breast cancer screening reminder-who needs it and when #BreastCancerAwarenessMonth
During Breast Cancer Awareness Month I want to remind you of physician recommendations for screening. Currently, the only test recommended for screening is mammography.
image used courtesy of the Public Health Image Library, CDC
No other test has evidence that its use will decrease breast cancer deaths, although they may be useful for diagnosis in women who have breast symptoms.
These guidelines for screening apply only to women at average risk of breast cancer, which is most women. They do not apply to women who have ever been diagnosed and/or treated for breast cancer, or to women who currently have symptoms related to their breasts, such as a lump, pain, discharge, or skin changes.
Guidelines for screening come chiefly from two organizations- The American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF). Other organizations such as the American Academy of Family Physicians (AAFP) , of which I am a member, usually follow their recommendations .
guidelines from the ACS
Offer annual screening to women age 40 to 44 years.
Perform a mammogram annually in women 45 to 54 years.
Perform a mammogram annually or every other year starting at age 55 years.
Continue screen mammography as long as a woman’s overall health is good, with a life expectancy of 10 years or longer.
Routine breast exams by either the patient or a physician are not recommended.
guidelines from the U.S. Preventive Services Task Force (USPSTF)
For ages 40-49 years, individualize the decision to screen every 2 years
For ages 50-74 years, screen every 2 years
For ages 75 years and older there is no recommendation.
Both organizations recommend that physicians discuss the decision to screen or not to screen with patients and base the decision after considering possible harms versus potential benefit.These are guidelines for physicians to apply to each individual patient, not hard and fast rules.
a mammogram revealing a breast cancer image source- National Library of Medicine, Open-i
Screening guidelines are not used for high risk women- women with
a history of previous breast cancer or ovarian cancer
a suspected or confirmed genetic mutation , BRCA, known to increase breast cancer risk
a history of radiation to the chest
a close family history of breast history, usually meaning parent, sibling, child, grandparent, aunt/uncle, or first cousin.
graphic courtesy of the CDC, U.S. Department of Health and Human Services
Screening guidelines also do not apply to women with breast symptoms suggestive of cancer.
a lump in the breast or axilla (armpit)
pain, especially in only one breast
nipple discharge
persistent rash or skin changes over the breast
These women need appropriate diagnostic testing which might include
“Both women and men can get breast cancer, though it is much more common in women. Other than skin cancer, breast cancer is the most common cancer among women in the United States.”
“You should talk to your doctor about the benefits and drawbacks of mammograms. Together, you can decide when to start and how often to have a mammogram.”
“Mammograms are not perfect tests. They can miss some cancers, and they can find lesions that may look like cancers but are not actually cancers (false-positive results), resulting in additional testing and procedures. They can also find very low-risk cancers that would never have caused any health problems if they were never found or treated (overdiagnosis).”
I first learned about Norma Bauerschmidt on Facebook when a friend shared a video about her. She was a 90 year old woman who decided to spend the last months of her life “on the road” travelling with her son in a motorhome. She was diagnosed with cancer but decided to forgo treatment so she could enjoy her remaining time.
I “met” Norma Bauerschmidt on Facebook when a friend shared a video about her. She was a 90 year old woman who decided to spend the last months of her life “on the road” travelling with her son in a motorhome. She was diagnosed with cancer but decided to forgo treatment so she could enjoy her remaining time.
She finished her journey and “died peacefully and with no regrets on September 30, 2016.” Her family shared this remembrance on her Facebook page 1 year later:
“The lessons she taught us in her last days help cut through our grief. The conversations we had together provide tremendous peace.
We now see her light shine through in the natural world: as a spectacular rainbow, a visiting dragonfly, or a lavender sunset — always reminding us what is important.
On this anniversary of Miss Norma’s death, we remember her final wish to infuse some joy in the world.”
Here is my review of the memoir her son and daughter-in-law wrote after Norma’s death. Even if you read it before, I hope you will read and share it again.
One Family’s Journey Saying “Yes” to Living- a memoir
By Tim Bauerschmidt and Ramie Liddle
Harper Collins, 2017
(This post contains affiliate links.)
The Grand Canyon- stock photo compliments of Pixabay
I first learned about Norma Bauerschmidt on Facebook when a friend shared a video about her. She was a 90 year old woman who decided to spend the last months of her life “on the road” travelling with her son in a motorhome. She was diagnosed with cancer but decided to forgo treatment so she could enjoy her remaining time.
I didn’t learn more about her until I saw this book. I decided to read it, expecting a feel good entertaining read. The story turned out to be far more complex than the little I knew.
Driving Miss Norma tells the story of Norma Bauerschmidt, a WWII WAVE veteran, wife, and mother. She was still in good health at 90 years of age, until she was diagnosed with cancer.
Her doctor recommended surgery to be followed by chemotherapy, and warned her the treatment and recovery would be long and difficult. She told him no, she would rather “hit the road” with her son and daughter-in-law and enjoy her life, seeing and doing things she had not had a chance to do before. And her doctor agreed, saying that is just what he would do.
