Monthly Archives: November 2009

Don’t They Understand “Recommends Against?”

A comment in today’s Wall Street Journal (accompanied by a large picture of a very angry Congresswoman) should not go unnoticed and cannot be left unchallenged, especially given the confusion caused by the mammography guidelines released earlier this week.


 


The story as reported in the Journal is headlined, “Group Issues Clarification on Mammography Advice.” 


 


And here is the comment from the vice-chair of the Task Force:


“The task force is not against women having mammograms in their 40s,” Dr. Petitti said in an interview. Instead, she said, it is in favor of women in that age range deciding on their own, after consulting with their doctors, whether to undergo regular screenings.”


Here is the recommendation as published by the Task Force:


The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. (emphasis mine) The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms. This is a C recommendation.”


 


You can draw your own conclusions.  No wonder women are confused.Continue reading →

Live Chat Thursday

I hosted a chat Thursday, November 19th about the new mammography guidelines issued this week by the USPSTF. Thanks to all who participated.

During the chat I emphasized that the American Cancer Society stands by its guidelines of recommending that women 40 and over at average risk for the disease continue to receive an annual mammogram and clinical breast exam every year. We discussed this and other aspects of the guidelines in our chat. You can see the transcript here:


Transcript of
Dr. Len’s Chat: 11/19/09

Becky Erwin, ACS: We’d like to welcome you all to our chat, and welcome Dr. Len who
has just joined us.


Dr. Len:    Good afternoon.   Glad to be
here.

Becky Erwin, ACS: To start, Dr. Len, can you please
tell us what the American Cancer Society recommends women 40-49 do about getting
their mammograms?

Dr. Len:   The American Cancer Society currently
recommends–and will continue to recommend –screening mammograms beginning at
age 40, every year for women at average risk.

[Comment
From Gretchen]

Dr. Len, thank you for joining
us. My question is about the recommendation that people stop doing their self
exams.

Dr. Len:  Let’s be clear about what … Continue reading →

Finding Breast Cancer Early: Age 40, Every Year

The United States Preventivec Services Task Force (USPSTF) today released a series of reports updating their guideline recommendations for screening mammography for the early detection of breast cancer.  Their conclusions are bound to raise another round of intense discussion about the benefits, risks and harms of screening for breast cancer.


 


There is certainly nothing wrong with that, with the exception that if we make the wrong decisions or offer women the wrong guidance about the early detection of breast cancer, we could reverse the considerable progress that has been make in reducing deaths from this disease over the past twenty years.


 


Unlike the Task Force, the American Cancer Society is not changing its current recommendations that women at average risk of getting breast cancer should get a mammogram every year starting at age 40.


 


In this era of health care reform, these new Task Force guidelines could have real implications for how insurers, government programs and maybe even the pending health care reform bills will cover screening mammography in the future.


 


Before I actually discuss the guidelines, I would like to set the stage with the very last sentence of the report that came from … Continue reading →

On To The Next Steps In Health Care Reform

I find myself early on Sunday morning after the House of Representatives passed landmark health care reform legislation last night asking how I really feel about this momentous event.


 


The answer is that I actually feel pretty good. And I must admit that surprised me. 


 


Like you, I have been exposed to many “inputs” that have vied for my attention and have tried to influence my opinions.  I would expect nothing less, especially with something as momentous as health care reform legislation.  After all, this is a bill which inevitably will have a substantial influence on how we receive our medical care, how we provide our medical care, and how we pay for our medical care.


 


Some of those inputs are “pro,” some are “con” and all try to sway us into their camp as part of the political process.  Some of the sources are “distant,” but some are very “up close and personal.”


 


I can start in my own family, where our internal discussions about this legislation have given rise to a considerable amount of disagreement. To put it mildly, not everyone in my household thinks this version of health care … Continue reading →

It’s Time (Again) To Talk About Excess Body Fat

I think it is time for one of my irregular updates on a favorite subject, and one of my personal failings: being overweight or obese.


 


The information yesterday from the American Institute for Cancer Research (AICR) that excess body fat (who doesn’t have excess body fat???) causes an extra 100,500 cases of cancer every year in this country didn’t help matters.


 


First, let’s talk about the science.


 


Since my colleagues at the American Cancer Society first published their research on the impact of overweight and obesity on the incidence and deaths from cancer several years ago, there has been an increased recognition of the role that weight plays in increasing deaths from a number of cancers.


 


The sad truth, as we have known for some time and confirmed once again yesterday by the AICR, is that people still don’t get it, that being overweight or obese can increase your risk of developing and dying from cancer.   Just like high blood pressure, heart disease and other maladies, how much you carry around every day makes a real difference in your risk of getting cancer.


 


The information from AICR highlights some of that increased risk:


 Continue reading →

A New Vaccine Holds Promise For Women With VIN

An article in today’s New England Journal of Medicine reports some interesting and intriguing research that may help some women with a not uncommon pre-cancerous lesion of the vulva called vulvar intraepithelial neoplasia, or VIN.


 


By using proteins found in the cancer-causing human papilloma virus type 16 (HPV-16), the researchers were able to make a vaccine that actually led to an effective treatment for a small group of women with VIN, resulting in complete disappearance of the lesion in almost half of the women they treated.


 


You may have heard of HPV infections.  These are the viruses that cause cervical cancer.  Two of these viruses—types 16 and 18—are responsible for the majority of cervical cancers in the United States.  They are also the viruses targeted by currently available vaccines which prevent infection with HPV thus reducing the risk of developing cervical cancer.


 


It turns out that the same viruses are also related to VIN, especially type 16 which causes over 75% of VIN. (VIN is a superficial lesion on the vulva which can actually last for many years.) 


 


The problem is that the treatments for VIN are sometimes unsatisfactory, and … Continue reading →