Breast Exam Guidelines Changed

[mike_v_s]

Two articles, both saying the same thing.

http://www.washingtonpost.com/wp-dyn...111602822.html

http://www.msnbc.msn.com/id/33973665...womens_health/

Although the incidence of breast cancer in men is nearly zero, I'm baffled by these new guidelines. No mammagrams until you're 50? Don't people get cancer in their 40's? Why are they not supposed to get checked? Once you reach 50, they recommend that you only get one every two years. Yeah, because cancer will wait around. And then discouraging self-exams in all age groups? If my mom had waited an additional year between exams, she'd likely be dead.

Mike

[Dr. Cheese]

Originally Posted by mike_v_s

Two articles, both saying the same thing.

http://www.washingtonpost.com/wp-dyn...111602822.html

http://www.msnbc.msn.com/id/33973665...womens_health/

Although the incidence of breast cancer in men is nearly zero, I'm baffled by these new guidelines. No mammagrams until you're 50? Don't people get cancer in their 40's? Why are they not supposed to get checked? Once you reach 50, they recommend that you only get one every two years. Yeah, because cancer will wait around. And then discouraging self-exams in all age groups? If my mom had waited an additional year between exams, she'd likely be dead.

Mike

From what I have heard, the new guidelines really stress understanding one's personal likelihood of developing breast cancer and basing mammagrams on that. The problem is that insurance likes to base things on an average, and the new guidelines are likely to make it more expensive for those women who do need regular mammagrams more early in life.

[pointbass]

Originally Posted by mike_v_s

If my mom had waited an additional year between exams, she'd likely be dead.

As would my wife ....

And I've read this following statement several times in many publications (likely just from the AP):

Originally Posted by Task Force??

"We're not saying women shouldn't get screened. Screening does saves lives," said Diana B. Petitti, vice chairman of the U.S. Preventive Services Task Force, which released the recommendations Monday in a paper being published in Tuesday's Annals of Internal Medicine. "But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully."

Exactly how do they propose to find the cancer if 1) mammograms are held off and 2) self-examination is eliminated? And exactly what are those negatives? A false positive and the inevitable biopsy? Surely that's better than allowing an aggressive CA to develop for possibly 10 years ...

[mike_v_s]

Originally Posted by Dr. Cheese

From what I have heard, the new guidelines really stress understanding one's personal likelihood of developing breast cancer and basing mammagrams on that.

I can understand that being important, but I'm not sure the general population should be told not to get regular exams until they are 50 and then to space those exams out to every two years. As I said, my mother would likely not be here if she followed those guidelines. One of the reasons stated was the anxiety of getting the exams and the false positives. How about the anxiety of getting cancer because you didn't get a mammagram until it was too late?

Mike

[billhilly66]

Gotta keep those costs down somehow right?

On the plus side, I am still offering free breast exams back stage at all my gigs.

[warwick.hoy]

Originally Posted by mike_v_s

Two articles, both saying the same thing.

http://www.washingtonpost.com/wp-dyn...111602822.html

http://www.msnbc.msn.com/id/33973665...womens_health/

Although the incidence of breast cancer in men is nearly zero, I'm baffled by these new guidelines. No mammagrams until you're 50? Don't people get cancer in their 40's? Why are they not supposed to get checked? Once you reach 50, they recommend that you only get one every two years. Yeah, because cancer will wait around. And then discouraging self-exams in all age groups? If my mom had waited an additional year between exams, she'd likely be dead.

Mike

In conservative America the last we want is 40 year old women fondling themselves. "Checking for lumps" she says,....yeah right.

/joking aside,...I'm glad your mother followed the former guidelines. Without reading the article I think it's not a doctor's or the surgeon general's (or whoever comes up with these cockamamie guidelines) place to tell people not to know their own bodies.

[Dr. Cheese]

The new guidelines say, for instance, that if a woman is black, she should get annual mammagrams since black women die of breast cancer at a higher rate. The problem is that black women do not develop breast cancer at a higher rate, black women die more because of less access to medical care. The bottom line is that it makes no sense to essentially tell a black woman to have her breasts checked because of a higher incidence of poverty while telling a poor white woman to check with her physician (like a poor person while have a physician!)

[Horny Toad]

Originally Posted by billhilly66

Gotta keep those costs down somehow right?

On the plus side, I am still offering free breast exams back stage at all my gigs.

[mike_v_s]

Originally Posted by warwick.hoy

In conservative America the last we want is 40 year old women fondling themselves. "Checking for lumps" she says,....yeah right.

/joking aside,...I'm glad your mother followed the former guidelines. Without reading the article I think it's not a doctor's or the surgeon general's (or whoever comes up with these cockamamie guidelines) place to tell people not to know their own bodies.

I think that's what sticks with me the most. I simply CANNOT fathom the problem of self-examination. If they don't feel people are capable of doing it themselves with the available information, educate them. I just never saw the problem with prevention.

Mike

[mike_v_s]

Originally Posted by Dr. Cheese

The new guidelines say, for instance, that if a woman is black, she should get annual mammagrams since black women die of breast cancer at a higher rate. The problem is that black women do not develop breast cancer at a higher rate, black women die more because of less access to medical care. The bottom line is that it makes no sense to essentially tell a black woman to have her breasts checked because of a higher incidence of poverty while telling a poor white woman to check with her physician (like a poor person while have a physician!)

