Health (/health) DOCTORS The Best Doctors You've Never ... · Health (/health) DOCTORS (/TAGS/DOCTORS-1) The Best Doctors You've Never Heard Of JUNE 25, 2015 ... body/yoga-poses-relieve-stress)

01/07/15 11:33The Trouble With Getting a Mammogram at 40 | Prevention

Page 1 of 36http://www.prevention.com/health/osteopathic-doctors

Health (/health) DOCTORS (/TAGS/DOCTORS-1)

The Best Doctors You've NeverHeard OfJUNE 25, 2015

(/HEALTH/OSTEOPATHIC-DOCTORS#BOTTOM)!

By MEEHAN CRIST

PHOTO BY DAVE LAURIDSENPHOTO BY DAVE LAURIDSEN

No white linoleum or fluorescent lightinghere. There's classical music, dark woodenbookcases, a desk disappearing under dog-eared medical tomes. A human skeletondangles from a metal pole; I reflexivelyimagine the hollow clackety-clack ofjostling bones. Taking off my shoes, I standnext to a padded exam table. Dr. DanielShadoan places his hands lightly on myshoulders. I stand straight and breathedeep, wondering what his hands are tellinghim. Is my weight distributed evenly onboth feet? Is one shoulder higher than theother? He asks how I'm feeling, and I saymy lower back has been hurting. "Hmm,"

http://www.prevention.com/health/osteopathic-doctors#

http://www.prevention.com/


http://www.prevention.com/health

http://www.prevention.com/tags/doctors-1

http://www.prevention.com/health/osteopathic-doctors#bottom



he murmurs. Shadoan is an osteopathicphysician, or DO, and I'm about to receive atreatment known as osteopathic manualmanipulation.

While DOs are often indistinguishable fromMDs (they are fully licensed, and canprescribe drugs and perform surgery like anMD), their medical education is rooted in adistinctive philosophy. Like all integrativedoctors, osteopathic physicians are taughtto encourage the body back toward healthusing the least invasive measures first.What differentiates their training is this: Itfocuses on how the structures of our bodiesare deeply linked with how healthy we are.The field was founded upon manualmanipulation, a therapy designed toimprove the flow of air and blood,lymphatic, and other fluids in the body tomaximize self-healing mechanisms andimprove the function of our brain, organs,and joints. Doctors who practicemanipulation, like Shadoan, say they canhelp a body return to health by adjustingtissues and bones just so. Sounds like a longshot, but there may be increasingly good

(PHOTO BY DAVE LAURIDSEN)(PHOTO BY DAVE LAURIDSEN)



reason to believe in this touch-centeredmedical approach.

For one thing, DOs are fast becoming apillar of American health care. As we barreltoward an unprecedented physicianshortage, they are stepping up to fill thewidening gap. One in four medical studentsin the US are enrolled in a DO program,and this number is rising rapidly. In 1970there were 14,000 Dos in the US; thatnumber is expected to be more than100,000 by 2016.

MORE: 7 Stress-Busting Yoga Poses YouNeed (http://www.prevention.com/mind-body/yoga-poses-relieve-stress)

DOs like Daniel Shadoan return you to health by adjusting tissues and

bones.

Next time you visit your oncologist,psychiatrist, or even your primary caredoctor, eyeball their credentials; you mightbe seeing a DO without even realizing it.Today's osteopathic doctors can be found inall medical specialties; out of 100 DOs,


http://www.prevention.com/mind-body/yoga-poses-relieve-stress



fewer than five specialize in manualmanipulation, the way Shadoan does. Butthe other 95 have been trained in it and arelikely to use their hands: to diagnose you, tosoothe you, to convey warmth andconnection, says Boyd Buser, dean of theUniversity of Pikeville–Kentucky College ofOsteopathic Medicine. Studies from thepast couple of decades show associationsbetween touch and faster wound healing,stronger immunity, and reduced pain,suggesting that doctors who touch theirpatients may be able to offer more effectivemedical care.

(http://fluidsurveys.com/s/pvnplans615/?cid=PVN_Survey_June15)

Anecdotally, Buser and other physicians,MDs included, say that touch is crucial toeffective diagnosis, too. In light of thesenotions, it's distressing that many MDs areputting their hands ever more firmly intheir pockets (it's true; see why moredoctors won't shake hands with youanymore(http://www.prevention.com/health/healthy-living/handshakes-and-high-fives-spread-germs-hospitals)), doing away withthe physical exam entirely, and in somecases turning toward telemedicine,conducted via screens and at a distance.The oncoming wave of DOs may be poisedto counter this trend, as physicians trainedin the art and science of touch join their

http://fluidsurveys.com/s/pvnplans615/?cid=PVN_Survey_June15

http://www.prevention.com/health/healthy-living/handshakes-and-high-fives-spread-germs-hospitals



MD counterparts in hospitals and clinicsaround the country.

