Sunday, November 22, 2009

Mammogram Screening For Breast Cancer: No Mammograms until Age 50? New Task Force Recommendations.

The current mammogram screening recommendation put forward by the American Cancer Society is for yearly mammograms for all women aged 40 years and older. Women with a strong family history of breast cancer are urged to start mammogram screening from the age of 35.

The U.S. Preventive Services Task Force (USPSTF), a government-appointed expert panel, recently made new recommendations for mammogram screening for breast cancer:

  • Women between 40 and 49 years old should not be having routine screening mammograms.  Instead, they say that women should make an informed decision about screening mammography before 50, and weigh their potential risks and benefits with their doctors.
  • Women who are 50 to 74 years old should be having a screening mammogram every other year (not yearly), because the risk for breast cancer increases as you age. 
  • Women over 74 years old are not given specific guidelines about routine screening mammography - as their risk of death from heart disease and other ailments is greater than from breast cancer.
  • Women of any age should not be taught to do breast self-exams, but breast self-examination is not forbidden.
  • Clinical breast exams (CBE) will not be required before screening mammograms, because CBE appears to add no benefit to the information gained from a mammogram.
In case you're interested, here are Task Force recommendations on the USPSTF website.

So what does this all mean? Basically, the Task Force is recommending women delay screening mammograms until age 50 in most instances. They say that there's no value in doing breast self-exams and that clinical breast exams don't make any difference either. Also, your breast health could go completely unchecked for years, even though risk for breast cancer increases as you age.

According to Dr. Susan Love, a renowned breast surgeon and activist, "this is rationing of the best kind" since the guidelines were based on scientific data.  However, the data that was considered by the task force was from 2002 - digital mammography has become more accurate since then.

The timing of these recommendations is interesting to me, just when the health care debate is firing up. Any Government health initiative like the "Public Option" for instance, will surely be using these federal guidelines rather than the American Cancer Society guidelines. This feels a little too much like cost-cutting, especially when you consider that since the onset of regular mammogram screening in 1990, the death rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent.

I also heard Dr Love mention in an interview that mammograms aren't very good. A lot of cancers are missed. I agree with that. Mammograms can miss up to 20% of breast lesions. But for $125 that's the best we have right now. I'm all for doing away with mammograms but only if we have something better to replace them with. Right now, that's MRI but obviously no-one is advocating yearly screening MRIs, primarily because of the huge cost that would incur.

Dr Love also said that "all bets are off" if a woman feels a lump.... "she should seek medical advice immediately". How is a woman going to feel a lump when all of a sudden these guidelines are telling doctors NOT to teach women how to perform a breast exam? If that's not a contradiction, what is? We've spent decades educating women and the public to perform this early detection and now we've just  done a complete 180.

One of the bodies the task force has certainly influenced over the years is the insurance industry. These recommendations may provide the reason for some private insurance companies to cut back coverage for annual screenings, particularly for young women. I can hear it now... "the task force doesn't support mammogram screening so we're not going to pay for it."

In the end, women need to remember one very important fact: breast cancer kills more than 40,000 women each year. I would recommend you don't treat these guidelines as gospel and for you to be your own health care advocate. Discuss the benefits and risks of a mammogram, ultrasound, clinical breast exam and breast self-exam with your own doctor.

If you're against these recommendations you have the opportunity to make your voice heard. By signing this petition you'll be encouraging governing bodies and key medical institutions to keep the present mammogram screening guidelines.

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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction and scar healing. Keep up to date with the latest news in breast cancer reconstruction at The Breast Cancer Reconstruction Blog. Also join us on Facebook and Twitter!

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Sunday, November 15, 2009

Growing Breasts from Fat Stem Cells: the Future of Breast Reconstruction

A new form of breast reconstruction that allows women to re-grow breasts from their own fat stem cells after a mastectomy could be offered to British and Australian breast cancer patients for the first time in 2010.

A human trial of the new technique is being planned by plastic surgeons at a London hospital. The trial will study whether fat cells can be induced to multiply and fill a breast-shaped mold implanted under the chest skin to recreate a breast after mastectomy. Australian scientists also recently announced that they would start similar treatments on women within six months, following animal studies involving mice and pigs that successfully re-grew breasts from fat.

If the human trials are as successful, this new technique could transform breast reconstruction surgery, offering an alternative to breast implant reconstruction and more complex tissue transfer techniques requiring significant down-time.

