This week there has been a raging war of words around the US Preventive Services Task Force recommendations for screening around two women’s health care issues. Well, in the US, anyway. Mammograms and Pap tests (smears).
The mammography guidelines have stirred up a lot of fear, accusations, confusion, political posturing, and backtracking, among many other things. Bubbling up for moments are reasonable conversations about the science and the guidelines.
I am a huge advocate of screening and early detection. Like most providers, I have seen cancer in young people, AND in people not considered high risk. I have also seen people in high risk categories of a disease, who never get the disease. Screening is an important tool in health care.
With that said, I think it is important to remember that these are “recommendations”.
I also want to remind people that the CDC and other organizations have relied on the advice of the US Preventive Services Task Force to set standards because of the excellent, thorough and unbiased work they do. Much of Europe has been using these guidelines for years based on a meta analysis of many research projects over decades from around the world.. And on the global health scale, these countries have a much stronger record of health than the US, which consistently is in the bottom for most health indicators except expenditures.
So, bottom line is to look at screening both individually and societal. There are costs…not just monetary, but other costs. There are unnecessary treatments and surgeries
We know screening mammograms can detect early stage breast cancer, but when do we start….at 40? 35? 30? 20? What about for men, who tend to find out later, and for whom the cancer is deadlier? How do we decide? This is what this task force is providing us information about. The recommendations are not “deciding whether you should ever screen a 40 year old”, but “when” and “how often”. Not blindly follow the guidelines, but evaluate and make the best educated guesses about early detection.
Now let’s take a big breath.
My recommendations are – Go over your family history, personal history, lifestyle and toxin exposures. BRACA gene? (Those at higher risk need to start earlier and potentially with an MRI) Look at geographically where you live, and whether cancer rates are higher. Your ethnic background makes a difference in terms of cancer risk as well. Physical exams and present health concerns. Look at the statistics and incidences. THEN make a decision. Not out of fear, but out of empowerment and knowledge. And don’t forget about intuition. Intuition is a powerful tool. This is often mistaken for fear, but if you have a gut feeling or are worried, by all means talk with your doctor and get a mammogram.
Also, it is important to remind ourselves of the reality that none of us knows everything and that even tests are not 100%. In this country we are looking for perfection and absolutes. But in reality, there are none. Weigh the factors….the pros and cons. And then make a decision that is right for you. Don’t judge others for their decisions. Re-evaluate often. The research and you change all the time.
You are in control of your health. Make the choices that make the most sense for YOU.
Here’s a recent article that I found interesting from the New York Times.
Archive for November, 2009
New Breast Cancer Screening Guidelines • What am I supposed to do now?
Tuesday, November 24th, 2009
H1N1 Flu Update
Thursday, November 5th, 2009
As I was composing my 3rd installation of the basics, on water consumption, I began getting more questions about the H1N1 flu and shots. There are many thoughts and discussions out there about the H1N1 flu shot, and the seasonal flu shot. As of this date, there is a shortage of vaccines and supplies are less than previously anticipated.
I urge people to be calm. I am quite disconcerted at the level of panic that has been created. Many people have asked me about the H1N1 shot and what I think about it. Like I approach health care, I believe it is important to look at the short and long term consequences and benefits and risks, and take into account the individual. Look at all the alternative options as well. THEN make well-informed choices that are right for you.
Here are my recommendations:
- Support your immune system to be able to have the best fighting chance of beating any sort of illness, including the flu. Even if you have the shot, it is not 100%.
- Talk to your health care provider about the vaccine and the benefits and risks and whether you are high risk and therefore on the priority list. Then make an informed decision. The reality is that not everyone who wants to get the shot will be able to…at least not before this present flu season is over. And apparently only about 50% of the population is interested in getting the vaccination.
- There are plenty of unknowns about the H1N1 flu and the vaccine. The information will change and it is important to be okay with that. Medicine and health care is always evolving. New information is uncovered daily. The flu strain may get weaker or stronger. No one knows at this point. The vaccine has many unknowns such as long term effectiveness, among others. Like any vaccine, it also has risks. And the risks and indications are different for the nasal vaccine(composed of live virus) and the shot (dead virus).
- If you do get the shot, do not take Tylenol (acetominophen) afterwards unless you really need to. Recent research shows that children who take Tylenol (acetominophen) after immunizations, have a weaker antibody response, making the shot less effective.
- If you do get flu symptoms now, most likely it is H1N1, because the regular seasonal flu season has not begun yet. I still recommend getting tested as it is good for the public health department to keep track. If you are sick, stay home, rest and get plenty of liquids.
- There are conventional anti-virals but they need to be given within the first 48 hours to be the most effective. Health care providers are often only utilizing these for those at highest risk of complications. Because lab tests will not be in within the first 48 hours, these medications may be started before confirmation of a diagnosis.
- There are natural remedies (anti-virals and immune system stimulants) that can be recommended/prescribed by your complementary care provider that can help hasten the recovery should you get ill.
This flu is affecting pregnant women, children and those up to age 49 the most significantly. With that said, it is important to remember that most children who are basically healthy recover from this flu without complications. It is well known that although there are deaths associated with this flu (as there are with any flu) many people are getting only mild symptoms.
My biggest message today is to be calm about H1N1. It is easy to get alarmed. But the stress of alarm actually negatively affects your immune system by raising your cortisol levels. It doesn’t mean to be too laid back either. The best way to combat the flu is to do the best you can by being the healthiest you can. Prepare for the flu to come knocking on your door, like with any flu season. You can’t avoid being exposed. We all go to public places or have exposure to others that go to public places. But you do have control over making your body as strong as possible to combat the flu or other infectious diseases. And it is important to have your immune system strong whether you recieve the vaccine or not. It will help mount a successful immune response either way.
Here are some helpful websites specifically concerning the H1N1 flu and shot:
kingcounty.gov/healthservices/health/preparedness/pandemicflu/swineflu.aspx
www.cdc.gov/h1n1flu/general_info.htm
Oh, yeah, and in terms of water….staying well hydrated has been shown to improve resistance to infection among other things. So, drink that water.