Osteopathic manipulation is most commonly used to treat joint neck,

and back pain, but it also appears to offer relief from a range of

medical problems.

Manipulation exemplifies the traditionalosteopathic approach to medical care.There is also evidence that it can helprelieve lower-back pain(http://www.prevention.com/health/health-concerns/highly-effective-treatments-lower-back-pain), which is why I'mstanding sock-footed in Shadoan's office,listening to classical music andconcentrating on my breathing.

Shadoan asks me to lie faceup on the examtable. He rolls his stool to my right side andslides his hands under my back, palms up.There are multiple manipulationapproaches, and he specializes in oneknown as cranial osteopathy, a sometimescontroversial practice focused on thecranial bones and the tissues surroundingthe brain and spinal cord. DOs like Shadoan


http://www.prevention.com/health/health-concerns/highly-effective-treatments-lower-back-pain



are particularly concerned with increasingthe flow of cerebrospinal fluid, whichprovides nutrients, cushions the braininside the skull, and circulates rhythmicallythrough the brain—between themembranes that surround it and up anddown the spinal column.

As Shadoan sets to work using his fingers toinvestigate each vertebra in my spine, heexplains the DO philosophy: "Many drugsaddress the symptoms, not the cause.You're not sleeping, here's something tomake you sleep; you're nauseated, here'ssomething that will block your nausearesponse." He has intense brown eyes and acropped beard—more East Coastintellectual than New Age spiritualist."Medicine that treats the patient," he says,"seeks to understand why the problem isthere and resolve the conditions that createthat problem." When medication isnecessary, Shadoan uses it. "Drugs andsurgery are often a less efficient, lesshealthy way to deal with things," he says."But sometimes they're necessary." If apatient needs a knee replacement orradiation therapy for cancer, Shadoanrefers them to a specialist and suggestsmanual manipulation as a complementarytreatment.



There's good evidence that osteopathic manual manipulation can

relieve lower-back pain. In one randomized, controlled study, people

with back pain who got OMM once a week for 4 weeks showed more

improvement than those given painkillers and physical therapy alone.

His fingers work down my spine and intomy right hip, then slowly down my right legall the way to my ankle. He's checking the"movement and quality of tissues," he says,explaining that the texture and flexibility ofbones, joints, muscles, ligaments, fasciae,and organs beneath his fingertips tell him alot about my health, and what adjustmentsmight improve it. He repositions himself tostand at the end of the table, facing my feet.He gently presses his fingertips between thetendons on the top of my right foot, and Ifeel an unpleasant tenderness. When hetests the same spot on the left foot,eyebrows raised at me in question, I tellhim it doesn't hurt at all. He nods.

Taking my less sensitive foot in his hands,Shadoan pushes his palm flat against mysole and gently rotates the foot outward."Does this hurt?" he asks. No. He repeatsthe position on my right foot. "Ow!" I yelp,recoiling slightly. Pain has just gone




shooting up my right leg, through my hip,and into my lower back. It wasn'texcruciating, but it was completelyunexpected. "I thought that might be it,"Shadoan nods. It's a little unsettling that heseems to know things about my body that Idon't.

"'I thought that mightbe it,' Shadoan nods.It's a little unsettlingthat he seems to knowthings about my bodythat I don't."

That ankle got injured awhile back, andShadoan suggests that to ease the pain inmy still-unhealed ankle, it's possible I'dunconsciously begun to favor that footwhen I walk. This would have alleviated thediscomfort in my ankle, but also would havechanged how my weight was distributedthroughout my body, causing my hip totwist and putting stress on my lower back,an imbalance that could strain muscles andput pressure on nerves. I have no way totest this theory, of course, but it'sintriguing.

A massage therapist might have helpfullykneaded tight muscles near my spine; anMD might have prescribed a painkiller.Shadoan did something that felt more like agentle untangling, what he would describeas resetting the alignment of tissues andbones so that I would bear my weight moreevenly and so blood and other healing fluids



could flow unimpeded through my systemagain.

