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Observatory: Studying Rare Penguin, Scientist Finds New Species
By HENRY FOUNTAIN, The New York Times, November 25, 2008
It’s not every day that a scientist studying one animal species comes across another, previously unknown, one. But that’s what happened to Sanne Boessenkool of the University of Otago in New Zealand.
What makes the discovery even more unusual is the status of the new species: it’s extinct.
Ms. Boessenkool and her colleagues were studying an endangered New Zealand bird, the yellow-eyed penguin (Megadyptes antipodes), trying to determine if it was naturally rare or had been more abundant in the past. They looked at living birds and museum specimens dating back hundreds of years, including many from a part of New Zealand’s South Island where yellow-eyed penguins are no longer found.
But genetic analysis, as well as morphological evidence from bones, pointed to a startling finding: the oldest specimens, from before the arrival of Europeans in the 17th century, were different from more recent birds. So different, the researchers report in The Proceedings of the Royal Society B: Biological Sciences, that these oldest specimens actually represent a new species, which they named Megadyptes waitaha.
Ms. Boessenkool said she was shocked by the genetic data. “I was looking at these sequences and saying, ‘Why do I have these weird patterns here?’ ” she said. “We never expected to find another species.”
She said it was likely that before the first humans arrived in the 13th century, M. waitaha was able to outcompete the yellow-eyed penguins, relegating them to smaller islands to the south. But then Polynesians arrived and within 200 years had wiped out many big animals including, presumably, M. waitaha.
Their competitors gone, Ms. Boessenkool said, yellow-eyed penguins were able to take over.
“It’s great to see that a species like that has been able to expand,” she said, “but it still is a very vulnerable population.”
Well: A New Face for A.D.H.D., and a Debate
By TARA PARKER-POPE, The New York Times, November 25, 2008
When pediatricians diagnose attention deficit hyperactivity disorder, they often ask their patients whether they know anybody else with the problem.
These days, children are likely to reply with a household name: Michael Phelps, the Olympic superstar, who is emerging as an inspirational role model among parents and children whose lives are affected by attention problems.
“There is a tremendous, tremendous amount of pride — I got the impression sometimes that some of the kids felt like they owned Michael,” said Dr. Harold S. Koplewicz, director of the Child Study Center at New York University Langone Medical Center. “There is a special feeling when someone belongs to your club and the whole world is adoring him.”
But the emergence of a major celebrity with attention deficit has revealed a schism in the community of patients, parents, doctors and educators who deal with the disorder. For years, these people have debated whether it means a lifetime of limitations or whether it can sometimes be a good thing.
Children with the disorder typically have trouble sitting still and paying attention. But they may also have boundless energy and a laserlike focus on favorite things — qualities that could be very helpful in, say, an Olympic athlete.
For that reason, some doctors are pushing for a new view that focuses on the potential strengths of the disorder. Dr. Edward M. Hallowell, a psychiatrist and author whose books include “Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder From Childhood Through Adulthood” (Touchstone, 1995), says the current “deficit-based medical model” of the disorder results in low-self esteem.
“It’s not an unmitigated blessing, but neither is it an unmitigated curse, which is usually the way it’s presented,” said Dr. Hallowell, who has the disorder himself. “I have been treating this condition for 25 years and I know that if you manage it right, this apparent deficit can become an asset. I think of it as a trait and not a disability.”
The notion that a disability can be harnessed in a positive way is not a new concept. Last year, a study found that 35 percent of the small-business entrepreneurs surveyed identified themselves as dyslexic. The researchers concluded that dyslexia made them better communicators and problem solvers, more likely to delegate authority.
Dr. Hallowell says low-self esteem and low expectations result from the way the A.D.H.D. diagnosis is presented to children, parents and teachers. He tells children with attention deficit that they have the brain of a race car, and he wants to work with them to build better brakes.
“We want to tell children, ‘You’ve got a difference, but not a disease,’ ” he said. “Michael Phelps is one of any thousands of examples of mega-successful people, C.E.O.s and brain surgeons and famous writers, inventors and entrepreneurs, who have A.D.H.D.”
