SBE....Sooo what happens when
So what happens when a 40 year-old woman ignores the task force guidlines and touches her own breasts (LOL), discovers a lump, and walks into the office of a Dr. who follows the guidelines. Does the doctor tell her "well, it's not in the guidelines for you to find that lump, so just come back when you are 50, okay?" Do they just leave that lump sitting there for 10 years?
Comments
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No, you must say (in advance of telling the doctor you found a lump) that your mother, father, two sisters and both grandmothers had BC. You are experiencing great pain radiating from the both breasts and your husband says there is a noted color change in the nipple/areola. Then ask him if he thinks your have dermatitis.
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In other words, you must stretch the truth if your physician won't look into your compalint.
Another option....tell him you didn't find it with a SBE, your spouse did with SEX!
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LOL Meece...
That is the stupidity of it. Speaking from experience when talking with a Doctor who follows the changes (this has nothing to do with "guidelines" because they wont be paid for) the Dr. will placate you into thinking everything is fine and that it is all in your head and point out that only a very small percentage of lumps are actually cancer. When you come back in 2 months complaining of pain, then the Dr. will give you some medicine to get rid of the pain and tell you again, how you are just imagining it and state that you seem depressed...so here is some more medicine...
To put it bluntly, everyone's health care will be like what the VA health care is currently.
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So either the woman won't make won't it til age 50..or it will spread to her lungs and she will be diagnosed with lung cancer...and the case of BC will not be recorded..and wow..our BC rates will drop and show the task force guidelines to be a huge success!! Can it get any more disgusting??
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In between all that He'll give you Valium for your anxiety. LOL
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So we're basically returning to the pre-HMO insurance model -- no *preventive* care, just targeted diagnostic care -- like when we used to go to the gynecologist for our annual pelvic exam and she had to tell the insurance company that we had come in because of dysmenorrhea in order to be reiumbursed.
I.e., if you have a good relationship with a good doctor (which is what I wish for everyone), then if you find a lump, s/he will order a diagnostic mammogram for a reason that the insurers will accept.
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I am reading this thread and don't know if all of the responses to Peppi1's initital question are serious or not. Nothing in the guidelines states that a lump should not be investigated because a woman is under the age of 50. Nothing states that a lump will only be investigated if a woman has a family history of breast cancer. If a woman discovers a lump, a diagnostic mammogram (not a screening mammogram) should be ordered.
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OP, you need to read the actual guidelines. They are about doing ROUTINE mammograms.
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Lisa-e...mine was very serious because that is exactly what happened with me. I speak from experiance when you have new Dr. who will follow the guidelines to a "T" as to not cause any waves...totally ignoring the reality of the situation.
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Lisa-e, I posed the question toungue in cheek to point out a ridiculous scenario that will likely happen to some. When they tell women they don't need to sbe, it raises concern as to why. Most lumps turn out to be benign in the same way most mammos don't reveal a cancer. You don't have to think too far to see where this line of reasoning will eventually lead. The insurance companies view this as an opportunity to deny coverage of these things...that's where all of this seems to be heading in my opinion. I will be many many women with lumps will be told "it's nothing" and be sent home.
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Peppi1...This is already happening with my Sister in law. She found a lump on her first mammogram at 40. Well, from what I understand they told her to wait and look at it again next year for any changes. This is already happening people!
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Colette, perhaps your sister-in-law should be blaming her doctor for not following up on the lump???
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For me, the bottom line is that it' seems Dr's will be put in a position of having to fight to get mammo's and biopsies when their medical opinion warrants them. That is not a good thing. Yes, some have problems now with a particular Dr. or insurance company...my fear is that it will be blanket type thing and all will have this problem. Dr.'s will not be able to act upon what is best for their patients. I do not have blind faith in this task force or our government. Their is and has been way too much corruption and ulterior motives at play. All in all, the task force guidelines, which make no suggestions on how to prevent or dectect early BC in the 40-49 age range, are an ominous thing.
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I disagree that the guidelines puts doctors in the position of having to fight to get mammograms and biopsies. The guidelines only address the effectiveness of mammograms and BSE for routine screening in younger woman.
I second what LInda said: Colette, if your sil's doc is not following up on the lump she should be blamming the doctor. These guidlelines have nothing to do with her doctor's actions.
Peppi, it you talk about ulterior motives: I think that many of the professionals protesting the new guidelines are radiologists or breast surgeons. All benefit financially from the status quo and stand to lose financially from the new guidelines.
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Peppi1...That is my feeling about all of this also.
I mean look at what the government has done with Social Security...They dip into it at a moments whim whenever they needed a little money here and there, and then in the next breath they yell that it is going broke! That has worked out really well for my generation that has been taxed to death with SS, and we will never see a dime out of it.
