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For Young Women Undergoing MRI Mammography Is of No Added Value

By MedImaging International staff writers
Posted on 29 Mar 2010

According to a recent prospective multicenter cohort study, a revision of current recommendations for breast cancer screening is advisable at least for young women carrying an increased risk of breast cancer. The results of the EVA trial confirm that magnetic resonance imaging (MRI) is substantially more accurate for early diagnosis of breast cancer than digital mammography or breast ultrasound: MRI is three times more sensitive for breast cancer than digital mammography.

For the EVA (Evista Alendronate Comparison) trial, nearly 700 women were enrolled. The goal of the trial was to refine existing guidelines for surveillance of women at high and moderately increased risk of breast cancer. Findings suggest that in these women, MRI is essential for early diagnosis and that a mammogram or an ultrasound examination does not increase the "cancer yield” compared to what is achieved by MRI alone. The researchers concluded that an annual MRI is not only necessary, but also sufficient for screening young women at elevated risk of breast cancer. In women undergoing screening MRI, mammograms will have no benefit and they should be discontinued. Moreover, MRI screening is important not only for women at high risk, but also for those at moderately increased risk.

Between 2002 and 2007, the EVA trial recruited 687 women who carried a moderately increased risk of breast cancer (lifetime risk of 20% and over). Women underwent 1679 screening rounds consisting of annual MRI, annual digital mammography, and half-annual screening ultrasound examinations. During this period, 27 women received a new diagnosis of invasive cancer or ductal carcinoma in situ (DCIS).

Of all imaging methods under investigation (digital mammography, ultrasound, and MRI), MRI offered by far the highest sensitivity: MRI identified 93% of breast cancers. Thirty-seven percent of cancers were detected by ultrasound. The lowest sensitivity was achieved by digital mammography, which identified only one-third of breast cancers (33%). These results confirm once more that MRI is essential for surveillance not only of women at high risk, but also for women at moderately increased risk of breast cancer. Moreover, the results contradict current guidelines according to which mammography is considered indispensable for breast cancer screening.

One aim of the EVA trial was to question this concept and to ask whether it is still appropriate to require that MRI should only be used in addition to mammography. The results, according to the researchers, speak for themselves: If an MRI is available, then the added value of mammography is literally negligible. The investigators concluded that MRI is necessary as well as sufficient for screening young women at elevated risk of breast cancer. Since mammography appears to be unnecessary in women undergoing MRI, its use is no longer justifiable, and current guidelines should be revised to reflect this.

Current guidelines for women at high familial risk of breast cancer recommend a yearly MRI scan (with or without ultrasound) and annual MRI scan starting at age 25-30. "These guidelines were set up based on little or no scientific evidence, and mainly reflect expert opinion,” summarized Prof. Christiane Kuhl, a radiologist at the University of Bonn (Germany) and lead investigator of the EVA trial. "In the light of the results of the EVA trial, such recommendations should be revisited.”

This seems even more important because digital mammography uses X-rays (ionizing radiation) to detect breast cancer. "The radiation dose associated with regular mammographic screening is clearly acceptable and safe,” underscored Dr. Kuhl. "However, regular mammographic screening usually starts at age 40-50.” The situation is different if systematic annual mammographic screening is started at age 25-30. "Not only because these women will undergo more mammograms and therefore will experience a cumulative lifetime radiation dose that will be substantially higher, but also because the breast tissue of young women is more vulnerable to the mutagenic effects of radiation.”

This appears to be particularly true for BRCA mutation carriers. "Accordingly, we impose more radiation on less radiation-tolerant breast tissue for a very limited, if any, diagnostic benefit,” noted Dr. Kuhl. Therefore, he advocates a revision of existing guidelines: "It is no longer justifiable to insist on annual mammographic screening women in their thirties if they have access to screening MRI.”

In the past, MRI was used strictly in addition to mammography only. The allegedly high rate of false-positive diagnoses and the allegedly insufficient sensitivity for DCIS were the main reason to discourage its use as a stand-alone method for breast cancer screening. "In this multicenter trial, with basic quality assurance implemented not only for mammography, but also for MRI, we were able to prove that false-positive diagnoses are avoidable if MRI studies are interpreted with adequate radiologist expertise.”

In the EVA cohort, the positive predictive value achieved with MRI was already even higher than that of mammography or breast ultrasound. "Moreover, we found that MRI offered the highest sensitivity especially for DCIS,” added Dr. Kuhl. "It is simply wrong to state that we need a mammogram to detect intraductal cancer.”

The study's findings were published in the February 22, 2010, issue of the Journal of Clinical Oncology.

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57 (!!!!! 1749.0386962891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

58 (283.95652770996): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

59 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

60 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

61 (115.87142944336): 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 (886.91711425781): SELECT fid FROM jos_deeppockets WHERE id=294728703 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728703 AND published='1' LIMIT 1

63 (46.014785766602): 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=211 ORDER BY `ordering`

64 (385.04600524902): select jos_twitters.link from jos_twitters where cat=10

65 (72.002410888672): select jos_facebook.link from jos_facebook where cat=10

66 (43.869018554688): select jos_google_plus.link from jos_google_plus where cat=10

67 (34.809112548828): select jos_linkedin.link from jos_linkedin where cat=10

68 (211.00044250488): SELECT fid FROM jos_deeppockets WHERE id=294728703 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728703 AND published='1' LIMIT 1

69 (122.7855682373): 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=211 ORDER BY `ordering`

70 (899.07646179199): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728703 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (382.1849822998): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728703 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (40.054321289062): 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 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (88.930130004883): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728703 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (34.093856811523): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728703 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (42.200088500977): 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 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

105 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

106 (51.021575927734): 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=294728703 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.014785766602): 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=294728703 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

109 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

110 (54.121017456055): 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=294728703 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (648.97537231445): 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=294728703 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (518.0835723877): 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 (355.95893859863): 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 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

115 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

116 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

117 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

118 (70.095062255859): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

119 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

120 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

121 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

122 (268.93615722656): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 20428.895950317): 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 (473.97613525391): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728703 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728703 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7966.0415649414): ( 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 (77.009201049805): ( 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 (56.982040405273): 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 (30.994415283203): 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 (34.809112548828): 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 (29.087066650391): 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 (373.12507629395): 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 (77.009201049805): 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 (35.04753112793): 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 (29.087066650391): 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 (473.0224609375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (337.12387084961): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=211

138 (30.040740966797): SELECT name FROM jos_deeppockets WHERE id=211

139 (643.96858215332): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (499.01008605957): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

142 (43.153762817383): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

143 (!!!!! 9871.0060119629): TRUNCATE TABLE jos_trademed_module

144 (135.18333435059): 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=294728703 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (84.161758422852): 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=294728703 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (787.97340393066): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

149 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

150 (!!!!! 1275.0625610352): 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 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

152 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

153 (64.849853515625): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728703 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728703 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (46.014785766602): 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=211 or channel_id is null)

155 (41.961669921875): 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=211 or channel_id is null)

156 (57.93571472168): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (227.92816162109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

158 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728703 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728703 AND published='1' LIMIT 1

159 (66.041946411133): select jos_twitters.link from jos_twitters where cat=10

160 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

161 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

163 (308.99047851562): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1003.9806365967): insert into jos_banners_delta values (14615,'2025-06-28 12:04:36','216.73.216.249','view'),(14202,'2025-06-28 12:04:36','216.73.216.249','view'),(14203,'2025-06-28 12:04:36','216.73.216.249','view')

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