New Mammogram Screening Guidelines FAQ
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Written by Salynn Boyles
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Friday, 28 May 2010 22:49 |
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The U.S. Preventive Services Task Force (USPSTF) is recommending sweeping changes in its breast cancer screening guidelines.
The USPSTF, which is a group of independent health experts convened by the Department of Health and Human Services, reviewed and commissioned research to develop computer-simulated models comparing the expected outcomes under different screening scenarios.
Here are the USPSTF's recommendations, based on all that work:
- Routine screening of average-risk women should begin at age 50, instead of age 40.
- Routine screening should end at age 74.
- Women should get screening mammograms every two years instead of every year.
- Breast self-exams have little value, based on findings from several large studies.
But the new recommendations may leave some women confused, since the American Cancer Society continues to recommend annual mammographyscreening for all healthy women beginning at age 40. What's the bottom line on mammogram screening? WebMD asked breast cancer experts about the new USPSTF screening guidelines.
If a woman younger than 50 or older than 74 wants to get a screening mammogram, can she?
The guidelines don't ban anyone from getting a screening mammogram. But it's not yet known if the new guidelines will affect mammography coverage by insurance companies and other providers.
Task force vice-chair Diana B. Petitti, MD, tells WebMD the new guidelines don't apply to women with risk factors for breast cancer, such as BRCA mutations or a close family history of the disease.
She adds that they also do not mean average-risk women who are younger than 50 or older than 74 should never be screened.
"This is not telling [average-risk] women in these age groups they can't get screened," Petitti says. "A woman who still wants to be screened after having the conversation with her clinician and considering the balance of benefits and harms should absolutely be screened."
Will insurance pay for a mammogram if I'm younger than 50 or older than 74?
As for paying for those mammograms, the USPSTF recommendations are influential in guiding policy, but the group doesn't make specific recommendations about reimbursement.
It remains to be seen if the sweeping health care bill now being considered by Congress will reflect the new recommendations.
American Cancer Society national volunteer president Elizabeth T.H. Fontham, MD, says there is a good chance that Medicare and private insurers will stop paying for annual mammogram screenings and screening for women in their 40s and over 74.
"Ultimately, this could increase economic disparities associated with breast cancer screening," Fontham says. "Women who want to be screened and can pay for it can still get screened. But those who can't pay may be out of luck."
What if I find a lump and I'm younger than 50 or older than 74?
The new guidelines are just about routine screening mammograms. They're not about getting a mammogram when you have a lump or other suspicious finding or if you're at high risk of breast cancer.
Any woman, of any age, should get a suspicious lump or other breast change checked out.
Why is routine screening no longer recommended for women of average risk before age 50 and after age 74?
The American Cancer Society (ACS) will continue to recommend annual mammography screening to all healthy women starting at age 40.
Fontham says since age is the biggest risk factor for breast cancer, it makes little sense to stop screening relatively healthy women when they reach age 75.
"Screening would be a disservice for a woman in her 80s with three or four serious health conditions who could not tolerate treatment even if a tumor was found," Fontham says. "But there are plenty of relatively healthy women in their late 70s and 80s for whom screening may be appropriate."
In a joint statement emailed to WebMD, the American College of Radiology (ACR) and the Society of Breast Imaging say the new guidelines could cost women's lives.
Calling the guidelines a "cost-cutting" measure, the ACR states that "two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year."
In the statement, Carol H. Lee, MD, chairwoman of the ACR's Breast Imaging Commission, calls the USPSTF recommendations "unfounded." Lee adds, "Mammography is not a perfect test, but it has unquestionably been shown to save lives -- including in women aged 40-49."
Why is the USPSTF recommending routine mammograms every two years instead of every year?
Because that's the time frame that looked beneficial to the task force.
Studies showing a reduction in breast cancer deaths associated with mammography included screening intervals of 12 to 33 months. The evidence indicated that most of the benefits of screening are maintained when mammography is performed every two years as opposed to every one, while the harms are reduced by nearly half.
Kathryn Evers, MD, who directs the mammography program at Philadelphia's Fox Chase Cancer Center, tells WebMD she will continue to recommend annual mammograms to her patients.
