Mammogram or not to mammogram

For years women have been taught the great importance of doing a breast exam on a monthly basis and the need for annual mammograms >40 years old. Well, the USPSTF (U.S. Preventative Service Task Force) just recently recommended a drastic change from the norm. The new recommendations are as follows:

• The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. (grade C recommendation)
  


• The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. (grade B recommendation)
  


• The USPSTF recommends against teaching breast self-examination (BSE). (grade D recommendation)

So let me throw in my two point five, two, seven, five cents :) The argument for / against mammograms has been an issue for years. The major issue is that the number of women that need to be screened to save one life is around 2000. In addition along the way several women will have to deal with the scare of breast cancer and may have an unnecessary breast biopsy. The question... is the scare worth the life of one woman? I am convinced that if it is my wife, mother, aunt, grandmother, sister it is worth the scare.

Now it is beyond me why I, as a medical professional (in particular an OB/GYN), would choose to not teach a woman how to do her own breast exam. The fact that you have the knowledge base and are aware of what to bring to a physician's attention is key to early detection in my eyes.

Of course I will take a second to educate. Remember that the breast tissue is shaped like a tear drop. The tail points toward the arm pit (this is called the tail of Spence). The tail region and directly underneath the nipple are the high risk areas for breast cancer.

So here are my recommendations

1. Learn how to do a breast exam and do it on a monthly basis
2. In agreement with ACOG ( http://www.acog.org/from_home/Misc/uspstfResponse.cfm ) continue having your mammogram every 1-2 yrs age 40 - 49 and annually 50+ yrs

As always feel free to ask any questions.

I'm Pregnant with H1N1....Help!!

This has probably been the craziest flu season in a long time for patients and practitioners alike. In April 2009, when the first reported cases of the H1N1 novel virus hit the news I'm sure that no one could have anticipated how wide spread this problem would be.

I thought that I would make my comeback blog one that would dealt with a specific question concerning H1N1. What do you do if you are pregnant and have a confirmed diagnosis of H1N1? First lets establish the ground rules. As a physician I will suspect that a patient has the flu if they have:

• fever
• chills
• headache
• upper respiratory symptoms (cough, sore throat, running nose)
• muscle aches
• joint aches
• fatigue
• Nausea/Vomiting/Diarrhea (these symptoms are not very common with the seasonal flu)

After you have raised my suspicion I will swab your nose and send it for Influenza A &B. You may not know that the H1N1 is a variant of the Influenza A. The whole swine flu thing came from the fact that pigs can be infected by several different strains of influenza (bird, human, ducks, etc...). When you have a single host with several different viral strains a NEW (or NOVEL) strain can emerge that has not been seen before. This is part of the theory behind or 2009 flu virus.

If you are sick (see the above symptoms) the first thing to do is C A L L your OB doc. Right now ER's and Urgent care facilities are becoming a melding pot for sick patients. If your symptoms are mild and you don't have the following problems:

• Difficulty breathing
  
• Chest pain
• Persistent vomiting
  
• High fever not responding to Tylenol
• Baby moving much less or no movement

then the best thing to do is stay at home. You will need to be started on Tamiflu (this will help you fight the infection). Stay hydrated, get rest, and use Tylenol for symptom relief. If symptoms worsen and you experience the above then you must be seen quickly. We are trying to avoid pneumonia or other complications of the flu.

Handwashing is key. And if you are sneezing and coughing a lot then a face mask will probably be helpful for you to wear to decrease exposure to your family.

Breastfeeding (for the mom who has delivered) is a toss up. Thus far no one has brought any definitive proof showing that you should not breast feed your baby. The risk is that you could pass the virus to your newborn because of having an active infection. But we know that sooooo many good things are available in breast milk that not passing that on to the baby would be a crime. You can also use Tamiflu while you are breastfeeding.

Lastly, please...please...please get the H1N1 flu vaccine (the injection NOT the flu mist).