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Research Paper Guidelines

Rules to Follow Carefully When Setting Up Notes

1. Notes must be typed, single or double spaced, with 1" margins. Use only 12 pt. Times New Roman font.

2. Each set of notes begins with complete bibliographic information for the source.

3. Notes must begin with a well-written 100-200 word annotation of the source. This annotation does not need to be documented.

4. Each note should be numbered. Numbers for notes must correspond to paragraphs numbers of source documents. Take a minimum of 5 notes per source. If you have a source from which you cannot glean enough information then you must use another source. Failure to provide 5 meaningul notes from five separate paragraphs will result in an automatic F.

5. When quoting information from a source, never use a quotation longer than 3 typed lines. If you have vital information that will run longer than 3 typed lines, then write this information down as a summary note rather than a quotation.

6. Each note must begin with the author's last name. If the source does not list an author's name, begin with the name of the group or company responsible for publishing the information. After giving the source's name, follow with a strong, active voice verb such as "asserts," "argues," "indicates," "states," presents," "provides,". There are dozens of other good verbs to use. Establish variety. After the strong verb, then give the quotation or information taken from the source.

7. Each note must end with the page number or numbers from which the information was gathered. This page number should be placed in parentheses. Since you are supposed to give the source's name at the beginning of the sentence, it is not necessary for you to cite the source's name a second time in the parentheses. After the parentheses, put in the period to end the sentence. The period must always be placed after the parentheses, not before. Internet sources which are not paginated will not be given a page citation. Internet sources such as PDF files are paginated and their notes must contain a proper page reference.

8. Leave a double or triple space between notes.

9. Notes for each source must use a variety of quotation, paraphrase, and summary. It is not acceptable to use only quotations in your notes or your final papers. Failure to vary the form of your notes will be considered a minor mistake.

10. Never begin a sentence or a note with a quotation. This is a rule not only for taking notes but also for writing the final paper. Failure to follow this rule will be considered a minor mistake.

11. If you commit more than 3 minor mistakes in the preparation of a set of notes, you will receive an automatic F for a grade. In addition to the errors listed above, minor mistakes include errors in typing, punctuation & mechanics, format, grammar, spelling, and usage. If you receive an F for any set of notes, you may go back and correct your mistakes. Once your notes are in perfect order, I will give you an A and erase the original F from your record.

12. If you commit only one major mistake, you will receive an automatic F. Major mistakes include errors in citation and documentaion, misquoting or misrepresenting a source, failing to provide complete and accurate bibliographic information. If you receive an F for any set of notes, you may go back and correct your mistakes. If you do, I will give you an A and erase the original F from your record.

13. Notes must be turned in on time. If notes are turned in late, even if they are perfectly done, they will receive a grade of F. This grade will not be erased from your record.

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Kendrick, Dr. C.F. “The Latest Controversy on Mammograms.” www.mlis.org. 23 Feb. 2002
<<http://www.mlis.org/pages541662.htm>>

Abstract of Essay’s Main Points

In this article, Dr. C.F. Kendrick, a freelance writer with a business in DNA, clinical laboratory medicine and epidemiology, examines the idea that mammograms may not offer an accurate and thorough diagnosis for breast cancer, particularly in women under the age of fifty. Kendrick suggests that society may be relying solely on mammograms and not focusing on simple clinical breast examinations. Kendrick proposes the idea of increasing research on alternate tests such as DNA tests and also researching causes of breast cancer separate from genetic factors. Kendrick advises using other tools besides mammograms to reduce breast cancer and it’s affects.

Notes

#1 Kendrick uses statistics to discuss the idea that breast cancer is becoming much more common and is not only caused by hereditary factors. In fact, studies show that genetics only made up ten percent of breast cancer cases. In addition, 75 percent of the cases were found in women with no known risk.

#2 Kendrick cites a study done in Canada that investigated the difference in prognosis in women receiving clinical breast examinations and mammograms to those only receiving the exams.

#3 Kendrick adds that while the study may suggest that mammograms are not necessary, the researchers “were not trying to compare mammography with no screening, but were rather trying to prove the point of the value of competent clinical breast examinations.”

#3-4 Kendrick implies that women are not receiving adequate breast examinations, which are necessary and women and doctors are not emphasizing the importance of these exams. Kendrick asks, “do physicians and nurses feel that the…quickie…exam is sufficient because they know that most of their patients are going to have an annual mammogram anyway?”

#6 Kendrick uses statistics to show the increased amount of false diagnoses and inaccuracy in mammograms. She adds that nearly 40 percent of tumors aren’t spotted in premenopausal women and in those who aren’t 20 percent of tumors still go unnoticed.

#6-7 Kendrick explores the affect of the 40 percent of tumors detected that are false questioning “the increased costs and psychological and physical harm done to a woman…after a false positive mammogram.”

#14-15 Kendrick concludes that mammograms should not be disregarded but simply added too with increased research in other aspects of the disease such as risk factors and the idea that mammograms are not the only tool in preventing mammograms.
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Begley, Sharon. “Detection Dilemma.” Newsweek 04 Feb. 2002. 23 Feb. 2002
<<http://ehostvgw3.epnet.com/ehost.asp?key=204.179.122.129_8000_1984223075&si
te=ehost&return=n&custid=nsdl&profile=web>>

Abstract of Article’s Main Points

Sharon Begley, journalist, examines the effectiveness of mammograms presenting the idea of the possibility that they may not be as effective as once believed. Begley discusses the various meetings the National Cancer Institute (NCI) have had concerning the issue and the debates that have risen over the extreme idea that mammograms are unnecessary. She also adds that while the efficiency of mammograms in younger women has always been debated, sufficient evidence has arisen questioning the effect in mammograms for women over the age of fifty. Begley assures that he NCI is not dismissing mammograms completely, but rather that there is substantial new evidence they only help in one rare type of breast cancer: “goldilocks” tumors; those ones that are growing at the perfect rate, only found in a small amount of cases. Begley closes with the idea that the risk of mammograms causing cancer may be low but this is true: the risk of mammograms providing a false sense of security is high.