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lisa-e...yes, they do have to do with the new standard of care. It is the change that will be more prevalent once Dr start retiring. I specifically asked for a mammogram at age 35 and was denied one...even after pointing out that my mother had breast cancer at a young age. Now, at age 37, I have been fighting for my life. The cancer was originally IDC...and then after chemo a 10 cm DCIS was left. The mammogram showed a 9.5 cm tumor when I was first diagnosed and I have many Dr. tell me that it would have definitely been seen 2 years ago since it takes between 4 and 6+ years to get the size that it was.
These are real life experiences of the changes that these standard of care is bringing. It has nothing to do with "recommendations" since the insurances will adopt them as the norm. It may take 10 years, but from my experience as sited above, it wont take that long at all.
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Colette, the new guidelines do not have anything to do with your being denied a mammogram at at 35. They were not even in place at that time, if you are now 37. In any case, the guidelines specifically state that they only apply to asymptomatic women without a family history and that if you have a family history or are at higher risk then the decision on when to begin screening is a decision to be made by after a discussion between a woman and her doctor. The guidelines also don't address diagnostic mammograms. For these two reasons, I do not think the new guidelines have any bearing on your diagnosis or treatment.
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I just know too many women in their early 40's who were diagnosed with the routine mammo. They would not be here were it not for their routine mammo (and no, there were not all stage 0 and 1). So I got sick to my stomach when I read the new guidlines. That's my take...I have a bad feeling about the whole thing...I am glad for those who it does not worry...I am glad you are not upset and if you are on this board you need to be keeping your stress level down. Let's hope that I am wrong about where this seems to be leading. Of course they are not going to come out and state the guidelines implications for insurance coverage...but I bet...women under 50 will eventually be fighting to be screened.....I wish had as much faith in those involved that you..but I just don't.
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I'm curious...I thought 80 to 85% of breast cancer occurs in someone with no known risk factors, i.e. family history, BRCA gene, etc. If the vast majority of breast cancer does occur without any of these risk factors, doesn't that leave a lot of women out in the cold? Like me, for example. I was diagnosed at age 46, and there's not another person in my family who has had breast cancer (that I know of). I have always exercised, eaten well, and yet I got it. So how was that predicted? I was considered very low risk.
Also, in reading all of the articles in the media, it makes it sound so easy to differentiate the harmful breast cancer from the harmless breast cancer. If someone knew how to do that, we would have cured cancer by now! No one knows what will be serious and what won't be, and until we do, which may be years and years from now, then all breast cancer needs to be treated seriously. At least in my opinion.
One more ancillary question. If there is no more screening for under 50s women, does that then basically eliminate the possibility of identifying estrogen-created cancer? So what's the point of tamoxifen? I saw somewhere that they were recommending screening only post-menopausal women, but that doesn't make sense to me, given all of the women who have estrogen-created breast cancer. Again, these are just my thoughts.
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Digger, at this point which breast cancers need to be treated and which don't. Therefore some cancers are over treated. There are women dying of breast cancer, but there are also women being treated (lumpectomies and radiation, mastectomies) who do not need to be treated. So you have to weigh good of early routine screening against the harm it causes.
The organization Breast Cancer Action has a good discussion that is useful in understanding the issues:
http://www.bcaction.org/index.php?page=breast-cancer-screening-policy.
I don't think beginning routine screening at fifty eliminates the possibility of identifying estrogen positive cancer. First of all, if some under 50 has a lump that should be followed up on with the appropriate diagnostic tools, including mammograms. Nothing in the new guide lines suggests otherwise. Secondly, many women over 50 are diagnosed with estrogen positive cancers (I was one). Being post menopausal does not mean you don't produce estrogen, just that you produce less of it.
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"In between all that He'll give you Valium for your anxiety."
OMG - Too funny! Thanks Iodine...I needed a good laugh! Although there's probably a section that says any woman under the age of 80 cannot be prescribed anti-anxiety medication. Because, after-all, women under 80 shouldn't have anxiety!
Meece/peppi1 - I know this is a serious subject, but thanks to you too! Again...I really needed a good laugh.
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lisa-e...you are right, THESE guidelines were not in place. But the 40+ were. I was told via the GYN that I should wait till I was 40, even when I pointed out my mother having breast cancer at a young age. And this is exactly what will happen with women between 40 and 50. If they want a mammogram they will have to pay out of pocket for the test...that is if she can get a Dr. Order for it. Women between 40 - 50 will be fighting to get an order...but then what about the women under 40? What would happen to me if I didn't have a Dr. willing to do a breast exam on me (I was nursing at the time and they easily could have said plugged duct..in fact I DID get that comment) when I felt the lump?