Although osteopathic manipulation is mostcommonly used to treat musculoskeletalconditions like back, joint, and neck pain,its practitioners say it offers relief from arange of medical problems, from asthma tomigraines to Parkinson's symptoms. Someresearch bears this out. There is evidence,for example, that using manipulation totreat elderly patients with pneumoniaresults in shorter hospital stays and less useof medication. Other studies have suggesteda link between manipulation and activity inthe endocannabinoid system, the samesystem affected by the pain-relievingcannabis in marijuana.

MORE: Genius Natural Cures From YourKitchen(http://www.prevention.com/mind-body/natural-remedies/easy-home-remedies-food)

(ILLUSTRATION BY SCRIPT & SEAL)(ILLUSTRATION BY SCRIPT & SEAL)

http://www.prevention.com/mind-body/natural-remedies/easy-home-remedies-food



But the results of studies are mixed overall,and there have been few reliable trials. Thismay be partly because, like treatments suchas acupuncture(http://www.prevention.com/health/healthy-living/health-benefits-acupuncture),manipulation doesn't fit neatly into thescientific model of clinical testing. The goldstandard is the double-blind, placebo-controlled study, in which neitherpractitioner nor patient knows if the personis receiving the treatment or a placebo.These studies are incredibly difficult to doon manipulation, because you have to do"sham" treatments. At best, the patientwon't know if they're getting the treatment,but the practitioner will. Another reasonmay be cultural: The MD track hashistorically been better at training doctorsto do research, and MDs have not beenhugely motivated to do clinical trials onmanipulation. Only a slim percentage ofdoctors practice manual manipulation, andsome look on the therapy with skepticism.In recent years, there has been a push formore rigorous testing, which shouldeventually shed light on how and for whatconditions this therapy is most effective.

http://www.prevention.com/health/healthy-living/health-benefits-acupuncture



DOs are taught that the very basis of health is the structure of the

body.

Shadoan scoots his stool back, stands, andtakes hold of my right arm. He rotates myshoulder joint, then my elbow, kneadingtender points until they are no longertender. In this, the treatment is reminiscentof a session of physical therapy, in which atherapist might find points of tension,where muscles are contracting, and pressinto them until the muscles release. Findinga particularly sore spot on the outside of myelbow, Shadoan moves my arm into aslightly elevated and inward-twistedposition, which relieves the pain in myelbow and makes my head ache at the sametime. He lowers my now-floppy arm ontothe table and begins to press his fingers intomy abdomen, near my belly button, whileexplaining how he takes all the informationhe's getting and "puts it into a framework ofthe entire body being a tensegrity system."I'm getting pleasantly woozy, which makesit hard to concentrate on what he's saying.As he pushes the heel of his palm ratherforcefully into my rib cage, I breathe out,hard, then ask what he means by




"tensegrity system."

"Tensegrity is a term coined by the architectBuckminster Fuller," Shadoan says,"referring to tension and integrity. Inarchitecture, you find tensegrity in domes,where you have a latticework ofinterconnected joints and supportingmaterial stretched across them that putstension into it to hold it, transmitting forcethroughout the whole thing." Earlycivilizations built massive pyramids andziggurats that were simply stacked: notensegrity. Once we mastered the concept,it allowed us to build suspension bridgesand skyscrapers—buildings where theheight is much bigger than the footprint.

"Like skyscrapers, humans have small feetand relatively big torsos and heads," hegoes on. "Our brain monitors where theparts of the body are relative to each otherand decides, OK, we need a little moretension here, a little less tension there. Thebrain is doing that all the time, whetherwe're sitting, standing, running, throwing.The number of unconscious calculations isunbelievable. An osteopathic treatmentworks to help the body to be more efficientin how it distributes weight and force."

MORE: The Unbelievable Reason You'reShort On Vitamin D(http://www.prevention.com/health/how-much-vitamin-d-you-really-need)

Shadoan has his fingers tucked into mytorso and is pulling on my rib cage. My

http://www.prevention.com/health/how-much-vitamin-d-you-really-need



whole body is vibrating like a pluckedstring.

"It's why when we treat somebody, we treatthem from head to toe, whether they have ahead injury or a broken ankle," he explains."The body is trying to distribute all of ourweight and keep us in balance on our tinyfeet." When you're injured, suddenly otherareas near the injury may have to carrymore than their share, ultimately leading toproblems distant from the injury. "If youtwist your ankle, it's going to affect yourknee, your hip, your back, your shoulder;you may get headaches. Go to an osteopathwho specializes in manipulation and they'lltreat the whole system." Tensegrity hasbeen used to create and test models in fieldslike cell biology, but like a lot in medicalcare, the concept amounts to unproventheory. Nonetheless, it makes intuitivesense: Because the musculoskeletal systemis intimately interconnected with thenervous system, which controls thefunction of all our internal organs, thetheory says that adjusting structure canaffect a staggering range of processes in thehuman body—including disease.