Other experts, however, say that while such success stories can be inspiring, parents need to know that their children face real risks. Research shows that children with attention deficit have different brain patterns from other children, and that they are more likely to drop out of school, be involved in car accidents and use illicit drugs.
“This reframing A.D.H.D. as a gift, personally I don’t think it’s helpful,” said Natalie Knochenhauer, founder of A.D.H.D. Aware, an advocacy group in Doylestown, Pa. “You can’t have a disability that needs to be accommodated in the classroom, and also have this special gift. There are a lot of people out there — not only do their kids not have gifts, but their kids are really struggling.”
Ms. Knochenhauer, who has four children with the disorder, says they too were inspired by the astonishing performance of Mr. Phelps in Beijing. But she added, “I would argue that Michael Phelps is a great swimmer with A.D.H.D., but he’s not a great swimmer because he has A.D.H.D.”
Dr. Koplewicz, of N.Y.U., agreed. “There are lots of children in the world who have chronic illnesses or disorders like diabetes, allergies or dyslexia who accomplish great things in spite of the fact that they have these disorders,” he said. “I worry when we say A.D.H.D. is a gift, that this minimizes how real it is.”
Michael Phelps’s mother, Deborah Phelps, says she has spoken openly about her son’s diagnosis because she wants other parents to seek out resources and support. Her son stopped taking A.D.H.D. medication at age 10. But today, Ms. Phelps is a national spokeswoman for McNeil Pediatrics, which makes the attention-deficit drug Concerta. (Dr. Hallowell and Ms. Knochenhauer have also consulted for McNeil; Dr. Koplewicz has no industry ties.)
Ms. Phelps, who is a school principal in Baltimore, says the qualities that often accompany the disorder are not always negative, although it may require extra effort and knowledge to help children harness their talents.
“You’ll find they are creative children,” she said. “They do have determination when you are able to work with them and be consistent. I want young parents to reach out and get assistance and not give up hope.”
Study Suggests Some Cancers May Go Away
By GINA KOLATA, The New York Times, November 25, 2008
Cancer researchers have known for years that it was possible in rare cases for some cancers to go away on their own. There were occasional instances of melanomas and kidney cancers that just vanished. And neuroblastoma, a very rare childhood tumor, can go away without treatment.
But these were mostly seen as oddities — an unusual pediatric cancer that might not bear on common cancers of adults, a smattering of case reports of spontaneous cures. And since almost every cancer that is detected is treated, it seemed impossible even to ask what would happen if cancers were left alone.
Now, though, researchers say they have found a situation in Norway that has let them ask that question about breast cancer. And their new study, to be published Tuesday in The Archives of Internal Medicine, suggests that even invasive cancers may sometimes go away without treatment and in larger numbers than anyone ever believed.
At the moment, the finding has no practical applications because no one knows whether a detected cancer will disappear or continue to spread or kill.
And some experts remain unconvinced.
“Their simplification of a complicated issue is both overreaching and alarming,” said Robert A. Smith, director of breast cancer screening at the American Cancer Society.
But others, including Robert M. Kaplan, the chairman of the department of health services at the School of Public Health at the University of California, Los Angeles, are persuaded by the analysis. The implications are potentially enormous, Dr. Kaplan said.
If the results are replicated, he said, it could eventually be possible for some women to opt for so-called watchful waiting, monitoring a tumor in their breast to see whether it grows. “People have never thought that way about breast cancer,” he added.
Dr. Kaplan and his colleague, Dr. Franz Porzsolt, an oncologist at the University of Ulm, said in an editorial that accompanied the study, “If the spontaneous remission hypothesis is credible, it should cause a major re-evaluation in the approach to breast cancer research and treatment.”
The study was conducted by Dr. H. Gilbert Welch, a researcher at the VA Outcomes Group in White River Junction, Vt., and Dartmouth Medical School; Dr. Per-Henrik Zahl of the Norwegian Institute of Public Health; and Dr. Jan Maehlen of Ulleval University Hospital in Oslo. It compared two groups of women ages 50 to 64 in two consecutive six-year periods.
One group of 109,784 women was followed from 1992 to 1997. Mammography screening in Norway was initiated in 1996. In 1996 and 1997, all were offered mammograms, and nearly every woman accepted.
