Archive for the ‘mammography’ Category

Breast Cancer – to Screen Or Not To Screen

February 15, 2014

When the medical world agreed that mammography and breast self exams were a good thing, the whole discussion turned upside down with a recent publication in the British Medical Journal, that suggest that mammography is no longer necessary. This article will discuss that report and provide advice for women so that they may make the best decision regarding their screening for breast cancer.

What is mammography?
A mammogram is an x-ray picture of the breast. It can be used to check for breast cancer in women who have no signs or symptoms of the disease. It can also be used if you have a lump or other sign of breast cancer.

In the past screening mammography is the type of mammogram that checks a woman when she has no symptoms. It was thought that screening mammography would reduce the number of deaths from breast cancer among women ages 40 to 70. But it can also have drawbacks. Mammograms can sometimes find something that looks abnormal but isn’t cancer. This leads to further testing and can cause a woman significant anxiety. Sometimes mammograms can miss cancer when it is there. It also exposes the woman to radiation. The National Cancer Institute recommends that women age 40 or older have screening mammograms every 1 to 2 years.

How is a mammogram performed?
In a screening mammogram, each breast is X-rayed in two different positions: from top to bottom and from side to side. When a mammogram image is viewed, breast tissue appears white and opaque and fatty tissue appears darker and translucent.

How does it differ from breast self-examination?
A breast self exam is a check-up a woman does at home to look for changes or problems in the breast tissue. Many women feel that doing this is important to their health.
However, experts do not agree about the benefits of breast self exams in finding breast cancer or saving lives. Most organizations and doctors believe that breast self-exams have little value, based on findings from several large studies. However, this is far better than no examination or no mammography at all.

Talk to your health care provider about whether breast self exams are right for you.
The best time to do a self-breast exam is about 3 – 5 days after your period starts. Your breasts are not as tender or lumpy at this time in your monthly cycle.

If you have gone through menopause, do your exam on the same day every month.

What did the recent report say about mammography?
One of the largest and most meticulous studies of mammography ever done, involving 90,000 Canadian women age 40-59 and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age.

It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation.

The study, published in February 2014 in The British Medical Journal, is one of the few rigorous evaluations of mammograms conducted in the modern era of more effective breast cancer treatments. It randomly assigned half of the women to have regular mammograms and breast exams by trained nurses or to have breast exams alone.

The death rate from breast cancer was the same in both groups, but 1 in 424 women who had mammograms received unnecessary cancer treatment, including surgery, chemotherapy and radiation.

The findings of this study will not lead to any immediate change in guidelines for mammography, and many experts will dispute the idea that mammograms are on balance useless, or even harmful.

So what is a woman to do?
The American Cancer Society recommends yearly screening mammograms starting at age 40. However, the U.S. Preventive Services Task Force (USPSTF) does not recommend screening for women in their 40s. For women between the ages of 50 and 74, USPSTF experts say women should have mammograms every two years and do not recommend screening at all after age 74. The American Cancer Society and the American College of Obstetricians and Gynecologists suggest that woman consider screening mammograms beginning at age 40.

It is noted that women whose tumors are discovered through mammography are smaller and present at earlier stages and are more likely to undergo breast conservation therapy, i.e., lumpectomy and women who have their cancer identified through breast self examinations tend to have more advanced cancer and have mastectomies or the entire breast removed.

When you need a mammogram is a personal decision between you and your doctor. If you’re over 40, talk to you doctor about when you should begin mammogram screening.
Bottom Line: Breast cancer remains the most common cancer in women and early detection is important for improving outcomes and saving breast tissue, i.e., having a lumpectomy instead of a mastectomy. I encourage each woman to have a discussion with their doctor about when to begin screening for breast cancer and whether or not to screen with mammography.

Breast Cancer Screening- Does Screen Save Lives?

December 1, 2013

In 2013 there will be nearly 250,000 new cases of breast cancer and 40,000 deaths from breast cancer. Now there is a move to decrease screening for this most common cancer in women. This blog will discuss the guidelines from the Task Force on Preventive Healthcare.

Summary of the task force guidelines. Women 50-69 years of age should have mammograms every 2-3 years instead of every year. Women under 50 should not have mammograms. Clinical examinations by a doctor and breast self-exams have no benefit. Routine screening with MRI scans is not recommended.

These guidelines do not apply to women at high risk. These are women with a family history of breast cancer. Also includes women who test positive for the BRCA gene 1 or 2.

Self-examination has been the suggestion for women for decades. Experts say it is not a good idea.

Screening for women is not the lifesaver it was once thought to be. The task force looked at 2100 women between 40 and 59 years of age would have to be screened every 2-3 years for an eleven year period to prevent one breast cancer death. This suggests a very small benefit over a very large number of screenings. The task force even pointed out that screenings more do more harm than good. Nearly 700 of the 2100 women would have had a false mammogram requiring further imaging. 75 of these 700 women would have a biopsy just to confirm that they do not have breast cancer and at least 10 women would have part or all of their breast removed. This does not include all the anxiety that surrounds a positive mammogram and the waiting and discomfort associated with the biopsy.

What’s my advice? Certainly if a woman is in the high-risk group, mammography and screening is imperative. Women should have a discussion with their doctor and make an informed decision and weight the risks vs. the benefits of screening. This is not a doctor only decision it is a doctor-patient decision. Patients who become informed and have a discussion with their doctor will be the ones that make the best decision. Finally, I am not agreement with the recommendation on the breast self-exam. I still believe this a low cost valuable test that can detect small lesion in the breast before they become clinically relevant.