Whether they specialize in manipulation or not, DOs are likely to use

their hands: to diagnose you, to soothe you, to convey warmth and

connection. Studies show associations between touch and faster

wound healing, stronger immunity, and reduced pain.

My mind is a rowboat unmoored. The oarshave slipped from their locks into the waterbelow. But I try to remember this: Thehuman body is more like a skyscraper thana pyramid, which is why if you have asprained ankle you can end up withheadaches.

There's been much enthusiasm of late forpreventive medicine, both from thegovernment (as a feature of the AffordableCare Act) and from patients, who have beenturning to integrative care in droves. Thismay be why so many doctors-in-trainingare being drawn to the growing number ofosteopathic colleges—for the hands-onapproach and emphasis on preventive care.Because DO schools have historically beeneasier to get into than conventional medicalschools, however, some see them as a backdoor to a medical degree. But applicants'scores have been rising steadily over the




past decade, and competition for spots inosteopathic colleges is intensifying. Lastyear, 17,944 hopefuls applied for just over6,200 spots.

"When I float out ofShadoan's office, I'mbreathing moredeeply than I have inmonths."

While many MDs gravitate toward high-paying and more prestigious specialtiessuch as cardiology and surgery (in partbecause they have more student debt to payoff), 60% of DOs are primary carephysicians. Inspired by the social missionimparted in osteopathic med school, morethan one in five practice in underservedcommunities, both rural and urban. Andaccording to the American OsteopathicAssociation, graduating DOs are largelycontinuing this trend. This may be goodnews for a country in which the number ofMDs going into primary care isplummeting, and the anticipated physicianshortage will hit underserved communitieshardest.



A manual manipulation treats the whole body, head included.

Shadoan works the joints on both sides of the face, as well as the

forehead and temples. Studies show manipulation may be good for

sinusitis and chronic migraines.

At the same time the number of DOs isrising, the already hazy lines between DOand MD are getting blurred further. Lastyear, the Accreditation Council forGraduate Medical Education announced aplan to merge the historically separate DOand MD residency programs into a singlesystem. This means that by 2020 all doctorsin the US, whether MD or DO, will finishtheir medical training under one umbrella.In a press release, Stephen Shannon, thepresident of the American Association ofColleges of Osteopathic Medicine, said thatthis approach "not only streamlines butstrengthens the postdoctoral process,enhancing the ability of all physicians tolearn the unique characteristics ofosteopathic medical practice." Whether thisplays out in practice remains to be seen.

When I float out of Shadoan's office, it feelsas if I'm breathing more deeply than I have




in months. The pain in my back hassubsided, my arms swing loose at my sides,and my skull seems perched more squarelyatop my spine. I'll feel mildly euphoric andabsentminded, my whole body humming,for hours. After the initial pleasant effects,I'll be deeply sore for at least a day.

Shadoan takes all the information he gets through his fingers and puts

it into a framework of the entire body.

In the short term, my back pain wasrelieved, an effect that has also beenreported in clinical trials indicating thatmanipulation can lower rates of painrelapse, the use of pain medications, andmissed days at work. The long-term effectsof a single treatment are harder to quantify.Manual manipulation is designed tosupport the body's own healingmechanisms, so that you recover faster andstay healthier over time. I can't say howmuch faster I healed with this onetreatment than I might have healed withoutit. Or how fast I might have healed withmore regular treatments. Sometimes my




back still hurts, but I also sit hunched at acomputer all day. This is why controlledstudies like the one with pneumoniapatients are crucial to understandingmanipulation; they track a group of patientsover time.

In Search of a Treatment?To find an osteopathic doctor specializingin manipulation, search for "OsteopathicManipulative Treatment" or "OsteopathicManual Manipulation" at these threewebsites:

American Osteopathic Association(http://osteopathic.org)American Academy Of Osteopathy(http://physician.academyofosteopathy.org) The Osteopathic Cranial Academy(http://cranialacademy.org)

Most DOs who practice manipulationencourage patients to come in every fewweeks, or every few months, depending onthe person's age and medical history. Getyour musculoskeletal system tuned up, getyour fluids flowing, they say, and your bodywill be more disposed toward good health.It may be that manipulation works betterfor some patients, and some conditions,than for others. But having more doctorswho simply lay hands on their patients isgood news for all of us.