The second group of 119,472 women was followed from 1996 to 2001. All were offered regular mammograms, and nearly all accepted.
It might be expected that the two groups would have roughly the same number of breast cancers, either detected at the end or found along the way. Instead, the researchers report, the women who had regular routine screenings had 22 percent more cancers. For every 100,000 women who were screened regularly, 1,909 were diagnosed with invasive breast cancer over six years, compared with 1,564 women who did not have regular screening.
There are other explanations, but researchers say that they are less likely than the conclusion that the tumors disappeared.
The most likely explanation, Dr. Welch said, is that “there are some women who had cancer at one point and who later don’t have that cancer.”
The finding does not mean that mammograms caused breast cancer. Nor does it bear on whether women should continue to have mammograms, since so little is known about the progress of most cancers.
Mammograms save lives, Dr. Smith said. Even though they can have a downside — most notably the risk that a woman might have a biopsy to check on an abnormality that turns out not to be cancer — “the balance of benefits and harms is still considerably in favor of screening for breast cancer,” he said.
But Dr. Suzanne W. Fletcher, an emerita professor of ambulatory care and prevention at Harvard Medical School, said that it was also important for women and doctors to understand the entire picture of cancer screening. The new finding, she said, was “part of the picture.”
“The issue is the unintended consequences that can come with our screening,” Dr. Fletcher said, meaning biopsies for lumps that were not cancers or, it now appears, sometimes treating a cancer that might not have needed treatment. “In general we tend to underplay them.”
Dr. Welch said the cancers in question had broken through the milk ducts, where most breast cancers begin, and invaded the breast. Such cancers are not microscopic, often are palpable, and are bigger and look more ominous than those confined to milk ducts, so-called ductal carcinoma in situ, or DCIS, Dr. Welch said. Doctors surgically remove invasive cancers and, depending on the circumstances, may also treat women with radiation, chemotherapy or both.
The study’s design was not perfect, but researchers say the ideal study is not feasible. It would entail screening women, randomly assigning them to have their screen-detected cancers treated or not, and following them to see how many untreated cancers went away on their own.
But, they said, they were astonished by the results.
“I think everybody is surprised by this finding,” Dr. Kaplan said. He and Dr. Porzsolt spent a weekend reading and re-reading the paper.
“Our initial reaction was, ‘This is pretty weird,’ ” Dr. Kaplan said. “But the more we looked at it, the more we were persuaded.”
Dr. Barnett Kramer, director of the Office of Disease Prevention at the National Institutes of Health, had a similar reaction. “People who are familiar with the broad range of behaviors of a variety of cancers know spontaneous regression is possible,” he said. “But what is shocking is that it can occur so frequently.”
Although the researchers cannot completely rule out other explanations, Dr. Kramer said, “they do a good job of showing they are not highly likely.”
A leading alternative explanation for the results is that the women having regular scans used hormone therapy for menopause and the other women did not. But the researchers calculated that hormone use could account for no more than 3 percent of the effect.
Maybe mammography was more sensitive in the second six-year period, able to pick up more tumors. But, the authors report, mammography’s sensitivity did not appear to have changed.
Or perhaps the screened women had a higher cancer risk to begin with. But, the investigators say, the groups were remarkably similar in their risk factors.
Dr. Smith, however, said the study was flawed and the interpretation incorrect. Among other things, he said, one round of screening in the first group of women would never find all the cancers that regular screening had found in the second group. The reason, he said, is that mammography is not perfect, and cancers that are missed on one round of screening will be detected on another.
But Dr. Welch said that he and his colleagues considered that possibility, too. And, he said, their analysis found subsequent mammograms could not make up the difference.
Dr. Kaplan is already thinking of how to replicate the result. One possibility, he said, is to do the same sort of study in Mexico, where mammography screening is now being introduced.
Donald A. Berry, chairman of the department of biostatistics at M. D. Anderson Cancer Center in Houston, said the study increased his worries about screenings that find cancers earlier and earlier. Unless there is some understanding of the natural history of the cancers that are found — which are dangerous and which are not — the result can easily be more treatment of cancers that would not cause harm if left untreated, he said.