The technique is expected to take about eight months to grow a breast. Initially it will only be used to reconstruct breast cancer patients who have been cancer-free for at least 2 years. Eventually it may also be used for cosmetic breast augmentation allowing women to achieve a significantly larger breast size without needing saline or silicone implants.

The Australian team is led by Professor Wayne Morrison of the Bernard O’Brien Institute of Microsurgery in Melbourne. After a decade or so of working on this project he has now obtained ethical approval for a trial involving a handful of women.

I had the pleasure of listening to a presentation by Dr Morrison at the American Society for Reconstructive Microsurgery in 2008. The technique involves using liposuction to remove some of the woman’s own fat cells. The concentration of stem cells within this fat is then boosted in the laboratory. A biocompatible scaffold is then implanted under the patient’s skin, to create a cavity that matches the shape of her remaining, natural breast. The stem cell-enhanced fat solution is then injected into the scaffold. Over time, the scaffold is filled by the multiplying fat cells which obtain the necessary nutrients from blood vessels surgically wrapped around the scaffold.

The first trials will likely require that the scaffold is removed at the end of the reconstruction process though there is some talk of making the scaffold absorbable in the future so this extra step can be avoided.

Right now the focus remains on growing a breast made completely of fat, without breast glandular tissue, milk ducts or nipple-areolar tissue. The nipple and areola will therefore still need to be reconstructed as an additional step.

These developments are very exciting. I am sure this is the direction breast reconstruction is going in. The most advanced techniques currently available, like the DIEP flap for instance, already use the patient's own fat to recreate a very natural breast. In the case of the DIEP flap, this tissue (fat and skin) is taken from the lower abdomen, providing the benefit of a tummy-tuck at the same time.

While DIEP flap breast reconstruction only takes a few hours (as opposed to eight months), it does involve major surgery and the creation of scars on another part of the body (lower abdomen). In addition, women still need a second surgery for "fine tuning" and nipple reconstruction. In essence then, the reconstruction process can still be fairly drawn out and take several months. I am sure many women will be eager to avoid major surgery and scarring for what could be a very similar end result once this new technique is optimized.

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Dr Chrysopoulo is a board certified plastic surgeon specializing in breast reconstruction and scar healing. Keep up to date with the latest news in breast cancer reconstruction at The Breast Cancer Reconstruction Blog. Also join us on Facebook and Twitter!

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Saturday, November 7, 2009

Tammy's Breast Reconstruction Journey. Part I - My Breast Cancer Diagnosis

By Tammy Carrington

My name is Tammy and I was diagnosed with Ductal Carcinoma In Situ (DCIS) in June 2009. I underwent bilateral mastectomy and immediate reconstruction with DIEP flaps. I believe it is important to share my story on how I made my decision because when I was looking for information on other women’s experiences, it was hard to find. If I can help even one woman feel peaceful about making her own decision, then it was worth it all. That’s part of this process… reaching out and helping others who are behind us in the journey.

My nature is to research things completely so that I can make informed decisions. I am the mom to a severely brain injured little boy who is now 12 years old and I’ve spent lots of time over the years looking for information on how to help him to get better and have spent more than 20 years in the medical field as well.

My diagnosis came as a complete shock to me. I am sure it’s a shock to anyone who hears it for the first time, but somehow I never thought I would be hearing those words associated with me. I just remember how numb I felt when I heard the “C” word… CANCER.

I had no signs or symptoms to indicate that there was any type of problem. I went in for my routine annual mammogram and they asked me to return for an ultrasound of my breast. Having me return was not an unusual request because I have had fibrocystic breast tissue and it had almost become routine for me to have to return. They would always do an ultrasound where they could see the cysts and then I would then be sent on my merry way.

This year was different.

They called me back for the ultrasound but also wanted to do some spot compression views so they could look more closely at an area of my breast where they wanted to see more detail. The doctor told me that radiologists are trained to look for microcalcifications when they view mammograms. My mammogram showed some microcalcifications and this time I was told to follow up in 6 months to see if there were any changes in my breast during that time.

My gut feeling told me that I didn’t want to wait 6 months, so my physician sent me to a local surgeon and he decided to do a stereotactic breast biopsy right away. The results were back quickly and I was diagnosed with ductal carcinoma in situ (DCIS). I had breast cancer.

Time to get over the shock…


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Keep up to date with the latest news in breast cancer reconstruction at The Breast Cancer Reconstruction Blog. Also join us on Facebook and Twitter!

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