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The chatroom posts always start with words like "Help!” or “I’m flipping out”. And they’re all the same story -- a woman having a routine mammogram is called to come back for follow-up. She’s not told why, and the wait can be as long as six months.
A study published on Monday shows many women suffer intense stress after such a call -- and that the stress lasts long after a follow-up mammogram, ultrasound or biopsy shows they are cancer-free.
Most women are just fine, of course. But the study, published in the Annals of Family Medicine, suggests that doctors need to address the possibility of anxiety, even extreme anxiety, over a false-positive test result.
“False-positive findings on screening mammography causes long-term psychosocial harm: Three years after a false-positive finding, women experience psycho-social consequences that range between those experienced by women with a normal mammogram and those with a diagnosis of breast cancer,” John Brodersen and Volkert Dirk Siersma of the University of Copenhagen concluded in their report.
A 42-year-old woman wrote about her experience in one women’s health chatroom. “LADIES-HELP I’m flipping out,” she writes. “I am scared out of my mind. I have dry heaves because there’s nothing to vomit.”
The woman, whose identity could not be confirmed, got a letter asking for a follow-up visit to get additional imaging after a routine mammogram. “I called to make the appt & it's going to be A WEEK before they can fit me in!” she writes. “I am waiting for a call back from my Dr. to see if I can get any more info. I am SO SCARED!!!!!!!”
Talya Salz, who’s done some research on the anxiety that follows mammograms, says it’s not hard to imagine what women are going through. “At least in the initial period, you are going through the motions of imagining what it would be to have breast cancer,” Salz, who studies cancer survivors at Memorial Sloan-Kettering Cancer Center in New York, told NBC News.
Salz and colleagues did their own study of the psychological impact of having a false-positive mammogram in 2010. Their meta-analysis -- a study of studies -- showed that women who got a false positive were more likely to be anxious and distressed about breast cancer. Other studies have shown a similar effect. The latest study followed 454 women for three years.
“The risk of having false positives differs greatly from one country to another. The cumulative risk in Europe and the United States of false positives in 10 screening rounds ranges from 20 percent to 60 percent,” Broderson and colleagues wrote.
They compared women who had an abnormal mammogram that turned out to be nothing to women who did have breast cancer.
“Women with breast cancer experienced greater negative changes in psychosocial consequences than women with false positives, who again experienced greater negative changes than women with normal findings,” the researchers wrote. “In the two scales regarding inner calm and existential values, however, there was no statistically significant difference between women with false positives and those with breast cancer up to six months’ follow-up.”
Breast imaging specialist Dr. Alice Rim of the Cleveland Clinic in Ohio says this means doctors need to do a better job right after women get their mammograms.
“One of the most important things that I can do as a physician in a screening program is make sure the doctors have a talk with their patients,” said Rim, who was not involved with the latest study. “What does it mean when they call you back? It could be nothing.”
What looks like a tumor on an X-ray may be a cyst, or it maybe nothing at all. Sometimes growths just disappear, for reasons doctors don't quite understand. "You have to take a 3-dimensional object -- a breast -- and smash it onto a two-dimensional view," Rim said.
Rim says her clinic is careful about sending letters to women saying they need a follow-up mammogram. “Getting the letter is very scary,” she said. “Sometimes women don’t know what to do. They are freaking out.” Rim said often her clinic will call a patient before she gets the letter to explain what it means -- and what it doesn’t mean.
”We try to hold off on sending letters on a Friday or Saturday because there is no one to call,” Rim said.
This anxiety is of one of several reasons the U.S. Preventive Services Task Force recommends that women over 50 only get a mammogram every other year, and why the group says it might not be necessary for every woman aged 40 to 50 get a mammogram.
“We don’t think about the negative results of all the testing that we do until we get a scary result,” Salz said. But Salz and Rim agree -- this doesn’t mean women should not get mammograms, which can find breast cancer before it has spread and while it is easiest to treat.
While women may be anxious, Salz says, it doesn’t usually reach the point of damaging their lives. “We are not talking about anxiety that is going to send you to get medication,” she said.
But anxiety may deter women from coming back for their next routine screening -- and that’s not good, Salz said.
Cutting back to screening every other year can cut back the anxiety, too, a study funded by the National Cancer Institute earlier this year found. It found that over 10 years, 61 percent of women who have annual mammograms will get called back for what turns out to be a false positive, compared to 42 percent of women getting the screening tests every other year.
And another study published Monday confirms that women can safely skip every other year.
The team from the University of California San Francisco and Seattle’s Group Health Research Institute looked at data from more than 900,000 women. They found that women aged 50 to 74 who got screened every other year were no more likely to have advanced stage cancer or big tumors than women screened more frequently -- even if they had so-called dense breasts, which are harder to read on an X-ray.
“For women 50 to 74 years old with dense breasts who are cancer-free, we estimated that more than half will be recalled for additional mammography at least once over the course of 10 years of annual screening,” said Rebecca Hubbard of Group Health Research Institute, who worked on the study.
“Screening every other year decreases this risk by about a third. The risk of false-positive results is even higher for women who begin annual screening at age 40.”
