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Owning Our Boobs: An Integrative Medicine MD's Thoughts on the New Mammography Recommendations
Hiya Pinkies. I already posted something for today, but a bunch of you have come to me begging me to don my white coat and comment on the new recommendations from the U.S. Preventative Task Force about mammography in young women, so here goes.
Mammograms - Not Perfect, But Far From Pointless
My father was a radiology doctor who specialized in mammograms, so I grew up around those machines that take two perfectly good knockers and squash them into Swedish pancakes. Dad used to joke that if women were in charge of medicine, men would have to stick their penises between two plates and get “manograms” after the age of 40. When I was young, I remember sitting beside Dad in the dark screening rooms while he inspected film after film, hunting for subtle signs that might signal breast cancer. He likened it to reading a Where’s Waldo book. Mammograms may seem like torture, but they also may save your life.
But we all know that. Why am I writing this post? Because the U.S. Preventative Task Force just declared that women in their 40s of “normal risk” should no longer get routine mammograms. They also say women after 50 should only get mammograms every other year, recommend against teaching breast self-exams for all women, and say no mammograms after the age of 74. WTF? What changed since they recommended mammograms every 1-2 years in women over 40?
Okay, so mammograms are far from perfect. So we’re gonna throw all progress we’ve made in reducing breast cancer mortality out the window? What about new advances in digital mammography? What about my patient who just potentially saved her own life by finding a breast cancer while examining her breasts? What about Mrs. Olivier, my amazingly vital 81 year old patient whose mammogram found an early breast cancer ten years ago and is still alive and kicking after treatment?
Okay. So it's true. Self breast exam data isn’t stellar. Large studies have shown it to be pretty ineffective, actually. But what about those few women who do detect their own cancers and save their own lives? Plus, what’s the harm in feeling your boobies for lumps? And what’s with the recommendation against mammogram in women after 74? These are the women at highest risk, for whom mammography screens most effectively. All of the sudden, Grandma is no longer important? Have I just stepped into some alternate universe? I mean, seriously, people.
Why Did They Change The Guidelines?
There is no new data. It's all about how you look at the existing data. The Mautner Project summarizes the data:
The USPSTF used statistical modeling to predict the impact of screenings found over a 10 year period. It found that if a thousand women beginning at age 40 were screened with mammograms, there were small gains in cancer deaths averted, compared to if these women started at age 50. Specifically, their modeling found that 6.1 deaths would be averted, compared to 5.4. The panel judged that difference to be not worth the expense, biopsies and anxieties.
The woman whose life was saved might beg to differ.
Let’s look at those numbers in terms of larger numbers of women screened, using the statistical modeling provided by the USPSTF:
Deaths of women averted by screening in their 40s vs. deaths of women averted by women who start screening in their 50s:
1,000 women 6.1 5.4
10,000 women 61 54
100,000 women 610 540
1,000,000 women 6100 5400
So for every 100,000 women screened in their 40s, as opposed to waiting till their 50s, 70 more women would live. For every one million women, 700 more women would live. Over 33 million mammograms are performed each year in the United States.
The New York Times of 11/18/09 reported that the USPSTF also found differences in years of life gained by women receiving mammograms in their 40s, compared to starting mammograms at age 50:
Years of life gained per
1,000 women 120 99
10,000 women 1200 990
100,000 women 12,000 9,990
1,000,000 women 120,000 99,990
Gulp. Personally, I don't need some patronizing government board trying to protect me from anxiety. I'd rather be protected from breast cancer, thank you very much.
What the Studies Say
Whew…Deep breath, Dr. Lissa. Okay, so mammography for women in their 40s has long been a controversial issue. Truth is, mammography just isn’t a great screening tool for women age 40-49. In our forties, our breasts are more dense, making it harder for X-rays to penetrate breast tissue to see early signs of cancer. Also, because breast cancer is less common in this population, you’re more likely to wind up with false positives, leading to follow up mammograms, breast biopsy surgeries, and enough anxiety to leave you quivering. So medical societies have been mixed on their recommendations for women in their forties, but most agree that women in their forties should have mammograms no less than every other year.
While they’re not an ideal screening tool for breast cancer, studies estimate that mammograms detect about 75% of breast cancers in women in their 40s and 90% percent of breast cancers in women in their 50s and 60s.[i] Early detection can mean the difference between living and dying. If you’re over 40 and you get mammograms regularly, your risk of dying of breast cancer is reduced by 34%.[ii]
So why the push to nix it altogether when we already know that mammograms save lives? According to Dr. Otis Brawley, chief medical officer for the American Cancer Society, “With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.” Say what? Actually, I do hear what they’re saying. The task force isn’t saying that nobody should get screened in their 40s. They’re saying they should talk to their doctor about risk, but they shouldn’t get screened routinely. And I hear what they're saying from an epidemiological standpoint. So maybe it's not cost-effective. But price can you put on a mother of two young kids? I know we docs aren't supposed to, but I can't help getting emotional about this. I've lost too many people to breast cancer already...
Others Disagree
The American Society of Breast Surgeons just issued this statement. “We believe there is sufficient data to support annual mammography screening for women age 40 and older. We also believe the breast cancer survival rate of women between 40 and 50 will improve from the increased use of digital mammographic screening…The Society will continue to advocate for routine annual mammographic screening for all women beginning at age 40. Mammography screening reduces breast cancer mortality and saves lives.” The American Cancer Society and the American College of Obstetricians and Gynecologists agree.