"The evidence shows that by changing to biannual screening you lose some of the mortality benefits seen with yearly screening," Evers says.
The new guidelines recommend against breast self-exams and question the benefits of clinical breast exams performed by health care providers. Why?
Two major studies, one from China and another from Russia, found no evidence that breast self-examinations reduced deaths from breast cancer, but that the practice leads to additional screening and biopsies.
"The self-exam data were pretty definitive," Pettiti says. "There is high certainty that there is no benefit, and there are harms which include unnecessary anxiety from finding something that isn't cancer."
But that doesn't mean a woman should ever ignore a suspicious lump.
"That definitely is not the message," Petitti says. "Anything unusual should be checked out."
The USPSTF panel concluded the current evidence is insufficient to assess the risks and benefits of clinical breast exams performed by health care providers.
Evers says she will continue to recommend breast self-exams.
"I don't think the practice is useless," she says. "For many women it is important because it helps them feel somewhat empowered and in control of their own breast health."
What should average-risk women in their 40s be doing if mammography and self-exams are no longer recommended?
Although the experts interviewed for this story had different opinions about whether routine screening is advisable, they all agree that any woman concerned about breast cancer should discuss her own situation with her doctor or other health care provider.
The new guidelines don't apply to women at high risk for breast cancer. How often should these women get screened?
The new guidelines aren't about women at high risk of breast cancer.
The American Cancer Society defines high-risk as women with a greater than 20% lifetime risk of breast cancer. This includes women with BRCA1 and BRCA2 gene mutations and women who have not been tested but have a parent, sibling, or child with a BRCA mutation, as well as certain other groups of women.
The ACS recommends that high-risk women have annual mammograms along with an MRI beginning at age 30 and continuing for as long as they are in good health.
Women with a 15% to 20% lifetime risk for breast cancer are considered to have a moderately increased risk for the disease.
ACS recommends that these women talk to their doctors about the benefits and risks of adding MRI to annual mammogram screening.
If a woman's breast cancer risk increases with age, why stop screening at 74?
Very few breast cancer screening studies include women in their mid-70s and older. The task force noted that "breast cancer is a leading cause of death in older women, which might suggest that the benefits of screening could be important at this age."
However, the USPSTF also concluded that the benefits of screening are probably not as great for older women because they tend to have breast cancers that respond well to treatment and have a higher risk of dying from other causes.
The panel noted that the risk of overdiagnosis and unnecessary treatment is greater in elderly women than in younger ones because of their increased risk for death from other causes.
Do the new guidelines apply to women taking hormone therapy?
The panel did not address this question. Hormone therapy increases a woman's risk for breast cancer. The general consensus among the experts who talked to WebMD was that women on hormone therapy should discuss annual screening with their doctors.
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The Top 8 Secrets You Keep from Your Doctor
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Written by Jennifer Nelson
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Friday, 28 May 2010 22:42 |
By Jennifer Nelson
WebMD Feature
At your annual doctor's checkup, you hop up on the exam table and bare your deepest secrets.
You 'fess up about how much alcohol you consume, how many times you smoked last week, the herbal supplements you pop, or the fact that you're battling depression or are anxious about job layoffs at the office. Maybe you tell her you're worried about your 401K rebounding in time for retirement, or your recent new sexual partners.
No? Isn't everyone sharing this level of information with their doctor?
Apparently not. And that hush-hush attitude may be risky.
Why You're Not Telling
“People often don't share with their doctors aspects of dysfunction in their lives because it's embarrassing and creates a great level of discomfort," says Bernard Kaminetsky, MD, FACP, the medical director of MDVIP, a group of boutique medicine doctors headquartered in Boca Raton, Fla. “You're not going to share unless you have a very trusting relationship with your doctor."
Patients withhold information from their doctors for a variety of reasons. Often they just don't think their marital problems, anxiety, or worries are fodder for their cholesterol checkup. Or they're embarrassed to bring up touchy topics like sex or bathroom problems like incontinence or constipation.
Others may skip information that they don't think is important. And there's not much time during a checkup to tell all.
But not telling could spell trouble -- even if you'd rather not admit to an inconvenient truth or two.
Everything from your stress to your sexual history to your use of supplements can affect your health and should be disclosed to your doctor.
