Women's Health Archives - Page 2 of 3 - Screening for Better Health

When Mammograms are Wrong: False-Positives and False-Negatives

April 26, 2016 by drjaffer

First and foremost, let’s get this out of the way: Mammograms are often wrong. In fact, some estimates show that up to 90% of “positive” results (those that have detected abnormalities) are actually “false-positives”, meaning that there was no cancer despite the reading. And up to 20% of “negative” results are estimated to be “false-negatives,” meaning there actually was cancer present but it wasn’t detected.

Any screening test has a chance for false-negatives: it’s impossible to detect anything with 100% accuracy. Getting that percentage of false-negatives as low as possible is one of the reasons procedures are constantly re-evaluated and refined. But I want to focus today on the false-positive tests, because the impact of getting a false-positive on your mammography is a little less understood.

False-Positives

This number – up to 90% – may seem unacceptable at first glance. Getting something wrong 90% of the time is usually considered a deal-breaker elsewhere in life, after all!

According to the National Cancer Institute, false-positives are most common in young women, women who have had previous biopsies on their breasts, those with a family history of breast cancer, and women taken estrogen supplements.

Mammograms can also sometimes detect something known as localized ductal cancer. This is the finding of breast cancer that is localized to the ducts of the breasts known as ductal carcinoma in situ. The concern is that many women with ductal cancers may never die of breast cancer that was diagnosed with the screening mammography. These women may be are subjected to unnecessary breast surgery, radiation therapy and even chemotherapy in older age, leading to health problems and costs that were not truly contributing to their long-term survival.

False-positive tests can result in unnecessary procedures, stress, medical costs, lost time, and additional risks. Believing you have life-threatening breast cancer when you do not can be a tremendously disruptive, life-altering experience in the short term with long-term consequences. So how are you supposed to rely on a mammogram with such accuracy rates?

Using Mammograms the Right Way

It all comes down to how mammograms are utilized. The most important thing to understand is that an initial positive test does not necessarily mean you have cancer. In fact, odds are you do not! But follow-up tests will be needed to learn more information and get to the truth behind the positive result. Additional mammograms, ultrasounds, and surgery followed by biopsy are the typical followups, depending on what is found. It is important not to panic at this stage, and to understand that more information is needed before a complete diagnosis can be made.

Another important factor in using mammograms the right way is understanding when they should be conducted. Young women are much more likely to experience false-positive (and false-negative) results: as a result, for average-risk women the American Cancer Society recommends screening starting at age 45, while the United States Preventive Services Task Force recommends screening start at age 50. Screening in young women has not been shown to conclusively help prevent deaths from breast cancer, and may cause more harm than good in many cases. If you are at higher risk or want to begin screening earlier than these guidelines, you should discuss it with your doctor and understand some of the limitations inherent to mammograms.

As women reach their late years, the benefits of mammograms becomes difficult to determine. Women age 75 and older can still develop breast cancer, but in some cases their remaining life span may be less than the period required for breast cancer to become fatal. For women that are still healthy and likely have a number of years remaining, screening may be a good practice. For others, screening may cause more harm than help. It is recommended that you speak with your doctor and try to determine a plan that is right for you and your health as there are no set, agreed-upon guidelines.

Mammograms are still the best tool we have

For all their limitations, mammograms are the best tool for detecting early breast cancer and saving lives. Breast cancer is a fatal disease that takes the lives of about 40,000 women a year. If allowed to develop and spread to other parts of the body, it can be too late to save someone with breast cancer. By staying vigilant and following proper guidelines, it is possible to detect this dangerous disease early and save lives. Be sure to speak with your doctor and schedule the right tests at the right times for you!

Should I still check for lumps? The Controversy over Breast Exams

April 26, 2016 by drjaffer

If you are like millions of other women, you may have learned at an early age to check your breasts for lumps or other abnormalities. The self-breast exam is one of the most well-known screening procedure and an iconic symbol in the fight against cancer. For years doctors have been recommending and performing breast exams in an effort to detect early signs of one of the most common and deadly cancers in the world, an affliction that strikes approximately one in eight women in their lifetimes. But today, many medical professionals have stopped administering these tests in their offices… and have even stopped recommending self-breast exams to women!

nci-vol-1985-150 — Photo by Linda Bartlett for the National Cancer Institute

So what gives? Why have many doctors abandoned a decades-old practice? And does this mean you should stop performing self-breast exams?

The answer to both of these questions lies in the numbers. Specifically, the lack of them showing that breast exams help reduce deaths to breast cancer. In fact, some research has suggested that breast exams, performed at home or by a doctor in a clinic, may actually do more health than good!

There could be a number of reasons for these problems. The US Preventive Task Force suggests that some of the problem may arise because the clinical breast exam “currently lacks a standard approach and reporting standards.” It also highlights the tendency of breast exams to give false negatives, where a woman believes she has cancer but in reality is cancer-free. This can lead to needless tests, biopsies, anxiety, and medical costs, all of which can do a great deal of harm to a patient who mistakenly believes they are sick. The American Cancer Society points to the lack of research supporting the use of breast exams, but reminds women that they “should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.”

There is still research being done on this subject, and many doctors are optimistic that one day a standardized test with reasonable accuracy will be available for women that do not have access to mammograms. And many medical professionals still recommend that women be familiar with their body – even going so far as to recommend traditional breast self-exams. But as a woman, it’s important to understand that scheduled mammograms are your best defense against this deadly cancer – and to understand that, if you do find something unusual with your body, it could mean any number of things. So be sure to talk to your doctor, and keep up with your scheduled mammograms!