But the study also found that for women 40 to 49 who had extremely dense breasts, if they only got screened every other year they were almost twice as likely to have advanced stage cancer if a tumor was later found, and more than twice as likely to have a large tumor.
Women under 50 with dense breasts need to decide with their doctors whether to have annual mammograms, they wrote in the Journal of the American Medical Association’s JAMA Internal Medicine. But they should also “be informed that annual screening leads to a high cumulative probability of a false-positive mammography result because of the additional screening examinations.”
As for the 42-year-old woman who was so anxious she vomited?
"I had a biopsy done last week. The nurse called me with my results this morning...& they were benign!" she wrote. "I am very relieved! This has been the longest week of my life."
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Nice to have yet another study confirming that annual screening of average-risk middle-aged women has no substantive effect except more costs, more stress, and more unnecessary procedures. (Oh yes, and more overdiagnosis and unnecessary cancer treatment.) I decided a long time ago to favor the European guidelines because they are based on science, rather than self-interest, and do not come from a culture where "aggressive" is perceived as an unalloyed compliment.
Now downplaying the stress for women of false-positives on mammograms, but there is also a similar problem with PSA tests for men. A huge number of false positives on the test, urologists who depend on the revenue from biopsies and prostate "cancer" treatments, and a for-profit medical system that will tell any lie they can think of to keep you from knowing that 19 out of every 20 men with prostate cancer are non-clinical, meaning they require absolutely no treatment.
After going through that process, a huge majority of men simply give up and have the needless surgery, resulting usually in loss of bowel, urinary, and sexual function. This is the equivalent of women having double mastectomies based on a false positive mammogram.
I've been getting mammograms since age 36 due to a higher than normal risk. I've been called back twice. Once around 40, in which they performed the more sensitive mammogram with the very small plates. It was fine.
Then last year at 51, I was called back for a follow-up mammogram and ultrasound, if needed. I did have to have the ultrasound, which they did right after the mammogram. The doctor determined that again, it was due some some very dense breast tissue in the left breast like my very first call back some 10 years ago. They did recommend me having a 6 month follow-up instead of waiting a year.
I was able to get in within a week, so although I was a bit concerned and nervous, I figured I get mammograms every year - so anything found should be easily treated. I was also told if the were really concerned about what they saw, they probably would have got me in within a day or two.
Although it was a bit stressful, I knew if it was anything, I would deal with it. False-positives would never keep me from getting a mammogram.
Oh, it's the same reason it always is. The person saying, "Oh, we'll contact you next week (or your appointment is next week or month)" doesn't have to live with the fear. It's the same behavior that is callous and insensitive that keeps a lot of women from getting to the doctor. Oh, no big deal, that can't hurt. Oh, ask me more next time in 6 months. Oh, we'll just watch it and don't worry...we will talk about it in 6 months or so, and no, I don't know what it is, but no need to worry. Oh, those can't hurt you, so it's not hurting you. Try some Tylenol and I'm sure it will make that pain you say is excrutiating go away. Oh, well stop worrying...you may still be around to raise your family in a year, but we can talk about that in 6 months at your checkup.
I know sometimes there just aren't firm answers, but it is disrespectful and cruel to make women wait for test results that could be given earlier. Of course it is to do that to men as well, but this goes along with how women are frequently treated anyway. It is just plain bad medicine.
Jane, happy to hear you are getting screened. Be aware though that by waiting 2 years cancers will have had longer to grow and likely present at a more advanced stage. This contributes to the lower survival rate following breast cancer diagnosis in Europe as opposed to the U.S.
@Kevin: Monthly self-exams are pretty good at detecting early lumps and every woman should know how to perform one. Many times, it's a husband or lover who feels a lump even before a mammogram screening is performed.
I agree with Jane. It's not necessary for every woman to have a screening every year unless she is already at high-risk (family history, uses birth control pills or some kind of hormone therapy). Women with breast implants should be screened every year too.
Charle7834, I appreciate your response. A primary goal of screening mammography is to detect cancers before they become palpable or clinically apparent. I never like seeing cancer, but it is extremely gratifying to find an 8 mm tumor and know I may have saved a life.
We could debate pros/cons all day but the bottom line is that anyone willing to participate in their healthcare and engage in screening is ok by me. Best wishes.
Great response, Kevin. There is no reason not to do a yearly mammogram when age appropriate. With the many survivors of breast cancer in this day and age, to take the risk of not having one, yearly, is foolish, in my opinion only.
Of late many are wanting ultrasounds over mammograms. Please know that ultrasounds will by no means ever replace a screening mammogram, and in most Imaging Centers, Radiology Protocols will not even consider a breast ultrasound in place of a mammogram.
I had a baseline screening at 35 due to breast cancer on my mothers side. I am not willing to put myself, or my loved ones through something that is completely preventable.
