Federal task force says women need fewer mammograms. Sound reasoning or rationing?

BY SUSAN MCCLURE | NOVEMBER 17, 2009

Bewilderment. That's the only word I can use to describe how I felt upon reading an article in my daily newspaper this morning (Yes, I still read the daily paper). The story reported on an influential federal task force's recommendation that women have fewer mammograms. "We're not saying that women shouldn't get screened. Screening saves lives," said Diana Petitti, vice chairman of the U.S. Preventive Services Task Force. "But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully." The recommendations of this committee would set the standards for preventative health care services under health care reform and would be used to determine which tests would be covered by insurance plans. These guidelines are for the general population, not for those at high risk of breast cancer.

The 16-member committee recommended that most women in their 40s should not routinely get mammograms. Additionally, women 50 to 74 should get mammograms every other year until they turn 75, after which the risks and benefits are unknown. Women 75 and older should not get regular screening. The committee is also against teaching women to do regular self exams because "the value of breast exams by doctors is unknown and breast self exams are of no value."

Those who side with the task force's findings say that more testing, exams, and treatment are not always beneficial and may cause harm to patients. The article stated that in about 10 percent of cases, false positive results caused anxiety among patients and lead to unnecessary procedures such as disfiguring biopsies and in some cases, surgery, chemotherapy, and radiation.

Those on the opposing side said that this is a huge step in the wrong direction. Daniel Kopans, a radiology professor at Harvard Medical School said, "Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it." Dr. Phil Evans, director of the Center for Breast Care at UT Southwestern Medical Center in Dallas predicted that conducting fewer mammograms would be a mistake. "Mammography is not a perfect test, but it's still the best test for finding breast cancer early," argued Evans.

The most ominous quote in the article came from Dr. Michael Grant, my breast surgeon at Baylor University Medical Center at Dallas. He said that the timing of this made him suspicious. "Ultimately, this may be how we provide rationale for rationing. They're not saying it isn't worth it -- just that the number of lives it saves is not counter balanced by the cost and trouble of doing it," said Grant. Roughly 39 million women in the U.S. have mammograms each year, costing the healthcare system more than $5 billion annually.

I think I need to dust off my old copy of George Orwell's, Animal Farm. This arguement is sounding vaguely familiar. "All animals are equal-- just some are more equal than others."

Certain anti-depressants taken with tamoxifen pose risk

BY SUSAN MCCLURE | SEPTEMBER 8, 2009

In CURE's upcoming Fall issue we write about the importance of talking with your doctor if you are taking tamoxifen along with an anti-depressant such as Prozac, Paxil, or Zoloft--three widely prescribed serotonin reuptake inhibitors (SSRIs for short). Many women are prescribed anti-depressants to combat hot flashes--a well documented side effect of tamoxifen. New studies indicate that certain SSRIs may in fact put women at a much higher risk for recurrent breast cancer. It appears that not all SSRIs are alike, and while some demonstrated cause for alarm, others didn't pose a problem at all. Before you flush your anti-depressants down the toilet, however, let me give you a warning... Don't discontinue taking any anti-depressant without first consulting your doctor.

I was talking with a close friend recently who began taking Lexapro a couple of years ago to combat hot flashes. She lives in Brazil now and has discovered that it's very difficult to get her prescriptions filled in South America. She was spending a few hundred dollars each month to refill her prescription and decided to stop taking the Lexapro rather than battle the bureaucracy. In her mind, the benefit didn't outweigh the cost.

Fast forward a couple of weeks... She began to feel like she was getting the flu. She was achy, having chills, was feverish, and disoriented. She was incredibly depressed too. She slept all day and told me that she didn't even have enough energy to go outside. As her mystery illness progressed, she and her husband became very concerned. After a bit of investigative work (and an overdue trip to the doctor), they realized that she was experiencing withdrawal symptoms from her abrupt discontinuation of Lexapro. She was put back on the medication and after a few days, she felt normal again. Her doctor informed her that she should never stop taking her Lexapro without talking to him first and that she needed to gradually wean herself from the drug in order to minimize the risk of withdrawal symptoms.

All drugs are given with specific product information. It's a good idea to keep the package insert for future reference–-since some people experience the infrequent side effects, which can be major. And always discuss stopping a medication with your doctor-- don't just do it.

When ordinary people do extraordinary things

BY SUSAN MCCLURE | JULY 1, 2009

Currently, the world is abuzz with news of Michael Jackson's death. When a superstar like Jackson dies, it becomes difficult to find a news agency that isn't covering the story 24/7. We can't hide from it. Our voyeuristic fascination with the rich and famous sometimes makes us miss the more poignant, heartwarming, heroic tales of people like us--ordinary people who do extraordinary things.

Take the story of Dr. Jerri Nielson Fitzgerald. She's the doctor who discovered and treated her own breast cancer while stationed in Antarctica in 1999. Her base was closed for the winter when she detected a lump in her breast. There was no way for her to be airlifted to a hospital until the weather improved. When the lymph nodes under her arm began to swell she realized that if she didn't do something drastic she might not make it out alive.

With the help of a welder she performed a biopsy on herself in order to confirm that she did indeed have cancer. She said that she'd work on herself until she got tired, then he'd do it, then she'd do it, and so on. Once the cancer was confirmed, she had supplies airdropped by a US Air Force plane and taught the welder how to administer chemotherapy. Three months later when the weather improved, she was airlifted out.

Dr. Nielson Fitzgerald wrote a book about her harrowing journey called Ice Bound: A Doctor's Incredible Battle for Survival at the South Pole, and was in remission until 2005 when her cancer returned. She spent the final years of her life inspiring cancer patients worldwide, saying that her experience with the disease gave her life "colour and texture." She also said that she used to think adventures were a thing of the past and that no more were to be found. Her time at the South Pole taught her that adventures are all around us. "The adventure is now", she said.

Dr. Nielson Fitzgerald died on June 24th--one day before Michael Jackson.