RE: RE: [organics] Mammograms

[Guest guest]

Hi Sharon and OR DCs,

Responding to your post Sharron highlights for me the usefulness of (and the

frustration with) clinical practice guidelines. You wrote...

>I looked up the .gov site and see the wide range of opinions and

>information. In my mind, and in those women who have cried in my office and

>lost their lives, there has to be a smart and multifaceted approach to

>breast cancer prevention and early diagnosis.

I couldn't agree more! Guidelines are just that...guidelines. They exist

to help patients and practitioners make informed decisions about appropriate

health care, not to provide a " cookbook " for doing health care.

There are issues of affordability however, both an an individual basis ( the

under- and uninsured) and on a society-wide basis (do we have enough

resources to everything possible every time?). To my mind the question is

(or should be) is this the right choice for this patient in this

circumstance, at this time?

If guidelines can do anything, they can provide reliable information to

patients (women in this case) about health care (mammograms) that will help

them, along with their caregivers, make the right choices.

Go well,

Chuck Simpson

And, by-the-way, women are more likely to get lung cancer than breast cancer

Re: Mammograms

: I have done the same thing using ultrasound on breast bruises post

car crash with good results. However,,, these scars frequently look like

cancer in later mammograms. If the woman can write down which side and

where the injury was, they can probably avoid unnecessary surgery. I

haven't seen breast trauma result in breast cancer, only scares.

Ann Goldeen, D.C.

1010 Duane Street

Astoria OR 97103

503-325-3311

Mammograms

> >

> > Listmates,

> > My wife's GYN recommended a baseline mammogram.

> > My wife is 40, no family history, breast fed our 3 boys one year plus

each.

> > I thought I remembered reading about new guidelines not recommending

> > mammograms until age 50.

> > And even at that, a poor technology to evaluate with:

> > damage to breast?, poor sensitivity/specifity?

> > Can any one confirm/make recommendations?

> > Thanks,Mike Riemhofer

> >

>

>

>

>

>

>

[Guest guest]

Dear Colleagues:

Mammograms are recommended every 3 years after age 40 for all women (

transvestite men too) who are also ready to have biopsies performed on

suspicious lesions (known as positives). If the woman is not interested in

getting biopsies to confirm or refute a " positive " mammogram, then I advise

her to avoid the whole show altogether. She might want to consider getting

serum studies, aka the female PSA, such as CEA, CA19, E3/E2+E1 ratios, etc.

Again, if she is unwilling to seek positives with follow up, I would suggest

no tests and considerable belief in the afterlife as a preference to the

present life.

Finally, for those who prefer to avoid radiation from mammograms, which do

increase the risk of cancer, start with the physical exam, follow with the

serum studies, follow-up all positives with ultrasound, and all positives

from there with biopsy. She would be willing to reduce risk factors

discovered in the course of evaluation:

1. High fiber diet to objectively reduce estradiol and estrone levels

2. Low fat, all EFA and olive type oils

3. Zero tolerance for PMS, perimenopausal syndromes

4. Totally relaxed atlas and midthoracic spine

5. No smoking, low caffeine

6. Must be Republican ( just kidding ) but must be able to take a joke.

Willard

Re: Mammograms

: I have done the same thing using ultrasound on breast bruises post

car crash with good results. However,,, these scars frequently look like

cancer in later mammograms. If the woman can write down which side and

where the injury was, they can probably avoid unnecessary surgery. I

haven't seen breast trauma result in breast cancer, only scares.

Ann Goldeen, D.C.

1010 Duane Street

Astoria OR 97103

503-325-3311

Mammograms

> >

> > Listmates,

> > My wife's GYN recommended a baseline mammogram.

> > My wife is 40, no family history, breast fed our 3 boys one year plus

each.

> > I thought I remembered reading about new guidelines not recommending

> > mammograms until age 50.

> > And even at that, a poor technology to evaluate with:

> > damage to breast?, poor sensitivity/specifity?

> > Can any one confirm/make recommendations?

> > Thanks,Mike Riemhofer

> >

>

>

>

>

>

>

[Guest guest]

HI, There are some great suggestions in Dr. Bertrand's note below. Given my

mind set however, I would never deviate from the known standard of care just

because a patient won't follow through. This is a recipe for disaster and

would certainly read well in the deposition that the doctor would give at a

later date. The guidelines do vary from one to two (possibly three) years

beginning at age 40 and the variance depends on what the mammograms show.

For instance, dense breasts (which get denser with age),may need every year

mammograms. If the patient knows her breasts, is good about monthly bse

(breast self examination) then possibly the 2-3 year interval can be

recommended. If the patient gets a suspicious mammogram then an US is done

and possibly a fine needle aspiration or biopsy. If the patient refuses to

follow through with additonal studies then make a referral to a breast

specialist and document, document, document. Do not, I repeat do not, put

yourself in a bad position because the patient has other wishes. You are the

doctor, give the information and recommendation then cya. Also remember that

this stuff is very scary and the woman may refuse to follow up due to fear,

giving comfort and reassurance can help but let her also know that this fear

ain't nothin compared to the consequences of a cancer diagnosed too late.

vty,

sharron fuchs dc

Re: Mammograms

: I have done the same thing using ultrasound on breast bruises post

car crash with good results. However,,, these scars frequently look like

cancer in later mammograms. If the woman can write down which side and

where the injury was, they can probably avoid unnecessary surgery. I

haven't seen breast trauma result in breast cancer, only scares.

Ann Goldeen, D.C.

1010 Duane Street

Astoria OR 97103

503-325-3311

Mammograms

> >

> > Listmates,

> > My wife's GYN recommended a baseline mammogram.

> > My wife is 40, no family history, breast fed our 3 boys one year plus

each.

> > I thought I remembered reading about new guidelines not recommending

> > mammograms until age 50.

> > And even at that, a poor technology to evaluate with:

> > damage to breast?, poor sensitivity/specifity?

> > Can any one confirm/make recommendations?

> > Thanks,Mike Riemhofer

> >

>

>

>

>

>

>