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A Family Physician’s View

A woman should remember that the guidelines are based on the entire population and that her own decision must be an individual one, said Dr. David Baron, a family physician and chief of staff at Santa Monica-UCLA Medical Center and Orthopaedic Hospital in Santa Monica, Calif., and an assistant clinical professor of family medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

“That’s why communication between a patient and her health-care professional is very important,” Baron said.

The new guidelines, in his view, are encouraging physicians to individualize the screenings.

“Some of this will depend on how risk-adverse a woman is,” Baron said. A 40-year-old woman, for instance, might be afraid of radiation from a mammogram and be at average risk for breast cancer. No matter how much a doctor explains that the radiation amount is minimal, he said, she might not be convinced, and she might be advised to wait.

On the other hand, he said, another 40-year-old woman might be very frightened of breast cancer and want the screening. For her, Baron said, he might advise sticking with annual screening.

To women 50 and up, Baron said he would say: “I think it’s important to have a mammogram. Whether you want to have it every year or every two years is negotiable.”

And for his patients 75 and older? “It’s really a matter of individual choice,” he said.

The task force has drawn criticism for recommending fewer mammograms and starting them later. But Baron offered another perspective. “I respect them a great deal,” he said. “They’ve got no horse in the race. They are independent experts.”

He said the task force did its best to sort through the available evidence and come up with the most scientifically sound guidelines.

Women should also realize that the results of future studies might change the recommendations yet again, Baron said. And no matter what the recommendations are, he said, women must always discuss their own medical history and risks with their doctors when making a decision about screening for breast cancer or any other disease.

The best advice, according to Baron: Know the guidelines. Know your risk. Decide with your health-care professional the best screening schedule for you.

On Wednesday, U.S. Health and Human Services Secretary Kathleen Sebelius issued the following statement on the new screening recommendations:

“There is no question that the U.S. Preventive Services Task Force Recommendations have caused a great deal of confusion and worry among women and their families across this country. I want to address that confusion head on. The U.S. Preventive Task Force is an outside independent panel of doctors and scientists who make recommendations. They do not set federal policy and they don’t determine what services are covered by the federal government.”

“There has been debate in this country for years about the age at which routine screening mammograms should begin, and how often they should be given. The Task Force has presented some new evidence for consideration but our policies remain unchanged. Indeed, I would be very surprised if any private insurance company changed its mammography coverage decisions as a result of this action.”

“What is clear is that there is a great need for more evidence, more research and more scientific innovation to help women prevent, detect and fight breast cancer, the second leading cause of cancer deaths among women.”

“My message to women is simple. Mammograms have always been an important lifesaving tool in the fight against breast cancer and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions, and make the decision that is right for you,” the statement concluded.

When a U.S. government task force recommended that women wait until they’re 50 to get their first mammogram to check for breast cancer, reaction was swift.

Critics such as the American Cancer Society vowed to stand by its advice that annual screening begin at age 40 for women of average risk. The American College of Radiology agreed.

But what will doctors who see female patients day after day suggest they do?

The guidelines, released Nov. 16 by a federal panel of experts known as the U.S. Preventive Services Task Force, recommend that women aged 40 to 49 and at average risk for breast cancer talk to their doctor about when it would be best for them to begin mammography screening. Those aged 50 to 74 should have every-other-year screenings, rather than an annual mammogram, according to the new guidelines. As for women aged 75 and older, the task force concluded that there is not enough evidence to assess the benefits and harms of the test.

Whether they agree or disagree with the guidelines, experts seem to agree that women should talk to their health-care providers for guidance based on their individual medical history and other factors.

Three such providers — an internist, a family physician and a gynecologist — weigh in on what they will advise their patients to do.

An Internist’s View

“The evidence supports the recommendation,” said Dr. Karla Kerlikowske, director of the Women Veteran’s Comprehensive Health Center at the San Francisco Veterans Affairs Medical Center, who wrote an editorial accompanying publication of the guidelines in the Annals of Internal Medicine.

“I think for women 40 to 49, we should target women who are at high risk,” she said, such as those with a first-degree relative with breast cancer.

Changing the screening interval from annually to every two years for women 50 to 74, she said, “is one of the best things they did.” At her clinic, Kerlikowske said, biennial screening has been a standard for years.

A Gynecologist’s View

Gynecologist Judi Chervenak, an associate clinical professor of obstetrics-gynecology and women’s health at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, said she will tell her patients this: “From age 39 on, a woman should have a yearly visit to her health-care provider, during which she discusses which routine tests are appropriate for her, including mammography.”

But, she also said she favors mammography for many women.

