February 23, 2010

To our patients:

As you probably know, the U.S. Preventive Services Task Force (USPSTF) recently withdrew its support for screening mammography for women 40-49 and for women over 75, and recommended that women ages 50-74 be screened every two years instead of annually. In addition, they recommended against Clinical Breast Examination and Breast Self-Examination.

Those of us involved in the diagnosis of breast cancer here at The Center for Women’s Health at Mercy Hospital Anderson disagree with these new guidelines. Under the current screening guidelines, there has been a 30% drop in breast cancer deaths in women of all ages in the U.S. Here are some of the real problems we have with the USPSTF recommendations:

• The 16-member USPSTF did not have one physician specializing in breast cancer screening, diagnosis, or treatment on its panel.

• In our own practice at The Center for Women’s Health, we have diagnosed 325 breast cancers since 2006. 67 (20%) were in women under 50. Most of these would have gone undiagnosed in the early stages had the USPSTF guidelines been in force.

• Screening mammography is the most carefully studied test in medical history, with multiple comparison studies world-wide showing a 30% to 63% decrease in breast cancer deaths overall in women undergoing screening mammography. USPSTF chose to ignore virtually all of these studies, and claimed only a 15% reduction in breast cancer deaths in women 40-49. The actual decrease in this age group was between 23% and 44%. (References available on request)

• The USPSTF claimed that false positive exams cause "harm" to patients by increasing pain and anxiety. In fact, the vast majority of screening mammograms actually relieve anxiety about breast cancer. For most women, it is a "good news" exam.

We all know that there is no perfect test in medicine, and that mammography is no exception. However, it is by far the best weapon we have in our fight against breast cancer, and it is a proven one. We urge you to follow the recommendations of the American Cancer Society:

SCREENING MAMMOGRAM EVERY YEAR, BEGINNING AT AGE 40.

Please feel free to call to discuss this issue in more depth.

Yours very truly,

Charles Perme, MD, Cliff Pleatman, MD, Mary Alfidi, MD, Catherine Perez, MD

The College sent the following letter to the New York Times regarding a March 31, 2009, article which questions the overall effectiveness of mammography screening.

Mammography Screening Saves Lives

Women need the facts about mammography screening in order to make informed decisions. Unfortunately, many statements in the March 31 Roni Caryn Rabin article titled "Benefits of Mammogram Under Debate in Britain are incorrect or greatly exaggerated.  

All medical tests can result in false positives or false negatives. The question is does mammography save lives? The answer is a resounding Yes.

Scientific evidence clearly shows that in the United States, the death rate from breast cancer, unchanged for the 50 years prior to 1990, is down nearly 30 percent since 1990, primarily due to mammography screening.  

The medical and scientific communities continually work to improve care, but any discussion of mammography must include that the exam has saved tens of thousands of lives and that, at present, there is no better breast cancer screening exam for the general population.

Carol H. Lee, M.D.
Chair
Breast Imaging Commission
American College of Radiology
President
Society of Breast Imaging

The U.S. Food and Drug Administration today issued a Public Health Advisory to alert consumers, patients, health care professionals, and caregivers about potentially serious and life-threatening side effects from the improper use of skin numbing products. The products, also known as topical anesthetics, are available in over-the-counter (OTC) and prescription forms. 

Skin numbing products are used to desensitize nerve endings that lie near the surface of the skin, causing a numbness of the skin. These topical anesthetics contain anesthetic drugs such as lidocaine, tetracaine, benzocaine, and prilocaine in a cream, ointment, or gel. When applied to the skin surface, they can be absorbed into the blood stream and, if used improperly, may cause life-threatening side effects, such as irregular heartbeat, seizures, breathing difficulties, coma, or even death. FDA has received reports of adverse events and deaths of two women who used topical anesthetics before laser hair removal.  In February 2007, the FDA issued a Public Health Advisory - “Life-Threatening Side Effects with the Use of Skin Products containing Numbing Ingredients for Cosmetic Procedures,” to warn consumers about these products.

Patients for whom an over-the-counter or prescription topical anesthetic is recommended should consider using a topical anesthetic that contains the lowest amount possible of medication that will relieve your pain. Also, health care professionals should determine whether adequate pain relief can be safely achieved with a topical anesthetic, or whether a different treatment would be more appropriate.

The FDA strongly advises consumers not to:

• make heavy application of topical anesthetic  products over large areas of skin;
• use formulations that are stronger or more concentrated than necessary;
• apply these products to irritated or broken skin;
• wrap the treated skin with plastic wrap or other dressings; and
• apply heat from a heating pad to skin treated with these products.

When skin temperature increases, the amount of anesthetic reaching the blood stream is unpredictable and the risk of life-threatening side effects increases with greater amounts of lidocaine in the blood.

A recently published study in Radiology looked at women taking acetaminophen and ibuprofen by mouth versus applying lidocaine gel, a topical anesthetic, to the skin to decrease discomfort during mammography. The lidocaine gel was applied to a wide skin surface area and then covered with plastic wrap. There were no serious or life-threatening side effects reported in the study, nor were any reported when FDA discussed the results with the doctor who performed the study. The study results favored the use of lidocaine as there was significantly less discomfort than with the plain gel or oral acetaminophen or ibuprofen.  However, given the life-threatening side effects associated with the use of topical anesthetics during laser hair removal, FDA is concerned that similar side effects could occur when topical anesthetics are used during mammography. Further, the study was small and it is possible that a larger study might show different findings.
Patients should talk with their health care professional if they are considering using a topical anesthetic before a mammogram. The following summarizes advice for patients if a topical anesthetic is recommended for their use:

• use a topical anesthetic that contains the lowest strength, and amount, of medication that will relieve the pain; 
• apply the topical anesthetic sparingly and only to the area where pain exists or is expected to occur;
• do not apply the topical anesthetic to broken or irritated skin;
• ask their healthcare professional what side effects are possible and how to lower their chance of having life-threatening side effects from anesthetic drugs; and
• be aware that wrapping or covering the skin treated with topical anesthetics with any type of material or dressing  can increase the chance of serious side effects, as can applying heat to the treated area while the medication is still present.

To read the FDA's 2009 Public Health Advisory, to to: http://www.fda.gov/cder/drug/advisory/topical_anesthetics2009.htm.

Le-Petross said the findings suggest the alternating rotation may increase the chances of picking up cancers earlier. She said many of the cancers caught by the MRIs were not seen on the mammogram six months earlier.

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