True Story, Fake Name
Emma came in for a second opinion. Should she continue annual mammograms? The problem was, they frequently showed worrisome areas in her breasts. About half-a-dozen times she'd needed a lump removed to test for cancer, but it was always negative. Her breast exam showed six or eight easily visible scars, two with shallow divots. She had obvious fibrocystic changes with normal small lumps-nothing alarming. She feared she was losing breast tissue for no reason.
I agreed. Mammography followed by biopsy when something appears questionable seems reasonable for most women, but not in her case. Her normal breast tissue often looked abnormal in a mammogram, hence the biopsies. I told her she could still get breast cancer, as any woman might, but mammography seemed to be adding to the problem. Maybe she should go back to the old system, periodic examination by her primary care doc followed by specialty consultation if a lump actually seemed to be enlarging. Or better yet, if she could manage it, an annual exam by a breast specialist. Surely there were other women in the same boat.
She returned a few times for this and other matters, then returned to her usual family doc. I wish I could tell you if she ever got breast cancer, but that's medicine in the real world. You don't always get to hear the rest of the story.
The Mammogram Wars
In fact, mammogram wars may be coming to an end. For several decades, various physician groups have argued over the optimal age to begin screening for breast cancer. You may have seen some of this in the news, but the fighting was particularly intense behind the scenes. Start at age 40, start at age 50, don't do them at all, stop at age 75, do MRI's instead-you needed your head on a swivel.
Over 50,000 women have signed up for a study of this problem, called the https://www.thewisdomstudy.org/ Wisdom Study. Their voluntary participation will help answer this question: does an annual standardized screening work best, or are women better off with screening guided by family history, genetic testing, and other personalized measures? In the latter case, the individualized case, women who appear to have less risk are given fewer mammograms.
You see, it's an open question. Screen frequently and you get some falsely positive tests and sometimes do unnecessary surgery. Screen less frequently and some women have aggressive breast cancer diagnosed less promptly. How do we solve this?
https://www.thewisdomstudy.org/ You may be eligible to sign up and help find out the answer.
Vaccines and Nobel Prizes
In the headlines this month: "COVID-19 is expected to become a seasonal illness like most respiratory viruses that strike in the winter months."
True enough. COVID-19 appeared in the winter. The virus is a modification of a normal winter coronavirus, and so named COronaVIrus Disease 2019, remember? What we knew about coronavirus was that it was one of a number of viruses that cause colds and flu-like illness in the winter, viruses with names like rhinovirus, parainfluenza virus, influenza virus, adenovirus, respiratory syncytial virus, and. coronavirus. So we got some mixing and matching of the genetic material in an Asian population of coronavirus in late 2019 and presto-chango, the evolved virus spread around the globe and killed so many people that New York and other large cities had to bring in refrigerated trucks for the dead. Now with vaccines and natural immunity the danger is less. As it has for millennia, coronavirus in its new form will continue to circulate. As usual, it'll do that in the winter.
This https://www.youtube.com/watch?v=w4sUuFBEo2g two-minute video shows why I bared my arm for my seventh COVID vaccine recently. Nobel Prize winning https://publichealth.jhu.edu/2021/the-long-history-of-mrna-vaccines people have worked on them for decades. The vaccines have proven to be much, much safer than going without them.
Next in line for me, RSV-the respiratory syncytial virus, given to the very young and the very old. (Well, it doesn't seem old, once you get here.)
So, free advice! Get your flu vax, your COVID-19 update, and if you are over 60, your RSV.