Posted by Nathan Switzer on Tue, Feb 23, 2010
Sheila Reilly went on record last November as someone who is glad that the American Cancer Society recommends screening for women age 40 and older. According to a new recommendation by the United States Preventive Services Task Force, she shouldn't have had a mammogram in her 40's.
She was interviewed by Ellen Lockyear at APRN last December. The podcast is available at KSKA.org and is also available here for download. Here is the lead in to her story, which was posted December 7, 2009:
The U.S. Senate has voted to require health insurance companies to provide free mammograms and other preventive services to women with a 61 - 39 vote during health care reform discussions. This on the heels of new information released by a federal advisory panel last month indicating that women don't need mammograms before age 50. The vote may override the panel's recommendations. Meanwhile, women are questioning the new guidelines, and want more information.
Ellen Lockyer, APRN - Anchorage
Download Audio (MP3)
Posted by Nathan Switzer on Tue, Feb 23, 2010
The following article, released jointly by the American College of Radiology and the Society of Breast Imaging, confirms what our medical director feared would happen. Fewer women are choosing to get a screening mammogram as a result of misguided recommendations by the US Preventive Services Task Force which were published last November. Imaging centers around the country are reporting a downturn in screening mammograms, and this is reflected in our Alaskan population as well. Please make a careful, well-researched decision to continue with the guidelines that have led to a 30% reduction in breast cancer mortality in the last two decades: encourage the women you love to get their annual, screening mammogram beginning at age 40.
Reston, VA - Feb. 22, 2010 - A recent Avon Foundation for Women survey confirms what the American College of Radiology and other experts warned would happen: states are using deeply flawed and widely discredited U.S. Preventive Services Task Force mammography recommendations to deny women coverage for mammograms, and many women are foregoing long proven, life-saving mammography care based on the mistaken USPSTF recommendations.
According to the Avon national survey of cancer health educators and providers, respondents from more than a dozen states reported changes in their states' breast and cervical cancer early detection programs following the USPSTF recommendations including the elimination of early screening programs for women under age 50. Avon reports that California, New York, Florida, Illinois and Michigan are among those states that have changed their breast cancer screening programs since the USPSTF released its guidelines. Respondents to the Avon survey also reported a decline in the number of women under 50 seeking mammograms and that many women already reluctant to have a mammogram are using the guidelines as their rationale to put off screening.
"Allowing a small number of people with no demonstrated expertise in breast cancer care to make recommendations regarding diagnosis of the nation's second leading cancer killer makes no scientific sense, and has set a off a chain of political and clinical events that many women may ultimately pay for with their lives," said James H. Thrall, MD, chair of the American College of Radiology Board of Chancellors. "Lawmakers at all levels need to act now to ensure that these recommendations do no further damage, and that women have full and ready access to mammography."
The federally funded and staffed USPSTF includes representatives from major health insurers, but not a single radiologist, oncologist, breast surgeon, or any other clinician with demonstrated expertise in breast cancer diagnosis or treatment. Despite their own analyses that screening annually beginning at age 40 saves the most lives and most years of life, the Task Force recommended against routine mammography screening for women 40-49 years of age, against annual mammograms for women between 50 and 74 (in favor of only every other year), and said there was insufficient evidence for breast cancer screening in women over 74. These recommendations run counter to the Task Force's own data and are out of touch with the long-proven policies of the American Cancer Society, American College of Radiology and other experts in the field.
"Breast cancer experts have explained why the USPSTF recommendations are scientifically mistaken and the recommendations have been disavowed by the Secretary of the Department of Health and Human Services and in Congressional legislation. Any action to curtail mammography coverage or discourage women 40 and over from seeking routine mammography based on the USPSTF recommendations is unjustifiable and will result in unnecessary breast cancer deaths, said Carol H. Lee, MD, chair of the ACR Breast Imaging Commission.
Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent nationwide. Ignoring direct scientific evidence from large clinical trials, the USPSTF based their recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50. There are no data to support this premise.
"Women need to speak up now before their access to mammograms, which have undisputedly saved tens of thousands of lives and continue to help drive down the breast cancer death rate every year, is taken from them. Doctors, payers, and patients should disregard the USPSTF recommendations and continue to adhere to American Cancer Society, American College of Radiology, and Society of Breast Imaging screening recommendations," said W. Phil Evans, M.D., president of the Society of Breast Imaging (SBI).