Notes

#1 Begley introduces the 1997 meeting of the NCI over the issue of mammograms not being necessary and the controversy that became of it. The NCI received hate mail, angry phone calls, and angry members when some suggested that mammograms prevented no more deaths then those of women who did not have annual ones. However, when the issue was recently brought up again, the scientists all agreed with the previous suggestion.

#1 Begley quotes panel member Dr. Russell Harris of the University of North Carolina--“‘some groups are finally recognizing that mammography is not going to solve the problem of breast cancer.’”—over his thoughts of why many are finally agreeing over the idea that mammograms may not be the answer.

#2 Begley argues that mammograms may help in early detection, but mammograms are difficult to trust in young women because the X-Ray cannot examine through the dense breast tissue of women before menopause.

#3 Begley asserts that the reason for the pro-mammogram results can be explained by and article from the medical journal The Lancet: often women volunteered to partake in a mammogram study, rather than being chosen at random, suggesting that possibly the women were healthier slanting the results.

#4 Begley indicates that the NCI also suggests that mammograms benefit some women, but only those with tumors not growing too fast or too slow. The NCI suggests this is due to the fact that these types of tumors are so slow growing that with or without early detection they could be cured, while younger women often possess rapidly growing tumors that are often detected too late and hard to cure.

#4 Begley indicates that detection by mammograms only assists when tumors are found in tissue in the middle of the breast, which only account for 15 to 20 percent of breast cancer cases.

#5 Begley includes that mammograms do not provide harm in radiation but they do present a major risk—“the false sense of security mammograms provide millions of women every year”.
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Elmore, Joann G., M.D., et al., eds. “Ten-Year Risk of False Positive Screening Mammograms and Clinical Breast
Examinations.” NEJM.org. (16 Apr. 1998). 02 March 2002 <<http://content.nejm.org/cgi/content/full/338/16/1089>>

Abstract of Article’s Main Points

Joann Elmore, M.D. and doctor for the New England Medical Journal, discusses the results found in the study performed examining the risk or false positive results in breast-cancer screening. The test was performed over ten years on women between the ages of 40 and 69 and yielded the result that many women are being diagnosed with breast cancer falsely. The risk increased in women receiving a multiple number of examinations, either mammography or clinical examinations provided by the health care organization. Elmore discusses the definition of false positives used for the tests—a test being indeterminate, holding a suspicion of cancer, or additional work suggested—as being too broad, but sufficient with other definitions and explained a large number of the results from the test. Elmore also suggests that women need to be educated about the possibility of receiving a false positive and the medical world also needs to devise a way to reduce this result.

Notes

#4 Elmore tells that the reason for the test is due to the fact that while many tests suggest women receive mammograms over many decades, a minimal amount of studies have been done to detect the number of false positive results that may be possible

#5 Elmore introduces the statistic that a women who begins annual breast examinations at the age of 40 will have 60 chances for a false positive by the age of 70 after having 30 mammograms and clinical breast examinations

#9 Elmore’s study consisted of 2400 women chosen at random from the HMO Harvard Pilgrim Health Care in New England between that ages of 40 and 69 and were required to have had no previous bouts with breast cancer, a mastectomy, or breast implants before the ten year study was done.

#15 Elmore classified a test as being a false positive if “the results were indeterminate or aroused a suspicion of cancer, or if there was a recommendation for nonroutine follow up.” Elmore argues that the definition is broad, but it is sufficient with the one used in the medical world and other tests.

#24 Elmore records that among the woman tested, 23.8 percent had at least one false positive result and required additional follow up treatment. Also, Elmore launches the result that as the amount of time receiving examinations increased so did the risk of receiving a false positive.

#27 Elmore depicts that the conclusively change of receiving a false positive test after ten mammograms was 49.1 percent and 22.3 percent after ten breast examinations.

#37 Elmore stresses that a false positive test is concluded over a period of twelve months, meaning that if a woman is not diagnosed with breast cancer after twelve months of receiving a positive test it is determined as a false positive.

#42 Elmore claims that this study indicates the need to develop a form of medical science to reduce the number of false positive results “and their associated psychological and economic costs.”

#42 Elmore suggests using on-site radiologists who could gather information immediately after a positive result to keep woman from being required to return for follow up treatment. But, primarily, woman need to be educated about the possibility of a false positive and health care providers need to learn how to handle positive results as soon as they are detected.
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“Thermography – Detecting Breast Cancer Years Earlier.” The Sheppard Foundation (1997). 23 Feb. 2002
<<www.sheppardfoundation.org/sf_earlydetect.html>>

Abstract of Essay’s Main Points

The Sheppard Foundation, a foundation promoting alternative medicine, addresses the downfalls of mammography and an alternative method called thermography, which uses a machine called the Thermal Image Processor (TIP) to detect breast cancer. The TIP works by recording irregular thermal (heat) data in a woman’s breast. The foundation argues that mammography was chosen over thermography because society today shies away from alternative medicine and believes surgery is always the answer and thermography could not pinpoint a location for a surgeon to operate on, while mammography can. The Sheppard Foundation claims that thermography is more effective in detecting breast cancer in premenopausal woman, which mammography may not be as effective in doing. Another false belief that mammograms provide, according to the Sheppard Foundation, is the belief that earlier detection leads to longer life, which is untrue. The Foundation suggests that a mammogram only be used as a last resort after a TPI is performed because there are fewer side effects to a TPI and it detects much earlier then a mammogram.

Notes

#3 The Sheppard Foundation introduces thermography—a type of detection that uses heat to detect cancer or tumors two to three years before any other method could

#3 The Sheppard Foundation argues that a TPI—the form of thermography used for breast cancer—is safer and more effective in detecting breast cancer because it simply uses temperature to detect cancer.

#5 The Sheppard Foundation explains that this is possible because “the heat that is radiated from the surface of a body contains information about its interior structure.”

#7 The Sheppard Foundation hypothesizes that mammography was chosen before thermography because, while both provided the same number of correct diagnosis, mammography used radiation which many doctors believed was the only way to cure cancer and were hesitant to purchase both types of equipment.

#8 The Sheppard Foundation spoke to Philip Hoekstra, Ph. B, “a pioneer in the use of thermography,” and he believes that thermography should be used before mammography and mammograms only used if the woman desires a confirmation.