“There may be some benefit to very early detection, but the costs will be huge — and I don’t mean monetary costs,” Dr. Berry said. “It’s possible that we all have cells that are cancerous and that grow a bit before being dumped by the body. ‘Hell bent for leather’ early detection research will lead to finding some of them. What will be the consequence? Prophylactic removal of organs in the masses? It’s really scary.”
But Dr. Laura Esserman, professor of surgery and radiology at the University of California, San Francisco, sees a real opportunity to figure out why some cancers go away.
“I am a breast cancer surgeon; I run a breast cancer program,” she said. “I treat women every day, and I promise you it’s a problem. Every time you tell a person they have cancer, their whole life runs before their eyes.
“What if I could say, ‘It’s not a real cancer, it will go away, don’t worry about it,’ ” she added. “That’s such a different message. Imagine how you would feel.”
Microsoft Examines Causes of ‘Cyberchondria’
By JOHN MARKOFF, The New York Times, November 25, 2008
If that headache plaguing you this morning led you first to a Web search and then to the conclusion that you must have a brain tumor, you may instead be suffering from cyberchondria.
On Monday, Microsoft researchers published the results of a study of health-related Web searches on popular search engines as well as a survey of the company’s employees.
The study suggests that self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them.
The researchers said they had undertaken the study as part of an effort to add features to Microsoft’s search service that could make it more of an adviser and less of a blind information retrieval tool.
Although the term “cyberchondria” emerged in 2000 to refer to the practice of leaping to dire conclusions while researching health matters online, the Microsoft study is the first systematic look at the anxieties of people doing searches related to health care, Eric Horvitz said.
Mr. Horvitz, an artificial intelligence researcher at Microsoft Research, said many people treated search engines as if they could answer questions like a human expert.
“People tend to look at just the first couple results,” Mr. Horvitz said. “If they find ‘brain tumor’ or ‘A.L.S.,’ that’s their launching point.”
Mr. Horvitz is a computer scientist and has a medical degree, and his fellow investigator, Ryen W. White, is a specialist in information retrieval technology.
They found that Web searches for things like headache and chest pain were just as likely or more likely to lead people to pages describing serious conditions as benign ones, even though the serious illnesses are much more rare.
For example, there were just as many results that linked headaches with brain tumors as with caffeine withdrawal, although the chance of having a brain tumor is infinitesimally small.
The researchers said they had not intended their work to send the message that people should ignore symptoms. But their examination of search records indicated that researching particular symptoms often led quickly to anxiousness.
They found that roughly 2 percent of all Web queries were health-related, and about 250,000 users, or about a quarter of the sample, engaged in a least one medical search during the study.
About a third of the subjects “escalated” their follow-up searches to explore serious illnesses, the researchers said.
Of the more than 500 Microsoft employees who answered a survey on their medical search habits, more than half said that online medical queries related to a serious illness had interrupted their day-to-day activities at least once.
Mr. Horvitz said that in addition to his interest in creating a Web search tool that would give more reliable answers, the research was driven by clear memories from his medical school education of what was often referred to as “second-year syndrome” or “medical schoolitis.”
He said he remembered “sitting on a cold seat with my legs dangling off the examination table,” convinced that he was suffering from a rare and incurable skin disease.
While the doctor was out of the room, Mr. Horvitz said, he took a look at his medical chart and saw that the doctor’s notes read, “Eric is in medical school, and he has been reading a lot.”
The researchers said that Web searchers’ propensity to jump to awful conclusions was basic human behavior that has been noted by research scientists for decades.
In 1974, the psychologists Amos Tversky and Daniel Kahneman wrote a seminal paper about decisions that are based on beliefs about the likelihood of uncertain events, like the outcome of an election or the future value of the dollar.
They said that people usually employ common sense rules to aid in decisions. The rules can be quite useful, but they also frequently lead to systematic errors in judgment.
The Microsoft researchers noted that reliance on the rankings of Web search results contributes a similar bias to the judgments people make about illness.
At the same time, Mr. Horvitz said he believed that the Web would evolve to offer more reliable information.
In the 1990s, Microsoft researchers built a health advisory system for pregnancy and child care. Mr. Horvitz said that in the future it would be possible to create search engines that were able to detect medical queries and offer advice that did not automatically make Web searchers fear the worst.
