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Widespread Use of Mammograms Leads to Detection of Lower Risk Breast Tumors

By MedImaging International staff writers
Posted on 30 Jan 2012

As a woman ages, her risks of being diagnosed with a lower-risk breast tumor increase, according to new research, which revealed that for women over 50, a significant number of tumors detected by mammograms have good prognoses.

The study provides the first molecular evidence of an increase in low- or ultra-low-risk cancers in the tumors when detected by screening mammography. More...

Moreover, it provides a foundation for incorporating molecular profiling at the time of diagnosis to help avoid overtreatment.
In their research, the scientists from the University of California, San Francisco (UCSF; USA), working in collaboration with colleagues at the Netherlands Cancer Institute, analyzed the biology of tumors detected more than 20 years ago--before the advent of routine mammography--alongside tumors detected five years ago, after widespread screening for breast cancer was implemented. They found that mammography appears to reveal slow- to moderate-growth tumors in the population today.

The article was published December 2011 in the journal Breast Cancer Research and Treatment. “A significant number of screen-detected tumors are very low risk,” said lead author Laura Esserman, MD, MBA, director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center. “It shows that we have an opportunity to improve care by using molecular predictors to recognize who has these ultra-low-risk or idle tumors, and safely minimize treatment. This information should also help inform radiologists and surgeons about how aggressive we should be in recommending biopsy for low-risk abnormalities seen on mammograms. If most of the cancer we find is low risk, then we may very well be able to test a less aggressive approach for the very low-suspicion findings on mammograms that turn out to be benign. Simple follow up may be the better approach.”

Breast cancer rates have been on a steady rise over the past 20 years, especially among women over 50. The increase has been attributed in large degree to the widespread use of mammogram screening, in addition to changes in population risk factors such as earlier menstruation, later pregnancies, higher alcohol consumption, and until recently, the use of hormone replacement therapy. This rate upsurge has occurred in many countries that have instituted population-based screening, but whether it reflects an actual increase in low-risk tumors or the detection of harmless tumors--or both--has been unclear, according to the investigators.

Early detection can make a significant difference in outcomes for some cancers. However, the authors noted, vital questions remain about the role of mammography in the increased detection of low-risk tumors. If much of the rate increase is caused by tumors with little potential for malignancy, and if those cancers can be reliably identified, they wrote, “then patients and providers could make informed decisions to avoid treatment that may do more harm than good.”

The researchers utilized MammaPrint, a US Food and Drug Administration (FDA)-approved diagnostic test used by physicians to assess the risk that a tumor in the breast will metastasize elsewhere. Clarifying the importance of “bench to bedside” healthcare in which basic laboratory research leads to practical clinical use, MammaPrint was developed by Laura J. van 't Veer, PhD, the senior author of the study and leader of the breast oncology program at UCSF’s cancer center. The technology is marketed by Agendia (Irvine, CA, USA).

In their study, the researchers focused on three basic questions: Has there been a swing toward the detection of molecularly “good prognosis” tumors? Moreover, is there an increase in the detection of ultra-low-risk tumors, which have an excellent prognosis without treatment, and are these tumors more common in women who have cancers detected by mammogram screening?

The scientists analyzed the molecular signature of node-negative tumors from 866 patients in Europe. Approximately half of the patients were diagnosed between 1980 and 1991, before breast cancer screening was routine. The other half of the patients had tumors diagnosed between 2004 and 2006, when mammograms were routine for 80% of the target population. The percentage of poor prognosis tumors varies significantly by age, the investigators discovered, with the probability of having a good prognosis growing higher as a woman ages.

The researchers also established that for women under 40, who are not routinely screened, the prospect of good or poor prognosis did not differ between the time period before widespread screening and the present time with routine screening. Typically, young women are much more likely to have poor prognosis tumors than older women do. However, for tumors in patients 49 to 60, when comparing the two time periods, there was a substantial increase in good prognosis tumors for those diagnosed more recently.