On the flip side, Dr. Susan Love, author of Dr. Susan Love’s Breast Book agrees with the new task force recommendations. She says:
These recommendations are long overdue. Most countries do no support mammography screening under 50 and do it every other year after 50 in their government-sponsored screening programs. I hope that the insurers will change reimbursement, because it is probably the only way that women will be spared the extra radiation exposure of too many mammograms. Since our system pays the radiologist, hospital, or mammography center and biopsying surgeon by the more they do, there is no incentive for this to come from the medical profession.
Strong words. Yes. Mammograms have their risks. Applying radiation to a breast in order to reduce the risk of breast cancer may indeed seem counterintuitive. I work at a holistic health center, and many in the holistic health world recommend against mammography altogether, favoring breast thermography, which my patients often choose to use as an alternative to mammography. And yes, it’s true that mammography is not a great screening tool for younger women. But what's a girl to do?
So what do I think?
Well, I’m admittedly biased. Half a dozen of my closest friends and many of the women I’ve worked with for The Woman Inside Project were diagnosed with breast cancer in their early forties, some of them by routine mammography alone. Had they not been screened, would they have survived their cancers? No way to know. How much is one life worth? Also, since Dad was a radiologist, I grew up around stories of breast cancer near misses. I know that’s not scientific reasoning, but these new recommendations bring up a lot of feelings for me.
My biggest concern about the task force recommendations is that insurance companies may use this as an excuse to deny coverage for women in their forties who wish to get mammograms. If they have to pay out of pocket, fewer women will get screened, and we might wind back the clock to the days when women only got diagnosed with breast cancer after a lump was detected. Why would we want to go backwards? Is this all part of some government plan to cut back spending on the cusp of health care reform? Are our best interests really at heart? I'm not sure. What do I know?
Breast Thermography
Every woman ultimately has to make this decision for herself, assessing her own risk tolerance. At my office, we offer breast thermography as an adjunct to mammography or as a mammography alternative for those who are young or who choose to avoid mammography because of radiation concerns. If mammograms give you the heebie-jeebies and you’ve opted to skip them, check out breast thermography. Thermography, a non-invasive procedure using digital infrared imaging to assess heat in the breasts, may reflect an increase in blood vessels that are commonly seen with evolving cancer. If there's heat on the body's surface, this can indicate cellular damage, increased cellular activity, and inflammation- which may be cancer precursors. Breast thermography may be useful for screening young women, and it may even detect changes in the breast before breast cancer arises.
Breast thermography has some great advantages over mammography. Unlike mammography, which does nothing to prevent breast cancer- only death- thermography can actually assess the conditions in your body that may lead to breast cancer. And these changes can be treated- and often reversed- through dietary changes, lifestyle modifications, supplements, and bioidentical progesterone cream applied to the breasts.
Keep in mind that studies to support thermography as a replacement for mammography are limited. But as an adjunct or alternative for those who wish to avoid radiation or fall into that younger age group for whom mammography works less well, it has great promise.
Breast Thermography
Will I get a mammogram?
You betcha. I just turned forty, so I’ll soon be making the phone call to get my hooters mashed between the plates. I’ve got a three year old, a husband, and a beautiful mission to serve. I’ve got a lot to live for, and I’m not going to let some new recommendations get between me and a long life. But I may not do it every year. I may get thermograms in between (and in addition to mammograms), just to reduce my radiation exposure and assess any breast health issues I might be able to reverse. Ultimately, you’ve got to go with your gut. What feels right to you? When there’s controversy among various organizations, it usually means there’s no one right way. Listen to your body. Ask for guidance from the Universe. Let your boobs tell you what to do…
Freaked out about breast cancer? Don't be. Fear won't help. But these tips may (regardless of what the task force says).
Integrative Medicine Approaches to Reducing Breast Cancer Risk
-Practice monthly self-breast exams.
-Eat 5 or more servings of fruits and vegetables per day, preferably raw
-Limit your intake of animal fats, particularly red meat.
-Eat lots of fiber
-Avoid drinking two or more glasses of alcohol per day
-Increase your intake of superfoods high in antioxidants, such as kale, beets, carrots, beans, collard greens, brussel sprouts, and broccoli. If you’re not good about eating your veggies, try Sun Chlorella.
-Drink green juice. It’s a great way to alkalinize your body, and cancer likes acid, not alkalinity.
-Avoid dairy or use organic butter, cheese, and milk, as they are less likely to be contaminated with human growth hormone or estrogen, which is sometimes used to stimulate milk production in cows.
-Use extra-virgin olive oil, raw flaxseed oil, and cod liver oil.
-Expose yourself to the sun. High levels of Vitamin D help fight cancer.
-Exercise. It helps detoxify the body and decreases the amount of estrogen that reaches the breasts. Women who exercise regularly have a 30% lower risk of breast cancer.
-Apply loving energy to your breasts with daily massage. Massage your breast tissue and the area under your arms while you're soaping yourself in the shower. Close your eyes and visualize healthy breast tissue. Release all fear of breast cancer through a release valve at your root chakra. Dump the toxic energy of fear into the earth's core and allow the golden light and radiant healing of the Universe to enter through the top of your head. Close your eyes and imagine healing energy extending from your heart, through your arms, to your hands.
-Talk to your doctor about when you should begin mammography and/or breast thermography.