By HENRY FOUNTAIN, The New York Times, November 25, 2008
It’s not every day that a scientist studying one animal species comes across another, previously unknown, one. But that’s what happened to Sanne Boessenkool of the University of Otago in New Zealand.
What makes the discovery even more unusual is the status of the new species: it’s extinct.
Ms. Boessenkool and her colleagues were studying an endangered New Zealand bird, the yellow-eyed penguin (Megadyptes antipodes), trying to determine if it was naturally rare or had been more abundant in the past. They looked at living birds and museum specimens dating back hundreds of years, including many from a part of New Zealand’s South Island where yellow-eyed penguins are no longer found.
But genetic analysis, as well as morphological evidence from bones, pointed to a startling finding: the oldest specimens, from before the arrival of Europeans in the 17th century, were different from more recent birds. So different, the researchers report in The Proceedings of the Royal Society B: Biological Sciences, that these oldest specimens actually represent a new species, which they named Megadyptes waitaha.
Ms. Boessenkool said she was shocked by the genetic data. “I was looking at these sequences and saying, ‘Why do I have these weird patterns here?’ ” she said. “We never expected to find another species.”
She said it was likely that before the first humans arrived in the 13th century, M. waitaha was able to outcompete the yellow-eyed penguins, relegating them to smaller islands to the south. But then Polynesians arrived and within 200 years had wiped out many big animals including, presumably, M. waitaha.
Their competitors gone, Ms. Boessenkool said, yellow-eyed penguins were able to take over.
“It’s great to see that a species like that has been able to expand,” she said, “but it still is a very vulnerable population.”
Well: A New Face for A.D.H.D., and a Debate
By TARA PARKER-POPE, The New York Times, November 25, 2008
When pediatricians diagnose attention deficit hyperactivity disorder, they often ask their patients whether they know anybody else with the problem.
These days, children are likely to reply with a household name: Michael Phelps, the Olympic superstar, who is emerging as an inspirational role model among parents and children whose lives are affected by attention problems.
“There is a tremendous, tremendous amount of pride — I got the impression sometimes that some of the kids felt like they owned Michael,” said Dr. Harold S. Koplewicz, director of the Child Study Center at New York University Langone Medical Center. “There is a special feeling when someone belongs to your club and the whole world is adoring him.”
But the emergence of a major celebrity with attention deficit has revealed a schism in the community of patients, parents, doctors and educators who deal with the disorder. For years, these people have debated whether it means a lifetime of limitations or whether it can sometimes be a good thing.
Children with the disorder typically have trouble sitting still and paying attention. But they may also have boundless energy and a laserlike focus on favorite things — qualities that could be very helpful in, say, an Olympic athlete.
For that reason, some doctors are pushing for a new view that focuses on the potential strengths of the disorder. Dr. Edward M. Hallowell, a psychiatrist and author whose books include “Driven to Distraction: Recognizing and Coping With Attention Deficit Disorder From Childhood Through Adulthood” (Touchstone, 1995), says the current “deficit-based medical model” of the disorder results in low-self esteem.
“It’s not an unmitigated blessing, but neither is it an unmitigated curse, which is usually the way it’s presented,” said Dr. Hallowell, who has the disorder himself. “I have been treating this condition for 25 years and I know that if you manage it right, this apparent deficit can become an asset. I think of it as a trait and not a disability.”
The notion that a disability can be harnessed in a positive way is not a new concept. Last year, a study found that 35 percent of the small-business entrepreneurs surveyed identified themselves as dyslexic. The researchers concluded that dyslexia made them better communicators and problem solvers, more likely to delegate authority.
Dr. Hallowell says low-self esteem and low expectations result from the way the A.D.H.D. diagnosis is presented to children, parents and teachers. He tells children with attention deficit that they have the brain of a race car, and he wants to work with them to build better brakes.
“We want to tell children, ‘You’ve got a difference, but not a disease,’ ” he said. “Michael Phelps is one of any thousands of examples of mega-successful people, C.E.O.s and brain surgeons and famous writers, inventors and entrepreneurs, who have A.D.H.D.”
