Dr. Deb

Judy, Debbie, Kathy, Barb and Sarah. All these women are close friends of mine. All these women were diagnosed with breast cancer under age 50. I know clinically of hundreds more and I am sure that you can name countless others who were also diagnosed with breast cancer before 50. The USPSTF is now recommending these women (under age 50) should not have received the mammogram or done the self-breast exam (in all women) that found the cancer and saved their life.

Why?

Not because cancer is the leading cause of death in women in their 40s with breast cancer being at the top.

Not because mammograms reduce the risk of dying from breast cancer by 15%, the same rate as in women in their 50s.

Not because younger women have more aggressive cancers.

Not because there are other more effective screening tests for breast cancer.

Not because 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s.

Then why did they recommend stopping mammograms for women in their 40s?

They interpreted data stating the mammograms had a small net benefit in women in their 40s. (Grade C) What does this mean? There were many false positives or a finding that required additional testing that showed it was not cancer.

Younger women have lumpy, bumpy breast so it is harder to find cancer. The current testing will have many women get additional views with a mammogram. Very few of those will require a biopsy. There will be several biopsied that are not cancer. This translates into about 5 extra biopsies to diagnose 1 case of invasive cancer. The USPSTF says that cost is too high. The American Cancer Society and the America College of OB/GYNs (ACOG) say that it is not.

SO who decides? Unfortunately with the USPSTF, it may be your insurance company that may make the decision for you. Many will only cover preventative recommendations that have a grade A or B.

So what do I do?

Write your Congress person and well as your insurance company demanding that they continue to cover preventative mammograms for women in their 40s as recommended by ACOG and the American Cancer Society.

Continue to do self-breast exams.  The evidence that SBE’s help is much smaller but what is the other screening test that will find it in younger women? There is none. Recognize, that yes, I will find a lot of lumps and bumps that are not breast cancer and I may have an unnecessary procedures. You may also end up saving your life.

Click here for more information from the American College of OB/GYNs and Click here for a statement from the American Cancer Society.

Click here for The American College of Radiology who also came out with some harsh evidence based reactions.

When clinicians look at evidence based medicine they often forget to look at the greater risks and benefits to society as a whole. What is the cost of not having a mother? What is the benefit of surviving long enough to see your children get married? What does a working 40-year-old woman contribute to society for rest of her life? Let us make the decision of risk vs. benefit! I will suffer the cost of additional mammograms and even biopsy. My family is worth it. My fear is that the USPSTF will make it impossible for women who can’t afford it, to have the same standard of care.

Save the Ta-Tas

Dr. Deb

As a child I always prided myself on my memory. I could and still can remember specific childhood events as early as age 2 in vivid detail. Things started to blur during residency when I worked 36-hour shifts but nothing destroyed my memory  (as well as other body parts) like children.
The deep slide occurred after the birth of my twins when I boiled my breast pump after forgetting I left it on the stove.  The toxic smell of burnt plastic required the fire department to come and air out our apartment. That certainly ruined my chances for mother of the year. I realized 2 things. Hot soapy water is sufficient to clean a breast pump and hormones made me stupid. Certainly sleep deprivation had much to do with it but I remember the moment that I stood in the kitchen and realized my fantastic memory had slipped and I knew that it was related to my hormones.  Fortunately, my memory returned but I can’t wait to see what happens when I hit menopause.

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Jill Writes:
My daughter turned 16 in November and still does not have her period. She is very athletic. Should I worry about this?
I remember reading,  “Are you there God it’s Me, Margaret?” when I was about 10. I couldn’t wait to get my period. Now I can’t wait for it to go away.
Seems like when the period starts in a girl is a major news bulletin and there can be a lot of concern if it is not right on time. That time may be dictated by when all of her friends started but the reality is there is  about a 7 year time frame that girls start their period. (more…)

My first experience with breast cancer occurred the summer that I turned 14. I went to live with my Aunt who was just 37 years old and diagnosed with stage 4 breast cancer. She had 5 young children under the age of 12 including a new baby only a few months old. She had found a lump when she was pregnant and her doctor told her that it was milk duct… it was not. By the time they figured it out that it was breast cancer, it was too late.

I stayed with the family that summer watching the children and watching my Aunt’s body ravaged by the disease. I remember the big scar across her chest and the radiation that burned her body. She was so brave and beautiful and despite all of her suffering, never lost her humor or kind spirit. One day, she asked her husband while she was topless with only one breast and a huge slant of a scar where the other had been, “ Do you ever get the feeling that I am winking at you?” She only survived to the next summer. (more…)