-Be aware of your family history. If you have a first degree family member who was diagnosed with breast cancer before menopause, consider talking to a genetic counselor.
-Limit alcohol intake, and if you do drink alcohol, make sure you’re getting enough folic acid in your diet. If not, take a supplement that includes folic acid.
-If you are at higher risk for breast cancer, talk to your doctor about supplements you can use to reduce your risk.
What will you do, Pinkies? Please share your thoughts.
Loving you and your PINK boobies,
Lissa
PS. Want more? Watch this EXTRA video clip where they interviewed Pinkie survivor Marla Rosner Johson.
[i] National Institutes of Health Consensus Development Conference Statement Jan 21-23,1997. 103. Breast cancer screening for women ages 40-49.www. consensus.nih.gov/cons/103/103_intro.htm
[ii] Elwood, M, Cox, B, Richardson, A. The effectiveness of breast cancer screening by mammography in younger women: correction. Online J Curr Clin Trials 1994; 121:385.
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A great article about
By Lissa Rankin on Tuesday, 12/01/2009 at 3:10 PMA great article about radiation exposure from mammograms in young women at high risk for breast cancer: http://www.nytimes.com/2009/12/01/health/research/01cancer.html?_r=1&emc=eta1
Thank you dear Marsha for
By Lissa Rankin (not verified) on Saturday, 11/28/2009 at 8:05 PMThank you dear Marsha for your insightful and well-thought out comment. I agree- we need better screening. I fear most for those who simply can't afford to pay out of pocket for alternative screening. But yes, breast MRI is promising. Thanks for helping us keep this discussion so lively! xoxo Lissa
A comment on the recent
By Marsha Nunley, MD (not verified) on Saturday, 11/28/2009 at 8:03 PMA comment on the recent controversy from another integrative physician (just to offer another viewpoint)... I practiced primary care for years prior to concentrating on integrative health and these recommendations are not new. We have known for a long time that mammograms are a poor screening tool but it has been thought that they were the best we could do. As Dr Lissa says, the breasts in young women are more dense and the mammogram is even less sensitive and less specific in this group. Over the last few years, it has become increasingly clear that the incidence of breast cancer is not declining which one would expect if the screening was doing its job. Consider the decline in cervical cancer after the PAP smear became widespread which has not occurred in breast cancer. I think we are asking the wrong questions and trying to hold on to a test that is not very good but is CHEAP and women seem to believe that it saves their lives. (Or they have been led to believe this) There is also the issue of repeated low dose radiation in a highly metabolically active tissue. We know that radiation causes cancer in the thyroid and other tissues, why do we think the breast is exempt? I would suggest that the breast MRI though considerably more expensive is a much more sensitive and specific test and if we are going to screen for breast cancer, this is the test that we should be using. Even the thermogram though not widely available or covered by insurance is more sensitive and specific for breast cancer than the mammogram. I am 59 years old and have had one mammogram but recently had a breast MRI (paid out of pocket $200-500) and this is how I will continue to screen and protect myself from breast cancer. The MRI does not pose the radiation risks that occurs with standard mammography and does not require smashing of delicate breast tissue. I have a friend whose 34 yo daughter was recently diagnosed with breast cancer found by chance because she had tenderness, confirmed by needle biopsy and then by MRI to see extent of disease. This woman has 2 aunts with breast cancer and it is my opinion that all her other aunts and siblings should be screened with MRI beginning in their 30's. These women are not protected from breast cancer with mammograms. So I think we are asking the wrong questions and accepting less than what medicine has to offer. I think every woman over forty and those at high risk less than forty should be screened for breast cancer with MRI. The savings in unneeded tests and treatment would easily pay for the added costs and maybe we could truly decrease the devastation from this disease. Just another perspective...Hugs to Dr. Lissa
MARSHA NUNLEY, MD
I think you're spot on
By Lissa Rankin on Thursday, 11/19/2009 at 6:37 PMI think you're spot on Darline. I think the government sat down to figure out how we're going to afford health care reform, and when somebody said, "How can we cut costs," someone said, "Hey, let's ditch mammograms in young women. We'll save billions and we'll only lose a few 100,000 lives."
But why women's health? Why have we ALWAYS been the ones to get shafted? Why not cut off PSA testing? I mean, seriously, Pinkies.
How much IS one life worth? What if it's your loved one? What if it's YOU?
Thanks for such a well
By Darline Turner-Lee (not verified) on Thursday, 11/19/2009 at 6:33 PMThanks for such a well written explanation to the Government Task Force's recommendations. I agree with you 100% and was going to write as much on my blog. No need to reinvent the wheel, however.
But I do want to highlight one point that you made. One of my greatest concerns is that in the wake of the health care reform debate, Opponents and insurance lobbyist will use this recommendation to deny coverage of mammograms to women in their 40's. For women unable to pay out of pocket, this could have disastrous ramifications in that if they do have breast cancer, they won't be diagnosed until they have a very palpable mass-and if they aren't doing BSE's, who knows how large the mass will be and how advanced the cancer before a diagnosis is made?
I can't help wondering if all this "review of the data" isn't a prelude to the fact that a government sponsored health care plan is imminent and this is "a way to cut costs." Ladies, we have to stand and not let our health be dictated by those with nothing to lose and a whole lot to gain.
You go girl!