My next blog will discuss the guidelines on prostate cancer screening.

Medical Testing At Age 50-This Is Test You Can’t Afford to Fail

January 20, 2013

Most men and women do not need the services of the medical profession between the time they leave their pediatricians around age 18-20 until age 50. The exception is women who see their obstetrician for perinatal care and deliverying their children. Around age 50 you should start making regular visists to your doctor. This article will discuss the routine tests that you should consider when you reach middle age.

When you go for your annual physical, make sure your doctor performs or recommends these simple tests that may save your health — and your life — later. (Note that your doctor may recommend additional tests based on your personal health profile.)

Thyroid hormone test. Your thyroid, that innocuous looking gland in your neck, is the body’s powerhouse, producing hormones needed for metabolism. Aging (and an erratic immune system) can wreak havoc causing a variety of problems, especially in women. That’s why women should get a thyroid test at age 50 and then every 5 years.
The rectal exam. Dread it; hate it; joke with your friends about it: Just make sure you get one — every year. Along with other tests your doctor may recommend, it may give clues to treatable problems in your colon (think colon cancer) or prostate for men. Screening colonoscopy is recommended for everyone at 50 years old.
Stepping on the scales. This is the age when most people start gaining weight. Watch this weight gain carefully, and fight back with healthier eating and exercise. Being overweight puts you at high risk for developing a number of diseases — and studies show that weight loss can improve your odds.
Blood pressure. Untreated high blood pressure is an equal opportunity killer: It kills your heart, your brain, your eyes, and your kidneys. Don’t let hypertension sneak up on you. Get the test. It’s simple; it’s cheap; and it’s quick.
Cholesterol profile. Do you have high cholesterol? Find out — at least once every 5 years (more if you’re at risk for a heart attack). Controlling your cholesterol can add years to your life.
Blood sugar. Untreated diabetes can destroy your health, causing heart disease, kidney failure, and blindness. Don’t let it. Get a fasting blood sugar test at least once every 3 years and take control of diabetes early.
For women only: Pelvic exam and Pap smear. You may think you have suffered enough — at least 20 years of pelvic exams and Paps! But you still need these — especially if you’re sexually active. Ten minutes of mild discomfort once every 1 to 3 years pays big dividends in protecting you from cancer and sexually transmitted diseases.
For women only: Breast exam and mammogram. At this age, don’t ever let a year go by without getting a mammogram and having your doctor examine your breasts for any changes. Early detection of breast cancer can save your breast and your life.
Looking for moles: Love your skin. Check your skin monthly for any unusual spots or moles. Be sure to ask your doctor to check your skin once a year, as well.
Protecting your eyes. Vision-robbing diseases become more common as you age. Be sure to get your eyes examined regularly — every 2 years until age 60 and then yearly after that. Go more often if you have vision problems or risk factors for eye problems.
Checking your immunizations. People over age 50 should get a flu shot every year. And don’t forget, even healthy people need a tetanus booster shot every 10 years, and one of those should contain the pertussis vaccine for whooping cough. Be sure to ask your doctor to update any immunizations that you might need. Consider Hepatitis A and B vaccines if you haven’t already had them.

Use your birthday as a gentle reminder to schedule a visit to your dentist, and call your doctor to see if there are important tests you should take. By investing an hour or two now, you may be able to add years to your life.

Bottom Line: When you go for your annual physical, make sure your doctor performs or recommends these simple tests that may save your health — and your life — later. Remember of you don’t take time for your health, you won’t have time to enjoy life in your senior years.

For more information on women’s health, I suggest my new book, What’s Going On Down There-Everything You Need To KnowAbout Your Pelvic Health. the book is available from Amazon.com

New book on women's health

New book on women’s health

To Screen Or Not Screen-That’s the Question, What’s the Answer?

October 20, 2011

Annual cancer tests are becoming a thing of the past. New guidelines for cervical cancer screening have experts at odds over some things, but they are united in the view that the common practice of getting a Pap test for cervical cancer every year is too often and probably doing more harm than good.
A Pap smear once every three years is the best way to detect cervical cancer. Recently it was recommended against prostate cancer screening with PSA tests, which many men get every year.
Two years ago, it said mammograms to check for breast cancer are only needed every other year starting at age 50, although the American Cancer Society still advises annual tests starting at age 40. A large study found more false alarms for women getting mammograms every year instead of every other year.
It’s a fact that the more tests that you do, the more likely you are to be faced with a false-positive test that leads to unnecessary biopsies and possible harm. We see an emerging consensus that annual Pap tests are not required for us to see the benefits that we have seen from screening.
Those benefits are substantial. Cervical cancer has declined dramatically in the United States, from nearly 15 cases for every 100,000 women in 1975 to nearly 7 per 100,000 in 2008. About 12,200 new cases and 4,210 deaths from the disease occurred last year, most of them in women who have never been screened or not in the past five years.
The cancer society and other groups say using Pap smears together with tests for HPV, the virus that causes cervical cancer, could improve screening. Instead, reaching women who are not being adequately screened now probably could save more lives.
Bottom Line: Patients need to be informed about the benefits vs. the risks of screening. By being knowledgeable about the screening tests and having a discussion with your doctor is the best way to come to a decision about screening in your situation.