Federal and state legislators need to act to officially exclude USPSTF mammography recommendations from coverage decisions by federal and state insurance programs. Also, state and federal legislators need to act to ensure that public and private insurance companies cannot deny mammography coverage to women based on the deeply flawed USPSTF recommendations.
Further, the USPSTF process needs to be fundamentally changed. Lawmakers need to require that the USPSTF include experts from the field on which they are making recommendations, and that its recommendations be submitted for comment and review to outside stakeholders in similar fashion to rules enacted by the Centers for Medicare and Medicaid Services.
"Two decades of advances against a disease which kills 40,000 women each year may be on the cusp of being reversed because of recommendations made by those with no demonstrated breast cancer expertise, via a process with little or no transparency, with no input from those with the expertise and experience that even the Task Force admits continue to save thousands of lives each year. These USPSTF recommendations highlight that the USPSTF process must be changed for it to provide its intended benefit and avoid adverse domino effects, like that reflected in the Avon survey, which could mistakenly cost countless lives," said Thrall.
The USPSTF is a panel funded and staffed by the HHS Agency for Healthcare Research and Quality (AHRQ). The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gave the U.S. Deptartment of Health and Human Services the authority to consider USPSTF recommendations in Medicare coverage determinations. Private insurers and state governments may also incorporate the USPSTF recommendations as a cost-savings measure.
To speak to an ACR spokesperson, please contact ACR Director of Public Affairs Shawn Farley at 703-869-0292 or sfarley@acr-arrs.org.
Posted by Nathan Switzer on Tue, Nov 24, 2009
Someone recently pointed out this video to me as an example of how a heartfelt video can speak much louder than any words. In this case, the "words" came from a group of breast cancer fighters in Oregon who work at Providence St. Vincent, a sister facility. What strikes me about this video is that highlights the many different people who work to provide care and hospitality to patients. From the environmental services crew, to the barista who smiles as she hands over a coffee, to the lab techs who carefully handle test tubes, everyone makes an appearance. The video isn't preachy, but is tied together with pink gloves and the exuberance of a team of professionals who are passionate about the cause of fighting breast cancer. I believe I even saw an actual patient joining in the dance, which reminds me that "Laughter (and possibly dance) is the best medicine." It also appeared to me in one scene that some patients were in the background, wondering what in the world was going on, and probably harboring (like me) a secret desire to star in a healthcare music video on MTV (Medical Television).
I hope you enjoy this as much as I did, and please share as you see fit.
Posted by Nathan Switzer on Thu, Nov 19, 2009
This past Tuesday, November 17 new recommendations by the US Preventive Services Task Force rolled out. The Task Force took a "new" look at existing data, and made a recommendation to drastically change screening mammography guidelines. Instead of beginning at age 40, the Task Force stated that women should wait until 50 for their initial mammogram, unless they are high risk. Additionally, they recommend screening every other year, and that all screening stops at age 75.
Dr. Denise Farleigh, medical director of Providence Imaging Center (PIC), makes the following initial statement regarding the Task Force's announcement:
"The American Cancer Society, the American College of Radiology and the Society of Breast Imaging have already issued formal statements that express their opposition to the revised guidelines presented by the Task Force. I am in agreement with their comments, many of which can be viewed in the links below.
The ‘new' recommendations are irresponsible and dangerous, and will cost many women their lives if followed," emphasizes Dr. Farleigh.
"We are at risk to reverse the downward trend in the death rate from breast cancer in this country which is due in large part to screening with mammography, along with more effective treatment. The woman in her forties has a one in 69 chance of developing breast cancer, and delayed diagnosis will contribute to increased morbidity from treatment as well as an increase in deaths from the disease.
In summary, PIC will continue to recommend screening for women over the age of 40."
Here are links to some initial responses nationwide:
STATEMENT FROM THE AMERICAN COLLEGE OF RADIOLOGY AND THE SOCIETY OF BREAST IMAGING:
USPSTF Mammography Recommendations Will Result in Unnecessary Breast Cancer Deaths Each Year
Detailed ACR Statement on Ill Advised and Dangerous USPSTF Mammography Recommendations
American Cancer Society Statement
Susan G. Komen Screening Statement 11-16-09
Health & Human Services Secretary Sebelius Statement on New Breast Cancer Recommendations - 11-19-09
Posted by Nathan Switzer on Tue, Aug 18, 2009
What you need to know about these tests
Every year millions of women in the U.S. willingly bare their breasts to a stranger in the hope of learning they don't have cancer. These women get a mammogram, a crucial tool in the fight against breast cancer. What follows are some basic questions about mammograms with answers from local and national authorities.
