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Future Breast Cancer Screening Will Need Personalized Approach

By MedImaging International staff writers
Posted on 15 Apr 2013

Researchers are forecasting that new breast cancer screening developments will need a customized approach because mammography is not a “one strategy fits all” technology.

The review was published in the April 4, 2013, issue of the American Journal of Medicine. “Although mammography remains the gold standard for breast cancer screening, there is increasing awareness that there are subpopulations of women for whom mammography is limited because of its reduced sensitivity based on an individual’s breast density and other factors,” said study lead author Jennifer S. Drukteinis, MD, assistant member in Moffitt Cancer Center’s (Tampa, FL, USA) department of diagnostic imaging.

The investigators cited a controversial dispute on mammography-screening issues: In 2009, the US Preventive Services Task Force, a panel of healthcare specialists who reviewed published research and made healthcare policy recommendations, issued guidelines that women should get mammograms every two years starting at age 50. They advised against screening before 50. Their recommendation created great debate, even outrage, because of a well-established convention recommending screening beginning at 40, and for those with a first-degree relative with breast cancer, screening should begin 10 years before that relative’s age at diagnosis.

“At present, the task force is the only group or consensus panel in the United States recommending breast cancer screenings to begin at age 50,” said study coauthor Blaise P. Mooney, MD, an assistant member in Moffitt’s department of diagnostic imaging. “There is, however, clear evidence that mammography detects early breast cancers in this population. Data suggest that large-scale screening reduces mortality.”

As effective as mammography has been, the authors consider it an imperfect screening tool. The sensitivity of mammography is highly variable, the authors point out. The effectiveness for women with fatty breast tissue is as high as 98% while the effectiveness for women with dense breasts can be as low as 36%. Women who undergo a yearly mammogram may still present with tumors identified only on physical examination, according to the investigators. Moreover, some studies suggest that radiation exposure may contribute to an increase in breast cancer incidence in high-risk populations.

More effective breast cancer screening requires increased sensitivity and specificity while curbing costs and radiation doses, the authors recommended. They also suggested that optimal patient care would require a new screening model with patient-specific strategies customized to risk based on family history, age, genetic profiles, and breast density. “The sensitivity of mammography is inversely proportional to breast density,” explained Dr. Mooney. “Owing to decreased sensitivity in women with dense breast tissue, but with attention to radiation concerns and a high rate of false positives, breast imagers are adapting with new technologies.”

According to the authors, those new technologies include low-dose mammography, contrast-enhanced mammography (assesses blood flow in the breast), automated whole breast ultrasound, molecular imaging, magnetic resonance imaging (MRI), and tomosynthesis, i.e., multiple mammographic slices through the breast, similar to a computed tomography (CT) scan.

“Decreases in mortality have not been proved with any of these emerging technologies,” Dr. Drukteinis said. “Once more, it is unlikely that any of these new technologies will replace mammography. The role of these new technologies is primarily as an adjunct to screening mammography and can be used in a combination tailored to the individual’s risk factors and breast density, with the goal of maximizing sensitivity and specificity. Given the heterogeneity of the human population, a perfect imaging technology for breast cancer screening will likely never be found. In fact, because of this heterogeneity, the very concept of one strategy fits all may be outmoded.”

The investigators concurred that new technologies will be increasingly personalized, incorporating patient specific and age-dependent factors of cancer risk “with selective application of specific screening technologies best suited to the woman’s age, risk, and breast density.”

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65 (47.922134399414): select jos_facebook.link from jos_facebook where cat=10

66 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

67 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

68 (46.968460083008): SELECT fid FROM jos_deeppockets WHERE id=294745645 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294745645 AND published='1' LIMIT 1

69 (41.961669921875): 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 (362.87307739258): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745645 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (349.99847412109): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745645 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (64.849853515625): 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 (61.988830566406): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (48.160552978516): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745645 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745645 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (35.04753112793): 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 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (89.883804321289): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (91.075897216797): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

105 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

106 (57.93571472168): 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=294745645 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.968460083008): 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=294745645 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

109 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

110 (50.067901611328): 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=294745645 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (562.90626525879): 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=294745645 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (597.00012207031): 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 (483.98971557617): 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 (111.81831359863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

115 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

116 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

117 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

118 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

119 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

120 (383.13865661621): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 24901.151657104): 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

122 (118.97087097168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

123 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

124 (443.93539428711): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745645 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745645 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 601362.94364929): ( 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 (120.87821960449): ( 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 (61.03515625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (73.909759521484): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (42.915344238281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (41.007995605469): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (715.01731872559): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (562.90626525879): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (345.94535827637): SELECT name FROM jos_deeppockets WHERE id=211

136 (46.014785766602): SELECT name FROM jos_deeppockets WHERE id=211

137 (643.01490783691): 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

138 (577.92663574219): 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

139 (104.90417480469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

140 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

141 (!!!!! 11600.971221924): TRUNCATE TABLE jos_trademed_module

142 (160.93254089355): 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=294745645 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (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_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=294745645 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (715.97099304199): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

147 (110.86463928223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

148 (!!!!! 1525.87890625): 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

149 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

150 (69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

151 (54.836273193359): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294745645 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294745645 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (46.968460083008): 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)

153 (64.13459777832): 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)

154 (54.836273193359): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (86.069107055664): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

156 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294745645 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294745645 AND published='1' LIMIT 1

157 (56.028366088867): select jos_twitters.link from jos_twitters where cat=10

158 (45.061111450195): select jos_facebook.link from jos_facebook where cat=10

159 (43.153762817383): select jos_google_plus.link from jos_google_plus where cat=10

160 (41.961669921875): select jos_linkedin.link from jos_linkedin where cat=10

161 (380.03921508789): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1600.0270843506): insert into jos_banners_delta values (14615,'2025-06-20 06:02:37','216.73.216.120','view'),(14202,'2025-06-20 06:02:37','216.73.216.120','view'),(14203,'2025-06-20 06:02:37','216.73.216.120','view')

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