Tags: DOCTORS (/TAGS/DOCTORS-1) HEALTHY HABITS (/TAGS/HEALTHY-HABITS)

http://osteopathic.org/

http://physician.academyofosteopathy.org/

http://cranialacademy.org/


http://www.prevention.com/tags/healthy-habits



[email protected]

PreventionNewsletters

Exercise of the Week

Prevention Today

Recipe of the Day

Eat Up, Slim Down

Look Your Best Beauty

Flat Belly Diet

Outsmart Diabetes

You may unsubscribe at any time.Your Privacy Rights

(http://www.rodale.com/corp/sub/0,,1-28,00.html) | About Us

(http://www.rodaleinc.com/content/about-us)

Ghostery blocked comments powered by Disqus.

YOUR PRIVACY RIGHTS. (HTTP://WWW.RODALEINC.COM/YOUR-PRIVACY-RIGHTS) | ABOUT US. (HTTP://WWW.RODALEINC.COM/CONTENT/ABOUT-US)

SHOW COMMENTS

Health (/health) BREAST CANCER (/TAGS/BREAST-CANCER)

Why Getting A MammogramMay Cause More Trouble ThanIt's Worth

http://www.rodale.com/corp/sub/0,,1-28,00.html

http://www.rodaleinc.com/content/about-us



http://www.rodaleinc.com/your-privacy-rights


http://www.prevention.com/health

http://www.prevention.com/tags/breast-cancer



JUNE 30, 2015

(/HEALTH/TROUBLE-GETTING-MAMMOGRAM-40#BOTTOM)

!

By SARAH KLEIN

PHOTO BY ECHO/GETTY IMAGESPHOTO BY ECHO/GETTY IMAGES

After a routine mammogram found that shehad stage 0 breast cancer(http://www.prevention.com/health/health-concerns/how-prevent-breast-cancer), TVchef and cookbook author Sandra Leestarted soapboxing.

"I don't care if my niece is only 23," she saidon Good Morning America when sherevealed her diagnosis and her plan to get adouble mastectomy. "Girls in their 20s and30s just have to know. If you're sitting athome right now watching this... get yourrear end in there and get a mammogramright now."

This is singularly bad advice. There's littleevidence that all women need amammogram right now.

If you're a woman under 40, in fact, gettinga mammogram is far more likely to harmyour health than to help it. That's largelytrue for women between 40 and 49 as well.

http://www.prevention.com/health/trouble-getting-mammogram-40#bottom

http://www.prevention.com/health/health-concerns/how-prevent-breast-cancer



For those 50 and up, the benefits mayoutweigh the risks, simply because breastcancer occurs more frequently in olderwomen. But in all cases, mammograms arestartlingly less powerful than we give themcredit for. Ultimately, the decision to getscreened is a personal one, and one everywoman has the right to make. But there aresome things we must all first try tounderstand:

Mammograms Just Aren't ThatEffective At Saving Lives.

It's a blasphemous thing to say in this pink-washed country, but it's true—and it's noteven news. The American Cancer Societyfirst started recommending mammogramsto women in 1976, and screening reachedits peak in 2000, when 70.4% of women 40and up had had a mammogram in theprevious 2 years. As mammographyincreased, so too did breast cancerdiagnoses, which was exactly the idea. Butwhat didn't change much was the numberof diagnoses of late-stage breast cancer, the



significantly harder-to-treat disease thatkills women. Yes, mammograms werecatching a greater number of cancers, butlargely they were slow-moving, potentiallyharmless ones. If mammos had beenfinding more dangerous cancers early, therewould have been fewer cancers to catch atlater stages. Alas, that has not happened.The annual number of deaths from breastcancer has dropped, but experts say that'slargely because of improvements intreatment, not early detection. What'smore, breast cancer deaths are decreasingfaster among women younger than 50, whoget fewer routine mammograms.

An estimated 20% ofbreast cancersdisappear on theirown.

Mammograms are excellent at picking upon slow-moving cancers that likely aren't athreat—ones that may actually never needto be treated at all, or that are so slowmoving that you'd have eventually noticed alump while dressing or showering andultimately had the exact same treatmentand prognosis as if you'd discovered itearlier via mammogram. While they alsopick up on the more virulent, fast-movingtypes of breast cancer, they don'tnecessarily lessen treatment or improveprognosis.

