飽 嗚's List: mammogram

• This week two panels of medical experts recommended fewer screening tests for breast and cervical cancer. And recently, men got similar advice about prostate cancer screening.
• "The basic principle of evidence based medicine is that clinical decisions that are made between doctors and patients should be driven by data,"
• New information and new ways to analyze it mean that guidelines often change.
• That can make patients nervous, Heim says. "They want medicine to be absolute, and perfect, and unfortunately it's not."
• Insurers already use evidence-based medicine to some degree. The current health overhaul bills under consideration encourage it without any strict requirements.
• Researchers estimate that anywhere from one half to two-thirds of current medical practice is based on concepts that have not yet been proven.

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• Recently, the U.S. Preventive Services Task Force released recommendations that women in their 40s are not in need of mammograms; rather, they should start at age 50, having a mammogram every two years until the age of 75.
• The task force also said the breast self-exam holds no value.
• The task force said these guidelines are recommended for the general population, not for those at high risk of breast cancer.
• Dr. Alan Fairchild of Knox Gynecological Specialists
• we finally feel like we have made it public and easy access to mammograms. Now it all might change with these recommendations,
• said Dr. Amy Murnen, Mount Vernon Family Practice.
• Fairchild and Murnen agree the final decision on testing should be between the physician and the patient, and all options will be taken into consideration.
• Women who get a cancer in their breast in their late 30s and 40s up to mid-50s, they are usually very aggressive cancers and if you don’t find them early, they can die from it.
• Fairchild agreed with the task force’s recommendation against breast self-exams.
• [Breast self-exams] are worthless unless the tumor is so big, like the size of a golf ball. They’re not going to know what they’re feeling,
• Murnen is a firm advocate for breast self-exams, and has told women — and will continue to tell women — of their importance.
• I had a normal mammogram and it didn’t show it. I went to my physician and my physician didn’t feel it. Yet I was able to feel it by doing my own breast exam; that’s why I believe self breast exams are one of the most important things.
• I completely disagree with [the government task force’s] recommendation to not do self breast exams,
• Mammograms aren’t 100 percent accurate, said Murnen, but they can detect a lump much smaller than a person can feel.
• And if we’re not doing the screening of mammograms as frequently, they will have to wait until the woman or the physician can feel it, and then the potential [lump] may be at a later stage rather than earlier
• Dr. Lauren McDowell-Jacobs M.D., Community Surgical Specialists, agreed with Murnen on the importance of self breast exams.
• many breast cancers are found because a woman has identified it herself.
• I can tell you every breast society that I’m involved with has come down pretty hard against these recommendations, and feel like the research that has been accumulated over the last 40 years shows very, very clearly that breast cancer deaths are decreased as much as 30 percent by screening mammography and subsequent early diagnose and intervention.
• McDowell-Jacobs said 70 percent of breast cancer patients have no documented risk factors beyond the fact that they are women, and for 95 percent of women who have breast cancer, it doesn’t run in their family.
• “I think the guidelines to be put out there really serves to make women much more confused about what’s the right thing to do,” said McDowell-Jacobs.
• Why would we want to put out further information to confuse women and to make them less inclined to take advantage of something that has been clearly documented to decrease death from breast cancer?
• Over 4,000 mammograms are done each year at Knox Community Hospital
• The best detection is early detection
• Becky Dangelo, MSN, RN, CNOR, BHN, breast health navigator at Knox Community Hospital.
• Dangelo said she will not be changing the way she educates women on breast cancer awareness, but will continue to speak on the importance of annual mammograms, breast self-awareness exams, and clinical exams by a physician or practitioner.

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• The storm of criticism is not surprising, given the emotional valence of breast cancer and the fact that American women over 40 have been told for a long time that they ought to report for yearly mammograms.
• Dr. Susan Love is among those who don't think the guidelines are wrongheaded. Her reaction was, "It's about time!"
• Love says mammography has been oversimplified as a lifesaving strategy for all women.
• "There are five or six different types of breast cancer," she says. "They don't grow in a nice, orderly way. They spurt, they rest, and some are so fast-growing that you're never going to find them in time."
• Love says universal mammography has been "oversold, as if every cancer could be found early. I wish that were true, but it's not."
• One thing you should know about Hamel: At the age of 47, she had a suspicious mammogram, and a biopsy showed advanced cancer.
• That was eight years ago. Today she's fine.
• Hamel says she's going to keep telling all women to get yearly mammograms — including women younger than 50.
• Smith cites a very recent study from Sweden, where mammography has a long history and record-keeping is meticulous.
• It's not a randomized trial of mammography, but instead compares breast cancers diagnosed in different time periods among women who were screened for cancer with mammograms and women who weren't.
• Breast cancer deaths declined 19 percent over time among women who didn't get regular mammograms. But women who did get screening mammograms had a 48 percent reduction in breast cancer mortality.

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