I am writing this letter to thank the nice people who live between the Spruill Show Lambs road and Selden. Wednesday morning as my family was heading out to work for the day, we noticed our gate had broken over night and our two beloved big dogs had gotten out. I had these dogs for eight years and never once had they gotten out. Although we live almost 10 miles out in the country, we do not let our dogs run loose. They have always lived inside our fenced back yard or in our laundry room on wet and cold nights. We feared the worse as they would not know how to survive in the open. They always had someone to take care of them. We immediately started our search. I talked to neighbors, left notes, and called the Humane Society. Everyone was very willing to help keep an eye out. A couple of hours after beginning our search, we found my female Husky under a trailer about two miles from our house. She was alive and ok. There was still no sign of my male dog though. Thursday we resorted to posting signs at the end of 67 and the end of our county roads. As I was driving to work Friday morning I got several calls from caring people to tell me they thought they saw my dog on the side of the highway. I turned around and went to the area he was spotted and sure enough, it was him. He had been hit. He is now buried next to our garden behind our house. I wanted to send a special thank you from the bottom of my heart to all the people who didn’t hesitate to help me look for my dogs and to the caring people who called me to tell me, I am sure with a heavy heart, that they thought my beloved pet had been hit on the side of the highway. I am thankful to live around such caring and helpful people. We have closure now and Bear is now home forever.
In the news this week recommendations for screening mammography have been loosened by United States Preventative Services Task Force. In fact, the language used by the panelists suggests “the potential harm of mammography and chance of over diagnosis”. Their wording may raise fears or doubts in women about the benefits of mammography. The panel was made up of 16 studied persons, chosen by the Agency for Healthcare Research and Quality, a government agency that provided the funding for the evaluation. There were no breast imagers and no breast cancer experts on the panel. Most were academicians with limited or no current clinical practice. The AHRQ provided the information to be analyzed. At the time of the press release on Monday afternoon no one scientist or physician outside of the committee members had seen or reviewed the information they subsequently published. Routinely all research undergoes rigorous review prior to being published in order to confirm the validity of the claims made.
Several recommendations were given. The first is that we should not screen with routine mammography women aged 40-50. In this age group they felt the number of malignancies was less common and this was the group that suffered most from their perceived potential “harms”. The same concerns were raised in a related recent article I saw in a women’s fashion magazine. It is interesting that the panelists’ conceded that these recommendations would result in increased cancer deaths in this age group. Similar arguments and concession were made by the panel with regards to yearly screening in the 50 age group.
Breast cancer is the most common cause of cancer death in women aged 40-54. So where is the logic in not screening this population? Just what is the cost of a human life? The efficacy of mammography has been clearly demonstrated in a Swedish study where women were examined over a 30 year period. We are now reaping the benefits of screening mammography in the United States following implementation of routine screening in the 1970’s. We have seen a decline in mortality from this disease. It would be a costly mistake to change now.
The panel also felt that we should not teach women to do self breast exams- that it results in needless worry and expense. This one just makes no sense. If I was to follow this guideline then the women who are not being routinely examined would not be evaluated until their disease has spread, again significantly advancing their disease and reducing chance of a full recovery. Statistically the younger population’s incidence of breast cancer is small, however it is not zero. One life saved is worth the expense.
Finally the council stated that mammograms do not show added benefits after age 75. This one is also hard to understand. Breast cancer becomes more common with aging. Our population is reaching age 75 more routinely and with better health than the past. It is hard to conclude that this reasoning is not cost driven.
Please be assured, the mammography exam, while definitely not perfect (there is only One perfect thing that I know of) is a proven tool for reducing death from breast cancer. Breast cancer comes in many forms, some more aggressive than others, but over the past 30 years the number of cancers found has increased and the number of women dying from the disease has lessened. Do not be swayed from understanding that the best way to take care of the women we love is to continue to recommend
Age 18-35, Breast self exam once a month and clinical breast exams once every 3-4 years.
Age 35-40, Breast self exam once a month, clinical breast exam one a year and baseline screening mammogram.
Age 40 +, Breast self exam once a month, clinical breast exam once a year and annual mammogram.
for most women. Those with a family history of the disease or other risk factors should check with their doctors for possible additional evaluation.
Two days after the USPSTF relaxed recommendations the United States Department of Health and Human Services secretary Kathleen Sebelius issued a statement that federal policy (Medicare) remains unchanged. I pray that will be the case, that Medicare and Medicaid will not embrace these recommendations and that the advances that we have made will not be lost. In the meantime, take the time to ask your mother, your sister, your colleague and your friend, ”Have you had your mammogram this year?”
Dr. Nanette Evans, M.D.