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Mammography Screening Reveals Limited Effect on Breast Cancer Mortality in Swedish Study

By MedImaging International staff writers
Posted on 01 Aug 2012

Breast cancer-mortality statistics in Sweden are consistent with studies that have reported that screening has limited or no impact on breast cancer mortality among women aged 40-69, according to new data.

The study’s findings were published July 17, 2012, in the Journal of the National Cancer Institute. Since 1974, Swedish women aged 40-69 have increasingly been offered mammography screening, with nationwide coverage peaking in 1997. The investigators’ goal was to figure out if mortality trends would be reflected accordingly.

In order to determine this, Philippe Autier, MD, of the International Prevention Research Institute (iPRI; Nimes, France), and colleagues, looked at data from the Swedish Board of Health and Welfare from 1960-2009 to analyze trends in breast cancer mortality in women aged 40 and older by the county in which they lived. The researchers compared actual mortality trends with the theoretic outcomes using models in which screening would result in mortality reductions of 10%, 20%, and 30%.

The researchers expected that screening would be associated with a gradual reduction in mortality, especially because Swedish mammography trials and observational studies have suggested that mammography leads to a reduction in breast cancer mortality. In this researcher, however, they discovered that breast cancer mortality rates in Swedish women started to decrease in 1972, before the initiation of mammography, and have continued to drop at a rate similar to that in the prescreening period. “It seems paradoxical that the downward trends in breast cancer mortality in Sweden have evolved practically as if screening had never existed,” they stated in their study “Swedish breast cancer mortality statistics are consistent with studies that show limited or no impact of screening on mortality from breast cancer.”

The researchers noted specific limitations of their study--specifically, that it was observational, so unable to take into account the potential impact of other breast cancer risk factors such as obesity, which may have masked the effect of screening on mortality. They also reported that population mobility may have biased the findings.

The conclusion by Dr. Autier and colleagues that the 37% decline in breast cancer mortality in Sweden was not tied to breast cancer screening seems therefore hard to defend and partially unsupported by data (two groups of Swedish Counties do show a mortality decrease that, according to the stated criteria, could be tied to screening). They also feel, “it is time to move beyond an apparently never-ending debate on at what extent screening for breast cancer in itself conducted in the seventies through the nineties of the last century has reduced mortality for breast cancer, as if it was isolated from the rest of healthcare [...].The presence of an organized screening program may have promoted the provision of more effective care by monitoring the treatment quality of screen-detected cancers and by favoring the creation of multidisciplinary units of breast cancer specialists.”

In an accompanying editorial, Michael W. Vannier, MD, from the department of radiology at the University of Chicago Medical Center (IL, USA), noted that it is hard to see mortality decrease as a screening benefit because outliers such as the natural history of the disease, along with the frequency of screening as well as the duration of follow up may misrepresent the time patterns in the mortality reductions. “We know that isolating screening as an evaluable entity using death records fails to reveal major benefits,” he wrote, adding that even if screening were 100% effective, the number of deaths may remain unchanged. However, he feels that without a better option, mammography screening will continue to be utilized. “As our tools improve, we can begin to fully realize the promise of breast cancer screening to arrest this dread disease at its earliest stage with the least morbidity and cost.”

Related Links:
International Prevention Research Institute

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62 (719.07043457031): SELECT fid FROM jos_deeppockets WHERE id=294741908 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294741908 AND published='1' LIMIT 1

63 (80.108642578125): 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 (85.115432739258): select jos_twitters.link from jos_twitters where cat=10

65 (47.206878662109): select jos_facebook.link from jos_facebook where cat=10

66 (37.908554077148): select jos_google_plus.link from jos_google_plus where cat=10

67 (41.961669921875): select jos_linkedin.link from jos_linkedin where cat=10

68 (45.061111450195): SELECT fid FROM jos_deeppockets WHERE id=294741908 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294741908 AND published='1' LIMIT 1

69 (36.001205444336): 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 (377.89344787598): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (284.19494628906): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (56.982040405273): 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 (60.796737670898): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (45.061111450195): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (31.948089599609): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (34.809112548828): 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 (313.99726867676): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (56.028366088867): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (113.01040649414): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (87.976455688477): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (86.069107055664): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (70.095062255859): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (167.1314239502): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

105 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

106 (145.19691467285): 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=294741908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (72.002410888672): 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=294741908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (136.8522644043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

109 (132.08389282227): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

110 (72.956085205078): 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=294741908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (750.06484985352): 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=294741908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (988.96026611328): 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 (!!!!! 2227.0679473877): 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 (159.97886657715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

115 (108.00361633301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

116 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

117 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

118 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

119 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

120 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

121 (44.107437133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

122 (419.13986206055): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 56514.024734497): 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 (687.83760070801): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741908 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741908 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 23944.139480591): ( 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 (89.168548583984): ( 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 (76.055526733398): 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 (68.902969360352): 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 (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

131 (444.88906860352): 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 (50.067901611328): 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 (92.983245849609): 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 (43.869018554688): 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 (627.99453735352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (388.86070251465): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (51.975250244141): SELECT name FROM jos_deeppockets WHERE id=211

138 (38.14697265625): SELECT name FROM jos_deeppockets WHERE id=211

139 (853.06167602539): 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 (734.09080505371): 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 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

142 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

143 (!!!!! 19874.095916748): TRUNCATE TABLE jos_trademed_module

144 (368.11828613281): 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=294741908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 6959.9151611328): 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=294741908 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (548.12431335449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (535.96496582031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (532.86552429199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

149 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

150 (!!!!! 2163.1717681885): 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 (523.09036254883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

152 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

153 (76.055526733398): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294741908 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294741908 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (51.021575927734): 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 (41.007995605469): 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 (182.8670501709): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 4703.0448913574): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

158 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294741908 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294741908 AND published='1' LIMIT 1

159 (!!!!! 3296.1368560791): select jos_twitters.link from jos_twitters where cat=10

160 (164.98565673828): select jos_facebook.link from jos_facebook where cat=10

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

162 (41.007995605469): select jos_linkedin.link from jos_linkedin where cat=10

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