MORE: This Is What It's Like To Be In ACancer Clinical Trial

http://www.prevention.com/health/cancer-clinical-trial



(http://www.prevention.com/health/cancer-clinical-trial)

A Mammogram Probably Did NotSave Sandra Lee's Life.Lee's stage 0 cancer, aka ductal carcinomain situ, generally falls into thenonthreatening-for-now category. DCIS,abnormal growth of the cells lining the milkducts, is a diagnosis that was rarely seenbefore the 1980s, yet now accounts forabout a quarter of all breast cancerdiagnoses in the US. DCIS is confined to themilk duct; it has not yet grown in otherbreast tissue—and it may never.

It's impossible to know what would havehappened had Lee played the odds, but "awoman would not have a risk of dying ofDCIS in and of itself," says Tracy Onega,PhD, associate professor of biomedical datascience and epidemiology at Geisel Schoolof Medicine at Dartmouth. Lee chose tohave a double mastectomy, which can cutthe risk of ever having invasive breastcancer to about 1%, says Laura Esserman,MD, director of the Breast Care Center atthe University of California, San Francisco.Surgery—whether it's mastectomy orlumpectomy—is still standard DCIStreatment, although new research questionswhether it's always necessary, since itdoesn't appear to improve survival inwomen with the lowest-grade DCIS. "Weare now conducting studies to determine ifwomen with DCIS may be carefullymonitored and given preventive medicinesto reverse the condition instead of

http://www.prevention.com/health/cancer-clinical-trial



undergoing any treatment," Esserman says.

As few as 16% of cases of low-grade DCISeventually evolve into breast cancer. Amonghigh-grade DCIS cases, the portion is closerto 60%. Put another way, between 40% and84% of women diagnosed with DCIS, theway Lee was, would experience zero illeffects from not treating it at all. The hopeis to one day identify genetic markers thatcan distinguish between growths likely tobecome invasive and those that we canleave alone, but we don't yet have a tool todo that. (If you've been diagnosed withbreast cancer, Prevention's Ultimate GuideTo Breast Cancer(https://www.rodalestore.com/prevention/the-ultimate-guide-to-breast-cancer.html?keycode=238830) can help.)

Mammograms Can Lead To SomePretty Bad Things.

Since medicine still can't identify whichcancers are likely to morph into somethinglethal and which are better left alone todisappear on their own (as an estimated20% of breast cancers are thought to do),all breast cancers that get detected tend toget treated. That amounts to a lot of

https://www.rodalestore.com/prevention/the-ultimate-guide-to-breast-cancer.html?keycode=238830



unnecessary procedures—biopsies,mastectomies, radiation, and chemo—forwomen whose lives would have beenhealthy and long without them.

Another highly common byproduct ofregular mammograms: false positives, inwhich a woman gets called back foradditional imaging or biopsies after amammogram. While dealing with frayednerves and increased medical bills seemslike small potatoes once a woman learnsthat—whew!—she doesn't actually havecancer, new research shows that womenwho had false positives faced emotionalconsequences years after they were giventhe all-clear, including feeling anxious,dejected, and even less attractive.

In 2013, the SwissMedical Boardreviewed the evidencesupportingmammographyscreening and arrivedat a startlingconclusion: Do awaywith it.

Sandra Lee Probably Didn't Need AMammogram—And You Might NotEither Until You Turn 50.At 48, Lee is in the highly controversial 40to 49 age bracket at the center of thedecades-old debate over mammography.Some of the various medical organizationsthat give screening recommendations make



the case for yearly mammos for all womenstarting at age 40 and continuing as long asthey are in good health. Others recommendstarting at 50 and getting the test only everyother year until age 74. (None recommendmammograms for the average womanunder 40.) Based on the existing science,women in Lee's age group stand to beharmed more than they stand to benefitfrom a regular mammogram, albeit at alesser rate than women under 40.

In 2009, the United States PreventiveServices Task Force, a government-fundedpanel of medical experts charged withreviewing scientific evidence on diseaseprevention—basically the deciders of what'sconsidered good, science-backed medicinein the US—gave a C grade to the evidencesupporting regular screening before age 50.By their estimation, mammos before 50don't do a whole lot of good. Now, underpressure from outraged mammogramadvocates like the American Cancer Societyand the American College of Radiology, thetask force has softened therecommendations, advising women to talkto their doctors about the best time to startbreast cancer screening.

But the research hasn't changed: Formammograms to save the life of onewoman between 40 and 49, nearly 2,000women in that age range have to bescreened regularly over 10 years.Meanwhile, by conservative estimates, 20of those women will have a biopsy, amastectomy, radiation, or chemo treatment

http://www.prevention.com/health/health-concerns/everyday-cancer-prevention-tips



for cancers(http://www.prevention.com/health/health-concerns/everyday-cancer-prevention-tips) that never would have progressed, and1,200 will receive a false positive.