Big or small, save them all :)
Kevin - I am not yet getting screened, because I'm under 50 (not sayin' by how much!). Studies show a modest (15 to 20%) reduction in breast cancer death rates with screening mammography, but almost all of this benefit can be obtained from screening every two years. That has now been shown in multiple studies, including the one cited here. Therefore, screening frequency among screened women cannot be blamed for any disparities between Europe and the U.S. Less dangerous cancers usually take several years to spread, if they ever do; aggressive cancers spread fast, and by the time they can be screen-detected it's often too late. So there's nothing obviously superior about a 12-month screening period. The European recommendations are designed to maximize benefits while minimizing harms of screening.
Also, the five-year survival rate after diagnosis is not the appropriate metric to use; the overall breast cancer (or total) death rate is. As you no doubt know (since you indicate that you are employed in this field of medicine), earlier detection would increase five-year survival even if treatment had no effect on eventual time of death. What's more, more aggressive screening in America means more overdiagnosis of women who would never have died of their breast cancer, whose five-year survival rate will be 100% (not counting deaths from cancer treatment). This makes our five-year survival rates look artificially good.
So glad my wife insisted on annual exams. They were painful and annoying but ultimately life-saving. Her screening picked up calicifications, doctor told us there was an 83% chance it was nothing. The biopsy showed she was in the 17%. By catching the cancer early, her treatment was less invasive and less radical than if would have been if the cells had grown into the size of "lumps" that could have been detected by a hand exam.
Early detection is the key.
Jane - some of these forms of cancer are very aggressive and move quickly. I hope you keep an open mind.
USMC Vet - I've kept an open enough mind to read a scholarly book and a stack of reprints on this issue, and now I've decided what conclusions I like, unless contrary evidence of equal quality appears. If your wife had had a really aggressive, fast-moving cancer, she would probably have died despite annual screening. Recent studies indicate that if 100 women in a group would have died of breast cancer during a given time period without annual screening. 80 to 85 of them will die with screening. Your wife's calcifications were probably a slow-growing cancer (or DCIS) that would have been just as easily cured the following year - or possibly they'd even have disappeared in the meantime, sparing her any treatment-related harm. Those who are diagnosed can never know what their fate would have been without it. Since there's no way to guess in advance what is best for each individual, I prefer to trust in what seems best at a population level.
European guidelines killed my cousin. By the time her cancer was detected it was multi-focal with lymph involvement. We are very lucky to have yearly screening in this country.
Lesley, I take it that your cousin got mammograms every other year? The large study referenced here, and other major studies, have provided clear statistical evidence that she'd probably have died even if she got annual mammograms. Cancers like that may spread in a few months - nobody's going to get mammograms quarterly; imagine the cost and the radiation-induced cancers that would result - or even before they can be seen on mammograms.
It's important to understand this because we have a tendency to victim-blame with regard to breast cancer. In particular, if it's incurable and you didn't choose the most aggressive screening schedule, we hint that it's your fault that it "wasn't found in time." Telling women, usually falsely, that they could have avoided their fate by making different choices may lead them to wrongly blame themselves as they are dying, and leave grieving relatives indefinitely blaming them for not making the "right" choices.
The guidelines were every three years, stopping at age 60. I have seen how cancers can spread in three years. Patients who are in denial and refuse early treatment eventually come back for treatment when they are symtomatic. It is very sad indeed to deal with them at that stage.
Decades ago there was this kind of resistance to PAP smears, now mammography. Women are certainly entitled to make their own choices, but they should understand that our system offers them the best chance of beating a cancer. Yes, early detection will result in needle biopsies of some benign lesions. It also saves lives.
The fear factor is introduced when women do not understand that call backs are part of the screening process. A call-back is not a false positive, it is further investigation of an area that is assumed to be benign until proven otherwise.
I remain a dedicated once a year mammographer.
Jane, you stated -
If your wife had had a really aggressive, fast-moving cancer, she would probably have died despite annual screening. Recent studies indicate that if 100 women in a group would have died of breast cancer during a given time period without annual screening. 80 to 85 of them will die with screening.
I'm sure you didn't mean to sound callous, it just comes off that way. However, I am here to learn and keep an open mind. Can you state your sources?
Lesley - How do we know our system offers "the best" chance of beating a cancer? For those fast-moving ones, surely twice-a-year mammograms would offer an even better chance. Of course, that would also further increase the number of overdiagnoses - inflating the apparent cure rate - and maybe the number of radiation-induced cancers. The only way to estimate where the sweet spot lies is to conduct large studies. The results of those studies do not apply to women at highest risk, but for average women, it's rational to take them into account.
USMC Vet - I don't know why it should sound callous to say that women who die of disease are probably NOT responsible for their deaths. To me it is callous to say "Well, I bet [without evidence] that you'd have lived IF ONLY you'd gotten more mammograms", encouraging dying women to blame themselves for dying and leaving their families when in fact they probably could not have avoided that fate. It's very sad when women (or men) die young, but imagining that all such deaths are preventable would skew our decision-making badly.
