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Decision-Making Model Argues Whether Mammography Is Needed

By MedImaging International staff writers
Posted on 24 Oct 2012

How frequently should breast screening occur, and when it should begin are the topics of a new decision-making model strategy. More...

The current guidelines recommended yearly screening after a woman reached 40 years of age. However, because of the risk of false-positive results, needless biopsies, extra financial costs, and the psychologic anguish caused over treatment, the answer now is “it depends.”

Dr. Oguzhan Alagoz, from the University of Wisconsin-Madison (WI, USA), created a decision-making model that to provide a more definitive answer. According to Dr. Alagoz, he can personalize breast-screening decisions to fit a woman’s calculated risk of invasive breast cancer--instead of just focusing on her age.

The model was described in the September/October 2012 issue of the journal Operations Research issue. The decision-making model not only has the patient’s genetics, age, and other personal risk factors, but also detailed on her screening history. Dr. Alagoz said, “We illustrate how this extra piece of information might change which decision is optimal and help doctors make better screening decisions. Unlike other cancers such as colorectal, none of the existing breast cancer population-based guidelines currently consider this.”

Governments and societies are unable to agree on when women should start breast screening. Some, such as the American Cancer Society, still adhere to 40 years as the best time to start, whereas the US Preventive Services Task Force changed it to 50 years in 2011. It added that individual physicians and patients should decide on whether to start earlier.

Up until several years ago, routine mammography scanning was thought to reduce US breast cancer rates by at least 20%-30%. However, several studies have found this is not accurate. A large Swedish study demonstrated that breast screening has limited or no impact on breast cancer mortality among females aged 40 to 69 years. Their study was published July 17, 2011, in the Journal of the National Cancer Institute. However, another study, performed by researchers from the department of public health at the Erasmus MC (Rotterdam, The Netherlands), and published in Cancer Epidemiology, Biomarkers & Prevention, discovered that screening mammograms brought breast cancer mortally rates down by 49%.

For breast screening to be effective and beneficial for society and individual patients, its benefits need to be maximized, while at the same time minimizing its potential harms, which include over- or underscreening. Dr. Alagoz’s decision-making model depends on sequential decision-making techniques, which account for decisions that are taken several times and have a cascading effect, such as an abnormal screening findings that persuades a patient to go for another screening six months later, or a set of risk factors that prompt her to begin screening earlier and more frequently.

The model focuses on each patient’s individual cancer risk, which is calculated from a range of factors, including her family history, lifestyle, as well as previous screening history. The woman’s risk of cancer--and risk of “transition” to new states, such as biopsy and treatment--would go down if all her mammograms came back negative. This would mean that in some cases, clinicians might not recommend breast cancer screening for an individual patient for several years.

By tailoring screening needs to the individual patient, according to Dr. Alagoz, his model will increase the quality of life and number of years a woman enjoys, while bringing down the total number of mammograms a population as a whole receives, compared to standard population based screening recommendations. Dr. Alagoz said, “Our model might help reduce the number of unnecessary mammograms, which account for approximately USD 100 million in overspending per year in the United States.”

Personalizing breast screening recommendations will save many high-risk lives and reduce unnecessary biopsies, unnecessary radiation exposure, overtreatments, stress, and expenses for low risk women. Dr. Alagoz added that his model can create “a single easy statistic to describe multiple risk factors, a point that might ease communication among the radiologist, patient and referring physician, and perhaps even facilitate shared decision-making in a more partnership-oriented patient-clinician relationship.”

What are the ups and downs of breast screening? Most women noticeably overestimate their risk of dying from breast cancer, they also overestimate the advantages of screening mammography on reducing that risk. Some specialists noted that if women completely understood how small, but statistically significant, the impact of mammography screening are on overall cancer mortality rates, most of them would refuse them, according to Dr. Alagoz. No one seems to agree on what are the contribution of mammography to the general health and population lifespan. For women with benign lesions, mammography can cause emotional anguish and financial costs.

The majority of patients accept the false-positive risk in breast screening; in fact, most say it is not very stressful. Although many patients find the recall extremely frightening, they are relieved when told it was a false-positive (this occurs in about 90% of cases).

Routine breast screening’s major effect is to significantly increase early breast cancer detection rates, particularly for noninvasive ductal carcinoma in situ, which is sometimes called pre-breast cancer. This type of cancer very rarely ever develops into a lump. Mammography scans can detect such breast tumors very early on; however, most of them never become life threatening. This leads to the case that mammography on a large scale should not profess to save lives, but do cause unnecessary surgery, worry, and financial costs for patients.

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University of Wisconsin-Madison
Erasmus MC

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55 (45.061111450195): 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 (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=294743061 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (484.94338989258): 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=294743061 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (!!!!! 1661.0622406006): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

59 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

60 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

61 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

62 (169.99244689941): 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 (785.82763671875): SELECT fid FROM jos_deeppockets WHERE id=294743061 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743061 AND published='1' LIMIT 1

64 (83.92333984375): 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 (75.101852416992): select jos_twitters.link from jos_twitters where cat=10

66 (48.87580871582): select jos_facebook.link from jos_facebook where cat=10

67 (45.061111450195): select jos_google_plus.link from jos_google_plus where cat=10

68 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

69 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE id=294743061 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743061 AND published='1' LIMIT 1

70 (43.869018554688): 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 (544.07119750977): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743061 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (422.00088500977): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743061 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (68.902969360352): 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 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.001205444336): 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 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (98.943710327148): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743061 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (50.067901611328): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743061 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (47.922134399414): 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 (84.877014160156): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (118.01719665527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

106 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

107 (84.877014160156): 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=294743061 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (79.154968261719): 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=294743061 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (122.7855682373): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

110 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

111 (71.048736572266): 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=294743061 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (730.99136352539): 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=294743061 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (612.02049255371): 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 (432.96813964844): 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 (167.1314239502): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

116 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

117 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

118 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

119 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

120 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

121 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

122 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

123 (361.91940307617): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 20585.775375366): 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 (639.91546630859): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743061 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743061 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (!!!!! 7701.1585235596): ( 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 (82.015991210938): ( 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 (51.021575927734): 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 (34.093856811523): 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 (124.93133544922): 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 (59.127807617188): 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 (314.95094299316): 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 (38.14697265625): 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 (39.100646972656): 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 (28.848648071289): 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 (615.83518981934): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (477.79083251953): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=211

139 (47.922134399414): SELECT name FROM jos_deeppockets WHERE id=211

140 (774.14512634277): 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 (801.08642578125): 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 (126.12342834473): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

143 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

144 (!!!!! 10760.78414917): TRUNCATE TABLE jos_trademed_module

145 (215.05355834961): 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=294743061 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (77.009201049805): 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=294743061 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (625.1335144043): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

150 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

151 (!!!!! 1446.9623565674): 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 (92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

153 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

154 (41.007995605469): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743061 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743061 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (44.107437133789): 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 (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)

157 (40.054321289062): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (172.13821411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

159 (75.817108154297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743061 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743061 AND published='1' LIMIT 1

160 (55.074691772461): select jos_twitters.link from jos_twitters where cat=10

161 (35.04753112793): select jos_facebook.link from jos_facebook where cat=10

162 (40.054321289062): select jos_google_plus.link from jos_google_plus where cat=10

163 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

164 (426.05400085449): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

165 (!!!!! 1303.9112091064): insert into jos_banners_delta values (14615,'2025-08-19 15:49:47','216.73.216.0','view'),(14202,'2025-08-19 15:49:47','216.73.216.0','view'),(14203,'2025-08-19 15:49:47','216.73.216.0','view')

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