACR Thu Aug 25 9:57:08 PDT 2016
pfanderson "assess the safety of active surveillance for low risk ductal carcinoma in situ"https://t.co/RWfwRauyBk #jacr Thu Aug 25 9:57:18 PDT 2016
zaidirad RT @grebeccahaines: What would u tell your Mom? Screen or not? #jacr Thu Aug 25 9:57:18 PDT 2016
pfanderson RT @nxtstop1: Note: I will "Storify" this tweet chat & disseminate it under the hashtag#JACR ~ Thu Aug 25 9:57:26 PDT 2016
findlungcancer CT appropriate SDM & let patient values & preference drive screening with risk/benefittradeoff with personalized risk not averages #jacr Thu Aug 25 9:57:41 PDT 2016
vilavaite RT @RogueRad: You may have point there. Alternative inference: NNT is too many. I doagree USPSTF shd be more upfront #JACR https://t.co/C3qnKWeb9Z Thu Aug 25 9:57:55 PDT 2016
grebeccahaines RT @RogueRad: You may have point there. Alternative inference: NNT is too many. I doagree USPSTF shd be more upfront #JACR https://t.co/C3qnKWeb9Z Thu Aug 25 9:57:56 PDT 2016
ayannamonte #JACR https://t.co/eAtf77w66j Thu Aug 25 9:58:07 PDT 2016
findlungcancer RT @RogueRad: My closing thoughts ( x 2): Lung cancer is the model of screening bc theyexcluded ground glass opacities #JACR Thu Aug 25 9:58:10 PDT 2016
grebeccahaines RT @findlungcancer: CT appropriate SDM & let patient values & preference drivescreening with risk/benefit tradeoff with personalized risk not averages #jacr Thu Aug 25 9:58:17 PDT 2016
jedipd Keep the faith fellow warriors Life as water flows through turbulent times Thanks to@RogueRad @DrGMcGinty for moderating #JACR Thu Aug 25 9:58:21 PDT 2016
roguerad Screening saves lives and leads to overdiagnosis. Both facts are now irrefutable. #JACR Thu Aug 25 9:58:23 PDT 2016
findlungcancer AND SDM reqt RT @RogueRad: My closing thoughts ( x 2): Lung cancer is the model ofscreening bc they excluded ground glass opacities #jacr Thu Aug 25 9:58:35 PDT 2016
vilavaite RT @RogueRad: Screening saves lives and leads to overdiagnosis. Both facts are nowirrefutable. #JACR Thu Aug 25 9:58:54 PDT 2016
roguerad Thanks for all who participated. #JACR Thu Aug 25 9:58:56 PDT 2016
sara_jiang RT @RogueRad: Screening saves lives and leads to overdiagnosis. Both facts are nowirrefutable. #JACR
vilavaite RT @RogueRad: My closing thoughts ( x 2): Lung cancer is the model of screening bc theyexcluded ground glass opacities #JACR Thu Aug 25 9:59:18 PDT 2016
nxtstop1 CT: B4 Screening for cancer: thorough convos & shared decision making. Patients deserveit, as ones who suffer or benefit from results #jacr Thu Aug 25 9:59:20 PDT 2016
findlungcancer Yes risk/benefit trade based on personal risk and values RT @RogueRad: Screeningsaves lives and leads to overdiagnosis. #jacr Thu Aug 25 9:59:22 PDT 2016
amykpatel RT @RogueRad: Screening saves lives and leads to overdiagnosis. Both facts are nowirrefutable. #JACR Thu Aug 25 9:59:29 PDT 2016
sara_jiang @RogueRad Thanks for moderating! Good discussion. And no heads lost. #JACR Thu Aug 25 9:59:35 PDT 2016
dr_babu RT @RogueRad: Screening saves lives and leads to overdiagnosis. Both facts are nowirrefutable. #JACR Thu Aug 25 9:59:42 PDT 2016