I'm out of the office and don't have access to my files, so can't cite primary literature. A very good book on the subject is "Mammography Screening: Truth, Lies and Controversy"; the first author is Peter Gotzsche, a European member of the Cochrane Collaboration that focuses on reviews of the efficacy of medical interventions. The book is a good read - if a bit polemic because Gotzsche has been subject to some apparent slander by ideological opponents and was plainly hacked off about it - and would give sources for recent numbers. If you look him up on PubMed, he is also a co-author of several scientific publications on the subject. His own work seems to focus on the issue of overdiagnosis, but his most recent publications would surely cite the papers estimating a 15-20% reduction in breast cancer mortality with mammography. (Or you could try searching for "mammography" and "15%" or "20%".) Hope that helps.
How many radiation induced cancers do we currently have under the once per year guidelines. Are they real? Or hypothetical?
http://www.huffingtonpost.com/2010/09/23/mammograms-may-not-benefi_n_736262.html
http://www.cbsnews.com/8301-204_162-57553587/mammograms-lead-to-breast-cancer-overdiagnosis-in-1-million-women-study-finds/
http://abcnews.go.com/Health/ultrasound-mri-screenings-detect-breast-cancer/story?id=16062355
In my area, the local hospital is finding that all women need to come back in for additional radiation(X-rays)...they will get the new equiptment paid for in record time!
Never in any of these allopathic articles do they ever admit that Thermogram in a safe option.
Why Thermography is Not a
Replacement for Mammography
Therefore, no single test exists that can be used alone as an adequate screening
or detection method for breast cancer.
an anatomical imaging procedure (mammography). The two tests are “looking” for
completely different pathological processes.
some slow growing non-aggressive cancers will only be detected by mammography.
Because it isn't...
Even the IACT says thermography isn't a replacement for mammography. Link to the points speakingup referenced:
http://www.iact-org.org/patients/breastthermography/mammography-vs-therm.html
Jeeeeez, don't have any more tests.
This isn't a perfect world and even if it was you would still not like the answers and the procedures.
If you suffer long term stress over a damn Doctor's visit you need help from a different form of Doctor.
We now have a society that wants "instant" answers and if they don't like the first one, they demand a different second one "immediately."
And it is "all so stressful." Grow up, we all have fears, but if you chose to worry yourself to death about things, you shouldn't even bother going to a Doctor.
Don't waste the Dr.'s time and be taking service away from others that can be helped.
I have been on all ends of this situatiions: I do not consider anything a "false-positive." I have had things that were tumors and removed, only to find out they were benign and I would be ecstatic. Tumors that were removed and found to be in-situ and either required no further treatment or one I needed radiation and tamoxifen for. Then 10 years later on the other side they found another questionable area and needed an ultrasound, MRI and found it was infiltrating ductal carcinoma in situ, so then had a double mastectomy as the MRI also picked up something in the left breast again. Fortunately my lymph nodes are clear, they caught it early because I go for Mammograms every 6 months or a year. So if you want to talk about stress or pain of mammograms, I am thankful I was able to have all of it as they have saved my life!! The so-called "pain" is so minimal and for only a few seconds, I just do not know what you are whining about. And thermogram just measures surface heat and misses many deep tumors and it does not diagnose it as to whether or not it is malignant.
Easy for you to say, Bill as you clearly have not experienced it. Following a painful mammogram, What causes the undue stress for women is getting an urgent phone call and letter that indicates there is a potential problem. The letter is vague and when you speak to the person on the phone, they REFUSE to give you any information- they will not even tell you which breast but tell you that you can have another mammogram appointment after several weeks.
Then, you return after several weeks of worry, after having to go back to your referring doctor for a new prescription for a second mammogram and they PAINFULLY smash your breasts once again-
then send you in for an ultrasound- a painless, more definitive test that does not have a risk of giving you cancer like a mammogram does.
It is not about wanting an "instant answer" it is about wanting to be treated compassionately and humanely.
Bill, you need to just butt out if you haven't had this happen to you. A woman sitting waiting for weeks sometimes or months to find out something that could mean she needs to find homes for her children and might not see them grow up isn't whining. And speaking up, this isn't about the need to have a mammogram and it isn't whining. How sad we have lost compassion for the suffering of others whether any of us feel it can compare to ours or not.
I am really sorry you and anyone else goes through cancer, and I am also really sorry that women have to wait and wait for results and have tests that merely lead to more tests and could be avoided. The point here is that unnecessary waiting causes a lot of trauma, and that is true. There is enough compassion available on the planet for everyone who needs it, right?
Well put. No (informed) person doubts that mammography aids in early detection of cancer and saves lives. That being said, as doctors we have an obligation to communicate findings to patients promptly and in a compassionate manner. My day runs far more smoothly if I explain exactly what I know to a patient, explain the options for workup/treatment, and allow my patients to participate in their care. The point here is less about the dangers of "false positive" mammograms and more about how we can alleviate anxiety in patients.
I am shocked to hear that so many here have long waits from their doctors for results. At our Imaging Center we are provided the same day, from our Radiologist, all abnormal findings. A prepared letter is faxed to the ordering provider that day with with the Radiologist findings and follow up recommendation. Ones that are highly suspicious for cancer are called by our Radiologist to the ordering physician.