Here are the top eight secrets you keep from your doctor and why you should spill them.
1. Use of Over-the-Counter (OTC) Medicines, Herbal Supplements, and Vitamins
You may think the doctor will look down her nose at certain herbs and supplements, but you need to tell her exactly what you take.
Some supplements and OTC products may not mix well with prescription medicines you've been prescribed and could cause a reaction. Patients can even have specific conditions for which they shouldn't take an OTC medicine.
For instance, Kaminetsky says people with liver disease should use acetaminophen sparingly if at all. Likewise, certain weight loss supplements could have cardiac implications for someone with heart disease.
And "natural" does not always mean "safe," according to the web site for the National Center for Complementary and Alternative Medicine (NCCAM). "For example, the herbs comfrey and kava can cause serious harm to the liver," states NCCAM's web site.
Vitamins and minerals are also something your doctor needs to know about. High doses can be risky; for instance, too much selenium can cause gastrointestinal upset, hair loss, fatigue, irritability, and mild nerve damage, according to the National Institutes of Health's Office of Dietary Supplements.
2. Your Sexual History
"It's really important for us to know how many sexual partners someone has had, so if you've had 40, I may approach things differently than if you've had four," says Lissa Rankin, MD, author of the forthcoming What's up Down There? Questions You'd Only Ask your Gynecologist if She was your Best Friend.
It matters to a gynecologist because your lifetime chance of getting sexually transmitted diseases rises with how many partners you've had. “The new Pap guidelines say if you're low risk, you can go three years between Pap smears, but if someone's had 100 sexual partners, then I would say that rule doesn't apply to you," Rankin says.
Men need to come clean, too. Their risk for HIV, hepatitis, and other STDs increase with the number of sexual partners and their sexual preference. Doctors need to make sure men get screened properly and often enough.
3. How Much You Smoke, Drink, or use Illegal Substances
It may be difficult sharing these secrets because you think your doctor will give you yet another smoking lecture or judge you. But doctors aren't there to do that.
Plus, doctor-patient confidentiality laws ensure your information remains private. In most states, doctors can only break confidence if someone is an imminent danger to themselves or others.
What's more, your doctor needs to know what you're taking to protect your health, run the right tests, and diagnose correctly.
For instance, "we may need to check your liver function or you may be at risk of ulcers," Rankin says. There are a host of other medical issues if you've got an addiction or take too much of any drug -- legal or not.
4. Whether You're Stressed, Depressed, or Abused
If you're often stressed or sad -- or if you're in an abusive relationship -- speak up.
"Doctors may not be licensed therapists, but every primary care physician who has been practicing for a number of years is a bit of a therapist because we've heard it all," Kaminetsky says.
Your doctor can help in offering advice, referring you to the right specialist, or suggesting a counselor to deal with stress. He can also evaluate if medication or therapy might help with depression.
5. Defying Doctor's Orders
When your doctor asks if you're taking your cholesterol-lowering statins daily, don't lie and nod your head if you forget three days a week. Admit that you have trouble remembering.
The same goes for birth control pills. “If I give you the pill and you're not good at taking a pill every day, that would change my approach to birth control with somebody," Rankin says.
If you're bad about taking or finishing the drugs your doctor prescribed -- no matter what it is -- tell your doctor. Your doctor won't punish you. But if, for instance, you've had a stubborn infection that won't clear up, it helps your doctor to know that you didn't finish the antibiotic he or she prescribed.
6. You Can't Sleep
You may think a sleep issue is inconsequential, that it will pass, or that it's a simple factor of aging so you needn't bother the doctor about it. But sleep problems can quickly become chronic and often can be easily remedied.
There are so many factors to consider for people who are sleeping poorly, including stress, depression, menopausal changes, anxiety, or even serious medical conditions like sleep apnea, a chronic condition in which you repeatedly stop breathing throughout the night, leading to daytime sleepiness.
Tell your doctor you're having trouble sleeping, and whether it's falling asleep or staying asleep that's difficult. He may evaluate the problem and offer advice -- like not exercising too close to bedtime, not drinking alcohol too late, or not watching stimulating television before bed; or send you for a sleep study to get at the root cause.
