watercress words by Dr Aletha

You may have heard that the American Cancer Society (ACS) has published new guidelines on breast cancer screening. The last guidelines are 12 years old so it is time for an update based on current understanding of the value versus the risk of breast cancer screening.

According to the report published in JAMA, screening mammograms can reduce deaths from breast cancer. Breast exams done routinely do not decrease mortality.

These guidelines apply only to women at average risk of breast cancer, which is most women.

They are not used for high risk women- women with

a history of previous breast cancer
a suspected or confirmed genetic mutation known to increase breast cancer risk
a history of radiation to the chest
a close family history of breast history, usually meaning parent, sibling, grandparent, aunt/uncle, or cousin.

Screening guidelines also do not apply to women with breast symptoms suggestive of cancer.These women need appropriate diagnostic testing which might include mammography, ultrasound, MRI, and/or biopsy.

woman having a mammogram — photo from Medline, National Library of Medicine

In summary, here are the new 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.

These are guidelines for physicians to apply to each individual patient, not hard and fast rules. Some physicians may choose to follow the guidelines of 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.

And while breast cancer is the second leading cause of cancer death among women in the United States, it is treatable and the chance of long term survival is high.

Here are sources for more information

Breast Cancer

Mammography

Screening Guidelines

Breast cancer screening benefits and harms

This article has been updated with information from JAMA October 4, 2016

Treatments for Nausea and Vomiting During Pregnancy

Morning sickness– 70% of pregnant women experience it.

Still, we don’t understand a lot about it.

A review in the Clinical Evidence Handbook, published by the BMJ Publishing Group and reported in American Family Physician (Volume 92, Number 6) summarizes what doctors know about this baffling condition.

Nausea and vomiting of pregnancy doesn’t just happen in the morning, but can occur all through the day.
It typically begins at 4-7 weeks’ gestation and stops by 16 weeks.
The cause is unknown, but may be related to increased levels of a hormone called human chorionic gonadotropin, HCG. Pregnancy tests are based on measuring urine or blood levels of HCG.
About 1 in 200, or less than 1% of pregnant women develop severe nausea and vomiting called hyperemesis gravidarum. This can lead to dehydration and weight loss, and may require treatment in a hospital.

Catherine, Duchess of Cambridge (aka Princess Kate of England) suffered severe nausea and vomiting with her first pregnancy.

Women who experience pregnancy related nausea and vomiting look for relief. Since it is difficult to study drugs in pregnant women due to risk to the baby, few treatments are proven to work or not. But here is what we know from limited information.

Likely to be beneficial are acupressure , ginger and pyridoxine (vitamin B6), all available without prescription.

Prescription meds shown to help are the anti-nausea drugs metoclopramide, prochlorperazine, promethazine, ondansetron and hydroxyzine.

Most women can manage nausea by

eating small meals of bland foods,

avoiding spicy foods, and

avoiding strong or offensive odors.

Nausea of pregnancy is uncomfortable, inconvenient and sometimes dangerous. Anticipating the joy of holding your new baby helps make it bearable. And speaking of holding babies…