Dr. Lisa Checks In

February 4, 2010 at 8:00 am , by

Dr. Masterson

Lisa M. Masterson, M.D., stopped by our office yesterday (that’s her in the middle with me and Emily Chau, my fellow LHJ Health Lady) to fill us in on some of her latest adventures and causes. She was just back from Haiti, where she and her fellow physicians from the TV show The Doctors arrived with 7,000 pounds of much-needed supplies—and treated a number of victims. A specialist in obstetrics and gynecology, Dr. Masterson helped a pregnant woman with a leg injury find the care she needed. See clips from that episode here.

Dr. Masterson, who’s based in L.A., was in New York for an event promoting screening for human papillomavirus (HPV) and cervical cancer. She says that for women over 30, combining a pap test with an HPV test is the best way to prevent this cancer, which still kills some 4,000 women every year.

The good doc also got on her soapbox about the recent changes in screening guidelines for breast cancer. She’s afraid that many women will stop getting mammograms, especially if their insurance won’t pay for them to be done annually. She also wants to encourage women to continue to do self-exams, or at least “get to know their own breasts,” she says. “I’m seeing breast cancer more in younger women.” Feeling something and having it checked out by your doctor could save your life.

First Mammograms, Now Pap Tests

November 25, 2009 at 2:01 pm , by

3360002123_cb852b7011_tThe week before Thanksgiving was supposed to be peaceful. Let’s not talk about the fact that both your health editors were fighting bad colds, but the moment we finished dealing with the new guidelines for mammograms, the American College of Obstetrics and Gynecology (ACOG) announced that it was recommending women delay the age they start being tested for cervical cancer.

So now the annual Pap test bites the dust, too—also based on research that “screening at less frequent intervals prevents cervical cancer just as well, has decreased costs and avoids unnecessary interventions that could be harmful,” according to Alan G. Waxman, M.D., professor of obstetrics and gynecology at the University of New Mexico School of Medicine. What it means for you:

If you’re age 30 or more, you can now be tested every three years once you’ve had three negative results on consecutive tests. This isn’t a big change—starting in 2004 ACOG recommended testing every two to three years if you had negative results on three annual tests. Cervical cancer usually grows very slowly, so the interval is considered safe except for women with medical issues, such as abnormal results on previous tests. At 65 or 70, if you’ve had three negative tests in a row and no abnormal results in 10 years, you can stop completely.

If you’re 21 to 30—the group that used to get an annual test—you’re now supposed to be tested every two years, unless you have medical reasons to have them more often.

If you’re under 21, you shouldn’t get tested. A woman is supposed to wait until 21 for her first test, no matter how early she starts having intercourse. Previously, she was supposed to start about three years after her first intercourse or at 21, whichever came first. Why the change?

• invasive cervical cancer is very rare under 21
• most young women who get an HPV infection fight it off on their own, and
• treatments for cell abnormalities increase the risk of premature births.

Not all doctors agree. “For younger women, Pap smears save lives; 21 is way too late for most women in our culture,” says oncologist Elaine Schattner, MD, clinical associate professor of medicine at Weill Medical College of Cornell University in New York.

Unlike the mammogram changes, the American Cancer Society (ACS) supports the new cervical cancer guidelines and will be releasing its own revision next year. My own reading—I’m not a doctor, remember—is that the under 21 ban is the biggest question. As always, discuss what you should do for yourself (or your daughter) with your physician.

New Mammogram Guidelines: Should You Wait Till 50?

November 18, 2009 at 5:20 pm , by


UPDATE December 2, 2009
The mammogram debate continues. If we screen only “high risk” women, we’ll miss 75-90% of those get breast cancer, says Daniel B. Kopans, M.D., professor of radiology at Harvard Medical School and director of breast imaging at Massachusetts General Hospital, at a Radiology Society Of North America press conference.

Earlier this week, the distinguished U.S. Preventive Services Task Force (USPSTF) announced its new breast cancer screening guidelines, reversing many of its 2002 recommendations. In a move that has already become a point of controversy, USPSTF now recommends that women start getting mammograms later in life and less frequently. But after years of preaching  “prevention, prevention, prevention,” what should we do now?

What changed:
1. USPSTF advises women to start getting routine mammograms at age 50—not 40—until age 74.  However, those between ages of 40-49 who are at high risk for breast cancer should talk to their doctor whether to begin regular screenings sooner.
2. USPSTF suggests getting a routine mammogram every two years, instead of every year—again, women in high-risk groups may need a greater frequency.
3. USPSTF recommends that doctors should not teach women how to do breast self-exams.

The reasoning: USPSTF found that among women ages 40-49, mammograms save one cancer death per every 1,904 people screened for 10 years.  Among those ages 50-74, this number increases to 1 in every 1,339 women, and to 1 in every 337 women ages 60-69.

Based on these findings, the USPSTF concludes that for women ages 40-49, the risk of overtreatment (unnecessary biopsies, stress) from a mammogram outweighs its benefits.  There is also data showing breast self–exams don’t find cancers in a more treatable stage or decrease deaths (read a Q&A with Susan M. Love, M.D. about this topic from our October 2009 issue after the jump, below).

The controversy: Not everyone agrees with USPSTF’s interpretation. “The panel acknowledges that screening mammography for women in their 40s saves lives, but considers it too costly in dollars per woman saved and in false positives. This seems inappropriate to me and would be to most women in their 40s, I think,” says Etta D. Pisano, M.D., Kenan Professor of Radiology and Biomedical Engineering and Director of the UNC Biomedical Research Imaging Center at UNC School of Medicine in Chapel Hill, North Carolina.  “I do think the data support less frequent screening for older women,” she adds—but whether that should “start at 50 or later when women have fatty breasts…would be important to study.”

Moreover, the American Cancer Society still recommends women get an annual mammograms starting at 40. And so does Susan G. Komen for the Cure. And in terms of limiting mammograms from age 40 to 50 to just those with identified high risk factors: It turns out, according to Komen, that most women diagnosed with breast cancer in the U.S. do not have any risk factors aside from being female and getting older, and breast cancer that occurs in younger women is often more aggressive than breast cancer in women in their 50s or older.

The bottom line: Right now you still get to choose which recommendation you want to follow.  And for women who hate mammograms, this is medical confirmation that you can have them much less often. But if you want to keep being tested according to the old standards, be prepared that insurance companies and Medicare may look at whether they should reduce the number of mammograms they are willing to cover.

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