How much will women have to fight for the right for health care? This bill and the USPSTF is not health care..it is mortuary care which will be the result of it.
I see Dr. not caring to fight for their patients all the time because it takes too much work..so they give into the system. It may not happen right away, but as Dr retire the ones taking their place will not have the same work ethic and it will start to sway...
You may have faith in the government, but I do not. I do not expect to get anything back from SS because of the politicians dipping into it all the time. This health care bill and the USPSTF is nothing more than another tax and a way at reducing cancer screening.
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Lisa-e,
I get that we are overtreating some cancers (the second group in the BCA's guidelines, which I thank you for sending me the link), but I still don't see anywhere some definitive test for distinguishing which of the early cancers that are identified will become harder to treat once they're further along and which ones are "innocuous.". The three stages put forth my BCA sound great, but, again, we're still not able to do that.
I had stage 3 DCIS, solid and with comedo necrosis, that spread very rapidly in the space of 14 months. If I didn't have treatment, does that mean I would have needed to wait until the DCIS became invasive, and then treat it? Would I have been better off had the mammogram and ultrasound not picked it up (after I identified a lump on my own), and then just seen what happened? It just doesn't seem like science has any of these answers yet.
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LauraGTO..I got a laugh out of that too...there is definately humor in how ridiculous this thing can be...my initial question was posed tongue in cheek....lol
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I was 37 when they found the "cysts" told I was too young to have bc, come back in 6. I was told that my Grandmother having bc at the age of 62 did not count as she was to old to count. Her I am! They are raising the bar, when they should be lowering it. They WILL dismiss women under 50 just like they dismissed us under 40. My insurance company had to review and APPROVE all tests before I had them as their Drs. apparently knew more than mine. Too bad none of them caught it at 37. It WAS there then, but no biopsy, no MRI, no draining (sorry cant think of the correct word, chemo brain still), because I WAS TOO YOUNG TO HAVE Bc.
I have a GREAT relationship with my OBGYN who sent me to the bs. He knows me very well delivered 2 of my children. He now sees my Mom, Sister and a few friends. He knows my entire family, kids hubby, and he REALLY knows me. But that didnt do me anygood.
sick Sick SICK!
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Digger you wrote....
"Also, in reading all of the articles in the media, it makes it sound so easy to differentiate the harmful breast cancer from the harmless breast cancer."
Sad to say there is no harmless breast cancer......ALL breast cancer is harmful and potentially deadly.....ANYONE can go from being stage 1 to being stage 4 as no one knows if or when it will ever come back...SOme of us have a higher risk of it coming back and these new "guidelines" ( I read them as mandates) are just going to hurt more women than help.......
Also as I recall the younger a woman is the more aggressive her cancer.......Does this mean the women in their 30's are going to have an even tougher time getting screened?....ABSOLUTELY!.....They may even have to wait til they are 40!.......Who knows?....I just know the more the government takes over the more it hurts us.......And what is it with all these Czars that Obama is appointing?...I had no idea I had moved to Russia!....... -
".......And what is it with all these Czars that Obama is appointing?...I had no idea I had moved to Russia!......."
This is only the beginning! In a few short years, you will want to move to Russia. Fasten your seat belt...
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When these guidelines about BSE (breast self exam) are discussed, it is about the very formal program of breast exams that we used to teach. Where you lie down once a month (at the end of your periood, if you're still having them) and examine your breasts in whatever pattern the ACS currently recommends. Over the years it's gone from concentric circles, to up and down, to spokes of a bike patterns, making sure you inspect in the mirror with your arms in various positions.
THAT's the BSE they're referring to. That particular program has not been shown to improve overall mortality. The World Health Organization came out several years ago against spending money to teach this particualr method. So this task force's recommendation is nothing really new.
No one is telling you not to touch your breasts. It's just advised now that when you're in the shower on occasion or putting lotion on your body, whatever, to glide your hands around your breasts and just be aware of what's normal for you. That way you'll know when something unusual comes up. More women find their lumps this way, anyway, not through the formal BSE program. It's just that BSE has become synonamous with a generic self-exam.
Keep feeling those breasts, ladies. Your own fingertips are your best frineds!
Anne
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Anne wrote:
"...Keep feeling those breasts, ladies. Your own fingertips are your best frineds!"
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And how are the millions of women and young girls who heard the report, going to know this?
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Anne, The only thing I have read or seen in the media is that self breast exams are a waste of time. Laura poses an excellent question. AND there are women out there going along with this..defending it. So there will be a huge group of women out there that will do NOTIHNG until age 50.
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