Other experts, however, say that while such success stories can be inspiring, parents need to know that their children face real risks. Research shows that children with attention deficit have different brain patterns from other children, and that they are more likely to drop out of school, be involved in car accidents and use illicit drugs.
“This reframing A.D.H.D. as a gift, personally I don’t think it’s helpful,” said Natalie Knochenhauer, founder of A.D.H.D. Aware, an advocacy group in Doylestown, Pa. “You can’t have a disability that needs to be accommodated in the classroom, and also have this special gift. There are a lot of people out there — not only do their kids not have gifts, but their kids are really struggling.”
Ms. Knochenhauer, who has four children with the disorder, says they too were inspired by the astonishing performance of Mr. Phelps in Beijing. But she added, “I would argue that Michael Phelps is a great swimmer with A.D.H.D., but he’s not a great swimmer because he has A.D.H.D.”
Dr. Koplewicz, of N.Y.U., agreed. “There are lots of children in the world who have chronic illnesses or disorders like diabetes, allergies or dyslexia who accomplish great things in spite of the fact that they have these disorders,” he said. “I worry when we say A.D.H.D. is a gift, that this minimizes how real it is.”
Michael Phelps’s mother, Deborah Phelps, says she has spoken openly about her son’s diagnosis because she wants other parents to seek out resources and support. Her son stopped taking A.D.H.D. medication at age 10. But today, Ms. Phelps is a national spokeswoman for McNeil Pediatrics, which makes the attention-deficit drug Concerta. (Dr. Hallowell and Ms. Knochenhauer have also consulted for McNeil; Dr. Koplewicz has no industry ties.)
Ms. Phelps, who is a school principal in Baltimore, says the qualities that often accompany the disorder are not always negative, although it may require extra effort and knowledge to help children harness their talents.
“You’ll find they are creative children,” she said. “They do have determination when you are able to work with them and be consistent. I want young parents to reach out and get assistance and not give up hope.”
Study Suggests Some Cancers May Go Away
By GINA KOLATA, The New York Times, November 25, 2008
Cancer researchers have known for years that it was possible in rare cases for some cancers to go away on their own. There were occasional instances of melanomas and kidney cancers that just vanished. And neuroblastoma, a very rare childhood tumor, can go away without treatment.
But these were mostly seen as oddities — an unusual pediatric cancer that might not bear on common cancers of adults, a smattering of case reports of spontaneous cures. And since almost every cancer that is detected is treated, it seemed impossible even to ask what would happen if cancers were left alone.
Now, though, researchers say they have found a situation in Norway that has let them ask that question about breast cancer. And their new study, to be published Tuesday in The Archives of Internal Medicine, suggests that even invasive cancers may sometimes go away without treatment and in larger numbers than anyone ever believed.
At the moment, the finding has no practical applications because no one knows whether a detected cancer will disappear or continue to spread or kill.
And some experts remain unconvinced.
“Their simplification of a complicated issue is both overreaching and alarming,” said Robert A. Smith, director of breast cancer screening at the American Cancer Society.
But others, including Robert M. Kaplan, the chairman of the department of health services at the School of Public Health at the University of California, Los Angeles, are persuaded by the analysis. The implications are potentially enormous, Dr. Kaplan said.
If the results are replicated, he said, it could eventually be possible for some women to opt for so-called watchful waiting, monitoring a tumor in their breast to see whether it grows. “People have never thought that way about breast cancer,” he added.
Dr. Kaplan and his colleague, Dr. Franz Porzsolt, an oncologist at the University of Ulm, said in an editorial that accompanied the study, “If the spontaneous remission hypothesis is credible, it should cause a major re-evaluation in the approach to breast cancer research and treatment.”
The study was conducted by Dr. H. Gilbert Welch, a researcher at the VA Outcomes Group in White River Junction, Vt., and Dartmouth Medical School; Dr. Per-Henrik Zahl of the Norwegian Institute of Public Health; and Dr. Jan Maehlen of Ulleval University Hospital in Oslo. It compared two groups of women ages 50 to 64 in two consecutive six-year periods.
One group of 109,784 women was followed from 1992 to 1997. Mammography screening in Norway was initiated in 1996. In 1996 and 1997, all were offered mammograms, and nearly every woman accepted.
