BETTERHEALTH
“ Many of my patients decide to
forgo annual mammograms, but
some look at me like I’m crazy
and want one every year.”
C atherine Shan ahan , M.D.
CONFUSION AND CONTROVERSY
Mammograms were once a no-brainer: Start when
you’re 40 and go every year after that. But the 2009
guidelines were tougher to parse. If most women
in their 40s don’t need mammograms, how do you
know if you’re in the minority who does? It didn’t
take long for confusion to boil over into outrage.
Advocates staged protests from California to Mary-
land. Celebrities such as Sheryl Crow and Olivia
Newton-John, both diagnosed with breast cancer in
their 40s, took to the airwaves and fiercely defended
annual screenings. And with rumors swirling that
private insurance companies might drop mammog-
raphy coverage, Congress passed an amendment to
the Health Care Reform Bill specifically mandating
that the task force’s guidelines be ignored.
Members of the task force tried to do damage
control. The guidelines weren’t meant to discourage
women from getting mammograms, they said. The
aim simply was to raise awareness of the drawbacks
of mammograms (like the risk of false positives) and
get women talking to their physicians. Maybe you
need a mammogram; maybe you don’t— and that’s
something only you and your doctor can decide.
Fast-forward to 2010, however, and women and
doctors seem to be experiencing communication
breakdown. Catherine Shanahan, M.D., a physician
at the Family Health and Wellness Center at Bedford
in New Hampshire, says she adopted the guidelines
last year, trading a one-size-fits-all mammogram
regimen for individual discussions with her patients
about the procedure. Results so far have been mixed.
“Women come in with a lot of confusion about the
new guidelines,” Dr. Shanahan reports. “ So I explain
that getting a mammogram means potentially
finding and treating something that
isn 't
cancer or is
a nonagressive type of cancer that would otherwise
go away on its own. On the other hand,
not
getting
a mammogram means potentially missing a cancer
that will kill you. After considering all these factors,
many of my patients ultimately decide to forgo
annual mammograms. But some just look at me like
I’m crazy and want one every year.”
Self-Exams:
Beneficial or
Bunk?
The answer hangs
somewhere in the
middle. Last year the
U.S. Preventive
Services Task Force
determined that
monthly breast
self-exams don’t
save lives. In fact,
research shows that
such exams often
lead to unnecessary
mammograms and
biopsies. That said,
it’s important for
women to be in tune
with their bodies,
says Laura Esserman,
M.D., a breast sur-
geon at the University
of California in San
Francisco. To that
end, she recommends
doing a self-check
after a clean mammo
or clinical exam to
get a sense of what
“ normal” feels like.
“ Breasts can be
naturally lumpy
and bumpy,” Dr. Es-
serman notes. If at
any point afterward
you notice changes
in your breasts or
underarm area—in-
cluding lumps, pain,
nipple discharge, or
skin discoloration—
alert your doctor
immediately.
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