Despite Katie Couric's advice, doctors repudiate some ultrasound breast cancer screenings

Many doctors are questioning Katie Couric's new call for ultrasound screenings beyond annual mammograms to detect breast cancer.

A recent online Kaiser Health News story by Michelle Andrews notes that the 65-year-old former co-host of NBC's "Today" show is now pushing those sonograms because they "can sometimes identify malignancies that are hard to spot on a mammogram in women whose breasts are dense — that is, having a high proportion of fibrous tissue and glands vs. fatty tissue."

Dr. Carol Mangione

The KHN article, however, quotes Dr. Carol Mangione, professor of medicine and public health at UCLA who chairs the U.S. Preventive Services Task Force, a group of medical experts who make recommendations for preventive services after weighing their benefits and harm, as being in doubt. She says clearly, "We don't have evidence that auxiliary screening reduces breast cancer mortality or improves quality of life."

Dr. Sharon Mass, an OB-GYN in Morristown, New Jersey, and the former chair of the American College of Obstetricians and Gynecologists' New Jersey section, echoes that sentiment. "On the one hand," Andrews' piece quotes her as saying, "we want to do everything we can to improve detection. But on the other hand, there are lots of costs and emotional distress" associated with false-positive results.

Couric first shared the news of her own breast cancer diagnosis in September.

In addition to regular mammograms, many women are getting 3D mammograms, sonograms or MRIs as supplemental testings. That imaging in those who aren't at high risk for breast cancer, the KHN story says, "may identify potential trouble spots, which can lead to follow-up testing such as breast biopsies that are invasive and raise cancer fears for many patients. But research has found that very often these results turn out to be false alarms."

And that doesn't count the possible extra cost. "An ultrasound screening might cost $250 out-of-pocket while a breast MRI could run $1,084," according to the Brem Foundation to Defeat Breast Cancer," Andrews' story says. 

Meanwhile, Rep. Rosa DeLauro (D-Conn.) recently tweeted that she's working in conjunction with Couric on a bill to cover MRIs and ultrasounds for women with dense breasts "without any out-of-pocet costs," the article reports.

What are the real results of added screenings? Studies show, the KHN piece notes, that "if 1,000 women with dense breasts get an ultrasound after a negative mammogram, the ultrasound will identify two to three cancers. But the extra imaging will also identify up to 117 potential problems that lead to recall visits and test but are ultimately determined to be false positives."

Mass' group doesn't recommend supplemental screening for women with dense breasts who don't have any additional risk factors for cancer, the article reports. "Many other professional groups take a similar position."

Dense breasts, the story says, "are relatively common. In the United States, an estimated 43% of women 40 and older have breasts that are considered dense or extremely dense…Women with dense breasts are up to twice as likely to develop breast cancer as women with average-density breasts, research shows."

Other steps instead of extra screening could be helpful, according to Dr. Karla Kerlikowske, a professor of medicine and epidemiology/biostatistics at the University of California, San Francisco. "If you really want to help yourself, lose weight," she's quoted as saying. "Moderate your alcohol intake and avoid long-term hormone replacement. Those are things you can control."

Additional information on mammograms, sonograms and other screenings can be found in Rollercoaster: How a man can survive his partner's breast cancer, a VitalityPress book that I, Woody Weingarten, aimed at male caregivers.

24% dip in the disease's recurrence is possible

Exercise can help breast cancer patients diminish risks and bolster their quality of life

Exercise is hardly a cure-all for breast cancer.

But it can help.

Stacy Simon

According to an American Cancer Society story by senior editor Stacy Simon that I just found on the cancer.org website, exercise "is not only safe and possible during and after breast cancer treatment, but it also can reduce symptoms and improve quality of life."

The ACS article states that studies have shown "certain kinds of exercise appear to help breast cancer survivors at high risk for arm, breast and chest swelling (lymphedema) avoid the condition."

The studies have also shown that "some types of exercise can improve symptoms" for those who already have breast cancer.

And, as might be expected, that regular exercise "significantly improves physical functioning and reduces fatigue."

Perhaps most important is that Simon's piece notes, too, that physical activity "has also been linked to a 24% decrease in breast cancer coming back, and a 34% decrease in breast cancer deaths."

Her story cautions, however, that women should first check with their doctors to determine the exercise best suited for them (and to ensure their safety) — and then, after surgery, to wait to heal properly before starting a physical regimen.

The ACS story also lists possible exercise benefits as strengthening of muscles (or, at least, lessening muscle deterioration), heightening self-esteem and lowering anxiety and depression risk, and, finally, helping to control weight — "itself a risk factor for breast cancer recurrence."

Details about the healing process can be found in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at caregivers.

Debate rages on life following breast cancer

More women choosing to 'go flat,' skip reconstructive surgery after mastectomies

Many more women are now opting to forego reconstructive surgery after having their breasts removed.

Even though insurance would pay for the operation.

Even though reconstruction long has been the standard, with more than 60 percent of eligible women choosing it (106,000 of the procedures were done last year). 

And even though, according to an article by Roni Caryn Rabin in The New York Times last week, most "plastic surgeons and oncologists aggressively promote breast reconstruction as a way for women to 'feel whole again.'" 

"Going flat" certainly has become a more publicized choice.

Why? 

Dr. Deanna J. Attai

The Times article quotes Dr. Deanna J. Attai, a past president of the American Society of Breast Surgeons (ASPS), to the effect that "Reconstruction is not a simple process. Some women just feel like it's too much: It's too involved, there are too many steps, it's too long a process." 

The "nascent movements to 'go flat' after mastectomies," the piece continues, "challenges long-held assumptions about femininity and what it means to recover after breast cancer" — and flies in the face of the fact that "women's health advocates fought for and won approval of the Women's Health and Cancer Rights Act of 1998, which requires health plans to cover prosthetics and reconstructive procedures."

Rabin's story contends that "up to one-third of women who undergo reconstruction experience complications."

And that "a systemic review of 28 studies found that women who went without reconstruction fared no worse, and sometimes did better, in terms of body image, quality of life and sexual outcomes."

According to the article, Dr. Clara Lee, an associate prof of plastic surgery at Ohio State University who performs the procedure, says "the dirty little secret of breast construction" is that the "risk of a major complication is higher than for the average elective surgery."

In contrast, Dr. David H. Song, chief of plastic surgery at the University of Chicago and the immediate past president of the ASPS, is quoted as saying that focusing on the risk of complications is like focusing on plane crashes when millions of flights land safely.

Both pros and cons of reconstructive surgery are touched upon in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.