#9 The Sheppard Foundation claims, according to The Lancet (a British Medical Journal), that of the five percent of mammograms that suggest further testing, 93 percent provided a false positive

#11 The Sheppard Foundation questions whether or not the use of radiation in mammograms promotes breast cancer. The foundation spoke to John W. Gofman, M.D., Ph.D, praised for his studies of the effects of radiation, and he stated: “there is no ‘safe threshold’ for exposure to low-level ionizing radiation.’”

#12 The Sheppard Foundation quotes Dr. Charles B. Simone, a member of the National Cancer Institute, who claims that one of every 10,000 women tested positive for breast cancer inherited the disease as a result of mammography.

#13 The Sheppard Foundation explains the conspiracy that early detection means longer life after talking to Dr. Simone; he asserts that breast cancer is a fifteen year disease and mammograms where able to detect the disease in its 11-12 year, giving the patient about 3-4 more years to live. But with advances in technology, it is detected in its 7 or 8 year and it seems the patient lives longer, but really she does not.

#15 The Sheppard Foundation also indicates that mammograms are cost ineffective because price ranges from $50-$200 and only help about 2-6 of 10,000 women tested between the ages of 50-70 and only 1-2 of 10,000 women in their forties.
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Crewdson, John. “Questions about Cancer Study Fueling Mammography Debate.” Chicago Tribune
27 Jan. 2002, natl. ed: 1, 11.

Abstract of Article’s Main Points

John Crewsdon, Chicago Tribune correspondent, addresses the controversial issue that mammograms are not necessary. The controversy started about a year ago when two Danish scientists criticized mammogram studies and quickly reached the United States. Crewsdon suggests that the issue may not be whether mammograms work, but rather what do we do when they find tiny tumors too small to operate on? Dr. Laszlo Tabar, a Hungarian who is considered the father of mammography, has recently been widely criticized for his studies stating that mammograms will reduce breast cancer deaths, and he has withdrawn his participation and data in a recent study. Crewsdon implies that Tabar may also have realized he may have been wrong. The studies are debated because nowhere has anyone found as high a reduction in deaths as Tabar found. Crewsdon discovered that many scientists believe the money being used for mammogram studies could be better used because no two studies come up with the same results.

Notes

#2 Crewsdon introduces that mammography study began 25 years ago in Sweden when Dr. Laszlo Tabar stunned the medical world, saying “breast cancer deaths could be cut by nearly 40 percent when women received regular mammograms for only six years.” (1).

#6 Crewsdon argues that no one has ever replicated Tabar’s study anywhere but Sweden, which is considered to be the center for the study of mammography, deciding if it’s cost effective and effective in reducing deaths (1).

#7-8 Crewsdon tells that the debate over Tabar’s study began when two Danish researches documented all the falsehoods of it and now countries such as Norway, Denmark, and Switzerland have decided against promoting mammograms nationally (11).

#10 Crewsdon spoke to Donald A. Berry, the head of the M.D. Anderson Cancer Center in Houston who advised all women to decide for themselves if they wanted a mammogram after researching the benefits and risks (11).

#10 Crewsdon also spoke to Berry where he argued; “I certainly would not get mammograms. The benefits, if they exist, are not great enough to give the nod to mammography.” (11).

#11 Crewsdon addresses that many acclaimed medical committees recommend mammograms yearly and that there are numerous forces urging woman to have mammograms (11).

#11 Crewsdon also states that an estimated 33 million American woman will receive a mammogram this year, which costs health-care systems over 3 billion dollars (11).

#12 Crewsdon quotes Harvard professor, Dr. Suzanne Fletcher who has studied breast cancer all her life and she realizes that with this debate on the rise, it is critical we find a cure for breast cancer (11).

#17 Crewsdon suggests that “psuedo” tumors that would have never harmed the patient if undetected being treated with chemotherapy and radiation is one of the biggest risks in having mammograms “because they can not be distinguished from genuine cancer” (11).

#23 Crewsdon introduces four other mammogram studies aside from Tabar’s, and the results proved that none produced results anywhere near Tabar’s extreme results (11).

#33 Crewsdon argues that while that the British national mammography program was expected to cut the breast cancer death toll by 25 percent by 2000, it can only be accounted for a 6 percent decline (11).
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“False Positive Mammograms.” John Hopkins Breast Center (Nov. 2000). 02 Mar. 2002
<<http://www.med.jhu.edu/breastcenter/artemis/200011/feature.html>>

Abstract of Essay’s Main Points

The John Hopkins Breast Center, aimed at eliminating breast cancer while helping those with the disease, addresses the article from the October 18 issue of The Journal of the National Cancer Institute stating that a significant margin of woman undergoing mammograms received a false positive result. The Center discovered seven factors contributing to false positives ranging from genetic history to the ability of the radiologist. However, they stress that this study was not designed to steer women away from mammograms. The Center brings up a study done by Dr. Marcia Burman that found that receiving a false mammogram did not deter women from having annual mammograms, nor did the risk of receiving a false positive. The John Hopkins Center recognizes that the number of false positives and unnecessary follow up treatment needs to be fixed.

Notes

#4 The John Hopkins Breast Center researched a study done by Dr. Cindy Christiansen of Boston University that discovered seven factors impacting the threat of a false positive: it decreases with increasing age; it increases with the number of biopsies performed, with the current or past use of estrogen, with the longer time between mammograms, when a mammogram is not compared to an earlier mammogram; also that it increases or decreases depending on the skill of the radiologist.

#5 The John Hopkins Breast Center acknowledges that of the 93 radiologists used in the study the number of false positives ranged from less than 5 percent in one quarter, while over 10 percent in another.

#6 The John Hopkins Breast Center also acknowledges that the researches stressed that “their findings should not deter women from having mammograms, but rather…educate them about their risk of a false positive result and to reduce their anxiety when a mammogram requires…follow-up testing.”

#9 The John Hopkins Breast Center studied research done by Dr. Marcia Burman of the Veterans Administration Medical Center that found that women who had a false positive result were more likely to return for annual mammograms.