By Lissa Rankin on Thursday, 11/19/2009 at 11:08 AMYou go girl!
just had my annual
By jane (not verified) on Thursday, 11/19/2009 at 10:58 AMjust had my annual thermography yesterday! drove 5 hours to do it and it was so worth it...
p.s. I have been getting them
By Eileen Smith (not verified) on Thursday, 11/19/2009 at 10:12 AMp.s. I have been getting them done since I was 35, due to my maternal grandmother having had breast cancer. My insurance didn't cover it, and won't cover it every year. So I pay for it myself. I don't feel I have any other choice and feel a yearly examine is important. I would like to start getting the new digital ones offered now. I'm sure that won't be covered either.
Clare, There are some who
By Lissa Rankin on Thursday, 11/19/2009 at 10:07 AMClare, There are some who choose to do breast thermography instead of mammography. Like I said, I recommend both- together. We just don't have all the data yet to say whether thermography can replace the benefit of mammography.
Yes- we need better screening. Ultrasound as a screen has not been shown to be very effective, but it is useful at assessing lumps or following up abnormalities found on mammography. Pray for better tools, ladies!
Why don't you go for a breast
By Clare (not verified) on Thursday, 11/19/2009 at 9:57 AMWhy don't you go for a breast thermography instead of your mammography? All that squashing of a breast containing so much lymph can't be good for the lymphatic system of the breast. Another thing I have often wondered is why not just do a breast ultrasound. If a problem is detected w/ a mammo then they do an ultrasound. Why not just start out with an ultrasound--no squishing, no radiation and it must be cheaper b/c it removes a test. Thanks for the forum
Thank you Caroline. PLEASE-
By Lissa Rankin on Thursday, 11/19/2009 at 8:12 AMThank you Caroline. PLEASE- spread the word. I just want to empower women to be advocates for their own health and well-being.
And Jenn, yes- I'm a huge Dr. Christiane Northrup fan (can't believe she just said yes to writing the foreword for my new book What's Up Down There? Questions You'd Only Ask Your Gynecologist If She Was Your Best Friend, which will be out Fall 2010 from St. Martin's Press). And I do believe our bodies suffer when we don't nurture our souls.
Dear Lissa, am so glad of
By Jenn (not verified) on Thursday, 11/19/2009 at 7:51 AMDear Lissa, am so glad of this article and the insight you bring from wholistic medical viewpoint. There is so much fear surrounding the issue of breast health. As if women weren't holding enough inside them. I loved Dr Northrup's section in Women's Bodies Women's Wisdom linking 'too much giving, nurturing others' with rates of breast cancer. Someone else recently linked the high rate of divorce in N.A. to high rates of breast cancer. I think it's the tip of the iceberg...so much to discover. Would love you to write about the Pill, and its effects on women's health, especially menstrual suppression which is being recommended by some doctors and is downright scary.
Great article. too many
By Caroline (not verified) on Thursday, 11/19/2009 at 7:45 AMGreat article. too many reasons why this is a great post to name them. i'm just so relieved to hear your rationale. I have been "tweeting" with DrVal who has a blog, (getbetterhealth, i think) and her response also seems more of a compromise than the US Preventative Task Force: she asserts that we need a more effective test than the ones we use, BEFORE we make changes to the mammogram regimen. Switching people over to a better test is less offensive --not to mention safer-- than simply reducing the number of tests done. so i say, the govnt should quit wasting its/our time and energy with this type of ruling, and really apply its egergy to developing better tests for women. (preferably less painful and humiliating ones, for once.. but im not going to delve into the sexist history of women's medicine, which up til very recently had men at the helm.)
as a lady, I cant help but feel attacked by this attempt at restricting womens medicine. Am I being oversensitive? I mean, we only really JUST started talking about reducing health care costs and reform, and immediately we look to cut costs by reducing _women's_ safety. Its just so silly. a statistic that just came out of the American Cancer Society Annual conference states that 75% of women are formal or informal caregivers. Reducing our chances of fighting breast cancer is a fine "thank you" from the powers that be.
I hope you dont mind, but I'm going to quote you on a site that I'm helping on- SpeakHealth.org (http://speakhealth.org/with-cancer-screenings-first-do-no-harm/) because i've been quite upset about this debate, and I think you are stating my thoughts way more eloquently than I ever will. Thanks!!!
~caroline
I was just listening to NPR
By Eileen Smith (not verified) on Thursday, 11/19/2009 at 7:10 AMI was just listening to NPR radio yesterday and they were talking about this. Thank you for this important and timely article.
Heather -- maybe you can get
By Carole (not verified) on Thursday, 11/19/2009 at 3:57 AMHeather -- maybe you can get assistance with a mammogram from St. Mary's Medical Center. Check them out here http://www.nationalbreastcancer.org/About-NBCF/Our-Mission/St-Marys-Medical-Center.aspx
Pattie- I so appreciate
By Lissa Rankin on Wednesday, 11/18/2009 at 9:30 PMPattie- I so appreciate hearing your voice. And THANK GOD you're okay. I mean- really. What about all of us young people who have so much to live for? I hear you, sister. God bless you...
And Heather, I wish I knew where to send you for a free mammogram. I'm new to the SF area. I might call the public health clinics and let them know you are without health insurance and see if there are any public health services they might refer you to.