For more information on the recently updated Breast Cancer Screening Guidelines, click here!

Osteoporosis: Treatment starts with prevention

April 4, 2016 by drjaffer

Most of us are familiar with the symptoms of osteoporosis. It is a fairly common condition: approximately 44 million Americans have thin bones from calcium loss! It’s very likely you have relatives with osteoporosis, and there is a reasonable chance you or someone you are close to will develop it some day.

Osteoporosis is a condition in which your bones lose the calcium from their matrix or structure and become fragile. This loss of calcium results in a decrease in bone mass and bone density, and the outer mineral layer of your bone begins to thin. The inner mesh skeleton of the bone also begins to thin. This results in very brittle and fragile bones. People who have osteoporosis are at risk for fractures that can occur with very minimal trauma. A step down the stairs, a minor fall in the house, a slight slip on ice, or in some rare cases, even a hard cough can result in bone fracture.

You might be aware that osteoporosis affects both men and women, though women are about 4 times as likely to develop it as men. And it is fairly well known that the risk of developing the condition increases with age. But did you know there are several other major risk factors, many of which are controllable?

Treatment for osteoporosis can help mitigate the effects of the disease, but the best defense is to prepare your body in advance to fight off the approach of the disease. Taking care of yourself now can lead to a long and healthy future!

Prevention Matters: HPV Vaccinations Prevent Cervical Cancer

March 17, 2016 by drjaffer

The human papilloma virus (commonly known as HPV) is one of the most common sexually transmitted diseases. In fact, the National Cancer Institute estimates that more than 90% of sexually active men and more than 80% of sexually active women will be infected with some form of HPV in their lives.

While most HPV infections cause no noticeable symptoms and go away within a year or two, there are many strains of HPV, and some can have deadly lasting effects. One of the most serious of these effects is cervical cancer, a disease responsible for about 4,000 deaths a year in the United States. Since the vast majority of cervical cancer is caused by HPV, this virus is a major health concern for our country, especially considering that many strains of HPV can be prevented with vaccines that is readily available.

So why aren’t we all vaccinated against this disease?

The main issue with HPV vaccines is that they cannot cure existing HPV infections. They also don’t help prevent or cure diseases that existing HPV infections might cause – like cervical cancer. They have to be administered before you become infected – which means, for most people, before you become sexually active. And since the vaccines are not administered until at least 9 years of age, and are more typically recommended for people starting between 11 and 12 years old, they have to be scheduled for later in a child’s life than most of their early vaccines.

There is also a strong amount of political and social push-back against giving children and teenagers the HPV vaccine. Many religious, political, and parental groups argue that their children do not need to be vaccinated against a sexually transmitted disease until they are old enough to become sexually active.

Unfortunately, there is no way to predict when a person will become sexually active, and most young people are not educated enough in the need for the HPV vaccine to get it before they enter into a sexual relationship. And with cervical cancer being the 10th leading cause of cancer deaths in the United States, it is vital we work harder to ensure the next generation of young people are safe from this preventable infection.

In the mean time, it is extremely important that women get screened for cervical cancer with regular pap smears. In fact, even if you have gotten your HPV vaccine before becoming sexually active, you still need to be screened regularly. Cervical cancer is very curable if found early, but very deadly if found late. Either way, speak to your doctor about screening and vaccination, and you’re taking a big step toward living a long and healthy life!

Screening Matters: The Decline of Cervical Cancer

March 13, 2016 by drjaffer

Cervical cancer is the tenth-leading cause of cancer deaths in the country. An estimate 4,000 women die each year in the United States due to cervical cancer. This may seem like a lot, but the fact of the matter is that new cases of cervical cancer have declined by about 40% in the last 30 years alone. Whereas before approximately 14.2 women out of every 100,000 developed full-blown cervical cancer each year, now that number is down to 7.8 women per 100,000. This is an enormous improvement!

So what’s changed? The answer is diligent, annual screening, as well as the use of the HPV Vaccine. Today I want to focus on screening rather that than discuss the HPV vaccine – that’s a topic for another time.

Screening for cervical cancer is performed with a well-known procedure called the Pap test (Pap smear). This test is performed in the doctor’s office as part of the routine physical examination and typically begins at age 21, and is repeated every few years depending on which screening guidelines you and your doctor follow. It typically is conducted until you are at least 65 years old, at which point it may be stopped if several consecutive tests came up negative (meaning no abnormalities).

So why does screening matter so much?

In the case of cervical cancer, detecting cancer in the early stages can very often lead to a cure. In fact, in most cases doctors are able to detect pre-malignant cells that have not even developed yet into full-blown cancer. The survival rate is extremely good for cervical cancer detected early, enough so that a normal life expectancy is very likely. On the other hand, cervical cancer detected in the late stages that has metastasized, or spread to other parts of the body, has a very low life expectancy. Since cervical cancer often will not show any outward symptoms until later stages, screening allows doctors to find and treat cancerous cells long before most women reach these later stages – assuming they do stick to their schedule of exams.

Screening alone drastically reduces your chances of developing full-scale cervical cancer. It’s estimated that women who are not screened are 10 times more likely to develop cervical cancer.