“Unless the patient is at increased risk of radiation exposure or increased mental health stress of dealing with a false-positive test, I still feel that the use of the mammogram is a potentially lifesaving and quality-of-life improving test for many women,” Chervenak said.

“We know that mammography often picks up a cancer before it can be palpated,” she said. “We have to do everything we can to maintain our quality of life.”

If the stresses of college have put you at risk for high blood pressure, try transcendental meditation.

Blood pressure fell among college students who spent about 20 minutes at least once a day to reach the “restful alertness” state of transcendental meditation, Dr. Sanford I. Nidich, at Maharishi University of Management Research Institute in Maharishi Vedic City, Iowa, and colleagues report.

Their study, in the American Journal of Hypertension, found meditating students also had “reduced psychological distress, anxiety, and depression,” Nidich told Reuters Health in an email.

He and colleagues randomly assigned 298 healthy students with and without high blood pressure to transcendental meditation training or to a training wait list. The students, 40 percent men, were just under 26 years old on average and attended universities in and around Washington, D.C.

Among the 207 students still participating in the study 3 months later, those in the meditation group had slight reductions in blood pressure, while the wait-listed students had slight increases in average blood pressure from the start of the study.

The meditating students also showed greater reductions in overall mood disturbances, anxiety, depression, anger, and hostility, and better coping skills compared with baseline measures and wait-listed students.

Nidich’s team further assessed a subgroup of 48 meditating and 64 wait-listed students who initially had high blood pressure (above 130 over 85 millimeters of mercury) or were at risk for high blood pressure.

In this high-blood-pressure-risk group, the meditating students had blood pressures that were lower, on average, than at the start of the study, while the wait-listed students had increases in blood pressure.

Nidich and colleagues also found these “significant reductions” in blood pressure correlated with lower measures of psychological distress and greater coping measures.

The researchers suggest their findings warrant further investigations into the potential health benefits of longer-term transcendental meditation in college students.

Two new studies add to growing evidence that morphine and other opiate-based painkillers may promote the growth and spread of cancer cells.

The papers, scheduled to be presented Wednesday at an international cancer conference in Boston, also demonstrate how preventing opiates from reaching lung cancer cells reduces cancer cell proliferation, invasion and migration.

The findings from tests with cell cultures and mice suggest that the mu opiate receptor — where morphine acts in the body — may offer a potential treatment target.

“If confirmed clinically, this could change how we do surgical anesthesia for our cancer patients. It also suggests potential new applications for this novel class of drugs which should be explored,” Patrick A. Singleton, an assistant professor of medicine at the University of Chicago and principal author of both studies, said in a university news release.

Morphine can increase tumor cell proliferation, inhibit the immune system, promote the growth of new blood vessels (angiogenesis) that feed tumors and decrease barrier function. In cancer patients undergoing surgery, decreased barrier function may make it easier for tumors to invade tissue and spread to other parts of the body, while increased angiogenesis helps tumors thrive in a new location.

Singleton and colleagues found that mice without the mu opiate receptor didn’t develop tumors when injected with lung cancer cells, while normal mice did develop cancer. The researchers also found that methylnaltrexone — developed to treat opiate-induced constipation — reduced the proliferation of cancer cells in normal mice by 90 percent.

New research suggests that having multiple sclerosis puts pregnant women at slightly higher risk for giving birth via cesarean deliveries or having babies that grow at a slower rate in the womb.

But the researchers, whose findings were published online in Neurology, also reported that pregnant women with MS were not more likely than other women to develop such conditions as preeclampsia or premature rupture of membranes.

The findings came from an examination of a national database that included details on about 18.8 million childbirths in 38 states, including deliveries by an estimated 10,000 women with MS.

The two groups of pregnant women differed somewhat. Those with MS were more likely than those without chronic medical conditions to have fetuses that suffered from restricted growth, as defined by weight measured through ultrasound. Among women with MS, 2.7 percent had fetuses in that category, compared with 1.9 percent of other women.

Women with MS were also more likely to have a cesarean delivery: 42 percent had a c-section, compared with 33 percent of other women.

However, the study found that women with MS had lower pregnancy complication rates than did women who had diabetes before becoming pregnant.

“These results are reassuring for women with MS,” study author Dr. Eliza Chakravarty. of Stanford University School of Medicine. said in a news release from the American Academy of Neurology.

“Women and their doctors have been uncertain about the effect of MS on pregnancy, and some women have chosen to delay or even avoid pregnancy due to the uncertainty,” Chakravarty said. “We found that women with MS did not have an increased risk of most pregnancy complications.”