Re: observation
From: Gail Waldby (gwaldby@willinet.net)
Tue Jan 16 20:08:23 2001
Bob,
I don't think you will get anywhere with Radiologists observations because
Kopans in his Breast Imaging book observes that there is little correlation
between the physical firmness of breasts and their radiologic density.
His book has many other similar little observations which are helpful.
Another highly recommended book which I haven't read yet is Benign
Disorders and Diseases of the Breast by Hughes, Mansel, Webster from Saunders.
Gail Waldby, MD
Huron Clinic SD
At 08:48 PM 1/16/2001 -0600, you wrote:
>I've noticed something over the last several years. I'm curious whether
>anybody
>else has ever noticed the same thing.
>
>It started with one patient perhaps 4 years ago who had--well, there's
>simply no
>politically correct way to express this--the most gravity-defying breasts
>I've
>ever seen. What struck me is that she also had just about the most
>fibrocystic
>breasts I had ever seen.
>
>Since then, it has been quite consistent, I think. The few percent of
>women with
>the greatest elevation of the areolar complex above the inframammary
>fold--apparently independent of breast size--have all been heavily
>fibrocystic.
>And, conversely, those with the most ptotic breasts--whether large or
>small--tend to have little if any fibrocystic content. (Nearly all of my
>patients are in a narrow age spectrum of 18-28 or so, and nulliparous, so
>this
>observation is reasonably independent of age.)
>
>I can convince myself that this makes some sense: relatively more internal
>connective tissue would feel fibrocystic on exam and perhaps also provide
>more
>resistance to the inexorable effects of gravity. But this is, of course,
>after-the-fact reasoning, which is dangerously susceptible to bias.
>
>And my entire observation of such a trend may be bogus, the result purely
>of a
>confirmation bias induced by that first patient in whom I noticed the
>association. I may have subconsciouly noticed cases that confirm the
>hunch, and
>ignored those that don't.
>
>So I ask for the cumulative vast experience of this distinguished group of my
>colleagues. Am I just nuts here, or am I onto something? Would it be of
>sufficient interest to persue objectively? (E.g., make some sort of
>measurement
>of the degree of ptosis, have a blinded radiologist count the cysts or
>make some
>other quantitative measurement of fibrocystic content, and look for a
>statistical association.) Would anybody care if it happened to be
>demonstrably
>true? That is, would it be an observation that would shed any light on the
>nature of fibrocystic change, or how cosmetic breast surgery might be
>improved,
>or whatever?
>
>--
>---------------------------------------------------------------------------
>
>---------------------------------------------------------------------------
>
>---------------------------------------------------------------------------
>Bob Woolley
>St. Paul, Minnesota
>
>GIC
>
>Some presidents' names become adjectives -- Lincolnian gravity,
>Rooseveltian reassurance, Kennedyesque charisma, Nixonian deviousness,
>Reaganesque leadership. To understand the meaning of "Clintonian," parse
>this from a 1997 news conference: "I don't believe you can find any
>evidence of the fact that I have changed government policy solely
>because of a contribution." ...Clinton is not the worst president the
>republic has had, but he is the worst person ever to have been president.
>
> -- George Will, 1/11/01
