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Posts tagged with "mammograms"

How e-Patients Should Navigate the System to Get the Best Possible Treatment for Breast Cancer

I was recently diagnosed with breast cancer for the second time and exactly five years to the day after my first occurrence.  Although I do not usually discuss personal issues on this blog, I hope my experiences and approach might help others as they navigate the health care system to get the treatment needed.


Both incidences of  cancer for me were detected very early and  were small tumors .  Additionally, these cancers were separate incidences, not a cancer that had metastasized.  Since I have written the book on patient empowerment, engagement and education, I can say with confidence that if you approach this diagnosis well informed, suitably engaged, and with a positive attitude, you will  make better decisions that will result in a better outcome.  So here’s what I have to offer by way of advice and information:


First rule of thumb for every woman, particularly those over the age of 40, or those with a history of cancer in the family, is be diligent about self-examination and get an ANNUAL mammogram. A mammogram is an x-ray of the breast. Modern medicine has been doing mammograms for 43 years.The machines are designed to use very low levels of radiation.  Strict guidelines insure that mammogram equipment is safe so that the level of radiation does not increase the risk for breast cancer.   To put it in perspective, if a woman with breast cancer undergoes radiation therapy, she will receive a total of approximately 5,000 rads.  If that same individual  has yearly mammograms beginning at age 40 and until she is 90, her total radiation exposure will be between 20-40 rads. The American Cancer Society recommends that women age 40 and over should have a screening mammogram every year and should continue to do so for as long as they are in good health. Today’s digital mammogram machines  detect most abnormalities in the breast so be certain to have your mammogram at a facility that has digital capability.


The American Cancer Society  also recommends that women in their 20s and 30s should have a clinical breast exam as part of a periodic health exam by a health professional at least once every three years.The goal of these screening exams is to find cancers when they are small, still confined to the breast,  and before they start to cause symptoms. Breast cancers that you find yourself tend to be larger and are more likely to have  spread. This has a lot to do with your  prognosis and  is why breast self-examination, (BSE), starting around age 20 is so important.   (


Web sites where you can get excellent instruction on how to do a breast self exam include


If you are called back for a second set of mammograms, as I was, do not panic and do not procrastinate. It is very important to follow through.At my  call back for this occurrence I was sent immediately to ultrasound and the radiologist located a small but definitive tumor pretty quickly. By then I kind of knew what was ahead.


Two days later I had a biopsy that confirmed, a small cancerous tumor called a lobular carcinoma.  This was a different type of cancer than the  first round which was a ductal carcinoma in situ (DCIS).  I learned from asking the doctors that both of these cancers  types are estrogen positive and respond well to treatment.


Never quite satisfied that I had all of the information I needed, I did a lot of Internet research, talked with my primary care physicians and other individuals who were knowledgeable about breast cancer to find out as much as possible about what I had and what I was facing.


Armed with all the necessary information, I met with my oncology surgeon.  Lucky for me she is the same physician whotreated my first cancer. She is a doctor who knows just how to  communicate with her patients and explain everything that is happening in great detail and with great reassurance. As a result I did not need to seek second opinions or look for a doctor who might be the best surgeon for me.


If you do not have that health care team in place that you have complete confidence in, however, then you should do some research to determine who to seek for a second opinion.  The best way to find information on doctors is via other professionals, including the opinions of your primary care physician or from your friends and relatives. There are also web sites where you can find extensive information and ratings on doctors and hospitals.  Among the questions you want to consider are:  how often do they do this type of surgery,  and what is their quality and safety record,


I had my surgery, a lumpectomy with a sentinel node biopsy and am now recovering from that.  In a few weeks, I will meet with my full team: oncologist, oncology surgeon and radiation oncologist and determine next steps which might include medication and radiation.


Although cancer is a common problem, particularly for people over the age of 40, when it happens to you it is frightening.  You could become depressed, angry,and sad. However, if you remain positive, approach your diagnosis with a fighting attitude,  and  find a team of physicians that you have confidence in, you will be so much better off.

Is That Screening Test Really Necessary?

