The value of annual women mammograms in their 40s — the main topic of a lingering dispute among health policy and advocacy teams — has drawn resounding support from the nation’s largest group of obstetricians/gynecologists.
On Wednesday, the ACOG issued new guidelines that calling for mammograms to be done every year beginning at age 40. This is a departure from its former recommendations, which advised mammograms every one to 2 years beginning at 40 years old and then every year beginning at age 50, depending on the incidence of breast cancer in younger women and its typically speedier progression, guidelines co-author Dr. Jennifer Griffin explained.
The guidelines conflict with those issued in late 2009 by the U.S. Preventive Services Task Force, which encouraged screening mammograms only each other year beginning at 50 years old because they can result in many false positive results, prompting unnecessary biopsies and extra tests.
“I think the main point we considered was that around 40,000 women yearly in their 40s are diagnosed with breast cancer, and about 20% of the women will die of it,” said Griffin, an assistant professor of OB/GYN at the University of Nebraska Medical Center. “Screening mammograms lower the risk of dying by 15%” in this population.
More than 207,000 U.S. women were diagnosed with invasive breast cancer in 2010, based on ACOG, and nearly 40,000 died from it. Breast cancer is the second most usual type of cancer in women in the U.S. after skin cancer. It may be determined by a mammogram while it is very tiny and before it grows large enough to become symptomatic.
A key factor in the ACOG suggestion is the lesser “sojourn time” — the period of time in which a breast cancer can be detected by a mammogram while it is still very small and before it gets big enough to result in symptoms — among younger women. Women aged 40 to 49 have a sojourn time of 2 to 2.4 years, the guidelines said, while those ages 50 to 59 have a sojourn time of 2.5 to 3.7 years, and women 70 to 74 have a sojourn time of 4 – 4.1 years.
“In these young patients, we have a smaller window because these cancers tend to grow faster, sooner,” said Dr. Lauren Cassell, chief of breast surgery at Lenox Hill Hospital in New York City. “There are lots of patients who develop breast cancer between 40 and 50. The fear was we would miss these patients and see them at later stages.”
The American Cancer Society and the National Comprehensive Cancer Network’s screening recommendations are identical to ACOG’s new guidelines, while the National Cancer Institute calls for mammograms every one to 2 years beginning at 40 years old. In addition to concerns about fear-inducing false great results, some officials have expressed concerns about radiation emitted from mammography machines, which typically equals that of a round-trip transcontinental airline flight.
“Mammograms are stressful to patients because some require follow-up,” Cassell said. “But regrettably, to find the breast cancer patients, some are going to have false positives” At some level, I feel we must accept that.”
Some early, noninvasive breast cancers, known as ductal carcinoma in situ (DCIS), never progress to dangerous cases, Griffin acknowledged, and the detection of mammogram may provoke aggressive treatment that finally is unnecessary or dangerous.
But, “there’s not a lot of consensus exactly how many cancers might regress” and no way of knowing which ones might regress or progress,” she said. “It is true that some of them we detect wouldn’t progress.” The possibility cost of mammograms was not taken into account in making the suggestions, Griffin said again, but that was also true of the 2009 U.S. Preventive Services Task Force guidelines. Overall, about 1,900 women aged 39 to 49 would have to be “invited for screening” (though some might decline) to save one woman in that age range from dying of breast cancer, the ACOG said.
“This is all depending on our best judgment with the best available proof,” Griffin said. “Women in their 40s typically have children, some have aged parents, many are active in the workforce. I do not think we can really underestimate the value of that one life saved.”
The American College of Radiology (ACR) and Society of Breast Imaging said they promoted the updated ACOG recommendations, noting that National Cancer Institute data show the U.S. breast cancer death rate — previously unchanged for 50 years — has dropped 37 percent since mammograms became widespread in 1990.
“I think not screening these patients yearly is taking a step backward,” said Dr. Donna Plecha, division chief of breast imaging at University Hospital’s Case Medical Center in Cleveland. “The cure rate of early breast cancer is in the high 90s (percent). So I believe that it’s sensible for patients in that age group to come in yearly.”
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Liver Cancer in India
Primary liver cancer begins in the cells of the liver itself. Although many cancers are declining in the United States, new cases of primary liver cancer are increasing.
Cancers that commonly spread to the liver include colon, lung and breast cancers. These cancers aren’t called liver cancer. Instead, they are named after the organ in which the cancer began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver. These metastatic cancers are treated based on where the cancer began, rather than being treated as primary liver cancers…
Symptoms of Liver Cancer
When symptoms do appear, they may include some or all of the following : –
Causes of Liver Cancer
Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach. Your liver processes most of the nutrients absorbed from your small intestine and determines how much sugar (glucose), protein and fat enter your bloodstream. It also manufactures blood-clotting substances and certain proteins. Your liver performs a vital detoxifying function by removing drugs, alcohol and other harmful substances from your bloodstream…
Tests and diagnosis of Liver Cancer
Screening : –
Screening for liver cancer hasn’t been definitively proved to reduce the risk of dying of liver cancer. For this reason, many medical groups don’t recommend liver cancer screening.
However, the American Association for the Study of Liver Diseases recommends liver cancer screening for those thought to have a high risk…
Diagnosis : –
If you experience any of the symptoms of liver cancer, your doctor will ask you about your medical history and perform a physical exam.
Tests and procedures used to diagnose liver cancer include : –
Treatments of Liver Cancer
Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health, feelings and personal preferences. Discuss all of your options carefully with your treatment team.
The goal of any treatment is to eliminate the cancer completely. When that isn’t possible, the focus may be on preventing the tumor from growing or spreading. In some cases palliative care only is appropriate. Palliative care refers to treatment aimed not at removing or slowing the disease but at helping relieve symptoms and making you as comfortable as possible…
Surgery : – The best treatment for localized resectable cancer is usually an operation known as surgical resection. In some cases, the area of the liver where the cancer is found can be completely removed. You aren’t a candidate for surgical removal of liver tumors if you have cirrhosis or only a small amount of healthy liver tissue. Even when resections are successful, there is a chance the cancer can recur elsewhere in the liver or in other areas within a few years…
Alcohol injection : -In this procedure, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol dries out the cells of the tumor and eventually the cells die. Each treatment consists of one injection, although you may need a series of injections for the best results. Alcohol injection has been shown to improve survival in people with small hepatocellular tumors…
Radiofrequency ablation : – In this procedure, electric current in the radiofrequency range is used to destroy malignant cells. Using an ultrasound or CT scan as a guide, your surgeon inserts several thin needles into small incisions in your abdomen. When the needles reach the tumor, they’re heated with an electric current, destroying the malignant cells. Radiofrequency ablation is an option for people with small, unresectable hepatocellular tumors and for some types of metastatic liver cancers…
Chemoembolization : – Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver. Chemoembolization isn’t curative, but it can shrink tumors in a certain percentage of people, which may provide symptom relief and improve survival. During the procedure, the hepatic artery — the artery from which liver cancers derive their blood supply — is blocked, and chemotherapy drugs are injected between the blockage and the liver…
Cryoablation (cryosurgery or cryotherapy) : – This treatment uses extreme cold to destroy cancer cells. Cryoablation may be an option for people with inoperable primary and metastatic liver cancers. It may also be used in addition to surgery, chemotherapy or other standard treatments…
Radiation therapy : – This treatment uses high-powered energy beams to destroy cancer cells and shrink tumors. Radiation may come from a machine outside your body or from radiation-containing materials inserted into your liver. Radiation may be used on its own to treat localized unresectable cancer…
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