The second group of 119,472 women was followed from 1996 to 2001. All were offered regular mammograms, and nearly all accepted.
It might be expected that the two groups would have roughly the same number of breast cancers, either detected at the end or found along the way. Instead, the researchers report, the women who had regular routine screenings had 22 percent more cancers. For every 100,000 women who were screened regularly, 1,909 were diagnosed with invasive breast cancer over six years, compared with 1,564 women who did not have regular screening.
There are other explanations, but researchers say that they are less likely than the conclusion that the tumors disappeared.
The most likely explanation, Dr. Welch said, is that “there are some women who had cancer at one point and who later don’t have that cancer.”
The finding does not mean that mammograms caused breast cancer. Nor does it bear on whether women should continue to have mammograms, since so little is known about the progress of most cancers.
Mammograms save lives, Dr. Smith said. Even though they can have a downside — most notably the risk that a woman might have a biopsy to check on an abnormality that turns out not to be cancer — “the balance of benefits and harms is still considerably in favor of screening for breast cancer,” he said.
But Dr. Suzanne W. Fletcher, an emerita professor of ambulatory care and prevention at Harvard Medical School, said that it was also important for women and doctors to understand the entire picture of cancer screening. The new finding, she said, was “part of the picture.”
“The issue is the unintended consequences that can come with our screening,” Dr. Fletcher said, meaning biopsies for lumps that were not cancers or, it now appears, sometimes treating a cancer that might not have needed treatment. “In general we tend to underplay them.”
Dr. Welch said the cancers in question had broken through the milk ducts, where most breast cancers begin, and invaded the breast. Such cancers are not microscopic, often are palpable, and are bigger and look more ominous than those confined to milk ducts, so-called ductal carcinoma in situ, or DCIS, Dr. Welch said. Doctors surgically remove invasive cancers and, depending on the circumstances, may also treat women with radiation, chemotherapy or both.
The study’s design was not perfect, but researchers say the ideal study is not feasible. It would entail screening women, randomly assigning them to have their screen-detected cancers treated or not, and following them to see how many untreated cancers went away on their own.
But, they said, they were astonished by the results.
“I think everybody is surprised by this finding,” Dr. Kaplan said. He and Dr. Porzsolt spent a weekend reading and re-reading the paper.
“Our initial reaction was, ‘This is pretty weird,’ ” Dr. Kaplan said. “But the more we looked at it, the more we were persuaded.”
Dr. Barnett Kramer, director of the Office of Disease Prevention at the National Institutes of Health, had a similar reaction. “People who are familiar with the broad range of behaviors of a variety of cancers know spontaneous regression is possible,” he said. “But what is shocking is that it can occur so frequently.”
Although the researchers cannot completely rule out other explanations, Dr. Kramer said, “they do a good job of showing they are not highly likely.”
A leading alternative explanation for the results is that the women having regular scans used hormone therapy for menopause and the other women did not. But the researchers calculated that hormone use could account for no more than 3 percent of the effect.
Maybe mammography was more sensitive in the second six-year period, able to pick up more tumors. But, the authors report, mammography’s sensitivity did not appear to have changed.
Or perhaps the screened women had a higher cancer risk to begin with. But, the investigators say, the groups were remarkably similar in their risk factors.
Dr. Smith, however, said the study was flawed and the interpretation incorrect. Among other things, he said, one round of screening in the first group of women would never find all the cancers that regular screening had found in the second group. The reason, he said, is that mammography is not perfect, and cancers that are missed on one round of screening will be detected on another.
But Dr. Welch said that he and his colleagues considered that possibility, too. And, he said, their analysis found subsequent mammograms could not make up the difference.
Dr. Kaplan is already thinking of how to replicate the result. One possibility, he said, is to do the same sort of study in Mexico, where mammography screening is now being introduced.
Donald A. Berry, chairman of the department of biostatistics at M. D. Anderson Cancer Center in Houston, said the study increased his worries about screenings that find cancers earlier and earlier. Unless there is some understanding of the natural history of the cancers that are found — which are dangerous and which are not — the result can easily be more treatment of cancers that would not cause harm if left untreated, he said.