Either way- take care of yourselves Pinkies. Be aware. Take precautions. Protect yourselves. Loving you Lissa
Ooops, anyway, she was lucky
By Heather in SF (not verified) on Wednesday, 11/18/2009 at 9:17 PMOoops, anyway, she was lucky to fund this lump during a self exam, so this idiot panel who says we shouldn't do exams are out of their minds... I really appreciate the forum here and to have a voice. Does anyone know where I can get a free mammogram in SF? I lost my health insurance at the the time of my mom's surgery and should get one if I can find a place. Thank you all, you are amazing women!
An update: I told my mom
By Heather in SF (not verified) on Wednesday, 11/18/2009 at 9:12 PMAn update: I told my mom about this blog and your kind comments - she said thank you!! She told me my aunt, her baby sister, had breast cancer 5 years ago (I didn't know the story). My aunt had a normal clear mammogram a month or so before she discovered a lump while in the shower. It was Stage 3 highly aggressive breast cancer. Quickly they scheduled a full masectomy, 2 rounds if chemo then radiation. Her remaining breast was clear but she had it removed for preventative measures, a move her surgeon approved. 2 years after this her breast reconstruction was complete. She had a melanoma on her leg 6 months before the breast cancer. She was also low in Vitamin D.
Being a three time breast
By Pattie Meyers (not verified) on Wednesday, 11/18/2009 at 8:51 PMBeing a three time breast cancer & brain surgery survivor, I am appalled at what I am hearing on the news. Is a mammogram the only thing to use in finding cancer - NO. However, it is another tool to be used along with self exam, knowing your breasts, regular check ups, etc. I do not know the validitiy of MRI's vs mammos, but I do know they are needed. My first two cancers were found by me, did not show up on my mammo, however, the third (during my 3 mo check up after intense treatment) was found by the Dr on my mammogram. I have met too many women who had no idea they had cancer until it was found on a mammogram. Nothing is perfect but refusing known ways of stopping cancer's early treatment is insane. My first mammo was at age 25, 1st cancer at age 36, 2nd at 46 and third at 48. Mammos for each occurrence. Drs are recommending to my two daughters (30 & 31) to receive a mammogram in their 30s. I wonder if this new "thought process" has anything to do with the last one of "drive thru mastectomy." Listen to your body ladies and then fight for what you already know is true.
Any yes, Pinkies- YOU KNOW
By Lissa Rankin on Wednesday, 11/18/2009 at 8:20 PMAny yes, Pinkies- YOU KNOW YOUR BODY BETTER THAN ANYONE. Of course, you go to docs and other health care professionals seeking guidance, but ultimately, only you know what your body needs. What I hear from you is confusion- but also resonance with what your body needs.
I am still investigating the data. What frustrates you is that it's true- there is no new data. These new recommendations appear to be about money- which just pisses me off. If that's the case - SAY SO. Just tell us its not cost-effective. But don't cloak it in public health broo-ha-ha.
I mean seriously. We all know young women who are only alive today because they got early breast cancer screening. What about them...
Loving you L
Jacqueline, Funny you should
By Lissa Rankin on Wednesday, 11/18/2009 at 8:17 PMJacqueline, Funny you should reference Women to Women, the site inspired by Dr. Christiane Northrup's clinic. I just found out today that she agreed to write the foreword for my book What's Up Down There? Questions You'd Only Ask Your Gynecologist if she was Your Best Friend. It must be karma!
Hi Lissa, Thanks for cutting
By Jacqueline (not verified) on Wednesday, 11/18/2009 at 6:35 PMHi Lissa,
Thanks for cutting through all the noise with a superbly insightful post! I am new to OwningPink, but if this is what you're all about, than I'm in! I tweeted this to you, too, but another pretty balanced article that has surfaced for me on the mammogram issue is this one from Dixie Mills at Women to Women... What — no annual mammogram screening? New recommendations for women -- Dr. Mills makes the point that these recs have been in place in Europe for over a decade and breast cancer death rates there are no higher than rates in US. Would be curious to know, though, how thermography is used in Europe and elsewhere.
This conversation is so
By Carole (not verified) on Wednesday, 11/18/2009 at 6:29 PMThis conversation is so terrific ... I keep being reminded that we need to be our own best advocates and not let all the "experts" take control, especially when we are just statistics to them. Thank goodness this information is out in public and that we have the internet to share it and learn. In the "old" days, we had to rely on a few people who may not have been vigilant enough on our behalf, or may have had their own agendas uppermost in their minds. Now we can research, read, get in touch with other people to learn from their experiences. I guess we are becoming better health consumers and that's in our best interest....
Thank you - this is so well
By Doreen (not verified) on Wednesday, 11/18/2009 at 4:32 PMThank you - this is so well thought out and balanced. I've been in a tither all day yesterday and today - outraged by the new recommendations.
I am a breast cancer survivor and my invasive breast cancer was detected on my first mammogram at age 44. My doctor had been suggesting I get a mammo every year since I turned 40 - I was too busy with work and my life and just didn't take the time to make that appointment and go. I had no family history of breast cancer so didn't think I was taking a big risk. I was glad I didn't wait any longer.
I know far too many women diagnosed with cancer in the 20's, 30's and 40's. I think the new recommendations are irresponsible - what's the value of each life saved ? In my mind it's far more valuable than the cost of the increased number of mammograms and the anxiety caused by a false positive.
There aren't any thermography centers where I live - I've read about them - but there seems to be little data on their effectiveness. It sounds promising - thanks again for your balanced and logical view.