#13 The John Hopkins Breast Center discovered a study done by Dr. Lisa Schwarz, also of the VAMC, that found that for every life saved by mammograms an average of 30-200 false positives occurred.

#15 The John Hopkins Breast Center emphasizes that “breast cancer experts universally agree that the high rate of false positives-and thus the number of unnecessary follow-up procedures such as biopsies and additional mammograms-must be reduced.” However, they also stress that this does not mean women should discontinue annual breast exams.
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Reynolds, Ann. Personal Interview. 12 Mar. 2002.

Abstract of Interview’s Main Points

Ann Reynolds, health teacher at Hononegah High School and also a specialist in alternative medicine, addressed her opinions on the discomfort both physically and emotionally mammograms and their disadvantages cause in women. Reynolds argues that mammograms are only effective through certain densities of tissue, and therefore false positive or negatives do occur, as they do in any test. She stated that she realizes there are testing limitations, but false results still bring about horrible emotional and physical discomforts. Reynolds suggested using ultrasounds to replace mammograms to reduce false results.

Notes

#1 Reynolds opened her opinion with the idea that mammograms affect only women; “they would never do them to men” (Personal Interview).

#2 Reynolds indicates that mammograms are very uncomfortable for women, and also cause humiliation (Personal Interview).

#3 Reynolds suggests using ultrasounds, much like a women who is pregnant, to detect tumors (Personal Interview).

#4 Reynolds asserts that while false positive and negatives are undesirable, they happen in every test because of testing limitations (Personal Interview).

#5 Reynolds argues that when a women receives a false negative, her life could be shattered; “having a false negative could be disastrous, physically, and emotionally” (Personal Interview).

#6 Reynolds believes that false positives and negatives lead to discomfort, pain, as well as humiliation (Personal Interview).

#7 Reynolds also relates a women losing her ovaries “because she doesn’t need them” to men never losing their testicles suggesting why thermography was never considered for women (Personal Interview).
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Rules & Guidelines for Setting Up Research Paper Outlines

1. Outlines should have 1" margins on each page. Double space between each section of the outline.

2. Use 12 pt. font, Times New Roman face. Make certain that the document you hand in is printed on clean, neat, white paper only.

3. Each part of the outline must be completed with full sentences.

4. Sentences must be written in active voice.

5. Introduction should be a one sentence thesis statement which includes a "because" clause. This thesis statement should express the main point you wish to argue followed by the three primary reasons for your opinion.

For example: The United States Congress should not increase the minimum wage because such an increase would (1) slow down the growth of the economy, (2) lead to higher unemployment, and (3) place an undue economic burden on small business owners.

Or: American high schools should adopt some form of block scheduling because these schedules (1) help reduce the number of students who fail, (2) they allow students and teachers more time to complete in-depth learning projects and labs, and (3) they increase the amount of personal attention the teacher can devote to individual students.

6. The first two to three paragraphs of the body must present the opposition's point of view and the reasons for it. These paragraphs, like all other paragraphs in the outline and essay, must use properly documented source references.

7. Topic sentences in the remainder of the body paragraphs should focus on one of the three reasons for the argument offered in the thesis.

For example: The American economy has not been in a recession since the late 1980s; an increase in the minimum wage could increase the possibility of a recession.

Or: Currently, at Hononegah High School, statistics indicate that almost 27 percent of the student body has at least one F on their current record; studies indicate that this percentage will drop dramatically if a school adopts a block schedule which gives studetns more time to complete work in class where the teacher is available to help.

8. The Introduction and Conclusion should not contain source references.

9. The 8-12 paragraphs in the body of the essay must contain at least 2 different source references per paragraph. Do not reference the same source more than twice in any one paragraph. These source references should be integrated into the outline in the sections which are labeled "Supporting Evidence" or "Explanation & Elaboration". The best possible location for source references is the area labled "Supporting Evidence".

10. All source references in the outline must be fully and correctly cited and documented.

11. The first time a source is referenced in the outline, the author's/source's full name and title/credentials must be given. Every subsequent time the same source is mentioned, it is acceptable to give only the author's last name (never use only the first name) or the source's abbreviated name.

12. Outline should contain no more than 3 minor mistakes in typing, grammar, spelling, usage, or mechanics.

13. Outline should not contain a single major error in format, citation, or documentation.

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I. Annual mammograms in women fail to prevent breast cancer single-handedly because they provide a false sense of security for women, hold many limitations, continue to initiate false-positives and negatives, lead to undesirable physical and emotional reactions, have little or no effectiveness in detecting breast cancer in premenopausal women, and contribute to the development of cancer. The most effective way women defeated breast cancer occurs when they integrate mammograms with regular clinical examinations and other methods such as thermography.

II. Many women believe that undergoing a mammogram will lead to no risk of breast cancer since many studies prove to be effective; however, quite the opposite is true because mammograms lead to a false sense of security.

A. Sharon Begley, Newsweek journalist, asserts that the reason for the pro-mammogram results are explained by an article from the medical journal The Lancet: often women volunteered to partake in a mammogram study, rather than being chosen at random, suggesting that possibly the women were healthier, slanting the results.

1. John Crewsdon, Chicago Tribune reporter, introduces that mammography study began 25 years ago in Sweden when Dr. Laszlo Tabar stunned the medical world, saying “breast cancer deaths could be cut by nearly 40 percent when women received regular mammograms for only six years” (1).

2. Crewsdon presents four other mammogram studies aside from Tabar’s, and the results proved that no one produced results anywhere near Tabar’s extreme results (11).

B. The Sheppard Foundation, a foundation promoting alternative medicine, concludes that many women believe that early detection by a mammogram leads to longer life.

1. Dr. Charles B. Simone, a member of the National Cancer Institute asserts that breast cancer is a fifteen year disease and mammograms where able to detect the disease in its 11-12 year, giving the patient about 3-4 more years to live. But with advances in technology, it is detected in its 7 or 8 year and it seems the patient lives longer, but really she does not (ctd. in Sheppard Foundation).

2. Begley also introduces that mammograms introduce a large risk: “the false sense of security mammograms provide millions of women every year”.