The patient is then notified by the ordering provider and those patients are back in for follow-up within a day or two. Those reports are back to their providers in less than 24 hours. We also tell these women that they can contact the doctor the next day for results.
With all of the new technology, there is no reason for long waits for results. Get on the phone and call your provider for your results. Don't wait for them to call you.
I am shocked as well as to how long some women have to wait to get answer and that some of those answers come in the mail. My wife had her annual mammogram on Jan 29th. We were told by phone that the doctor wanted to discuss the results on Jan 31st. We met with the doctor on Feb 1st and the biopsy was scheduled on the Feb 4th. He called with those results in two days. Her surgery was scheduled within two weeks.
I think the key here is the doctor - patient relationship. Our doctors is very hands on [no puns please] and gives out his home phone number. This is not a rural area, it is suburban Philadelphia. Just lucky to have had the right recommendation for a doctor.
I am also bewildered by these wait times. A couple of years ago I had to have a reshoot. I never even got my clothes back on, we did it right then and there.
This exact thing has happened to me multiple times - now I don't even want to come in for an annual mammo because I know they'll inevitably ask me to come back for an ultrasound. So if the ultrasound is better at detecting, why not do this first before a mammo? The first time I was told to come back for another screening, I also freaked out and didn't know what to think - your mind races for days wondering if you'll be told you have cancer. This is really a cruel way to deal with something that could easily be done in a more sensitive way by telling women up front that the percentage of those that are rescreened and their results come back negative is very high.
If I were you I would talk to my doctor about going straight to ultra sound due to your history. It should be cheaper for the insurance company to do the one instead of both tests.
Bluewave, for most women ultrasonography is not suitable as a screening modality. The biggest upsides of mammography are the enormous amount of data supporting its effectiveness and the standardization of interpretation. We typically use ultrasound as a problem solver, to help us distinguish between cysts and solid structures, and to further characterize solid structures as worrisome or not.
From a radiologist, if you're not happy with the way you're doctor is communicating your results to you, or if you have trouble scheduling a follow-up appointment in a timely manner by all means change doctors. Nothing convinces people to change their ways so quickly as losing business.
I'm in the same boat as you bluewave. I always get the callback for the ultrasound. Funny thing is that neither are as definitive as the MRI, which I wish I could just do once every ten years... because I am always running to the breast specialist.
As for the worry about call backs, I would rather have a false positive than miss one year and have a huge problem. Now that would be much worse!
After all, that mole on your arm, that rapid heartbeat, or the clinically insignificant liver cysts that keep multiplying every time you have a scan for something else... that's part of life. It's scary and it's totally NORMAL.
I understood the reports to read that the period spent waiting for a follow up mammogram when the findings were "unclear" was traumatic for patients. Perhaps patients who are in this limbo position should be considered in "urgent need" and thus given priority in rescheduling within a day or two, and with the immediacy of a phone call, not a form letter sent by snail mail saying "well the results aren't really clear. . . call us for a reappointment."
This "unclear" period leaves the patient living with "virtual breast cancer" for a week or two weeks or a month before a second mammogram. Then consider that the second mammogram might indicate the presence of cancer. By the time the patient can get a conclusive biopsy report and begin treatment the cancer has gone another month or more untreated.
This is unacceptable.
I speak with the authority of one who found herself in this position. My normal composure and level headedness flew out the window as I spent almost 10 days living with "virtual breast cancer." The shadows are still with me a few years later. And I was the lucky one who got an "all clear" after the second mammogram.
I understood the reports to read that the period spent waiting for a follow up mammogram when the findings were "unclear" was traumatic for patients. Perhaps patients who are in this limbo position should be considered in "urgent need" and thus given priority in rescheduling within a day or two, and with the immediacy of a phone call, not a form letter sent by snail mail saying "well the results aren't really clear. . . call us for a reappointment."
This "unclear" period leaves the patient living with "virtual breast cancer" for a week or two weeks or a month before a second mammogram. Then consider that the second mammogram might indicate the presence of cancer. By the time the patient can get a conclusive biopsy report and begin treatment the cancer has gone another month or more untreated.
This is unacceptable.
I speak with the authority of one who found herself in this position. My normal composure and level headedness flew out the window as I spent almost 10 days living with "virtual breast cancer." The shadows are still with me a few years later. And I was the lucky one who got an "all clear" after the second mammogram.
I was once in a business meeting that by chance, happened to involve 9 women, all in their late 30s and early 40s. I was about to get a breast lump biopsied, and one of my coworkers happened to mention that.
It turned out that every woman in that room had been through that experience and some more than once. That's not just a false positive mammogram, that's also a false positive ultrasound and then a negative biopsy in nine random women.
My most recent mammogram was followed by a letter on red paper, no less, saying that I needed an ultrasound. After an honest conversation with my PA, it turns out that particular radiologist was requiring second mammograms or ultrasounds on most of the patients that she had sent there...I doubt it's any coincidence that that particular hospital is in financial straits. It further turned out that the radiologist was not indicating a positive test, he was just refusing to do a complete rule-out because of scar tissue from my previous biopsy.
