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AAPM 2025 - 67th Annual Meeting & Exhibition of the American Association of Physicists in Medicine

MRI Use May Clarify Trend in Increased Mastectomies

By MedImaging staff writers
Posted on 09 Jun 2008

Image: Colored magnetic resonance imaging (MRI) scan of breast cancer (Photo courtesy of the National Cancer Institute).

The number of women undergoing mastectomy for early-stage breast cancer has increased in the last three years at a specific health institution in the United States. This increase follows a steady decline during the prior seven years.

Researchers reported the reasons for this increase are unclear. However, they have determined that women at the Mayo Clinic (Rochester, MN, USA) who underwent diagnostic magnetic resonance imaging (MRI) before surgery to treat early-stage breast cancer had a higher rate of mastectomy, compared to women who did not have an MRI.

"We found that if a woman undergoes an MRI before surgery, she is about 10-15% more likely to have a mastectomy, compared to women who did not undergo MRI,” said the study's lead author, Rajini Katipamula, M.D., a senior clinical fellow in hematology/oncology at the Mayo Clinic.

Results were presented May 31, 2008, at the 44th annual meeting of the American Society of Clinical Oncology (ASCO), held in Alexandria, VA, USA, and were highlighted in an ASCO press conference. The study's senior author, Matthew Goetz, M.D., assistant professor of oncology at the Mayo Clinic, participated in that press conference.

Mayo researchers evaluated mastectomy trends by year and by use of preoperative breast MRI among 5,414 women who had surgery for early-stage breast cancer at Mayo Clinic between 1997 and 2006. They found that the mastectomy rate declined from 44% in 1997 to 30% in 2003, but then had risen to 43% in 2006. During this time, the percentage of women who had breast MRI more than doubled, from 11% in 2003 to 23% in 2006. The mastectomy rate was significantly higher in women who had a presurgical MRI (52%) compared to women who did not have the test and chose breast removal (41%).

"Our study is the largest to examine the association between MRI and mastectomy rates at a single institution and may reflect national trends,” stated Dr. Goetz who went on to report that MRI, which easily detects both cancerous and noncancerous breast lesions, may prompt a woman or her physician to choose total breast removal instead of lumpectomy, even though both procedures have long been established to offer the same survival benefit.

"What we don't know from this study is whether the higher rate of mastectomy observed in our patients undergoing MRI is related to the detection of additional disease, or whether the uncertainty raised by MRI leads to greater anxiety for the patient and physician, thus leading patients and physicians to choose mastectomy over lumpectomy,” said Dr. Goetz.

"Although MRI was associated with a higher mastectomy rate, we cannot assume it is a cause-and-effect relationship,” remarked co-author Amy Degnim, M.D., a breast surgeon at Mayo Clinic, and an assistant professor of surgery. "More investigation at an individual level is needed to understand better how MRI may impact personal choices for breast cancer surgery.”

According to Dr. Goetz, while MRI was associated with an increased mastectomy rate, the mastectomy rates also increased in women who did not undergo MRI, suggesting other factors are playing an important role in the decision-making process of patients and physicians.

"In the past 10 years, we have observed numerous changes in the preoperative management of patients with breast cancer,” stated Dr. Goetz. "In addition to new imaging modalities such as MRI, more women are familiar with the role of genetics as a risk factor for breast cancer, and some of our patients are undergoing testing. Additionally, there has been improved access to better breast reconstruction methods.”

Lumpectomy plus radiation therapy (known as breast-conserving therapy [BCT]) has been the standard of care for most women with early-stage disease since 1990. That year, the U.S. National Institutes of Health (Bethesda, MD, USA) issued a report stating that BCT was as effective as mastectomy for overall survival for most women with stage I or stage II breast cancer. Shortly thereafter, mastectomy rates began to decline. But the data from Mayo Clinic suggest that this trend may be in reversal.

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56 (576.01928710938): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=285030000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

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58 (!!!!! 5651.9508361816): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

59 (!!!!! 3770.112991333): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

60 (!!!!! 1193.0465698242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

61 (!!!!! 20220.994949341): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (708.10317993164): SELECT fid FROM jos_deeppockets WHERE id=285030000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=285030000 AND published='1' LIMIT 1

63 (840.90232849121): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (!!!!! 4332.0655822754): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 3359.0793609619): select jos_facebook.link from jos_facebook where cat=10

66 (94.890594482422): select jos_google_plus.link from jos_google_plus where cat=10

67 (46.014785766602): select jos_linkedin.link from jos_linkedin where cat=10

68 (319.9577331543): SELECT fid FROM jos_deeppockets WHERE id=285030000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=285030000 AND published='1' LIMIT 1

69 (179.05235290527): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (!!!!! 1429.0809631348): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=285030000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (483.03604125977): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=285030000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (70.095062255859): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (!!!!! 1361.8469238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (112.05673217773): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=285030000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (!!!!! 3458.9767456055): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=285030000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (58.889389038086): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 9196.9966888428): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 3895.0443267822): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (586.03286743164): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (58.174133300781): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (705.00373840332): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 1479.8641204834): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

105 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

106 (!!!!! 3878.8318634033): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=285030000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (802.04010009766): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=285030000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 7213.1156921387): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

109 (!!!!! 7911.9205474854): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

110 (!!!!! 7833.9576721191): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=285030000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 7967.9489135742): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=285030000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 4456.9969177246): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (!!!!! 8841.9914245605): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (!!!!! 2242.8035736084): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

115 (!!!!! 7972.0020294189): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

116 (!!!!! 7661.1042022705): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

117 (!!!!! 7967.9489135742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

118 (!!!!! 3698.1105804443): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

119 (!!!!! 1528.0246734619): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

120 (710.96420288086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

121 (243.9022064209): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

122 (452.99530029297): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 78877.925872803): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (442.0280456543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=285030000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=285030000 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 46042.203903198): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 22614.002227783): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (634.90867614746): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (355.00526428223): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (952.00538635254): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (272.03559875488): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (646.11434936523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (197.8874206543): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (733.1371307373): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (45.061111450195): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (!!!!! 2892.9710388184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 9840.0115966797): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 5622.1485137939): SELECT name FROM jos_deeppockets WHERE id=212

138 (!!!!! 3540.9927368164): SELECT name FROM jos_deeppockets WHERE id=212

139 (!!!!! 5181.0741424561): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (!!!!! 2029.1805267334): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (!!!!! 4029.0355682373): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

142 (342.13066101074): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

143 (!!!!! 16777.992248535): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 6989.9559020996): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=285030000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 5885.8394622803): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=285030000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 3545.0458526611): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (339.98489379883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (844.95544433594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

149 (473.0224609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

150 (!!!!! 2905.1303863525): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (!!!!! 2091.8846130371): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

152 (468.96934509277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

153 (!!!!! 1729.0115356445): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=285030000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=285030000 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (378.13186645508): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (!!!!! 3924.8466491699): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (!!!!! 7802.0095825195): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 4699.9454498291): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

158 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=285030000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=285030000 AND published='1' LIMIT 1

159 (892.16232299805): select jos_twitters.link from jos_twitters where cat=10

160 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

161 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

162 (283.95652770996): select jos_linkedin.link from jos_linkedin where cat=10

163 (!!!!! 1384.973526001): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1498.2223510742): insert into jos_banners_delta values (14615,'2025-06-30 17:35:10','216.73.216.249','view'),(14202,'2025-06-30 17:35:10','216.73.216.249','view'),(14203,'2025-06-30 17:35:10','216.73.216.249','view')

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