Q What is a mammogram, and what is it used for?
A A mammogram is an x-ray picture of the breast. It is the best screening tool for finding breast cancer, reports the
National Women's Health Information Center (NWHIC).
The test is done while you stand or sit in front of a low-dose x-ray machine, and a technologist places your breast-first one, then the other-between two plates that press the breast and flatten it. The
compression, which helps the technologist produce a better picture, may be uncomfortable, but it lasts only a few seconds.
A radiologist interprets the x-rays, looking for suspicious areas or lumps you may not be able to feel or that may not be causing symptoms. If needed, follow-up tests may be ordered by your doctor.
Q What is the difference between screening and diagnostic
mammograms?
A A screening mammogram is a routine test for women who don’t have symptoms of breast cancer. The disease can take many years to develop and may cause no symptoms early on. A mammogram can help find cancer at its earliest stages, when there may be more treatment options and treatment may be more successful. A diagnostic mammogram is a follow-up exam. It may be ordered if a
screening mammogram shows an abnormality or after a woman or her doctor finds something, such as a lump, that warrants further testing.
“It is important that a woman talk to her healthcare provider about any breast changes prior to her annual mammogram. Then, when she comes for her mammogram I can thoroughly evaluate any identified problems” says Denise Farleigh, MD, Medical Director at Providence Imaging Center (PIC).
More images of the breast are taken during a diagnostic mammogram than a screening test.
Q How often should I get a mammogram?
Should I also get an MRI?
A According to the American
Cancer Society (ACS), women 40
and older should have yearly screening
mammograms.
The ACS recommends a yearly MRI
in addition to a screening mammogram
if you have an increased risk of breast
cancer—for example, you have a BRCA1
or BRCA2 gene mutation or have a parent,
sibling or child with either of these
mutations.
“If you have a strong family history of breast cancer
or think you may have increased risk, talk to your healthcare provider about risk assessment.
At PIC, we work closely with genetic counselor Maggie Miller, at the Providence Cancer Center. She reviews family and personal history and determines if you are a candidate for
Breast MRI screening,” explains Dr. Farleigh.
For most women at high risk of breast
cancer, MRI and mammogram screening
should begin at age 30, reports the ACS.
Q What are the benefits and risks of
mammography?
A As good as mammograms are at
detecting breast cancer, they aren’t
perfect, say experts. There are risks of
both false-negative and false-positive
results.
A false-negative result means that a
breast looks normal on a mammogram
but cancer is actually present. False negatives
are rare, according to the NWHIC.
They are more common in younger women
because their breast tissue tends to be
denser than the tissue in older women.
A false-positive result means that
it looks like cancer is present when it’s
not. Women between the ages of 40 and
49 have the highest incidence of false positive
mammograms reports the Radiological Society of North
America.
According to Dr. Farleigh, "When I see something new on a mammogram, I need to investigate further with additional tests until I am satisfied that the new finding is not a cancer."
In addition to screening mammography and breast MRI screening, PIC offers complete breast diagnostic services including: diagnostic mammography, ultrasound, diagnostic MRI, and imaging guided biopsies using stereotactic, ultrasound and MRI guidance. If a woman is diagnosed with breast cancer, we can link her with the Patient Navigators at the Providence Cancer Center to help her access resources during treatment and beyond.
What a radiologist looks for
When a radiologist reads a mammogram, he or she looks for calcifications
and masses (lumps).
Calcifications appear as small, white spots on the x-rays. They are
mineral deposits that may or may not be caused by cancer.
Large calcifications, called macrocalcifications, are often related
to aging, injury or inflammation. They typically don’t require a biopsy
(removal of a small amount of tissue) because they are almost never cancerous.
About half of all women older than 50 have macrocalcifications,
reports the American Cancer Society (ACS).
Tiny specks of calcium, called microcalcifications, can sometimes
signal cancer if they are grouped in a certain way. A radiologist will
carefully evaluate the shape and layout of the calcifications and may
recommend a biopsy.
Masses (lumps) in the breast can be caused by many things. For
example, a mass may be a cyst—a noncancerous, fluid-filled sac—which
is diagnosed with an ultrasound or aspiration, fluid removal with a
needle.
If a mass is partly solid, however, it may be a tumor. The radiologist
will study the size and shape of the mass on the mammogram. He or
she will also see if the mass was present on past mammograms and will
compare how the mass looked on those tests with the current one.