“The bottom line is that screen detection should be taken into account when patient treatment is planned,” Dr. van 't Veer said. “We can use this information to guide treatment recommendations and as the basis for the development of clinical trials that test the safety of less aggressive treatments for patients with the lowest risk tumors.”

The study “provides information that will allow us to improve screening,” the authors concluded. “Not only can this help us to guide the use of risk stratifying tools to avoid overtreatment, but it should also enable us to reset thresholds for biopsy for very low-risk mammographic lesions.”

The scientists are currently working to confirm the results of two studies, including a European clinical trial for about 2,500 women diagnosed with early stage breast cancer. Moreover, the Athena Breast Health Network, a collaboration among the five University of California medical campuses through which some 150,000 women in California will be screened for breast cancer and monitored for decades, “will give us the opportunity to evaluate California UC patients,'” said Dr. van 't Veer.

Related Links:
University of California, San Francisco
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55 (61.03515625): SELECT a.* FROM jos_components AS a WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' ) AND a.option = 'com_syndicate'

56 (97.036361694336): 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=294739072 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (560.04524230957): 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=294739072 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1765.0127410889): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

59 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

60 (160.93254089355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

61 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

62 (133.03756713867): 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

63 (822.78251647949): SELECT fid FROM jos_deeppockets WHERE id=294739072 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739072 AND published='1' LIMIT 1

64 (68.902969360352): 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`

65 (78.916549682617): select jos_twitters.link from jos_twitters where cat=10

66 (47.922134399414): select jos_facebook.link from jos_facebook where cat=10

67 (43.153762817383): select jos_google_plus.link from jos_google_plus where cat=10

68 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

69 (60.796737670898): SELECT fid FROM jos_deeppockets WHERE id=294739072 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739072 AND published='1' LIMIT 1

70 (60.081481933594): 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`

71 (567.91305541992): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739072 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (360.96572875977): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739072 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (49.114227294922): 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`

74 (57.93571472168): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (44.822692871094): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739072 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (29.802322387695): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739072 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (32.901763916016): 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`

91 (83.92333984375): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (94.890594482422): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

106 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

107 (61.988830566406): 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=294739072 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (66.041946411133): 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=294739072 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (99.18212890625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

110 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

111 (53.167343139648): 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=294739072 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (751.97219848633): 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=294739072 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (694.03648376465): 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 (638.00811767578): 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

115 (269.88983154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

116 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

117 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

118 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

119 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

120 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

121 (81.777572631836): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

122 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

123 (411.9873046875): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 21810.054779053): 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

125 (628.94821166992): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739072 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739072 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 8741.1403656006): ( 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 (121.11663818359): ( 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

128 (53.167343139648): 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 (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

130 (80.108642578125): 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 (44.822692871094): 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

132 (380.9928894043): 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 (139.95170593262): 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

134 (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

135 (29.802322387695): 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

136 (638.96179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (484.94338989258): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (51.975250244141): SELECT name FROM jos_deeppockets WHERE id=211

139 (61.988830566406): SELECT name FROM jos_deeppockets WHERE id=211

140 (754.11796569824): 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 (620.12672424316): 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

142 (112.05673217773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

143 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

144 (!!!!! 11289.834976196): TRUNCATE TABLE jos_trademed_module

145 (141.85905456543): 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=294739072 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (97.990036010742): 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=294739072 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (838.04130554199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (69.141387939453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (138.0443572998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

150 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

151 (!!!!! 1717.8058624268): 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

152 (115.15617370605): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

153 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

154 (43.153762817383): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739072 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739072 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (33.855438232422): 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 (34.093856811523): 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)

157 (48.160552978516): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (225.06713867188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

159 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739072 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739072 AND published='1' LIMIT 1

160 (75.817108154297): select jos_twitters.link from jos_twitters where cat=10

161 (51.975250244141): select jos_facebook.link from jos_facebook where cat=10

162 (46.968460083008): select jos_google_plus.link from jos_google_plus where cat=10

163 (49.829483032227): select jos_linkedin.link from jos_linkedin where cat=10

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