7. You're Often Low on Energy
Fatigue is a factor in many illnesses, though people just think it's a byproduct of getting older. “But usually there is a reason that accounts for a change in their stamina or energy level, and if you don't tell the doctor, you won't get relief and may miss something important," Kaminetsky says.
Low energy levels could stem from illnesses, including stress, a poor diet, anemia, depression, and thyroid function. So mention it to your doctor so she can check if something medical is going on.
8. Your Hobbies
You may not think sharing your hobbies with your doctor is of any importance, especially since many hobbies are an excellent way to reduce stress and contribute to good health. But it could be your hobby that's responsible for some medical symptoms.
Perhaps the way you sit at your desk writing your novel causes back or neck pain. Maybe piano playing contributes to your Carpal Tunnel Syndrome, or building model airplanes in a non-ventilated area is leading to chronic headaches on weekends.
So mention any hobbies to your doctor on the off chance an activity you take up may be related to your medical condition.
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Statins May Lower Testosterone, Libido
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Written by Kathleen Doheny
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Friday, 28 May 2010 22:36 |
Men With Erectile Dysfunction on Statin Therapy Are Twice as Likely to Have Low Testosterone, Study Finds
April 16, 2010 -- Statin therapy prescribed to lower cholesterol also appears to lower testosterone, according to a new study that evaluated nearly 3,500 men who haderectile dysfunction or ED.
''Current statin therapy is associated with a twofold increased prevalence of hypogonadism," a condition in which men don't produce enough testosterone, study author Giovanni Corona, MD, PHD, a researcher at the University of Florence in Italy, tells WebMD.
Although previous studies have produced mixed findings on the possible link between taking cholesterol-lowering drugs and a drop in testosterone, most involved a limited number of patients, with few studies including more than 50 people, Corona says.
"Our study is the first report showing a negative association between statin therapy and testosterone levels in a large series of patients consulting for sexual dysfunction," he says.
About one of six adults in the U.S. has high cholesterol, according to the CDC. The number of people buying a statin (such as Lipitor or Zocor) rose 88% from 2000 to 2005, from 15.8 million people to 29.7 million, according to the federal Agency for Healthcare Research and Quality.
Statins, Testosterone, and ED: The Study
Corona and colleagues evaluated 3,484 men, average age 51, who visited an outpatient clinic at the University of Florence with complaints of sexual dysfunction between January 2002 and August 2009.
Of that total, 244, or 7%, were being treated with statins for their high cholesterol. Most often the statin was simvastatin (Zocor) or atorvastatin (Lipitor).
The researchers calculated the men's total testosterone as well as free testosterone, the amount of unbound testosterone in the bloodstream.
When they compared men on statins to those not, the men on statins were twice as likely to have low testosterone, regardless of which of three commonly used thresholds for low testosterone they looked at.
The researchers emphasize they have found a link, not a cause and effect, between statins and lower testosterone. They can't explain the link with certainty.
One possibility, Corona says, is that low testosterone levels and the need for statin treatment share some common causes.
Some researchers also have looked at the possibility that the statins' inhibition of cholesterol synthesis may interfere with the production of testosterone, which depends on a supply of cholesterol. The statins may disrupt the body's feedback mechanism to instruct it to make more testosterone.
Statins, Testosterone, and ED: Other Views
''This is huge," says Irwin Goldstein, MD, director of sexual medicine at Alvarado Hospital in San Diego and editor-in-chief of the Journal of Sexual Medicine.
The study results, he says, demonstrate the need for more study to replicate the finding and figure out the reason for the link.
According to the authors, he says, the best explanation for now is that "statins may disrupt the pituitary feedback to the testicles, telling them to produce testosterone."
For consumers, he says, the message is for men on statins to pay attention to early warning signs of testosterone deficiency. That includes falling asleep after meals when they did not in the past, noticing poorer athletic performance, having a change from an upbeat mood to a grumpy mood, and experiencing a reduced sex drive, Goldstein says.
If a man suspects testosterone deficiency, Goldstein says he should ask his doctor about checking his testosterone levels.
