Guidelines say begin mammograms at age 40
Guidelines say begin mammograms at age 40
If women begin annual mammography at age 40, their early detection and survival odds increase enough to make it a cost-effective practice, according the American Cancer Society in Atlanta.
Oncologist Marilyn Leitch, MD, who chairs the society’s breast cancer advisory committee, notes that breast cancers in 40-something women grow faster than in their older counterparts. That finding offsets the disadvantages of false readings that often happen because the breast tissue of younger women is more dense. (For more details, see chart, below.)
The society cites new evidence from yet unpublished studies that annual screenings lower death rates significantly. On the strength of that evidence, the society’s latest recommendations overturn its former ones, which called for mammograms every 18 to 24 months beginning at age 40.
Within days of the American Cancer Society’s announcement, the National Cancer Institute (NCI) in Bethesda, MD, reversed its breast cancer screening guidelines for 40-something women. NCI now recommends screening mammograms every one to two years. Its former recommendations were based on the Consensus Development Conference’s guidance against routine screening mammography for 40- to 49-year-olds.
The conference, a group of medical scientists whom the National Institutes of Health in Bethesda, MD, commissioned to analyze longitudinal mammography screening data, presented its findings in January to the NCI, which officially adopted them. (For more information, see Women’s Health Center Management, April 1997, p. 41.)
Clinical exams still important
NCI’s latest guidelines are based on the findings of the Bethesda-based National Cancer Advisory Board. Appointed by President Clinton, the advisory board performed further analyses of longitudinal data and revised the consensus development conference’s recommendations. The board’s statement, released in late March, concluded that because of mammography’s limitations, women’s health providers should continue doing clinical breast examinations as part of routine breast care. The board also pointed out that 80% of breast cancers occur in women over 50.
The upshot is this: NCI acted on one set of advice received in January, then changed its position when it received new advice in late March.
The latest guidelines meet with applause from Maxine Brinkman, BSN, director of Women and Children’s Services at the North Iowa Mercy Health Center in Mason City and president of the Chicago-based National Association of Women’s Health Professionals. "Women and their providers rely on guidance from experts that is based on the most recent research available, as these new recommendations are." she says.
The earlier NCI recommendations cited that dense breast tissue of women under 50 contributed to false negative and false positive mammograms. At Brinkman’s facility, however, 30- to 40-year-old breast cancer survivors expressed concern over those guidelines. Discussing the cost of screening vs. the value of testing younger women, one survivor asked, "Aren’t they worth it?"
[Editor’s note: For a full copy of the American Cancer Society’s report, contact the society at 1599 Clifton Road NE, Atlanta, GA 30329-4251. Telephone: (800) 227-2345. World Wide Web: http://www.cancer.org.
For more information on the debate over the best mammography guidelines for 40- to 49-year-olds, see Women’s Health Center Management, April 1997, p. 41.]
• The four biggest medical rip-offs are the focus of a report in the April McCall’s. Women are warned that the public is paying much more for medical care than is necessary. While some managed care groups have come under fire for skimping on legitimate use of high-ticket procedures, an equally onerous practice exists among certain hospitals and clinics. According to a health policy expert at Rush Presbyterian- St. Luke’s Medical Center in Chicago, doctors sometimes experience pressure to order costly but unnecessary procedures to generate profits.
The article urges women to protect themselves against practices that raise their bills and even expose them to undue risk.
For example, back pain sufferers often undergo magnetic resonance imaging (MRI) to detect the cause of the pain. The price tag is $750 to $1,000. The article explains that MRI in fact identifies many herniated disks. Interestingly, back surgeries have risen over the last decade. However, 80% of people with herniated disks get better without surgery. Readers are advised to consider back surgery if the physician suspects an extremely herniated disk, spinal infection, or cancer.
Also, laser surgery has not lived up to the promise of revolutionizing surgery. For example, it is no more effective than a scalpel in hemorrhoid surgery, but it costs $3,700 compared to $2,000 for a scalpel hemorrhoidectomy, the articles says. Lasers are not effective in removing stretch marks, the article notes. Lasers are better than traditional methods for correcting retinal tears and nearsightedness and for removing port-wine stains.
