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Breast Screening for Women over 70 Does Not Result in Sharp Drop in Advanced Disease

By MedImaging International staff writers
Posted on 22 Sep 2014

Breast screening for women over age 70 does not prompt a sharp fall in advanced disease. Instead, it may just lead to overdiagnosis and overtreatment, suggests new findings by Dutch researchers.

The researchers led by a team based at Leiden University Medical Center (The Netherlands) are presenting their data at the Preventing Overdiagnosis Conference, held September 15–17, 2014, in Oxford (UK), where experts worldwide will discuss how to handle the threat to health and the waste of money caused by unnecessary care. The conference is hosted by the Center for Evidence-Based Medicine at the University of Oxford (UK) in partnership with the British Medical Journal (BMJ) "Too Much Medicine campaign."

The upper age limit for the national breast cancer screening program was extended to women aged 69 to 75 in 1998 in the Netherlands, and national guidelines now recommend screening women up to the age of 75. This is in spite of no strong evidence showing that screening much older women is effective, according to the researchers, due to the scarcity of this age group in any of the clinical trials on which the policy is founded. However, breast cancer is the most common cancer and biggest cause of death from cancer in women worldwide. Furthermore, as populations age, the percentage of older women who are diagnosed with the disease is set to increase in the developed world.

The researchers therefore set out to find whether the national breast screening program in the Netherlands has made a significant impact in the numbers of late stage cancers among 70–75 year old—a hallmark of success. They monitored all new cases of invasive and non-invasive (in situ) breast cancer, diagnosed in this age group from 1995 up to 2011, using data from the Netherlands Cancer Registry. They separated cases into the period before (1995-7), after (2003-11), and in-between (1998-2002) the introduction of the national screening program, which came to almost 25,500 in all. Furthermore, they included 13,000 women aged 76–80, to take account of any changes in breast cancer incidence among older women ineligible for national screening.

Data analysis showed that new cases of early stage breast cancer among 70–75 year olds rose sharply after national screening was introduced, from 248.7 to 362.9 per 100,000 women. However, while there was a substantial decrease in the numbers of new cases of advanced breast cancer, the absolute decrease was small; dropping from 58.6 before, to 51.8 instances per 100,000 women after, the national screening program was introduced.

Among 76–80 year olds, new cases of early stage disease fell slightly, but the numbers of new cases of advance breast cancer did not change. The researchers calculated, based on the figures, that for every advanced stage cancer detected by screening among 70–75 year olds, around 20 “extra” and therefore “overdiagnosed” early stage tumors are identified, which the researchers described as a “considerable proportion.”

Overdiagnosis and overtreatment are important, the researchers emphasized, because they can undermine quality of life, and because older individuals are more susceptible to the side effects of breast cancer treatment. Moreover, they come with a potentially huge cost in return for little obvious health benefit, the investigators pointed out. “Instead of using mass screening, the decision to participate in the screening program should be personalized, based on remaining life expectancy, breast cancer risk, functional status and patients’ preferences,” the authors concluded.

The study’s findings were published September 16, 2014, in the British Medical Journal (BMJ).

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62 (368.83354187012): 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 (!!!!! 2956.8672180176): SELECT fid FROM jos_deeppockets WHERE id=294754696 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754696 AND published='1' LIMIT 1

64 (317.09671020508): 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 (!!!!! 1281.9766998291): select jos_twitters.link from jos_twitters where cat=10

66 (182.8670501709): select jos_facebook.link from jos_facebook where cat=10

67 (51.021575927734): select jos_google_plus.link from jos_google_plus where cat=10

68 (34.093856811523): select jos_linkedin.link from jos_linkedin where cat=10

69 (269.88983154297): SELECT fid FROM jos_deeppockets WHERE id=294754696 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294754696 AND published='1' LIMIT 1

70 (!!!!! 1347.0649719238): 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 (756.97898864746): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754696 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (314.95094299316): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754696 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (308.99047851562): 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 (!!!!! 1142.9786682129): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (264.16778564453): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (264.88304138184): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (51.975250244141): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (!!!!! 2785.9210968018): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (68.902969360352): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (224.11346435547): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (271.08192443848): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (207.90100097656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (171.89979553223): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (!!!!! 2630.9490203857): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754696 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (37.908554077148): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754696 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (188.11225891113): 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 (!!!!! 4004.0016174316): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (68.187713623047): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (489.95018005371): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (62.227249145508): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (153.0647277832): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (180.95970153809): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (607.96737670898): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (84.161758422852): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (!!!!! 3654.0031433105): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (96.08268737793): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (324.01084899902): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (124.93133544922): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (!!!!! 1139.8792266846): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

106 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

107 (147.10426330566): 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=294754696 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (837.08763122559): 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=294754696 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (!!!!! 1290.7981872559): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

110 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

111 (!!!!! 1272.9167938232): 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=294754696 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (534.0576171875): 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=294754696 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (!!!!! 1302.0038604736): 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 (729.08401489258): 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 (602.00691223145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

116 (205.99365234375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

117 (520.94459533691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

118 (319.9577331543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

119 (866.88995361328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

120 (160.93254089355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

121 (!!!!! 3876.9245147705): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

122 (399.82795715332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

123 (771.04568481445): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

124 (!!!!! 46828.985214233): 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 (823.974609375): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754696 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754696 AND type='deeppockets_item' AND published='1' LIMIT 1

126 (47.922134399414): ( 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 (36.001205444336): ( 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 (169.03877258301): 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 (437.97492980957): 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 (347.13745117188): 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 (46.968460083008): 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 (32.901763916016): 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 (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 (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

136 (!!!!! 1024.9614715576): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 1260.0421905518): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (639.91546630859): SELECT name FROM jos_deeppockets WHERE id=211

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

140 (984.19189453125): 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 (!!!!! 1579.9999237061): 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 (!!!!! 1271.0094451904): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

143 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

144 (!!!!! 18046.855926514): TRUNCATE TABLE jos_trademed_module

145 (!!!!! 6747.9610443115): 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=294754696 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (!!!!! 8396.1486816406): 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=294754696 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (!!!!! 1518.0110931396): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (394.82116699219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

150 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

151 (!!!!! 2475.0232696533): 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 (!!!!! 1915.9317016602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

153 (214.0998840332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

154 (!!!!! 1993.8945770264): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294754696 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294754696 AND type='deeppockets_item' AND published='1' LIMIT 1

155 (!!!!! 3344.0589904785): 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 (494.00329589844): 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 (169.99244689941): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

158 (860.21423339844): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

159 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294754696 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294754696 AND published='1' LIMIT 1

160 (524.04403686523): select jos_twitters.link from jos_twitters where cat=10

161 (393.86749267578): select jos_facebook.link from jos_facebook where cat=10

162 (36.954879760742): select jos_google_plus.link from jos_google_plus where cat=10

163 (189.06593322754): select jos_linkedin.link from jos_linkedin where cat=10

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