Good example. I'm still pushing the self-examination angle. Granted, it might be further along at that point, but ANY detection is better than not going at all because of cost.

Mike

[Jerose]

When I read the title I automatically assumed that there was now a different technique for doing physical breast exams. I was about to call my girlfriend and tell her that she needs to come here so I can test the new proper way.


Maybe I'll do it anyways...

[iamlowsound]

What about the people that develop breast cancer early in age? People like Christina Applegate who had breast cancer before the age of 40 and found it due to self examination? Are those people just supposed to die now? Plus the new mammogram techniques have a much lower percentage of false diagnoses than the old ones. I, for one, would rather have the stress of a false diagnoses than the stress of finding out too late.

lowsound

[jmattbassplaya]

Originally Posted by iamlowsound

What about the people that develop breast cancer early in age? People like Christina Applegate who had breast cancer before the age of 40 and found it due to self examination? Are those people just supposed to die now? Plus the new mammogram techniques have a much lower percentage of false diagnoses than the old ones. I, for one, would rather have the stress of a false diagnoses than the stress of finding out too late.

lowsound

+1

[anyonefortennis]

I'll stick with what the ACS suggests as opposed to what the gov't suggests.

http://www.cancer.org/docroot/CRI/co....asp?sitearea=

[MakiSupaStar]

That's it. I'm setting up a free breast exam clinic.

[senorblues]

Oh Boy, here we go again, nyuk, nyuk, nyuk.
As soon as this study came out, the controlled media, (not by government, but by the multinational corporate owners) started discrediting the study. Breast cancer is big business. guess who is the biggest maker of mammogram machines---Its General Electric who also owns NBC. What the study stopped short of concluding is that mammograms have been found to CAUSE cancer. (Google "mammogram cause cancer" and see 180,000 items). Radiation not good, Kimo Sabe.

[bassguppy]

Originally Posted by senorblues

Oh Boy, here we go again, nyuk, nyuk, nyuk.
As soon as this study came out, the controlled media, (not by government, but by the multinational corporate owners) started discrediting the study. Breast cancer is big business. guess who is the biggest maker of mammogram machines---Its General Electric who also owns NBC. What the study stopped short of concluding is that mammograms have been found to CAUSE cancer. (Google "mammogram cause cancer" and see 180,000 items). Radiation not good, Kimo Sabe.

mammograms do not cause cancer. You're right, radiation is not good in high doses or prolonged exposure but you would probably need several hundred x-rays, CAT scans, or MRI's for it be of a concern.

Insurance companies may welcome this study but the uproar will probably bring this study to a dead end.

[Sterling_Bass]

If studies have shown that mammograms cause too many false positives, then a reinvention of mammography techniques and technology should be had, not a reduction in the total amount of procedures completed. Such a response to a single study is outright foolish, and clearly marked by outside interests. Yes, mammographies are a very common procedure, and therefore cost the health care system a large sum, but these screening methods have proven to be effective at saving lives. I applaud the ACS for not changing its policies so hastily.
Also, why would anyone be in favor of halting self-examination? A patient who discovers a questionable lump discusses the matter with her doctor, who then helps her plan what steps need to be taken.

[JimS]

There are some very good concepts in this thread. Some random thoughts which are tangential:

1. Physical examination is insensitive and not specific for detecting breast cancer. But it's certainly cheap (zero cost), can't hurt, and is beneficial especially for true negative findings. Eg: a woman knows and feels a asymmetry of normal breast tissue in a breast for decades. A 'new' doctor to her will feel and get alarmed. The woman can say "I've had that for 20 years; no worry." That's only one single example.
   
   Again, physical examination is a poor screening for cancer but you have little to lose by doing it.
   
2. Mammograms aren't perfect and neither are the radiologists who read them. Some hospitals I read for do great mammograms; today I reamed out a tech for doing crappy studies with poor image quality. Within my own group there a range of expertise and confidence levels. Bolstering the number of 'unnecessary' biopsies is litigney: the #1 cause of lawsuits in medicine arises from mammography; not obstetric or otherwise. If a radiologist is 'on the fence' about deciding if mammogram has cancer, he really doesn't to any great harm in recommending a biospy. That's not the way I read but some folk do. And they contrary thought is "I'm not sure but I'd rather recommend a biopsy even if this lesion has a small chance of being a cancer." I am simplifying things but to make a point.
   
3. Cost efficiency: that's all that matters to the insurance and goverment. When a 30 year old woman gets cancer, she's a rare statistic but to her it's 100%.
   
4. A woman should take into account risk factors or lack thereof.
   
5. Note that a year or two ago the media was praising MRI of the breast as the be all and end all; now the govt doesn't want to encourage screening mammography at the age of 40.
   
6. Statistics are cold, objective numbers that create emotional responses: the vast majority of mammograms are normal. Yet 1 of 8 women will get breast cancer. That's a very high rate.
   
7. Generally, the most aggressive breast cancers occur in younger women.
   
   FYI, my credentials are more than respectable in this area.

[Sterling_Bass]

Jim, as a practitioner, do you notice any direct pressure from insurance companies regarding this issue within the hospital?