Depending on the radiologist’s findings, a doctor may take a wait-and-see approach—using periodic mammograms to monitor the
mass—or recommend a biopsy.
About 10 percent of women who have screening mammograms
need more testing, such as an additional mammogram, an ultrasound
or a biopsy. But most will learn that they don’t have cancer, reports the
ACS.
To learn more about mammograms and breast cancer, visit www.cancer.org
and www.cancer.gov
Posted by Nathan Switzer on Fri, Mar 20, 2009
When your healthcare provider hands you an order for an MRI exam and you aren't expecting it, sometimes it can make everything else you hear afterwards sound like gibberish. "Why do I need an MRI? Isn't that an expensive test? Can you get out of that machine if you want to?" are some thoughts that may flash through your mind.
Don't fear. Be informed, and know that it is a common imaging test that's been around for more than 20 years. Here are a few things you should know before you schedule your first MRI exam, no matter where you go.
1) Do they perform high field or open MRI?
Imaging facilities typically offer one or the other. While an "open" unit may have a bit more room for some patients, others will still encounter a low ceiling which may cause some anxiety for the claustrophobic patient. Open units typically have a higher table weight limit, and may help patients who have wider shoulders or perhaps a larger girth. Many specialists like neurologists and orthopedists prefer the image quality obtained from a high field magnet. A plus for the patient is that the exam tends to be faster as well, because there is a more powerful magnetic field (1.5 T or higher).
2) Does my insurance allow me to go wherever I want?
It is always advisable to check with your insurance to see if they have a preference for where you receive your imaging services. It is also a good practice to get a quote from a facility you might be interested in, as prices can vary.
3) Does the MRI staff have any specialized training?
It is always good to check and see if the MRI technologists in a facility are not only ARRT registered technologists, but registered in the specific field of MRI. This is a special test of their knowledge of the physics of the equipment, the specific pathologies and anatomy that MRI sees, and magnetic safety. Providence Imaging Center requires all technologists that they hire to not only be ARRT registered but pass the MRI registry within 16 months of their date of hire.
4) Can I easily get images from my exam on a CD?
A CD of your entire exam is available at many facilities. If it is created shortly after your scan, it will not have the radiologist's report on it. Be sure that the facility provides the images in a standard format called DICOM, which means the images can be viewed in the correct, original format no matter where you travel for healthcare. Typically, CDs will only be viewable on PCs, not Apple computers. There are work arounds for this, mentioned on our website www.provimaging.com/cd
5) Do they make accomodations for people who are anxious or may be claustrophobic?
Some imaging facilities advertise an "open" MRI scanner, which can help some patients who are extremely claustrophobic, while others utilize conscious sedation to completely "knock" a patient out. The skilled technologist has many techniques to help put patients at ease, and even very claustrophobic patients have done well in high field (more tubular shaped) MRI scanners. One tip is to have a damp washcloth to cover the eyes. Another is to have a friend drive you to and from your appointment, and receive a small dose of oral sedation like Xanax, which taken appropriately beforehand will relax you. This is offered at Providence Imaging Center upon request.
6) Do they have appointments in the evenings or on weekends?
Check with the MRI scheduling staff of the imaging center if you need a special appointment time; not all will be able to accomodate your request.
7) Is the equipment well-maintained and certified by an overseeing board?
MRI equipment is quite complicated, and needs regular maintenance to run smoothly and accurately. The American College of Radiology specializes in accreditation of imaging centers and their various modalities. A physicist reviews images that are submitted for review, and either passes or fails a facility based on strict criteria. It is expensive and time consuming to get accredited in this way, and completely voluntary as well.
8) Is the facility located near other medical appointments that I have?
It can be inconvenient to go to a specialty center for one test, only to find out they don't offer a companion test that has been ordered. For example, not all facilities offer x-ray along with MRI, or offer a nearby outpatient laboratory.
9) Is MRI safe if I have a tatoo or metal piercings?
Check with MRI scheduling staff to find out about the safety of various metallic adornments. Some may have to be removed, or may interfere with image quality but not be a danger in the MRI scanner which is ALWAYS on (even when it's not making noise).
10) I have kidney problems -- can I still have an MRI?
Let the Imaging Center know if you have a history of kidney failure. Some MRI scans utilize a contrast agent containing gadolinium, which may require some special precautions be taken. The conscientious technologist will check your laboratory results and possibly consult a radiologist to determine the safest way to proceed with your examination.