Sports Medicine

In California approximately 95% of teens and young adults participate in some sort of sport, either on a team or simply recreationally. While major injuries are the purview of orthopedists, many of the problems that face athletes should be treated and monitored by a primary care physician. For example, even teens...

Women's Health

In the past few years, recommendations for screening and preventive health measures for women have changed dramatically. In addition, the medical community is increasingly realizing that the presenting symptoms of many illnesses can be different in women.

Breast Cancer Screening Changes

There has been much controversy lately about screening for breast cancer, both with mammograms and breast self exams. The controversy stems from a guideline published in the November issue of the Annals of Internal Medicine by the U.S. Preventive Services Task Force (USPSTF) for patients without recognized signs or symptoms of breast cancer. The USPSTF us a group of health experts that reviews published research and make recommendations about preventive health care.

The following are the USPSTF recommendations.

• Regarding mammography: no routine screening mammography should be done before the age of 50.
• Between the ages of 50 and 74, screening should take place once every two years, and stopped at age 75.
• Self breast exams should be discontinued.

These USPSTF recommendations take into account potential harms of anxiety, procedures related to false positives and added costs. The recommendations also take into account that the benefit of doing mammography every 2 years is nearly the same as doing it every year (but with only half as many potential harms). Please note that within this recommendation, it is stated that the decision to start doing mammography earlier or more frequently should be made by a woman and her physician.

The USPSTF information also recommends against teaching women breast self exams, as the harms clearly outweigh the benefits. Evidence regarding the value of clinical breast examination is mixed – therefore the recommendation for periodic clinical breast exams remains in place until more studies are done.

The controversy regarding the USPSTF recommendations arises because there are organizations such as the American Cancer Society, the American College of Physicians (Internal Medicine), the American Academy of Family Physicians and others who also publish guidelines. The American Cancer Society is standing firmly behind their recommendation regarding screening mammography starting at age 40 and yearly mammograms after age 50. Their primary concern is that insurance companies will use the USPSTF recommendations to deny coverage for more frequent screenings in patients whose physicians feel are at higher risk. However, the American College of Physicians issued a recommendation in 2007 to start routine mammograms at age 50 unless there is a reason to start sooner.

I personally agree with the USPSTF recommendations, under the condition that a woman and her physician should be making the final decision as to when and how often to do screening mammograms based on risks and potential harms. I particularly agree with the recommendation against breast self exam and I am suggesting to my own patients that they discontinue self-exams.

This topic will continue to be discussed by scientists and physicians, and I will keep you informed as new information becomes available.