Pinkies, I've been gone all
By Lissa Rankin on Wednesday, 11/18/2009 at 4:00 PMPinkies, I've been gone all day and will catch up responding to you, but I'm about to run out again. First, yes Sharon- constantly X-raying the breasts appears to increase the risk of cancer. I recently read an article (I think it was out of UCSF- I'm trying to find the data- forgive me for not having a reference- this has all happened so fast and I'm in the throws of finishing my book due Dec 1!) But if I recall, they found that more than 10 mammograms in one's lifetime may increase the risk of breast cancer. But that appears not to be why this task force changed their recommendations. In fact, they don't even MENTION radiation (which is a real concern). I'll keep looking into this issue and hopefully present you with more science soon. I've been on the phone (UP IN ARMS!) all day about this...
Don't get me started. Ah yes- meditating... (there's a reason we put that post up today. Lissa needed to get her blood pressure down....)
Love you PInkies More soon... xoxo
Quote from the clinical
By lynn @ human, being (not verified) on Wednesday, 11/18/2009 at 12:01 PMQuote from the clinical research director of the cancer center I work for in today's Denver Post:
"The thing that most disturbs me about this publication is that there is no new information," said Dr. Anthony Elias, director of breast-cancer research at the University of Colorado Denver's division of medical oncology. "It's merely a reinterpretation of what's going on, then people put together a computer model and decided the cost-effectiveness may not be as good.
"The impetus of this is health care reform and cost-cutting," he said.
In Prostate cancer, there's also a big pushback against PSA screening, but the data looks more solid on that aspect. I find it interesting that Komen is taking an "on the fence"-ish stance on this issue, too.
[...] 2. There is some
By From the Stupak Amendment to Lice | Melia Lore: Chick Guru & (not verified) on Wednesday, 11/18/2009 at 11:50 AM[...] 2. There is some strange new “women’s health” recommendation coming down the pipe at the same time as the Stupid Amendment. No mammograms until 50? Again, I’m sure the generous Insurance companies will completely overlook another way to save money by cutting their coverage for mammograms. Confused about this? Go talk to Dr. Lissa at Owning Pink. [...]
Body tapping to keep the
By Sharon (not verified) on Wednesday, 11/18/2009 at 10:42 AMBody tapping to keep the lymph flowing is good!
Also, I have been under the impression that constantly x-raying the breasts actually can contribute to causing cancer.
Thank you for the
By Christa (not verified) on Wednesday, 11/18/2009 at 9:03 AMThank you for the "man-o-gram" visual. I would LOVE to see a guy stick his penis in between two plates for a serious squishing. You made my day with thaty one! I've had my boobs flattened out once and I am in no rush to go back for more (HATED THAT, humiliation central) but I sure don't want to get breast cancer!
All fun and bitching aside, this post will save lives Liss, I have no doubt. Keep beatin' your drum. We hear you. Good job!
I love all the preventative
By jessica (not verified) on Wednesday, 11/18/2009 at 8:06 AMI love all the preventative suggestions you make; nutrition, exercise, loving massage, etc. Those are ALL wonderful and need to be emphasized. I especially love how that blog followed after the meditation blog. In my hypnosis practice where I also use Emotional Freedom Technique (EFT), I guide clients to relax, and let go of stressors. If they come upon anxiety (that's where the EFT comes into play) more times than not women 'hold' those in their emotional hearts. When they tap there, they often say it is tender.
That says so much to me, as I believe holding onto a fear/unresolved emotional pain can eventually manifest into a physical ailment and explains why so many women I know with breast concerns have them in the left breast (the one over the heart) and why heart disease is a leading killer for American Women. I know it sounds a little Woo Woo, but I think it's a valid idea worth looking into for any woman, it's non invasive, they can do this on their own (Youtube has some good vids demonstrating EFT) and there are no drugs, it's gentle, and it's free.
Kathy, I'm so honored to see
By Lissa Rankin on Wednesday, 11/18/2009 at 7:21 AMKathy, I'm so honored to see you here! Thank you for your comment. Nancy Bellen told me she had spoken to you when I called her for help in writing this article. I agree with you, sister. I'm afraid women are going to go running for the hills and miss one of the few opportunities we have for screening. Most cancers simply can't be screened for. There's no effective screen for lung cancer, pancreatic cancer, ovarian cancer...
But we do have cervical, breast, skin, and colon cancer screening. Let's USE them!
But yet, diet and lifestyle are very important. And yes, Paula- if you're a wine afficienado, add a folic acid supplement- just to do everything you can to protect yourself.
Be well! Lissa
Emily- I completely agree
By Lissa Rankin on Wednesday, 11/18/2009 at 7:18 AMEmily- I completely agree with you about baseline mammography. As a kid, I remember sitting the dark room with my women's imaging specialist radiologist Dad, while he read mammograms. He would pull up a film, study it, make red circles on it, then pull out an old film- see the same thing- and say "See- it was there when she was 35 and now she's 55. If it was cancer, it would have changed." And boom- problem solved. It scares me too.
Thanks Lissa appreciate it! I
By Paula G (not verified) on Wednesday, 11/18/2009 at 7:12 AMThanks Lissa appreciate it! I will have to see if my daily stuff has folic acid in it. I use Juice + which I love (all fruits & veggies & berries in capsule), but it's impossible to figure out any %RDA values of anything....