Statins and Testosterone: Industry Input
In a prepared statement, Sally Beatty, a spokeswoman for Pfizer, the manufacturer of Lipitor, says, "Millions of people have been prescribed Lipitor, which is clinically proven to lower bad cholesterol levels 39%-60% (this is an average effect depending on dose), when diet and exercise aren't enough."
The label on Lipitor does warn of the possibility of interference with hormone production, she says. "As described in the Lipitor U.S. prescribing information, statins interfere with cholesterol synthesis and theoretically might blunt adrenal and/or gonadal steroid production."
But she says, "It is important to note that some other studies and analyses have shown that Lipitor does not have an effect on levels of testosterone or other reproductive steroid hormones."
Spokesman Lee Davies of Merck and Schering-Plough, which make Zocor andVytorin, had no comment on the study, but says neither of its two statin labels refers to low testosterone.
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BPA May Raise Risk of Asthma in Kids
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Written by Amanda Gardner
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Monday, 01 March 2010 01:57 |
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SUNDAY, Feb. 28 (HealthDay News) -- Mouse pups whose mothers were exposed to a common but controversial chemical developed allergicasthma , new research has found.
Bisphenol A (BPA) is a chemical commonly found in polycarbonate plastic bottles and the aluminum lining of food and beverage cans. Production of the chemical started about 40 years ago, a timing that scientists note coincides with increasing asthma rates.
Various U.S. health agencies recently pledged $30 million toward short- and long-term research aimed at clarifying the health effects of BPA. It has caused problems in lab animals and in people who have had occupational exposure. On Thursday, Maryland became the third state to tackle the issue, when the state legislature passed a ban on BPA in cups and bottles used by children younger than age 4. Minnesota and Connecticut passed similar laws last year.
Although the newest study looked only at mice, several experts believed that the findings could be worrisome for humans.
"They're using what are probably going to be reasonable estimates of human neonatal exposure, and that seems to have an effect on the developing immune system or sensitivity to asthma," said Dr. Steve Georas, chief of pulmonary and critical care medicine and director of the Mary Parkes Center for Asthma, Allergy and Pulmonary Care at the University of Rochester Medical Center in New York. "If you take it together with some epidemiologic studies, I would consider it cause for concern."
Dr. Erick Forno, an assistant professor of pediatrics at the University of Miami Miller School of Medicineadded that "the mice they used are very well-accepted models for asthma and allergies so it should be a very good model of what we would expect to happen in humans, although that is not always the case."
The findings were to be presented Sunday in New Orleans at the American Academy of Allergy, Asthma & Immunology annual meeting.
Previous studies by the same group had also suggested that pups born to mothers who had been exposed to BPA had an increased susceptibility to allergic asthma. The new study focused on which doses might tip the scale.
The researchers put 0.1, 1 or 10 micrograms per milliliter of BPA in the drinking water of female mice before, during and after pregnancy. Once born, their pups were injected with ovalbumin to make them susceptible to asthma.
Mice born to mothers who had been exposed to 10 micrograms of BPA developed airway problems, though that did not occur among mice born to mothers with lower or no exposure.
"It's an exciting finding, an initial finding," Forno said. "I think the next thing is going to have to be not only the level of exposure but also how much or how prolonged does the exposure have to be and if there are any other factors involved."
The study's senior author, Dr. Terumi Midoro-Horiuti, an associate professor of pediatrics and biochemistry and molecular biology in the Child Health Research Center at Children's Hospital, University of Texas Medical Branch in Galveston, said her group is now collecting cord blood in humans, grouping that according to BPA exposure and following offspring to see if they develop asthma.
A second study being presented at the meeting found that children whose mothers had high levels of folate, a B vitamin, during pregnancy were more likely to develop asthma by the age of 3.
Too little folate, or folic acid, can contribute to neural tube defects in babies.
"This goes along the lines of thinking if some is good, more is better, and we have seen certainly with vitamin supplements, especially with antioxidants, that more is not necessarily better and may be worse," Horovitz said. "Here we're seeing it again."
Data came from 507 mothers of children with asthma and 1,455 mothers of children without asthma, all part of the Norwegian Mother and Child Cohort Study.
"In both cases, these studies illustrate how much prenatal environmental influence there is," Horovitz said.
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