3. Joann Elmore, M.D. and doctor for the New England Medical Journal suggests women educate themselves before assuming mammograms are the answer.

4. Barbara Brotman, Chicago Tribune journalist, spoke with Rosita De La Rosa, and avid partaker in mammograms, who said; “ ‘I’ve listened to the [debate over mammograms] with half an ear…’”(section 8: 1).

III. Mammograms have testing limitations and doctors question what to do with some cases.

A. Begley argues that mammograms are difficult to trust in young women because the X-Ray cannot examine through the dense breast tissue of women before menopause.

1. Mammograms benefit some women, but only those with tumors not growing too fast or too slow. The National Cancer Institute suggests this is due to the fact that these types of tumors are so slow growing that with or without early detection they could be cured, while younger women often possess rapidly growing tumors that are often detected too late and hard to cure (Begley).

2. The Southern Medical Association, an organization conceived to advance scientific medicine, also introduced that the risk of a false result increased in younger women.

B. Recently the number of breast cancer cases that were DCIS cancer cases—miniature tumors that usually do not spread to the rest of the body—increased and doctors are not sure how to treat them (Gorman “Rethinking Breast Cancer” 50).

1. Crewsdon suggests that “psuedo” tumors that would have never harmed the patient if undetected being treated with chemotherapy and radiation is one of the biggest risks in having mammograms “because they can not be distinguished from genuine cancer” (11).

2. Dr. Julie Gralow, an oncologist, stressed that “we’ve now got women being diagnosed with tumors…that would have lived long, natural, healthy lives never knowing they had breast cancer” (qtd. in Gorman “Rethinking Breast Cancer” 52).

3. Ann Reynolds, Hononegah High School health teacher, asserts that testing limitations are found in every test.

4. Ideally one day, mammograms will know what to do and how to handle these psuedo tumors.

IV. Mammograms are not able to detect and prevent breast cancer in the large numbers hoped for, which doctors are finally realizing.

A. Mammograms and breast cancer have become much less predictable.

1. Crewsdon argues that while that the British national mammography program was expected to cut the breast cancer death toll by 25 percent by 2000, it can only be accounted for a 6 percent decline (11).

2. Dr. C.F. Kendrick, a freelance writer with a business in DNA, clinical laboratory medicine and epidemiology, uses statistics to discuss the idea that breast cancer is becoming much more common and is not only caused by hereditary factors. In fact, studies show that genetics only made up ten percent of breast cancer cases. In addition, 75 percent of the cases were found in women with no known risk.

B. When the mammogram debate heated up many doctors could not accept the idea that mammograms were unnecessary, but that has since changed.

1. Donald A. Berry, the head of the M.D. Anderson Cancer Center in Houston argued, “I certainly would not get mammograms. The benefits, if they exist, are not great enough to give the nod to mammography.” (qtd. in Crewsdon 11).

2. Begley introduces the 1997 meeting of the NCI over the issue of mammograms not being necessary and the controversy that became of it. The NCI received hate mail, angry phone calls, and angry members when some suggested that mammograms prevented no more deaths then those of women who did not have annual ones. However, when the issue was recently brought up again, the scientists all agreed with the previous suggestion.

3. Begley quotes panel member Dr. Russell Harris of the University of North Carolina--“‘some groups are finally recognizing that mammography is not going to solve the problem of breast cancer.’”—over his thoughts of why many are finally agreeing over the idea that mammograms may not be the answer.

C. “There is no reliable evidence that suggests women who get mammograms live any longer than women who don’t” (Gorman “To Test or Not to Test” 49).

1. When women were tested for breast cancer using thermography, a form of detection using heat instead of radiation but is rarely used today, there was no difference in the number of cases found in using thermography or mammography (Sheppard Foundation).

2. Women who received only mammograms were tested against women who received only breast examinations—there was no difference in the results (Kendrick).

V. Mammograms alone make it difficult to eliminate breast cancer because of the amount of cases missed and risks associated.

A. Even the best of mammograms cannot detect every case of breast cancer, even in women who are postmenopausal.

1. Detection by mammograms only assists when tumors are found in tissue in the middle of the breast, which only account for 15 to 20 percent of breast cancer cases (Begley).

2. Nearly 40 percent of tumors aren’t spotted in premenopausal women and in those who aren’t, 20 percent of tumors still go unnoticed (Kendrick).

3. The Southern Medical Association addresses that mammograms can easily miss a large majority of breast cancer all together.

4. Reynolds argues that when a women receives a false negative, her life could be shattered; “having a false negative could be disastrous, physically, and emotionally”.

B. Mammograms sometimes contribute to cancer because of an increased amount of radiation (Southern Medical Association).

1. Simone claims that one of every 10,000 women tested positive for breast cancer inherited the disease as a result of mammography (ctd. in Sheppard Foundation).

2. The Sheppard Foundation questions whether or not the use of radiation in mammograms promotes breast cancer. The foundation spoke to John W. Gofman, M.D., Ph.D, praised for his studies of the effects of radiation, and he stated: “there is no ‘safe threshold’ for exposure to low-level ionizing radiation.’”

VI. In the course of women receiving mammograms, the chance of receiving a false result, either positive or negative, was extreme.

A. Elmore classified a test as being a false positive if “the results were indeterminate or aroused a suspicion of cancer, or if there was a recommendation for nonroutine follow up.” Elmore argues that the definition is broad, but it is sufficient with the one used in the medical world and other tests.

1. Elmore stresses that a false positive test is concluded over a period of twelve months, meaning that if a woman is not diagnosed with breast cancer after twelve months of receiving a positive test it is determined as a false positive.

2. The John Hopkins Breast Center, aimed at eliminating breast cancer while helping those with the disease, conducted a test using 93 radiologist the number of false positives range from less than 5 percent in one quarter, while over 10 percent in another.

3. Dr. Cindy Christiansen of Boston University discovered seven factors impacting the threat of a false positive: it decreases with increasing age; it increases with the number of biopsies performed, with the current or past use of estrogen, with the longer time between mammograms, when a mammogram is not compared to an earlier mammogram; also that it increases or decreases depending on the skill of the radiologist (ctd. in John Hopkins Breast Center).