Infertility clinics come under criticism in the article. The average couple pays $20,000 or more out of pocket and doesn’t always end up with a baby. Among the pricey but no more effective developments is assisted hatching, in which the outer coating of the egg is dissolved to increase the chances the embryo will implant in the uterus.
Some clinics urge couples to keep trying infertility treatments until the woman conceives, even though the odds diminish with each attempt. The report counsels women to consider the expensive alternatives to conventional in vitro fertilization only if the odds are good that they will work after conventional procedures have failed.
New drugs that mimic existing prescription and over-the-counter are another potential rip-off. When new calcium channel blockers come out for high blood pressure or "revolutionary" advances over Advil are rolled out, women should start asking questions and comparing the ingredients. The newcomers are often far more expensive and unproven over time. A rule of thumb, suggests the report: Wait until a drug has been on the market for five years.
• The April Ladies’ Home Journal asks why we still consider heart disease a male problem when it kills more women than any other illness. The article explains that the decades of heart disease research focused on male subjects, so the current heart function tests and prevention guidelines are geared to men.
One dangerous blind spot in the male-based indicators of heart trouble is the difference in heart attack symptoms. Though men often get unmistakable signs such as severe chest pain, women feel vague nausea, shortness of breath, or fatigue. Often women don’t even realize they’ve had a heart attack.
Given a family history of heart attacks and high cholesterol levels, women can develop heart disease before menopause. Healthy women with high cholesterol don’t benefit from cholesterol-lowering drugs, while men do. However, in a woman who already has heart disease, drugs such as Pravachol (Bristol-Myers Squibb Co., Princeton, NJ) provide more protection from high cholesterol than they do in men.
Though women’s cardiovascular research is in progress, the results aren’t in. Meanwhile, women of all ages can reduce their risks by not smoking, exercising 30 minutes three times a week, and limiting dietary fats to 30% of their total calorie intake. Other protections include taking one to six aspirins a week and, at the appropriate age, considering hormone replacement therapy.
• Heavy women can be fit, asserts a health feature in April’s Family Circle. Just because you’re overweight, don’t kill yourself by sitting around making promises you’ll never keep like "I’ll start jogging as soon as I lose 25 pounds." Readers receive encouragement to find classes at their local fitness facilities that go at a slower pace than those designed for their willow-thin sisters.
The emphasis is on aerobic fitness as well as building motivation to stick with the activity. The piece shows women how to stretch and tone muscles. Those aspects of fitness are particularly important to the large woman, the article says, because carrying extra weight can cause joint pain and arthritis.
The nagging issue of weight loss is replaced with a more encouraging message: Measure inches, not pounds. If you lose girth in the waist or hips, that signals better muscle tone, a valid indication of increased fitness, the article says. Another useful tip is to take quick water breaks during exercise to prevent dehydration.
• Redbook offers women new reasons to take vitamins even if they feel fine. Women who are too busy to sit down and eat regular meals should take a daily multiple vitamin tablet. Even those who eat the recommended five daily servings of fruits and vegetables ought to consider a daily vitamin because it’s tricky to combine foods that provide all the essential nutrients every day.
You’re likely to hear questions about new recommended daily allowances from women who read this piece because it suggests that scientists might be increasing the daily recommendations for vitamin C. It mentions that taking two to three times the current recommended amounts lower risks for age-related diseases such as cancer and cataracts.
Women ages 25 to 50 need at least 800 to 1,000 milligrams (mg) of calcium a day. If they aren’t getting it through dietary sources, a supplement is important. For pregnant or nursing women, the dose is 1,500 mg.
The report warns against exceeding the rec-ommended daily intake of the fat-soluble vitamins A, D, E, and K. Pregnant women are especially at risk as excesses can harm the fetus. The report visits the ongoing debate about the benefits of "organic" vitamins over those produced in test tubes. There are no apparent differences in the rates of absorption into the intestines except for vitamin E. Here the natural version is superior.
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