Spring 2010 e-Newsletter

Mammogram Guidelines

Last December, the United States Preventive Services Task Force (USPSTF) released updated guidelines for when and how often women should have screening mammograms. Prior to the recent announcement, the standard was every 1-2 years starting at age 40 and every year starting at age 50.

The new guide-lines were shocking and controversial. They recommended against routine screening mammograms from ages 40 to 49 and recommended a screening mammogram every 2 years after age 50, a significant departure from the previous standard.

Their reasons were lengthy but can be boiled down to a few issues:

  • Since breast cancer is less common from ages 40 to 49, more mammograms would be required to find a cancer.
  • The cancer will be found eventually even if the mammograms are done less often, and some data suggested that early detection and treatment of breast cancer did not seem to prolong survival. 
  • The extra mammograms would result in more women being exposed to radiation, more women dealing with the stress of an abnormal mammogram, and more unnecessary breast biopsies. 
  • Their own data showed that it would take 1,900 routine mammograms in the 40-49 age group to find one cancer, compared to 1,300 mammograms in the 50-59 age group, and so on.

Not surprisingly, not only their guidelines, but their explanation of the reasons for the guideline changes, generated a great deal of controversy. These guidelines failed the common sense test. For example, women ages 40-49 fear having cancer far more than they fear a breast biopsy procedure.

Cost was never addressed by the USPSTF but the public's reaction was immediate. This was a blatant cost-saving policy and would result in women being diagnosed with cancer at an advanced stage. It takes 600 more mammograms to find one cancer in the 40-49 age group. This is maybe $120,000 of cost per cancer detected. Most experts consider this a bargain. But not doing these mammograms at all would save the government and major insurance plans millions of dollars.

ltimately every major medical organization in the U.S. dealing with cancer and women's health denounced these new guidelines, and so did the White House. Our current recommendation remains the same: a baseline mammogram at age 38, and then annually at age 40. Early detection of breast cancer saves lives. Mammograms are safe and extremely cost-effective, and we support their continued availability.

Pap Smears and HPV Testing

Millions of people are infected with the virus known as HPV and most of them do not even know it. HPV (Human Papilloma Virus) infection of the cervix in women is known to be the cause of cervical cancer. Routine pap smears do not test for HPV unless special arrangements are made.

Typically, if the pap smear is abnormal an HPV DNA test is performed. But what if the pap smear is normal? Most practices do not test for HPV if the pap smear is normal. We have looked closely at the current information about this situation. The test for HPV is widely available and is covered by health insurance. Many women have HPV and they don't even know it. There are usually no symptoms. We believe that women need to know if they are infected with or harboring HPV.

Therefore, our practice is now routinely testing all
pap smears on women ages 30 to 65 for HPV.

One consequence of this is a situation where the pap smear is normal but the HPV test is positive. This is not a cause for alarm or panic. If the pap smear is normal, then there is no risk of cervical cancer. Furthermore, the first time the HPV test comes back positive means we do not know how long the HPV has been present. It could have been there for years or on occasion, the infection may have been acquired more recently.

Although there is no cure for HPV, there is a vaccine available. This vaccine will protect you from other strains of HPV, although the vaccine cannot protect you from the current strain that is causing the infection. For more information go to: www.thehpvtest.com

The Importance of Online Reviews

In the age of the Internet, many new patients will investigate physicians on the Internet prior to making their first appointment. In the past, a word-of-mouth recommendation was sufficient for someone to choose a doctor, but that is no longer the case. To be successful, physicians today also need to have good Internet reviews and rankings. We have thousands of satisfied patients, yet our physicians have only a handful of online reviews!

We really need your help. If we have given you excellent medical care, will you tell others about it by posting an online review? We would greatly appreciate it!

To Post Online Reviews

Google Insider Pages

1. Sign in to Google. (If you do not have a Google account, follow their instructions for creating one.)
2. Go to Insider Pages
3. Select Pasadena, CA as the city
4. In the Search Box enter "Fair Oaks Women's Health"
5. Click on the "Write a Review" box and share your experience with others.

Yelp

1. Go to the Pasadena Yelp page
2. In the "Search For" box, enter the doctor's name (e.g. Bryan Jick, Jennie Chang, Jennifer Park)
3. In the "Near" box, enter "Pasadena, CA."
4. Select the listing of your choice. Click "Write a Review."

Genetic Causes of Breast Cancer

We know that a family history of a disease usually means that relatives tend to have an increased risk of developing that disease. When it comes to breast cancer, an identifiable genetic condition has been identified that dramatically increases that person's risk for developing breast cancer (and ovarian cancer also). This mutation is called BRCA.

Here are some facts:

  • 10% of all cases of breast and ovarian cancer are due to this mutation. 
  • If you test positive for BRCA there is up to an 87% chance you will develop breast cancer in your lifetime. The normal risk is 15% in a lifetime. 
  • Treatments are available in BRCA positive individuals that will help lower their risk of breast cancer in the future.

You should consider testing for BRCA if:

  • you develop breast cancer before age 50 
  • there are 2 different breast cancers in the same person (2 primaries) 
  • both breast and ovarian cancer develop in the same individual 
  • there are 2 or more breast cancers in a family, one under age 50 
  • women of Ashkenazi Jewish descent have breast or ovarian cancer at any age 
  • there is a previously identified BRCA mutation in the family

Most health insurance companies pay for testing. More than 90% of tests receive coverage, and the average reimbursement is more than 90%. Also, Federal and state legislation protects your privacy and prohibits health insurance discrimination based on genetic information. In the last 10 years there are no documented cases of insurance discrimination.

Our office provides the testing for the BRCA mutation.

Please call 626-304-2626 for more information or go to one of these web sites:

http://www.bracnow.com (Myriad Genetics, provider of the BRCA test)

http://tinyurl.com/5y4lr (link to American Cancer Society Breast Cancer Risk Information)