B. As women acquire a higher number of mammograms, their chances of receiving a false results exceeds that of a women who does not get annual mammograms by a large margin (Elmore).

1. Elmore introduces the statistic that a women who begins annual breast examinations at the age of 40 will have 60 chances for a false positive by the age of 70 after having 30 mammograms and clinical breast examinations

2. According to The Lancet (a British Medical Journal), that of the five percent of mammograms that suggest further testing, 93 percent provided a false positive (ctd. in Sheppard Foundation).

VII. Many women believe that having one false positive over the course of a lifetime is a small price to pay in order to save a life, but this is true: a false negative or positive destroys a life; the emotions associated are catastrophic.

A. Dr. Marcia Burman of the Veterans Administration Medical Center that found that women who had a false positive result were more likely to return for annual mammograms (ctd. in John Hopkins Breast Center).

1. The John Hopkins Breast Center discovered a study done by Dr. Lisa Schwarz, also of the VAMC, that found that for every life saved by mammograms an average of 30-200 false positives occurred.

2. In a study done by the John Hopkins Breast Center, two-thirds of the women were willing to accept 500 false positive results for every one life saved by mammograms.

B. Kendrick emphasizes that false positives pertain to “increased costs and psychological and physical harm done to a woman…after a false positive mammogram.”

1. Elmore claims that this study indicates the need to develop a form of medical science to reduce the number of false positive results “and their associated psychological and economic costs.”

2. Christine Gorman, Time Magazine journalist, stresses that false results “translate into a lot of anxious women who are called back for another mammogram or advised to undergo either a needle aspiration or a biopsy. These can lead to problems such as scarring, infections and the complications of unnecessary surgery” (“To Test or Not to Test?” 49)

VIII. Mammograms are most effective if used amid regular breast examinations.

A. Kendrick cites a study done in Canada that investigated the difference in prognosis in women receiving clinical breast examinations and mammograms to those only receiving the exams; there was no difference in the women who had the mammograms and those that did not.

1. Kendrick adds that while the study may suggest that mammograms are not necessary, the researchers “were not trying to compare mammography with no screening, but were rather trying to prove the point of the value of competent clinical breast examinations.”

2. Elmore also shows that the chance of receiving a false positive was less in women receiving clinical breast examinations.

B. Doctors also need to increase their concentration and attempt to make adequate readings for women with risks of breast cancer.

1. Kendrick implies that women are not receiving adequate breast examinations, which are necessary and women and doctors are not emphasizing the importance of these exams. Kendrick asks, “do physicians and nurses feel that the…quickie…exam is sufficient because they know that most of their patients are going to have an annual mammogram anyway?”

2. The Southern Medical Association suggests conducting tests twice if they appear positive to reduce risks of false positives.

3. Elmore proposes health care providers need to learn how to handle positive results as soon as they are detected.

IX. Other methods show effectiveness in reducing breast cancer.

A. The Sheppard Foundation introduces thermography—a type of detection that uses heat to detect cancer or tumors two to three years before any other method could.

1. Thermography is safer because it does not use radiation, but heat instead.

2. The Sheppard Foundation explains that this is possible because “the heat that is radiated from the surface of a body contains information about its interior structure.”

3. Reynolds also relates a women losing her ovaries “because she doesn’t need them” to men never losing their testicles suggesting why thermography was never considered for women; society today immediately associates a cure with surgery or removal.

B. Kendrick adds that women need to realize mammograms are not the only tool in detecting breast cancer.

1. Elmore suggests using on-site radiologists who could gather information immediately after a positive result to keep woman from being required to return for follow up treatment.

2. Kendrick concludes that mammograms should not be disregarded but simply added too with increased research in other aspects of the disease.

X. Many women encounter the option undergoing a mammogram, but in most cases mammograms only exacerbate the problem with their increased risks and emotional and physical downfalls. Women need to educate themselves about whether mammography is the right choice for them.
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Guidelines & Policies for Paragraphs and Final Paper

1. 3" top margin on page one

2. Repeat title on page one. Do not use italics, bold, or quotation marks.

3. 1" gap between title and first line of text.

4. 1" side and bottom margins.

5. Do not put a page number on page one.

6. 1" inch margins--top, sides, bottom--on all subsequent pages.

7. All paragraphs should be unified and well-developed.

8. Do not use source references in the introduction or conclusion.

9. Thesis statement must be placed last or second to last in the introductory paragraph. Place thesis statement in bold face type.

10. The first two to three paragraphs of the essay's body must present your opponent's point of view on the given issue. These paragraphs must use source references which are carefully explained and which demonstrate your own full and accurate understanding of the opposing point of view. At no time in these paragraphs are you allowed to denigrate the opposing point of view or engage in any form of ad hominen attach. It is expected that as your essays progresses, you will refute your opponent's arguments in a logical, systematic manner which marshals the best evidence from your research. If you cannot fulfill these requirements, perhaps it is time to reconsider your position and the reasons for it?

11. Each paragraph in the body must contain at least 2 different source references which are fully documented and documented in exactly the same way that you were instructed to do in your notes. Do not reference the same source more than two times in any one paragraph. These source references must be logically related to one another, fully relevant to the focus of the paragraph, and explained in a manner which does not strain or misconstrue the source's idea.

12. All pages after page one must place the author's last name and the page number in the upper right hand corner of the page. Insert page numbers as headers at .5".

13. Language in the paper must at all times remain formal: do not use slang, conversational expressions, contractions, first or second person pronouns. Use distinctive, elevated diction at all times as this will constitue a major area of assessment for your final grade.

14. Sentence structures must be varied in length and structure. Try to use at least one of the specialized sentence structures per paragraph. At all times demonstrate your ability to write concisely, in the active voice, and in a manner which effectively balances loose and periodic constructions. Use the entire range of tools the English language offers for structuring stylish sentences.