Good site Lissa -- I'll keep
By Kathy LaTour (not verified) on Wednesday, 11/18/2009 at 7:10 AMGood site Lissa -- I'll keep up with you. I was diagnosed at 37 -- 23 years ago -- and would be dead had it not been for good mammogramphy. But I was under the age for a baseline and symptomatic (lump,weird itching). My concern about this is that women aren't getting mammograms now when then need them and ANY negatives about mammography will translate into fewer women going -- even when they hit 50. You see it all the time. Some article or piece of media comes out and whatever gets the play is what the majority of women internalize -- and the message here is that mammography doesn't work when the real message is it's not a great tool for women in their 40s. It's scary.
But I love what you said about healthy eating. I interviewed Dr. Brawley about health care reform for an article and he said, you know, we know what we need to do, we just need to do it, basically.
He also said obesity is now as big a risk factor for cancer as tobacco.
Kathy LaTour 23-year survivor Editor-at-Large CURE magazine curetoday.com
Thanks so much for addressing
By Emily (not verified) on Wednesday, 11/18/2009 at 7:07 AMThanks so much for addressing this, Lissa. I am 37, and went to my Dr. this year for my annual. She did her exam and said "Wow, you're really lumpy," and sent me off for a mammogram. I ended up getting the initial mammogram, followed by a diagnostic mammogram and then breast ultrasound and am now in the wait-six-months-and-see-what-happens phase. Shouldn't every woman be at least getting a baseline mammogram in her 30s or early 40s so there's something to compare to down the road? The radiologist who examined my results said it would be easier if he had something earlier to compare to...
HI Paula, Yes, I would go
By Lissa Rankin on Wednesday, 11/18/2009 at 6:47 AMHI Paula, Yes, I would go ahead and get that mammogram (that's what I'm doing too!)
Here's some data on folic acid and alcohol, with relation to breast cancer risk:
Folic acid intake may attenuate the effect of alcohol consumption on breast cancer. In the Nurses' Health Study, consumption of one or more drinks per day was associated with a nonsignificant 5 percent increase in risk of breast cancer among women who consumed at least 300 micrograms of folic acid daily [60]. In contrast, alcohol use was associated with a 32 percent increased risk of breast cancer in women with lower folate intake. A follow-up nested case-control study looked at plasma levels of folate and found that among women who consumed one or more drinks per day, the relative risk (RR) for breast cancer was 0.11 (95% CI 0.02-0.59) among women in the highest compared with lowest quintiles of plasma folate.
Similarly, the Iowa Women's Health Study found that folate intake can modify the higher risk of breast cancer in women who drink alcohol. In contrast to some of the studies described above, in this study the higher risk of breast cancer among regular drinkers (and thus the protective effect of folate) was limited to estrogen receptor negative tumors. The reason for this disparate result is not clear.
At a minimum, these reports suggest that women who consume alcohol should also take a daily multivitamin fortified with folic acid. It is uncertain if supplemental folate intake is necessary in the United States (US) where grain is fortified with folic acid.
I knew no one would tackle
By Paula G (not verified) on Wednesday, 11/18/2009 at 5:33 AMI knew no one would tackle this topic as well, thorough, and genuine as you! Thanks so much for this article.
Can you talk more about the link between folic acid and alcohol intake? Hadn't read that before... passionate wine buff that I am, I am curious...
I turn 40 in a month & I'm on schedule for that baseline mammo - wonder if I need/should do it asap before insurance guidelines likely change in 2010.
Oh honey- I'm SO sorry. But
By Lissa Rankin on Tuesday, 11/17/2009 at 5:19 PMOh honey- I'm SO sorry. But thank God your cancer was caught. And the idea that 49 year olds might have not even a baseline mammogram seems ludicrous to me. What's wrong with this system?
But yes- breast awareness as you describe is probably even more important than any formal breast exam (that's why I included the note about breast massage). For some women, formal breast exam brings up guilt and anxiety, but breast awareness is critical. Be in your body. Notice. Pay attention and alert anyone if you notice changes. Thanks for bringing that up, Carole. Be well Lissa
I'm 51 and 12 days post a
By Karen Hammond (not verified) on Tuesday, 11/17/2009 at 5:13 PMI'm 51 and 12 days post a double mastectomy and yes... diagnosed by a mammogram. One tiny speck of calcified cancer showed up and if my radiologist hadn't pulled out the past few years to compare them she would have ignored it! It was aggressive and invasive, and couldn't be felt. I owe my life to annual mammograms. My daughter is 27: Should I tell her to wait until she is 50 for a mammogram - with this family history?
In England where I was born, women only get mammograms every three years after age 45? It scares me that my sister, at 49, hasn't had one yet and not one single doc has suggested she should!
Yes, breast exams may not be great, but just the act of looking at yourself in a mirror regularly can tell you if your nipple is a bit askew or you have a small bump that won't go away. Being aware of your normal shape and texture can tell you if it becomes abnormal in any way. (Saved a close friend of mine a year ago!)
I'm not a happy puppy today - cancer sucks!
Yes, Carole. You're
By Lissa Rankin on Tuesday, 11/17/2009 at 5:09 PMYes, Carole. You're absolutely right. We need to focus on prevention, including environmental protection to save future generations from the endocrine disruptors in pesticides, plastics, and other environmental chemicals that may even increase the risk of breast cancer for our fetuses. Scary stuff. Even if you do everything right, you may still be at risk. So if you do get breast cancer, don't blame yourself. The world is- sadly- a dangerous place these days. All we can do is our best.
