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Revised Mammography Guidelines Result in Under Diagnosis

By MedImaging International staff writers
Posted on 20 Dec 2012

The impact of revised US guidelines for screening mammography has resulted in evidence that the new recommendations may lead to missed tumors and a decline in screening, according to two recent studies.

The studies’ findings were presented at the annual meeting of the Radiological Society of North America (RSNA), held in November 2012 in Chicago (IL, USA). More...

Routine screening mammography has typically been recommended by both the US Preventive Services Task Force (USPSTF; Rockville, MD, USA) and the American Cancer Society (Atlanta, GA, USA) for all women over the age of 40. In 2009, the USPSTF issued divisive new guidelines recommending routine screening with mammography every two years for women 50 to 74 years old. In the studies being presented at RSNA 2012, researchers analyzed the impact of the new guidelines on women between the ages of 40 and 49 and the US Medicare population.

“Recommendations on screening mammography are extremely important public policy and we wanted to contribute to that dialogue,” said Elizabeth Arleo, MD, assistant professor of radiology at New York-Presbyterian Hospital -Weill Cornell Medical College (New York, NY, USA; ). “We get questions all day long from patients and referring physicians on the appropriateness of screening mammography. The inconsistent information is very confusing for everyone.”

For her study, Dr. Arleo and a team of researchers analyzed data on screening mammography at New York-Presbyterian Hospital-Weill Cornell Medical College between 2007 and 2010. Over the four years, 43,351 screening exams were performed, which led to the detection of 205 breast cancers. “Nearly 20% of cancers detected with screening mammography were found among women in their 40s, Dr. Arleo said. “It seems unacceptable to potentially miss nearly 20% of the breast cancers we are identifying. This, in our view, would represent a substantial degree of under-diagnosis.”

Of the women screened in the study, 14,528, or 33.5%, were between the ages of 40 and 49. Of the 205 breast cancers detected, 39 (19%) were found in the 40-49 age group. Of those cancers, more than 50% (21 of 39) were invasive. Only three of the women between the ages of 40 and 49 diagnosed with cancer had a first-degree relative with premenopausal cancer. “Our data favor the American Cancer Society recommendations of annual mammograms starting at age 40,” Dr. Arleo said.

In the second study, another group of researchers analyzed data from The Medicare Part B Physician/Supplier Procedure Summary Master Files for 2005-2010. They calculated the following annual utilization rates for screening mammography per 1,000 female Medicare beneficiaries: 2005, 311.6; 2006, 312.4; 2007, 316.2; 2008, 320.1; 2009, 322.9; and 2010, 309.1.

The compound annual growth rate (CAGR) from 2005 to 2009 for screening mammography utilization was 0.9%, compared to a 4.3% falloff in the utilization rate from 2009 to 2010. “There was considerable controversy over the task force guidelines, but it was unclear how much they would influence women’s choices about screening,” said David C. Levin, MD, professor and chairman emeritus of the department of radiology at Thomas Jefferson University Hospital (Philadelphia, PA, USA). “We’re not able to tell from the data whether this significant drop in utilization was a result of women deciding to wait another year to have their mammogram, or women over the age of 74 not having the exam. But, clearly, the new USPSTF guidelines have had an effect.”

Dr. Levin reported that the decline in the utilization rate of mammography is especially concerning, given that the 2009 rate of 322.9 per 1,000 women was not exceptionally high. “We’ll never see 1,000 out of 1,000 women getting a screening mammogram, but you’d like to see that number closer to 1,000, and certainly higher than 322,” he said. “We need to continue to follow these numbers and to watch the breast cancer mortality statistics.”

Related Links:
US Preventive Services Task Force
American Cancer Society

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58 (710.01052856445): 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=294743910 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 1467.9431915283): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

60 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

61 (179.05235290527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

62 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

63 (144.95849609375): 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

64 (698.08959960938): SELECT fid FROM jos_deeppockets WHERE id=294743910 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743910 AND published='1' LIMIT 1

65 (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`

66 (89.168548583984): select jos_twitters.link from jos_twitters where cat=10

67 (49.114227294922): select jos_facebook.link from jos_facebook where cat=10

68 (48.87580871582): select jos_google_plus.link from jos_google_plus where cat=10

69 (46.968460083008): select jos_linkedin.link from jos_linkedin where cat=10

70 (79.870223999023): SELECT fid FROM jos_deeppockets WHERE id=294743910 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294743910 AND published='1' LIMIT 1

71 (62.942504882812): 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`

72 (553.84635925293): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743910 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (398.15902709961): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743910 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (61.03515625): 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`

75 (92.029571533203): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (90.837478637695): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743910 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (53.882598876953): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743910 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (53.882598876953): 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`

92 (95.129013061523): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (51.021575927734): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (122.0703125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

107 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

108 (108.95729064941): 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=294743910 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (90.122222900391): 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=294743910 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (137.0906829834): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

111 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

112 (87.02278137207): 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=294743910 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (872.85041809082): 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=294743910 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (690.93704223633): 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 (537.15705871582): 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

116 (200.03318786621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

117 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

118 (85.830688476562): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

119 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

120 (70.810317993164): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

121 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

122 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

123 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

124 (352.85949707031): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 24340.867996216): 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

126 (595.0927734375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743910 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743910 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 8894.9203491211): ( 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 (82.969665527344): ( 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

129 (39.815902709961): 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 (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

131 (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

132 (42.200088500977): 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

133 (419.13986206055): 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 (51.975250244141): 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

135 (47.922134399414): 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 (41.007995605469): 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

137 (634.90867614746): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (463.00888061523): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (48.160552978516): SELECT name FROM jos_deeppockets WHERE id=211

140 (30.994415283203): SELECT name FROM jos_deeppockets WHERE id=211

141 (580.0724029541): 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 (588.89389038086): 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

143 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

144 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

145 (!!!!! 10488.986968994): TRUNCATE TABLE jos_trademed_module

146 (200.98686218262): 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=294743910 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (78.916549682617): 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=294743910 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (674.96299743652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

151 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

152 (!!!!! 1626.9683837891): 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

153 (111.10305786133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

154 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

155 (49.829483032227): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294743910 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294743910 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (91.075897216797): 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 (45.061111450195): 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)

158 (58.889389038086): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

160 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294743910 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294743910 AND published='1' LIMIT 1

161 (41.961669921875): select jos_twitters.link from jos_twitters where cat=10

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

163 (32.186508178711): select jos_google_plus.link from jos_google_plus where cat=10

164 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

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