I have been asked by some patients what my thoughts are regarding the new mammogram recommendations. Quite frankly they don't make sense to me and will not change my current management of patients at all. Why?
Well first of all they are exactly what they claim to be "guidelines", I can choose to follow them or not. In this case I would rather not.
Mammograms are problematic from the standpoint of radiation however I have seen MANY patients diagnosed with Breast Cancer as a result of them. One of the most concerning trends has been the discovery of breast cancer in younger and younger women, the idea that they would not be diagnosed because they would delay their mammograms to the age of 50 is scary.
The bottom line is, as with most things in medicine, tailor the recommendation to the patient. It is important to have an on going relationship with a physician who knows you and who will make recommendations based on his or her knowledge of you and your particular situation, not based on guidelines. For example prolonged use of certain contraceptives, family history, breast exam findings are all things that would change how often and when a particular patient should get a mammogram.
Remember guidelines come and go, they are not set in stone and neither is your wellness. It should be a dynamic process arrived at by rational thinking and on going education.
When insurance companies finally start paying for thermograms we will have alternatives that don't involve radiation that may be more appropriate for some patients.
Until then for most people mammograms are the best they can afford ......
If you are at high risk remember to avoid caffeine, take indole-3, do regular self breast exams, do not take Provera and follow your doctors screening schedule.
Wishing you a healthful 2010
Dr Tuakli
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