Early Detection Is An OversoldPromise.

If Lee had decided to begin mammographyscreening at age 50, she might havediscovered nothing whatsoever; maybe shewould have been one of the lucky one-fifthof women whose cancer disappears withouttreatment. Or perhaps by then it might haveprogressed to highly treatable stage 1 orstage 2 breast cancer, Onega says. Breastcancer treatment has evolved to eliminatesome of the importance of screening, sheadds, because we've come so far insuccessfully treating this disease in its earlystages. That's to say, catching breast cancerearly with a routine mammogram maymake no difference in a woman's prognosisor treatment, compared with catching itwhen she notices a lump. Early detectionisn't the hero; it's treatment that actually

http://www.prevention.com/health/health-concerns/everyday-cancer-prevention-tips



saves lives.

It Wouldn't Be Crazy To Skip Out OnMammograms Entirely...Veneta Masson, a 71-year-old nursepractitioner in Washington, DC, had herlast mammogram at the age of 56. Afterreviewing the scientific literature, Massondecided there wasn't enough benefit toregular screening to warrant the risks, andshe opted out—for good—even though hersister had been diagnosed with breastcancer in her early 40s and later died of thedisease in 1997. "It's this search for answersand 20 years of experience caring forwomen...that led me to decide that I couldno longer endorse the tests as routinescreening measures for me or any otherwoman," she wrote in the journal HealthAffairs in 2010. "Breast cancer is just astreatable and just as deadly regardless ofscreening. I've opted out of routinescreening."

It all comes down tothat one life saved per2,000 women, over10 years of screening.Odds are it won’t beyours, but if it were?

This is so not-crazy, in fact, that entiregovernments are starting to get on boardwith the idea. In 2013, the Swiss MedicalBoard reviewed the evidence supportingmammography screening and arrived at astartling conclusion: Do away with it. The



board's final recommendation was that nonew awareness-raising initiatives would belaunched to support mammographyscreening and that existing programs wouldbe phased out over time.

MORE: The 8 Most Preventable Cancers—And How To Slash Your Risk(http://www.prevention.com/health/most-preventable-cancers)

...But It's Understandable To WantTo Get Them Anyway.

Of those 2,000 women screened every yearfor 10 years, 6 will still lose their lives tobreast cancer. That's compared with 7 liveslost among a group of 2,000 similar womenwho were never screened. That amounts toone life saved in the screening group—andhundreds of lives altered, sometimespermanently, by unnecessary treatment andfalse positives.

It all comes down to that one life. Odds areit won't be yours, but if it were? That smallfraction of a percent would matter to youand everyone who knows you. So who canblame Lee for wanting to have removed thebreasts that presumably came to represent

http://www.prevention.com/health/most-preventable-cancers



her cancer risk? This is an emotionalchoice. "Some women will think, 'Fine, I'lldo whatever it takes, I'm not going to die ofbreast cancer,' " Onega says. And how canwe judge them for that when any of usmight do the same?

If zero American women between 40 and49 were screened (in reality, about 60% inthat age group are screened), that oneavoidable death per every 2,000 womenwould amount to more than 11,000additional breast cancer deaths over 10years. That alone is enough to convince alot of reasonable people that screening isworth it for all women 40 and up. If you'rewilling to think about it beyond that, here'sthe impossible equation to consider: If allwomen ages 40 to 49 were screened, those11,000 lives would be saved, but at least220,000 women would experience life-altering, unnecessary treatment andapproximately 13 million would receivefalse positives. The enormity of thosenumbers is impressive; still, how can youweigh one lost life against many livesforever altered? You can't. So the debaterages on.

This Prevention article is clearly not the lastword. You, the reader, will undoubtedlycontinue to encounter scary stats about therisks of not being screened at 40 to 49—oreven younger. In fact, the paragraph belowjust came in to Prevention's offices as partof another reported story aboutmammograms. But our edits reveal the waythese stats can be construed to seem more



scary than they actually are:

OK, OK. So What Should You DoNow?Here's one thing to remember whenthinking about your own situation: Many,many cases of breast cancer are treatedexactly the same way whether they werecaught early via a mammogram or caughtby a woman who found a lump in herbreast. Skipping out on mammograms ifyou're under 50 is unlikely to increase yourrisk of ending up with late-stage breastcancer.

