Monday, April 20, 2015

Too Old For a Mammogram?

When to stop screening? My 85 year old patient was ‘disappointed’ that I turned down her request for a mammogram requisition slip. Her mammogram was a birthday ritual and had been for decades. She had no unusual risk factors for breast cancer and performed breast-self examinations monthly. While a matter of debate, finding breast cancer at age 85 may not help my patient survive longer, but it may cause medical problems, diminish her quality of life and cause unnecessary distress.

There is no doubt that screening mammograms will pick cancers at an earlier stage. The question of what to do if a cancer is found will be based on type of cancer, if there are other medical conditions, expected life expectancy and the wishes of the patient. Most of the studies that looked at women who had screening mammography after age 80 have found that those women tended to be white, married, and have higher education and income levels. They also were in better health with fewer other conditions such as heart disease or diabetes. The data are not clear if early detection of breast cancer in elderly women increase survival. For women with other medical problems (lung disease, peripheral vascular disease, heart disease, diabetes, rheumatologic disease), mammograms did not increase survival.

This discussion is about screening mammograms only. Any breast mass or breast change requires an evaluation – which could include mammogram, ultrasound or MRI.

I read an excellent guideline – women should have a yearly screening mammogram until they believe that they don’t have ten good years left.

Sunday, April 12, 2015

Prostate Cancer Screening

To screen or not to screen? The recurrent question for my older male patients.

Prostate cancer is common and most men will develop it if they live long enough. Dr. Andrew Vickers of Memorial Sloan Kettering Cancer Center wrote some excellent guidelines to help guide the choice

In summary:

The goal of screening is to find aggressive prostate cancer early and cure it before it spreads beyond the prostate.

Most cancer cases found by screening do no need to be treated and can be managed by “active surveillance.”

If you choose to be screened, there is a good chance that you will be diagnosed by with a low-risk cancer and you may face pressure from your physicians or family to treat it.

The entire short and easy to read article is available on line. You may need to read it at the library or ask your internist to access it for you.

Wednesday, April 8, 2015

Choose My Plate

We all have to eat – and more than once per day! Not too many of us are presented with an attractive, delicious and nutritionally perfect plate; it takes some effort to get there. An excellent resource is Choose My Plate from the United States Department of Agriculture.

The website provides abundant resources for families on a budget, dieters, children and healthcare professionals.