15. Include a properly presented works cited page.

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The Effectiveness of Annual Mammograms

A young woman breaths a sigh of relief, she slowly stands, she shakes the doctor’s hand, she slowly leaves the office—but her trustworthy mammogram fails to read a cancerous tumor, and one more woman heads home with breast cancer. Another woman leaves the office in tears after she learns that her mammogram detected a growth that suggests further testing; she lives in anxiety for weeks until her biopsy reveals no sign of cancer. Every year women undergo annual mammograms dutifully without questioning their effectiveness. However, mammograms do not always spot all the breast cancer cases that exist. Mammograms sometimes fail to detect breast cancer, and provide a false sense of security for women as well as initiating false-positives and negatives. Mammograms can lead to undesirable physical and mental conditions, have little or no effectiveness in detecting breast cancer in premenopausal women, and may even contribute to causing cancer because of increased radiation. The most effective way for women to identify and possibly defeat breast cancer is to integrate mammograms with regular clinical examinations and other methods such as thermography.

Many women believe that a negative mammogram translates into a ‘clean bill of health’ since many studies prove them an effective tool in identifying cancer. However, mammograms often provide a false sense of security. Joann Elmore, M.D. and doctor for the New England Medical Journal, suggests the best way to avoid this false sense of security is for women to educate themselves before assuming mammograms will spot breast cancer. The Lancet, a medical journal, explains the phenomenon of pro-mammogram results: often women volunteered to partake in a mammogram study, rather than being chosen at random, suggesting that because they volunteered that may have been healthier, slanting the results (ctd. in Begley). John Crewsdon, Chicago Tribune reporter, writes that the pro-mammogram studies began 25 years ago in Sweden by Dr. Laszlo Tabar who stunned the medical world claiming, “breast cancer deaths could be cut by nearly 40 percent when women received regular mammograms for only six years.” (1). Further tests reviewed by Crewsdon revealed that no other test results were as extreme as Tabar’s (11). The Sheppard Foundation, a foundation promoting alternative medicine, states that while today mammograms are capable of detecting breast cancer earlier than in the past this does not necessarily guarantee a prolonged life for cancer victims. The foundation states that in actuality, a woman diagnosed with cancer does not live longer because she had a mammogram, she is just aware the disease is present earlier than if she had had the mammogram ten years earlier. Studies promoting mammograms do not always include information against mammograms. Specifically they exclude information disproving their effectiveness, disregard testing limitations, or any possibility that mammograms are unnecessary.

An area that calls for further examination is the idea that mammograms, like many medical tests, have limitations and can lead to medical complications. Sharon Begley, Newsweek journalist, argues that mammograms are difficult to trust in young women because X-Rays cannot examine through the dense breast tissue of women before menopause. Begley says that while mammograms benefit some women, they assist only those with tumors not growing too fast or too slow (which are known as ‘goldilocks’ tumors). The National Cancer Institute suggests that some tumors in postmenopausal women are so slow growing that they would never be harmful, while younger women often possess rapidly growing tumors that are detected too late and are hard to cure (Begley). Christine Gorman, Time Magazine journalist, suggests that because mammograms have recently become more sufficient at detecting smaller tumors the number of DCIS cases—miniature tumors that usually stay contained in the breast tissue—has increased and the correct treatment is vague (“Rethinking Breast Cancer” 50). Crewsdon adds that these “psuedo” tumors present risks because they are harmless, are being treated with unnecessary chemotherapy and radiation, and are indistinguishable from genuine breast cancer (11). Dr. Julie Gralow, an oncologist, stressed that “we’ve now got women being diagnosed with tumors…that would have lived long, natural, healthy lives never knowing they had breast cancer” (qtd. in Gorman “Rethinking Breast Cancer” 52). Ann Reynolds, Hononegah High School health teacher, asserts that testing limitations like those in mammograms are found in every medical test. But when a woman’s life is at stake, these limitations are unacceptable.

With research, a primary testing limitation uncovers itself: false-positives; Elmore classifies a test as being false if “the results were indeterminate or aroused a suspicion of cancer, or if there was a recommendation for nonroutine follow up.” The definition continues that a false positive is conclusive over a period of twelve months: if a follow up test cannot diagnose a woman with any form of breast cancer twelve months after the mammogram detected irregular patterns, it is determined to be a false positive (Elmore). Elmore argues that the definition of a false positive seems broad, but it is consistent with the accepted definition in the medical world. Dr. Cindy Christiansen of Boston University discovered the threat of a false positive increased in women when more mammograms were performed, and when the time increased between each mammogram (ctd. in John Hopkins Breast Center). The John Hopkins Breast Center, aimed at eliminating breast cancer while helping those with the disease, conducted a test to determine whether the radiologist impacted the number of false positives. The test used 93 radiologists and the number of false positives ranged from less than 5 percent in one quarter, while over 10 percent in another, slanting results to suggest the skill does affect the result. This should deter women from mammograms because it is
impossible to ask every woman to inspect every radiologist she encounters. Also, because the chance of receiving a false positive increases with the amount of mammograms performed, stopping annual mammograms seems the reasonable solution to avoiding a false positive. According to The Lancet 5 percent of all mammograms performed suggest breast cancer may be present—of the 5 percent, 93 percent were false positives (ctd. in Sheppard Foundation).

Many women believe that having one false positive over the course of a lifetime is a small price to pay in order to save a life; but a false positive destroys a life; the emotions associated are catastrophic. Elmore indicates the need to develop a form of medical science to reduce the number of false positive results, and in turn reduce psychological and economic costs. Dr. C.F. Kendrick, a freelance writer with a business in DNA, clinical laboratory medicine, and epidemiology, emphasizes that false positives create “increased costs and psychological and physical harm” for women. After a false positive, hospitals force women to receive biopsies to test their tissue, and results take weeks to return, increasing a woman’s anxiety level only to discover no cancer existed. Gorman stresses that false results “translate into a lot of anxious women who are called back for another mammogram or advised to undergo either a needle aspiration or a biopsy” (“To Test or Not to Test” 49). Gorman says that these tests lead to disfigurement or infections, and Reynolds indicates the possibility of scarring after unnecessary surgery. False positives are yet another reason for women to avoid uncomfortable, often embarrassing, mammogram tests.