findlungcancer RT @RogueRad: Thanks, specially to #JACR for the courage to discuss a topic whichmakes so many of their members queasy. #JACR Thu Aug 25 10:00:30 PDT 2016
tirathpatelmd RT @zaidirad: @RogueRad In general, the overdiagnosis is worth the lives saved, difficultyis defining those parameters #JACR Thu Aug 25 10:00:41 PDT 2016
nxtstop1 CONCLUDING THOUGHT: @RogueRad: Screening (foc cancer) saves lives and leads tooverdiagnosis. Both facts are now irrefutable. #JACR Thu Aug 25 10:00:46 PDT 2016
pfanderson RT @TirathPatelMD: @chrisfilson #JACR My suggestion entirely: https://t.co/ty4snQ0ucA Thu Aug 25 10:00:57 PDT 2016
roguerad The sequel will be a discussion between me & @DrDkopans filmed by @Medscape inDecember. Stay tuned. #JACR Thu Aug 25 10:01:07 PDT 2016
vilavaite RT @RogueRad: I wouldn't assume! Ask @JeanneLenzer1 @cragcrest #JACRhttps://t.co/wkKAGMghOn Thu Aug 25 10:01:12 PDT 2016
pfanderson RT @RogueRad: Thanks, specially to #JACR for the courage to discuss a topic whichmakes so many of their members queasy. #JACR Thu Aug 25 10:01:18 PDT 2016
oxinahr RT @pfanderson: "Too much chemo. Too much radiation. And way too manymastectomies" https://t.co/laxPEHpBvW #jacr Thu Aug 25 10:02:40 PDT 2016
nxtstop1 RT @RogueRad: Screening saves lives and leads to overdiagnosis. Both facts are nowirrefutable. #JACR Thu Aug 25 10:03:40 PDT 2016
vilavaite RT @RogueRad: Thanks for all who participated. #JACR Thu Aug 25 10:04:59 PDT 2016
vilavaite RT @RogueRad: The sequel will be a discussion between me & @DrDkopans filmed by@Medscape in December. Stay tuned. #JACR Thu Aug 25 10:05:11 PDT 2016
findlungcancer agree key is to give patients information need 2 make informed choice 4 themselvesgiven risk/preference #jacr https://t.co/AkeOUbXvrw Thu Aug 25 10:05:16 PDT 2016
zaidirad RT @findlungcancer: agree key is to give patients information need 2 make informedchoice 4 themselves given risk/preference #jacr https://t.co/AkeOUbXvrw Thu Aug 25 10:05:31 PDT 2016
ruthcarlosmd Many thanks to @RogueRad for a controversial #JACR tweetchat today. Thu Aug 25 10:05:57 PDT 2016
zaidirad @findlungcancer @RogueRad need transparency in diagnostic accuracy and endoutcomes, with focus on outliers and reducing variability #JACR Thu Aug 25 10:07:43 PDT 2016
findlungcancer flawed study small sample; real story in clinical practice https://t.co/KLSVgnzCGm #lcsm (Iam lead author) #jacr https://t.co/Jhb0fdYux9 Thu Aug 25 10:07:45 PDT 2016
findlungcancer RT @zaidirad: @findlungcancer @RogueRad need transparency in diagnostic accuracyand end outcomes, with focus on outliers and reducing variability #JACR Thu Aug 25 10:10:03 PDT 2016
drsxr RT @RogueRad: Thanks for all who participated. #JACR Thu Aug 25 10:10:07 PDT 2016
ruthcarlosmd symplur sez #JACR tweet chat 2.1M impressions. thanks to all especially @RogueRad asguest mod Thu Aug 25 10:10:07 PDT 2016
drnic1 RT @ruthcarlosmd: Many thanks to @RogueRad for a controversial #JACR tweetchattoday. Thu Aug 25 10:10:46 PDT 2016
redunndant RT @RogueRad: It's hard to believe that overdiagnosis is a manufactured entity when yousee a graph like this. #JACR https://t.co/kN2llGP6IR Thu Aug 25 10:19:50 PDT 2016