Tim, her son, and Ramie, his wife, had already been living a nomadic life, travelling the country with their standard poodle Ringo in an Airstream travel trailer
photo courtesy Pixabay
they parked in campgrounds and Walmart parking lots. They enjoyed travelling, seeing new places, meeting new people. They wondered how adding a 90 year old woman to their wandering lifestyle would work.
By the time they completed arrangements for Norma to join them, she was already frail, and as her illness progressed she needed even more attention and care. Tim and Ramie soon realized that this might be more difficult and complex than they imagined.
In the book, co-written by Tim and Ramie, they tell their stories also; the mid-life challenge of caring for aging parents, making end of life decisions and plans, and coping with parents’ death and their subsequent grief. Having chosen not to have children, the role of caregivers was foreign to them, and one they had to painstakingly embrace and navigate.
By coincidence, Ramie had recently read the book Being Mortal “a critical examination of end-of-life medical care.” Until then she had not thought much about the subject. But when she finished the book
“I knew my life had changed. The way I looked at the end of life had been flipped upside down and backward. I knew now it was time to have those tough conversations.”
As they travelled, Ramie began writing about their adventures and posting on Facebook to close friends and family. She thought that other people might also be interested so she started a Page, Driving Miss Norma. They attracted a handful of followers initially, as she expected.
But after Norma’s story was reported on the Good News Network, followed by a CBS Evening News Story , the Page began adding followers by the thousands.
The were alarmed, even fearful, of what they perceived as an intrusion on their privacy. Until now, they had deliberately avoided media in their isolated lifestyle. Then they began noticing how Norma’s story was resonating with people in a way they had not expected.
Norma went on her first and only hot air balloon ride (complimentary stock photo from Pixabay)
“We had suddenly and dramatically found ourselves in the middle of an international conversation about the meaning of life, illness, dying and love. We were learning on the fly how to open ourselves to holding so much raw emotion.”
Her story opened their lives to new people and situations they never imagined would happen. Rather than being a burden, Norma’s growing fame became the vehicle for them to grow closer to her, each other, and a whole new set of friends all over the country and the world.
“We had the support of people all over the world and that was breathing new energy into our days. Here were so many people pouring out their deepest fears, losses, and desires to us. They told us of their caregiving struggles. They shared with us their innermost desires- to make peace with their recently deceased father, to tell someone “I love you.”
Throughout the story Tim and Ramie share about the places Norma visited (see map), people she met, from the common to famous, the foods she tried, sometimes for the first time, and activities she tried, also many for the first time, like riding a horse. They and the new friends they made shared food, fun, love, and laughter.
Norma visited all the sites marked on this map
But they also touch on the serious issues we all deal with sooner or later- aging, frailty, complex illness, terminal illness, end of life decisions, palliative care, death, and grief. They learned some important lessons about human relationships which they illustrate beautifully in their transparent writing.
“We learned how to greet people with open minds and open hearts…the lines that separate people into different boxes-religion and politics and race and age-blurred and faded and eventually disappeared. We got to see the truth in people, including in Norma: her glow, her tenacity, her joy, and her confidence.”
Tim and Ramie wrote the book after Norma’s death. They each took turns writing different chapters, and Ramie took all the photographs that illustrate it. But in a way Norma herself wrote the book, since it was the way she faced the final months of her life that produced the lessons her family learned and share with us in this book.
Norma kept a journal during their travels and after she died Tim and Ramie, with close friends, read it, and were somewhat surprised at what she wrote. Or rather, what she didn’t write.
“She did not write about cancer or fame- the two big themes of the trip for us. She did not write about the fear of dying or illness at all. Instead, she talked about life, living, and the things that brought her happiness:a sturdy wheelchair, mama and baby goats, a good hair perm, and her trusty sidekick Ringo.”
I feel sad that Norma’s trip did not bring her though my town so I could have met her. But there will be “Normas” in my life that I will meet, and perhaps someday I will be a Norma myself. When that happens I hope I remember the lessons this book teaches.
“Joy begets joy, love begets love, peace begets peace.”
You can continue to follow Tim and Ramie on Facebook where they are still
“In a culture obsessed with happiness, this wise, stirring book points the way toward a richer, more satisfying life.”
To explore how we can craft lives of meaning, Emily Esfahani Smith considers an array of sources–from psychologists, sociologists, philosophers, and neuroscientists to figures in literature and history.
Drawing on this research, Smith shows us how cultivating connections to others, identifying and working toward a purpose, telling stories about our place in the world, and seeking out mystery can immeasurably deepen our lives.
She explores how we might begin to build a culture that leaves space for introspection and awe, cultivates a sense of community, and imbues our lives with meaning.Inspiring and story-driven, The Power of Meaning will strike a profound chord in anyone seeking a life that matters.
About the Author
Emily Esfahani Smith’s writing has appeared in the Wall Street Journal, New York Times, The Atlantic, TIME, and other publications. She is also an instructor in positive psychology at the University of Pennsylvania, as well as an editor at the Stanford University Hoover Institution, where she manages the Ben Franklin Circles project.
Born in Zurich, Switzerland, Emily grew up in Montreal, Canada. She graduated from Dartmouth College and earned a masters in applied positive psychology from the University of Pennsylvania. She lives with her husband in Washington, DC.
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