“We are in the midst of an epidemic of diagnosis. Conventional wisdom tells us that this is good. Finding problems early saves lives, because we have the opportunity to fix small problems before they become big ones. What’s more, we believe that there are no downsides to looking for things to be wrong. But the truth is that early diagnosis is a double-edged sword. While it has the potential to help some, it always has a hidden danger – overdiagnosis – the detection of abnormalities that are not destined to ever bother us.”

Overdiagnosed: Making People Sick in the Pursuit of Health by H. Gilbert Welch, Lisa Schwaretzl, Steve Woloshin, published by Random House, 2011

We are getting mixed messages about whether or not screening for cancer and other diseases is a good thing or a bad thing. We read in the media that early, aggressive treatment is always best, yet some have begun to question that mantra. The belief that cancer screening, for example, will save your life has come under attack. Research now confirms that some cancerous tumors would, in fact, never cause harm because they are too slow-growing to ever threaten your life. Others are so aggressive that finding them early does not make much difference. Then there are the situations where early detection can make all the difference, actually stopping diseases before they start, e.g. testing blood sugar for diabetes, checking blood pressure, cholesterol and EKG for hypertension and other cardiac issues.

Dr Welch issues a reasonable call for change that would save patients pain, worry and money when he contends that “overdiagnosis is a big problem with modern medicine that leads millions of people to become patients unnecessarily while adding huge costs to an already overburdened system.”

So what is an intelligent empowered patient supposed to do when, for example, there are qualified medical providers who clamor for eliminating screening for prostate cancer and postponing mammograms, while other qualified providers are not only encouraging these screenings but insisting on them for their patients?

We know that many of the screening tests have risks, including false positives that lead to invasive biopsies and in some cases irreversible side effects. On the other hand if we look at mammography we also understand that although mammograms don’t prevent breast cancer they can save lives by finding tumors as early as possible. Overall mammograms pick up 80-90% of cancers and have shown to lower the risk of dying from breast cancer by 35% in women over the age of 50. In women between ages 40 and 50 the risk reduction appears to be somewhat less. Some groups including the National Cancer Institutes, the American Cancer Society and the American College of Radiology currently recommend annual mammograms for all women over the age of 40. Others suggest that screening for breast cancer does not need to begin for the general female populace until age 50, with obvious exceptions such as women with a family history of breast cancer.

Creating even more confusion are the results of two long-awaited studies – one conducted in the United states and the other in Europe. These studies were supposed to settle the debate over the value of PSA (prostate cancer) testing. These trials, published in the New England Journal of Medicine, March 2009, appear to reach opposite conclusions. The Prostate Lung Colorectal and Ovarian (PLCO) Cancer Screening Trial reported no survival benefit with PSA screening and digital rectal examination. The European Randomized Study of Screening for Prostate Cancer (ERSPC), however, found a 20% reduction in prostate cancer deaths. The ERSPC study estimated that for every life saved, 48 men are treated and 1,068 men are screened.

Is it therefore left to the patient to figure out whether to undergo screening or not? This is one of the best examples of why being an empowered patient is so important. The patient must weight the benefits and risks, talk to your physicians and ask the following questions:

1. Which test do you recommend for me and why?
2. How much do the tests cost
3. Will my health insurance help pay for these screening tests?
4. How soon after the tests will I learn the results?
5. If the results show a problem, how will we learn if I have cancer?
6. What are my choices once a diagnosis is confirmed?

Patients also need to be sure that their physicians follow a sensible protocol before rusiing into screening tests, including the following:

1.Physical exam and history. This exam checks the body for general health as well as signs of disease such as lumps or anything else that seems unusual.

2. Laboratory tests. A first step following the physican exam should be the least invasive screenings including blood and urine

3. Imaging procedures including mammography might be the next step because they are also less invasive

4. Genetic tests executed by drawing blood, that look for certain gene mutations (changes) that are linked to some types of cancer are another non-invasive screening option, although they are quite costly

5. Finally if there is enough evidence, a biopsy might be warranted.

It is up to each patient to drive the screening process, communicate with your physician at every step and weigh all the alternatives before agreeing to tests that may not, in the long run, change your outcome. Below are websites that have cancer support advice and tool kits.