It's quite clear to me that the tests we have for breast cancer are horribly inaccurate and more women need to be informed as to that reality so that they can make more informed and sane decisions about when/if to follow up.
One of the reasons so many doctors and radiologists request followup mammograms and ultrasounds and MRIs is because of the fear of malpractice claims filed against them. Thanks to a society that loves to sue.
If that were the case, you would expect mammogram followup rates to be much lower in Texas, where medical malpractice tort reform was instituted several years ago. In fact that is not the case; the national average is 8.4%, and in Texas it's 8.2 %. Not much different, if fear of malpractice was a huge factor.
http://www.dallasnews.com/business/headlines/20100707-Follow-up-mammogram-data-open-to-388.ece
DRK - Did the TX tort reform limit the ability to file a lawsuit or the amount of damages that could be awarded?
They request a follow up because the breast tissue is usually too dense to rule out any small tumors.
Anita, Texas tort reform limited the amount of damages that could be awarded to $250,000. Even if you've been the victim of the kind of poor care that leaves you paralyzed for life, $250,000 is all you can get from the doctor who injured you. You can file a lawsuit, but you must do it within two years of the malpractice.
http://www.citizen.org/documents/Texas_Liability_Limits.pdf
I am blessed to have an exceptional clinic where, if there is a possible on the mammogram, they can immediately perform an ultrasound followed by a biopsy, if need be. I found out all in one day (that I had cancer), and I'm glad I didn't have to wait because I know I would have driven myself nuts. I eventually had a mastectomy, which would have been ok but the Doctor used a pain pump that she knew to have issues with causing staph infections, so my last year has been spent in and out of hospital battling staph. I realized that her concern over potentially being sued was outweighing her care for me as a patient when she refused to refer me to an infectious disease doctor without "first seeing me", though she had seen me less than a month before. So, there are good doctors and there are bad doctors. I hope for all you ladies out there that you find more of the former and fewer of the latter; and remember that this disease does not kill or get out of control in a week or a month; many of us have it for years before it is discovered (those unfortunate dense breasts), so you DON'T HAVE TO MAKE A DECISION immediately. Hang in there! You have time to make rational, correct decisions!
This article hits home. In my 20s, my doc found a lump. He freaked me out, calling me at home to have surgery ASAP. I ended up going to 8 docs and it turned out to be nothing. At the same time, I was in a lawsuit with another doctor (we sued for negligence in a simple bunion operation; won). Lost trust in docs. And now I wait for a pap smear results. In may 20s, docs said I was going to die of cervical cancer (DES daughter); umpteen tests, etc. Nothing ever happened. Bottom line: I don't have trust. I listen to my own body and gut instincts.
We wouldn't have to be fearful of cancer if we took control of our health by eating a healthy diet, taking supplements, and living a healthy lifestyle. Cancer means our bodies are out of balance. Our med community doesn't treat the whole body. They are taught to treat the symptom and either do surgery or give meds. It is time that we don't see Doctors as gods. Alternative or Natural health approaches are far more humane and helpful in getting our bodies back into balance. Educate yourself in the toxins and poisons that are in our foods. Real food vs. processed foods. If you don't know where to start check out
I took supplements. I ate a nearly vegetarian and high fiber diet. I didn't smoke or take drugs. I exercised daily. I ended up with breast cancer.
A woman I work with...same age as me...weighs close to 300 lbs. She smokes. She drinks. She eats fatty foods and never exercises. Healthy as a horse.
Don't fool yourself. Cancer has far more to do with genetics than how much broccoli you eat.
Two of the three women I've known who died of breast cancer were vegetarians who ate only organic foods.
You're right Robbie. Your friends lifestyle isn't helping her quality of life and possibly not her quantity, but her genetics will have a far greater impact. Same goes for cholesterol and some types of heart disease. That is not to say that living a healthy lifestyle doesn't have huge benefits, and I do believe there are diseases like cancer that can be triggered environmentally, but at some point, genetics is destiny and if we spend all our time worrying about that, we miss what is going on in the here and now. None of us are going to live forever and pretending we can is a waste of our precious time.
It's genetics for some unlucky folks, but it's not all genetics. Genetics doesn't explain why the risk in middle-aged American white women is so much higher than it was a few generations ago; their genes haven't changed that much. When people from places with less cancer, e.g., in east Asia, move to the U.S. or adopt the Western lifestyle, their cancer risk shoots up. Here are a few things nobody wants to hear about: (1) Yes, lifestyle makes a big difference. The Western diet, lack of exercise, lack of sun exposure. How many of us want to go to special efforts to live in a way opposite to the one the TV tells us is the American way? (2) Our environments are full of endocrine-disrupting chemicals. Many of them we can't avoid. Do we want to become full-time environmental activists? Avoiding those we can theoretically avoid would mean rearranging our daily lives around cancer fear; is that what we want? (3) Bearing children, especially at a relatively early age, and prolonged nursing reduce the risk of breast cancer. Flip that around, and not having kids or having one when you're 35 or 40 increases your risk. Anybody want to start encouraging teen pregnancy to cut down on future breast cancer?