This news is so fascinating
By Carole (not verified) on Tuesday, 11/17/2009 at 5:06 PMThis news is so fascinating and scary! I just read the China Study and, although I've been a 99% vegetarian for years, I am totally overwelmemed by this new information. As a vegatarian, I've often relied upon dairy to make up the difference. And now I learn that not only animal meats but animal products such as dairy (milk, cheese) are causes of cancer (breast cancer, prostate cancer, liver cancer, pancreatic cancer), heart disease, obesity, diabetes, MS. you name it.
So now what!
My family is trying to figure out how to handle this info, but I am definitely pleased to hear about the medical establishment reporting that these tests are not all that perfect -- the tests and the drugs and the surgery are not the answer. W need to take control by eating better, exercising, etc. Don't wait too long to take control!
Amen, sister! I'm so glad
By Lissa Rankin on Tuesday, 11/17/2009 at 2:34 PMAmen, sister! I'm so glad your mom is okay. Here's to 20 more years for her!
This high handed taskforce
By Heather in SF (not verified) on Tuesday, 11/17/2009 at 11:52 AMThis high handed taskforce really angers me. My mom had a routine mammogram last year at this time, age 74, her second one ever. They detected odd granular spots, biopsied them and on Christmas eve told her she had breast cancer. Her surgery was in the first week of January. She is fine. Cancer free. I'm so happy about this naturally. According to this taskforce that mammogram wasn't necessary? It saved her life. Women in my family live until their nineties or longer. This mammogram gave her 20 more years plus an escape from a horrible death. It seems the trend these days with healthcare is to write off anyone "elderly" and it sucks.
Elizabeth, I'm glad you feel
By Lissa Rankin on Tuesday, 11/17/2009 at 10:56 AMElizabeth, I'm glad you feel relieved. Honor your feelings. And Nancy-darling- I know how many you know. I too am scratching my head. Why? What has changed? If there's new data out there, what is it? I may not read every journal that lands in my mailbox, but am I missing something?
Dear Lissa, Thank you for
By Nancy Bellen (not verified) on Tuesday, 11/17/2009 at 10:51 AMDear Lissa, Thank you for your reason in my morning. I have been sitting here in a lather reading and re-reading the new guidelines. How did we get here? I was diagnosed with breast cancer at age 32. For the past 13 years I have been a advocate for young woman who may become diagnosed with breast cancer.
This morning I have been reaching out to colleagues across the country to figure out an awareness rebuttal for young women. One of the women I spoke with was Kathy Latour - Editor at Large for Cure Magazine. We began the fools game of listing our friends diagnosed by mammography under 40 who would not be alive today if not for that powerful tool, we had to stop our lists as we felt ill.
The first time I had a
By Elizabeth (not verified) on Tuesday, 11/17/2009 at 10:39 AMThe first time I had a mammogram, my (now late) husband said, "How do they read it through all those bones?"
"Bones? What bones?" I demanded. "There aren't any bones in there!"
"Ohhhhh...!" he replied. "I thought it was like a chest X-Ray."
I'm in my late 50s and relieved to be on the hook only every other year. The last three times, I've been recalled for rescreening, and every time it's turned out to be a cyst (probably the same one). I wish I could just tell them, "It's a cyst, for Pete's sake."
Blessings to you Pinkies-
By Lissa Rankin on Tuesday, 11/17/2009 at 10:11 AMBlessings to you Pinkies- those with breast cancer, those who know someone (don't we all), and those who have lost loved ones. Keep screening, Pinkies- please. One way or another. Take care of yourselves. Pink machines? Sign me up. About to get my first mammogram in December....
when I was 11 I watch my dear
By Kat Caverly (not verified) on Tuesday, 11/17/2009 at 10:06 AMwhen I was 11 I watch my dear grandmother die of breast cancer and I decided then I wasn't going to die this way. I had my first biopsy (surgery) at 17 years old, when I discovered my first lump.
In college I found another lump and I was petrified. The leading tumor specialist at the time was associated with my University and he told me that I was ok and just needed to have regular check-ups.
I started yearly mammograms at 40 and they found another lump they couldn't explain 5 years ago; so another biopsy (needle) this one not so invasive. So started the every six months sonagrams as well as the yearly mammograms until 2 years ago when they "forgot" to mark my first biopsy scar and put me through another series of unnecessary tests.
Now it is time to do another mammogram though, since I still refuse to "die from breast cancer" and I need to get over the fact that I know that the doctors are only human too.
Hi Lissa, Thanks for this
By Kathy Jordan (not verified) on Tuesday, 11/17/2009 at 10:03 AMHi Lissa, Thanks for this thoughtful assessment of the new mammogram recommendations. When my sister was in her mid forties, she was diagnosed with an aggressive breast tumor which she found with a self-exam. It hadn't even been a year since her last mammogram. Seven years later, she is fine. I'd hate to think how she would have fared under the new recommendations. As a 50+ woman, I'm concerned that the insurance companies will start denying payment for annual exams. I vote for screening--maybe with pink machines :-) Getting squeezed may hurt for a few minutes. But it can save our lives.
And thanks Simone. Yes- I
By Lissa Rankin on Tuesday, 11/17/2009 at 10:00 AMAnd thanks Simone. Yes- I know. It's hard to assess the data sometimes when it's never quite "clean." Praying that we find a better way to reduce the risk of breast cancer diagnosis and death...Please?