“There may be some benefit to very early detection, but the costs will be huge — and I don’t mean monetary costs,” Dr. Berry said. “It’s possible that we all have cells that are cancerous and that grow a bit before being dumped by the body. ‘Hell bent for leather’ early detection research will lead to finding some of them. What will be the consequence? Prophylactic removal of organs in the masses? It’s really scary.”
But Dr. Laura Esserman, professor of surgery and radiology at the University of California, San Francisco, sees a real opportunity to figure out why some cancers go away.
“I am a breast cancer surgeon; I run a breast cancer program,” she said. “I treat women every day, and I promise you it’s a problem. Every time you tell a person they have cancer, their whole life runs before their eyes.
“What if I could say, ‘It’s not a real cancer, it will go away, don’t worry about it,’ ” she added. “That’s such a different message. Imagine how you would feel.”
Microsoft Examines Causes of ‘Cyberchondria’
By JOHN MARKOFF, The New York Times, November 25, 2008
If that headache plaguing you this morning led you first to a Web search and then to the conclusion that you must have a brain tumor, you may instead be suffering from cyberchondria.
On Monday, Microsoft researchers published the results of a study of health-related Web searches on popular search engines as well as a survey of the company’s employees.
The study suggests that self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them.
The researchers said they had undertaken the study as part of an effort to add features to Microsoft’s search service that could make it more of an adviser and less of a blind information retrieval tool.
Although the term “cyberchondria” emerged in 2000 to refer to the practice of leaping to dire conclusions while researching health matters online, the Microsoft study is the first systematic look at the anxieties of people doing searches related to health care, Eric Horvitz said.
Mr. Horvitz, an artificial intelligence researcher at Microsoft Research, said many people treated search engines as if they could answer questions like a human expert.
“People tend to look at just the first couple results,” Mr. Horvitz said. “If they find ‘brain tumor’ or ‘A.L.S.,’ that’s their launching point.”
Mr. Horvitz is a computer scientist and has a medical degree, and his fellow investigator, Ryen W. White, is a specialist in information retrieval technology.
They found that Web searches for things like headache and chest pain were just as likely or more likely to lead people to pages describing serious conditions as benign ones, even though the serious illnesses are much more rare.
For example, there were just as many results that linked headaches with brain tumors as with caffeine withdrawal, although the chance of having a brain tumor is infinitesimally small.
The researchers said they had not intended their work to send the message that people should ignore symptoms. But their examination of search records indicated that researching particular symptoms often led quickly to anxiousness.
They found that roughly 2 percent of all Web queries were health-related, and about 250,000 users, or about a quarter of the sample, engaged in a least one medical search during the study.
About a third of the subjects “escalated” their follow-up searches to explore serious illnesses, the researchers said.
Of the more than 500 Microsoft employees who answered a survey on their medical search habits, more than half said that online medical queries related to a serious illness had interrupted their day-to-day activities at least once.
Mr. Horvitz said that in addition to his interest in creating a Web search tool that would give more reliable answers, the research was driven by clear memories from his medical school education of what was often referred to as “second-year syndrome” or “medical schoolitis.”
He said he remembered “sitting on a cold seat with my legs dangling off the examination table,” convinced that he was suffering from a rare and incurable skin disease.
While the doctor was out of the room, Mr. Horvitz said, he took a look at his medical chart and saw that the doctor’s notes read, “Eric is in medical school, and he has been reading a lot.”
The researchers said that Web searchers’ propensity to jump to awful conclusions was basic human behavior that has been noted by research scientists for decades.
In 1974, the psychologists Amos Tversky and Daniel Kahneman wrote a seminal paper about decisions that are based on beliefs about the likelihood of uncertain events, like the outcome of an election or the future value of the dollar.
They said that people usually employ common sense rules to aid in decisions. The rules can be quite useful, but they also frequently lead to systematic errors in judgment.
The Microsoft researchers noted that reliance on the rankings of Web search results contributes a similar bias to the judgments people make about illness.
At the same time, Mr. Horvitz said he believed that the Web would evolve to offer more reliable information.
In the 1990s, Microsoft researchers built a health advisory system for pregnancy and child care. Mr. Horvitz said that in the future it would be possible to create search engines that were able to detect medical queries and offer advice that did not automatically make Web searchers fear the worst.