This is really ridiculous. I can understand some stress if you have to wait six months, but a week? I've had to have followup scans and ultrasounds after mammagrams as well as followups on PAP tests. Yes it is a bit nerve wracking for a few days but once I get the all clear I'm done and its time to move on. I had to go through CTs every six months for two years to monitor a spot on my lung. No change until the last one which resulted in surgery and it was still benign - so move on. I have friends who have actually had cancer who deal with it better than this. Yes, when you first get the news you call your best friend and tell them you are scared. When there is nothing to be scared about anymore, stop being scared. People waste so much time worrying about dying that they forget to live.
...oh and BTW - when you get the all clear call the friend you called when you were scared, go out to a nice place, order a good bottle of wine and a great dinner and have a party.
You've just accidentally made a case for the harms of overdiagnosis. As a result of your or your doctor's fear of some incidentaloma, you soaked up a huge amount of radiation, which may cause you someday to develop real lung cancer; you had needless lung surgery that could have killed you; and you no doubt spent a fair amount of money and a great deal of time over those two years worrying about whether you had cancer. You would have been much better off if that spot had never been found. I totally agree with you that people shouldn't spend so much time worrying about dying that they don't live; but isn't that what we do when we scuttle back and forth for tests, tests and more tests all the time?
Ladies, do your own research. Mammograms may not be as beneficial as they claim they are. It takes something like 2000 individual exams to save ONE life. We also don't know how many cases of cancer resulted from too many mammograms. It is radiation exposure, after all. Then there's the overtreatment of cancers that maybe ought to be left alone. Look it up.
Ladies, do your own research. stanmrak has absolutely no idea what he is talking about - his interpretation of the statistics is at best ignorant and at worst dangerous. Yes, many negative exams are performed for each cancer diagnosis which is the purpose of a screening exam. Furthermore, even the most pessimistic estimates of the # of cancers caused by radiation from mammography demonstrate that early detection (mammography) saves lives.
Ask your doctor, PA, or nurse practitioner. Get informed, and don't rely on bunk some yahoo posts on the internet.
Recent studies show that mammograms have only reduced the cancer death rate by about 2 percent. It doesn't take a rocket scientist to interpret the statistics. If mammograms were completely safe, you might be able to make an argument for their use. But they're not.
http://www.naturalnews.com/010886_breast_cancer_mammograms.html
http://articles.mercola.com/sites/articles/archive/2009/12/03/Avoid-Routine-Mammograms-if-You-are-Under-50.aspx
Your doctor, PA, or nurse practitioner is only regurgitating what they've been told by the people who sell the equipment and profit from the screenings - that's where they get their "post-graduate" education.
It would be difficult to find more biased or less credible references than the two you cite. In addition to referencing articles 15+ years old they over-estimate radiation dose from mammography by a factor of 3-10x.
An informed person can make their own healthcare decisions, even if they decide poorly. Encouraging others to avoid a screening exam with obvious, proven benefit though is not only idiocy, it's immoral. Here's hoping other readers have the good sense to ignore your nonsense and get informed.
Although stanmrak understates the value of mammograms in preventing breast cancer-specific death (it's at least a 15% reduction), he also understates the number of mammograms it may take to save one life. A decade of screening for 2000 women in their 40s will prevent one death from breast cancer. If they are getting screened annually American-style, that's nearly 20,000 mammograms, not 2000. For each life saved, several women will be overtreated, and will suffer lasting harm and even risk of immediate or eventual death from the side effects of treatment. As a woman in my 40s, I do not consider this a good deal.
I only had a mammogram once, and it hurt me so bad that I decided that I would NEVER have another one. I felt that this could actually cause me to have a problem! Therefore, I have not had another one, and it has been about six years and I have read recently online that it can cause problems. Looks like we need to use common sense!
Like seeing herbalists and aroma therapists, with the occasional acupuncture visit will keep you disease free all your life. Or maybe it's listening to all the bogus ads about cures or prevention for this or that if you only follow their simple advice, and send them money to obtain this advice. Be my guest. Darwin works in mysterious ways sometimes.
Seriously, Genie? It hurt so you never had another one? Please grow up. I know everyone's experience of pain is different, but really, it only hurts for a few seconds. Just because it's not pleasant does not mean it's harmful.
And Fool, I'm totally stealing "Darwin works in mysterious ways".
Genie, I'm with you! I had a 300lb "nurse" throw her weight into me for extra "help" flattening out the girls. It was no "few seconds" of pain, Michelle! It was weeks of bruising with all the colors of the rainbow. They tell us from puberty, don't pinch, twist, pull, or squeeze those girls. Then some male dr tells us to go get them smashed flat for a picture. I went back and told that male dr when he gets his nuts slammed in a refrigerator door, I'll get another mammo.
Never had one and never will and that goes for a colonoscopy as well. i don't dig for trouble. I've seen WAY TOO MANY people suffer thru radiation and chemo and still die, all that for nothing !