Importantly, this pertains only to womenwith normal breast cancer risk. The averagewoman has about a 1 in 8 lifetime chance ofever being diagnosed; about 12.4% ofwomen get the disease. For many of thosewomen whose risk is higher because ofgenetics or other circumstances, thebenefits of starting screening earlieractually outweigh the harms.

Breast cancer risk is most commonly



calculated using what's called the GailModel(http://www.cancer.gov/BCRISKTOOL),which takes just a minute or two to fill out.It will tell you your 5-year risk ofdeveloping breast cancer and your lifetimerisk, and compare those to the average risk.The tool takes into consideration knownrisk factors for breast cancer, like currentage, when you started menstruating, whenyou first gave birth (if ever), family historyof breast cancer, personal history of breastbiopsies, and race. While that's relativelycomprehensive, it still doesn't make thedecision of whether to start mammographybefore 50 easy or clear-cut.

As we wait for refinements to this verysticky decision-making process,communication is a good place to start,Onega says. "'Talk to your doctor' isn't avery satisfying answer to many women,"she says, but a doctor can help a womannavigate her known risk factors, which canbetter inform her decision and help herclarify what her own values and preferencesare when it comes to screening.

When you're having that conversation,there are a few things to consider:

Your personal likelihood of a falsepositive based on your age and breastcancer risk. Women who undergoregular screening for 10 years startingat age 50 have about a 61% chance ofhaving a false positive (see more statsbelow). Keep in mind, too, that

http://www.cancer.gov/BCRISKTOOL



between 7 and 10% of women whoexperience a false positive get a biopsy,which can hurt, be highly stressful, costmoney, and still find nothing.The percentage of women with yourrisk at your age who do end up havingbreast cancer and how many will diefrom itWhether you have dense breasts(http://www.prevention.com/health/mamogram-frequently-asked-questions)and whether they are "extremely" or"heterogeneously" dense, the two typesof breast density that increase yourbreast cancer risk.The stats, based on your age:

The Future Of Mammograms LooksPersonalThere's clearly room to improvemammography—or at least the process ofdeciding who gets it and when, says KirstenBibbins-Domingo, MD, PhD, vice-chair ofthe USPSTF. If the task force is going toleave the pre-50 screening decision up to awoman and her doctor, there needs to be amore precise way to determine her personalrisk.

MORE: Fight Colon Cancer, Diabetes, AndHigh Cholesterol With…Leftover Pasta?(http://www.prevention.com/food/health-benefits-resistant-starch)

Fine-tuning the process of predicting awoman's breast cancer risk can help herand her doctor decide how big a benefit shestands to gain from early screening,

http://www.prevention.com/health/mamogram-frequently-asked-questions

http://www.prevention.com/food/health-benefits-resistant-starch



YOUR PRIVACY RIGHTS. (HTTP://WWW.RODALEINC.COM/YOUR-PRIVACY-RIGHTS) | ABOUT US. (HTTP://WWW.RODALEINC.COM/CONTENT/ABOUT-US)

SHOW COMMENTS

(/health/osteopathic-doctors)(/health/trouble-getting-mammogram-40)(/health/most-expensive-hospitals)(/health/judith-newman-explores-personalized-medicine)

Bibbins-Domingo says. Scientists areworking to pinpoint what factors putwomen in their 40s at higher or lower risk.A project across the University ofCalifornia's Athena Breast Health Network,called the WISDOM trial, is enrolling100,000 women in a 5-year studycomparing annual mammographyscreening with a risk-based approach."Hopefully what we'll learn is which riskfactors are the most impactful when itcomes to screening recommendations, andwho is at risk for what kind of cancer,"Esserman says. "We're trying to get awayfrom that blanket recommendation thatapplies to everyone, because we know thatit doesn't work for all women. We don'ttreat all breast cancer the same, so weshouldn't screen for it this way either."

Tags: BREAST CANCER (/TAGS/BREAST-CANCER) CANCER(/TAGS/CANCER) DOCTORS(/TAGS/DOCTORS-1)

http://www.rodaleinc.com/your-privacy-rights


http://www.prevention.com/health/osteopathic-doctors

http://www.prevention.com/health/trouble-getting-mammogram-40

http://www.prevention.com/health/most-expensive-hospitals

http://www.prevention.com/health/judith-newman-explores-personalized-medicine

http://www.prevention.com/tags/breast-cancer

http://www.prevention.com/tags/cancer


Documents

Health (/health) DOCTORS The Best Doctors You've Never ... · Health (/health) DOCTORS (/TAGS/DOCTORS-1) The Best Doctors You've Never Heard Of JUNE 25, 2015 ... body/yoga-poses-relieve-stress)