September 17th 2024
Those least likely to schedule further screening mammograms had received a false-positive with recommendation for follow-up after only a short interval.
A Photo Quiz to Hone Dermatologic Skills
January 1st 2007A 51-year-old woman has had a progressiverash on the trunk, proximalarms, and legs for 2 weeks, followingthe latest round of chemotherapy forbreast cancer. Around the time thatthe rash erupted, she was also takinglevofloxacin for a productive cough.Cutaneous lupus erythematosus wasdiagnosed years ago, but she hasbeen disease-free for the past 5 years.Chemotherapy is being withheldpending diagnosis of the rash.
Breast Cancer Survivor With Fatigue and Musculoskeletal Pain
December 31st 2006For 2 weeks, a 58-year-old woman has experienced increasingfatigue with activity. She has needed to nap duringthe day, has not been able to perform her usual activities,and has missed 3 days of work. She also complains of“muscle aches”-mainly in her back. She denies headache,dyspnea, fever, hot or cold intolerance, and alteredmentation.
Focus on the Needs of Individual Patients- Not of Society as a Whole
December 31st 2006Any discussion of theutility and reliabilityof mammography mustfocus on what is good forindividual patients-not onwhat the results of a Europeanpublic health researchproject have determined isgood for society as a whole.What is good for most patientsis annual screeningmammography beginningat age 40 years (and for patientsat very high risk forbreast cancer, mammogramsbeginning much earlier,and possibly performedmore frequentlythan once a year).1
Timely, Appropriate Follow-up Is Critical
December 31st 2006The scientific literatureon screeningmammography can be confounding.This poses a continuingdilemma for bothpatients and clinicians. Nevertheless,objective analysisof the available data canprovide reasonable guidelinesfor the primary careclinician who must decidewhether screening mammographyhas benefit foran individual patient.
Practical Steps to Increase the Benefit of Mammography
December 31st 2006Although mammographyis still generallythought to be advantageous,a number of problemswith this screeningtool have recently beenbrought to light. Some ofthe latest studies suggestthat mammography maynot be as effective as washoped at decreasing mortalityfrom breast cancer.Moreover, the quality ofmammography itself hasbeen questioned-both theprocessing of films andtheir interpretation by radiologists.1 Errors can occuras a result of inadequateexposure or insufficientpenetration of the film. Radiologistswho have lesstraining in mammographyor who read a lower volumeof mammograms maymake more errors in interpretation.There are clearvariations between mammographycenters in ratesof false-positive and falsenegativeresults. While theanxiety and costs associatedwith false-positives areimportant, higher rates offalse-negatives are of mostconcern.
A Test With Inherent Limitations
December 31st 2006Mammography is auseful tool. However,it has limitations. Until recently,it had been viewedas the ultimate diagnostictest, capable of detecting allbreast cancers in their earliest,treatable stages. Thissimply is not true. Evenwhen performed by themost capable institutionsand radiologists, mammographyhas a sensitivity of80% to 85% for the detectionof breast cancer. This hasbeen established by numerousstudies.1,2