I get called back after I have a mammogram every time, and always have for the last 15 years (I started at age 25 due to fluid filled cysts that kept recurring). I have learned to appreciate the desire of the breast imaging center to be thorough. Being called back is not a confirmation of anything "wrong", in the least. It is just to rule out for certain. We all have a greater chance of getting lung and colon cancer anyway. Breast just gets so much attention because of everything being pink.
Me too. Sometimes I even point out (to the person doing a scan) where the cyst is located. Hopefully that will always be the reason I get called back. It's all so scarey.
Pretty sad if we decide that we need to decrease mammograms so that we don't scare so many women. Ultimately, it may result in a few cancers being missed, but think of all the people who aren't getting stressed out now! Silly.
At Penn Medicine in Philadelphia, you get your mammogram, wait 10-15 min, the radiologist comes and speaks with you and tells you it is fine or not and you see your doctor. NO WAITING, no stress. Why should women wait for WEEKS in anxiety? It is senseless, mammograms can be read quickly and even double checked by a computer.
I just had a biopsy that came back ok--what would have been stressful would have been a malignant result--life is stressful, people, quit your whining!
I have never had a healthcare provider that did not call me when my results were not normal and more screening was necessary. To just send a notice in the mail is inappropriate and should not be a standard of care anywhere. In my experience the written notification is used when results are normal or for follow-up notice to reitterate the need for further follow-up after an abnormal or questionable finding has been reported via telephone. I have been a RN in women's health for 21 years. If this is not the practice at your mammography/radiology center (and you should ask how you will be notified of your results) it is ok to request that you be promptly called with any abnormal findings and ask for clarification.
I was recently diagnosed with breast cancer at the age of 42. It was 14 mo. after my last mammogram, and 6 weeks after my 54 year old sister found a lump on her own and was diagnosed with breast cancer. My mammogram showed a suspicious area of calcification that ended up revealing LCIS which is a cell marker for an increased risk of breast cancer throughout your lifetime in either breast. I then had a larger excisional biopsy that revealed a 1.3 cm invasive ductal cancer behind the calcification that was missed on mammography because I am young with dense breast tissues. I am convinced that my tumor would have been over 2cm by my next routine screening which would have greatly changed my prognosis.
I would like to encourage women to take responsibility for their own health, get your mammograms and be an advocate for yourself. Don't be afraid to speak up and share your anxieties with your healthcare provider. Good communication is the key to establishing a good working relationship and should help curb the anxiety that comes with the stress of the unknown.
It was not easy hearing the news of my diagnosis but my doctor has been supportive and considerate in relaying info since my first "call back". I didn't get the news I had hoped for but I feel you can't underestimate the importance of sensitivity in the delivery of such important, life changing information.
We have gone from one side to the other side of the boob smasher, I hate them but since I have implants I go like a good girl. I have to tell you a story about my implants and what happened with my first mammo after I got them. First the mammo is a little different if you have implants. I went through the test and was waiting to make sure they clear for reading and the tech came running out telling me I needed to get to the hospital right away because both boobs were full of cancer, she had never seen a mammo with implants, and that she had already called for transportation. We all had a good laugh on that one. All funnin' a side, as much as I dislike the boob smasher they have their place, do we the test as often as stated I don't know, but as we pass 60 if we are going to catch anything are our bodies going to be strong enough to fight it off. I have had who were as fit as can be not be able to fight off illness and pass on. Do any of the results I get scare me you bet and I will do what I can to fight it off. Like one poster said listen to your body, it will let you know when it is sick and it will also let you when you are doing the right thing.
Before I had a mobile phone I was left a message on a Friday that I had to come back for a redo. I didn't retrieve the message until I came home from work. Too late to call back. I was a wreck over the weekend. Since then I tell doctors and other medical staff to mark on my file not to leave me a message on a Friday.
Fortunately all was well but I was a basket case for days.
No family hx of breast cancer. I had been getting yearly mammograms after age 50, had a call back in 2012 (first time) and two biopsies revealed multicentric ductal carcinoma in situ (Stage 0), underwent mammography, an clear. My sister chose every other year mammograms, a suspicious mass was found on mammogram, Stage 2-3, underwent horrendous chemotherapy and surgery and radiation therapy. Side effects of chemo caused ruptured colon. Her final pathology showed Stage 2-3 and areas of DCIS (Stage 0). I believe yearly mammogram caught my cancer in a very early stage. Though both of us survived, she was ravaged by the aggressive treatment required for her more advanced stage.
I've been in both situations (uncertainty ending in good news and a few years later, certainty of cancer), and both involved waiting for an unacceptable length of time for the definitive result.
What I'm wondering is this: Why did it take an official "study" to discover this result? Women who had to wait for a good result had more stress than women who didn't have to wait, and less stress than women who waited for a bad result? Isn't that --dare I say it -- logical?
I had my first mamogram last year. The nurses and techs all told me absolutely do not worry if you get a call for a recheck. More than half of all first checks come back irregular. Sure enough, I had to retest, but everything was just fine. And thanks to the staff at the clinic, I wasn't freaking out. This is how it should be. A woman should never have to wait 6 months without know anything! This is just is horrible