Doctors once believed that with Tabar’s discovery of mammography, breast cancer would soon end; only recently, they have realized that it will not. All the new tests seemed to point to a remarkable end to breast cancer, but their predictions proved false. The British National Mammography program expected to cut breast cancer death tolls by 25 percent by the year 2000, but it only accounts for a 6 percent decline (Crewsdon 11). As doctors become more open minded about the mammography debate, they accept the idea that mammogram effectiveness is less than originally believed. Donald A. Berry, the head of the M.D. Anderson Cancer Center in Houston, Texas, argues, “I certainly would not get mammograms. The benefits, if they exist, are not great enough to give the nod to mammography” (qtd. in Crewsdon 11). Begley summarizes the first meeting the NCI conducted over the mammogram debate in 1997: the board rejected the suggestion that mammograms were ineffective; they received hate mail, angry phone calls, and dealt with angry members after the mere suggestion that the importance of mammograms in eliminating breast cancer has declined. However, when the issue arose again—timidly of course—the vote was unanimous: mammograms were less important than once thought. Other evidence supports the board’s decision as tests offer other methods that help reduce breast cancer. The Sheppard Foundation claims that when thermography (a form of detection using heat instead of radiation but which is rarely used today) was performed on women, there was no difference in the number of cases found when using that test verses mammography. Doctors tested women who received mammograms and breast examinations against women who only undertook breast examination in doctors’ offices—there was again no difference in the results (Kendrick). With other methods proving just as effective, and doctors agreeing over the limited effectiveness, women have ample reason to doubt mammograms.

Mammograms alone make it difficult to eliminate breast cancer because of the amount of cases missed and the risks associated. Detection by mammograms only assists when tumors are found in the middle of the breast, which only account for 15 to 20 percent of breast cancer cases (Begley). At best mammograms do help these 15 to 20 percent, but the other 80 to 85 percent lose any chance of salvation because the location of the tumor is not perfect. Kendrick argues that while many know that tumors are not spotted in premenopausal women as easily as postmenopausal, 20 percent of tumors in postmenopausal women still go unnoticed. Reynolds asserts that when a woman receives a false negative, her life is in jeopardy: “having a false negative could be disastrous, physically and emotionally.” Both Major John L. Reichle, doctor and member of the Southern Medical Association, and the Sheppard Foundation suggest the use of radiation in mammograms may promote breast cancer, explaining the test misses certain cases because it is the very test itself that may be causing cancer, because of the patients increased contact with radiation. The foundation spoke to John W. Gofman, M.D., Ph.D, praised for his studies of the effects of radiation, and he stated: “there is no ‘safe threshold’ for exposure to low-level ionizing radiation.” A test that can devastate lives and possibly contribute to the development of cancer is certainly subject to ridicule.

Mammogram efficiency increases with the use of breast examinations during physicals; and Elmore states breast exams lower the risk of a false positive. Reynolds states that breast examinations are also more comfortable than mammograms. Doctors need to perform the examinations thoroughly, particularly in women with risks of breast cancer, and make accurate diagnoses in these women. Kendrick stresses that because some doctors do not place enough importance on breast examinations, inadequate exams are performed; “…physicians feel that the…quickie…exam is sufficient because they know that most of their patients are going to have an annual mammogram anyway.” Now another problem surfaces; do the nurses and physicians understand the importance of these exams—we assume yes. If they do know, a simple solution presents itself: health care organizations need to ensure that their physicians inform patients about the risks associated with mammograms and alternative tests, such as breast examinations. Elmore also proposes health care providers learn how to handle positive results after detection; this reduces stress on both the doctor and patient. This means providing a woman with the possibilities, such as a false positive or a DCIS case, after any positive test rather than sending an uninformed woman to a radiologist. If the doctor is familiar with the recent studies concerning breast cancer their comfort level rises in these situations. Breast examinations can help in the detection of breast cancer and eliminate mammograms if done properly. However, they are only beneficial when doctors are informed and in turn inform their patients.

Although society becomes narrow-minded when unusual techniques present themselves in the medical field, there are less familiar methods, aside from mammograms, which are effective in reducing breast cancer. One technique mentioned previously is thermography—the tests using heat—presented by the Sheppard Foundation. Because thermography refrains from using radiation it provides a safer test and eliminates the possibility of developing a disease because of radiation. The Sheppard Foundation explains that thermography works because “the heat that is radiated from the surface of a body contains information about its interior structure” like a tumor or mysterious growth. Thermography detects breast cancer before mammograms and shows efficiency in diagnosing breast cancer in premenopausal women; however, it cannot specify the area to operate within the breast tissue. Reynolds agrees that though mammography and thermography were introduced simultaneously, society associates a cure with surgery or removal, which thermography does not promote. For many women who are skeptical about trying an unknown product, Kendrick suggests that women not disregard mammograms, but simply open their minds to other possibilities. Trying thermography may be unconventional, but it also may save an unknowing woman’s life.

Often society shies away from change; when a coach presents a new game plan, players revert to old ways and positions; when a doctor informs a patient of a new product, the patient asks for a refill of his old medicine; when a new job opportunity is available, people are often hesitant to accept if relocating is required. But when studies prove a conservative method dangerous and worthless, a radical change is necessary. Mammograms possess flaws and women have the ability to avoid them by opening their minds to different methods. Influenced by others, it becomes difficult for women to accept diverse ways to save their lives. Many women encounter the option of undergoing a mammogram, but in most cases mammograms only exacerbate the problem with their increased risks and emotional and physical downfalls.

Works Cited

Crewdson, John. “Questions about Cancer Study Fueling Mammography Debate.” Chicago Tribune
27 Jan. 2002, natl. ed: 1, 11.

“False Positive Mammograms.” John Hopkins Breast Center (Nov. 2000). 02 Mar. 2002
<<http://www.med.jhu.edu/breastcenter/artemis/200011/feature.html>>

Kendrick, Dr. C.F. “The Latest Controversy on Mammograms.” www.mlis.org. 23 Feb. 2002
<<http://www.mlis.org/pages541662.htm>>

Reynolds, Ann. Personal Interview. 12 Mar. 2002.

“Thermography – Detecting Breast Cancer Years Earlier.” The Sheppard Foundation (1997). 23 Feb. 2002
<<www.sheppardfoundation.org/sf_earlydetect.html>>

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