Monthly Archives: October 2013

Breast cancer screening Qs answered

Breast cancer screening Qs answered

2013-10-07

By Dr. Otis Brawley, CNN contributor

For years there has been much discussion about mammography screening. Several medical organizations have reviewed the scientific literature and made various recommendations — to begin screening at age 40, or to begin at age 50. Some recommended screening every year; others said every two years.

Since the 1960s, doctors and patients have believed that mammographic screening and early detection of breast cancer, combined with effective treatment, will save lives. There are now at least eight large clinical trials that definitively show screening saves lives for women aged 50 to 69.

Unfortunately, the data for women aged 40 to 49 are not as clear.

Because of that, confusion surrounds breast cancer screening. In honor of Breast Cancer Awareness Month, I decided to tackle some of the most common questions:

Why is mammography a better test for older women?

The answer is twofold: It is easier to see a cancer in mammograms of older women, and older women are more likely to have cancer.

When the radiologist reads a mammogram or X-ray of the breast, cancer appears white. Young breasts have more dense tissue compared to older breasts; a dense breast appears white on mammogram. So in younger women, the radiologist is looking for white on a white background.

The aging of the breast slowly turns its X-ray appearance from white to black. In the breast of a 60- or 70-year-old woman, the radiologist is looking for white on a black background. For women in their 40s, the background can range from whitish to grayish, depending on the density of the individual’s breasts.

A mass seen on a mammogram done on an older woman is also more likely to be cancer than one found in a younger woman. One in every 42 women will develop breast cancer in their 60s, compared to one in 28 women in their 50s. So a mass found in a younger woman may not have an effect on saving her life. In fact, it could do the opposite if unnecessary treatment is performed.

What are some of the limitations of mammography?

Mammography screening is not very effective in women between the ages of 20 and 40, and only moderately effective in women aged 40 to 49.

It is estimated through mathematical modeling that regular screening of a woman between ages 40 and 49 will decrease her risk of breast cancer death by about 15%. In comparison, clinical trials show that screening reduces risk of death by 20% to 35% in women aged 50 to 70.

It is estimated that 1,900 women will have to undergo an annual mammogram in order to save one life. A substantial number of these women (by some estimates more than half) will have an abnormal screen during that decade. These abnormal screens require additional testing and inconvenience. This, of course, also causes a lot of fear and worry. Most of those abnormalities will turn out to be clinically insignificant.

One harmful effect of screening women aged 40 to 49 is that some women have such a bad experience with callbacks for re-evaluation that they stop getting screened, and even refuse screening when they are in their 50s and 60s, when mammography is a more useful test.

Some organizations recommend screening every other year versus every year. There are data to suggest that every-two-year screening saves almost as many lives (about 85% to 90%) as every-year screening, but the number of false positives is halved.

What do the most respected organizations recommend?

While most American organizations recommend annual, high-quality screening beginning at age 40, a few recommend routine mammography start at age 50. Even these organizations say that women who are very concerned about breast cancer and want to start earlier can do so. The choice is yours.

But as you make that choice, know the limitations of mammographic screening.

It is a fact that high-quality breast screening will find some abnormalities that, after extensive evaluation, turn out not to be cancer. High-quality evaluation will miss some cancers. This is especially true in younger women, and can be true even in older women with denser breasts.

So should younger women get screened?

A small number of women will develop breast cancer before the age of 40. No organization recommends mammography for average-risk women under 40.

Women without a family history and with average risk should receive a clinical breast examination with their regular gynecologic examination. They should also be aware of their bodies and get medical assistance if they detect a change in their breast.

Those who have a family history of early breast cancers should consult a physician with expertise in breast cancer. Some of these women will be candidates for screening using magnetic resonance imaging.

The opinions expressed in this article are solely those of Dr. Otis Brawley.

How Eye Contact Can Backfire

How Eye Contact Can Backfire

2013-10-03

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We’re often told to maintain eye contact when speaking with others. But a new study published in the journal Psychological Science is poking holes in the theory that looking deep into someone’s eyes shows interest and boosts persuasion.

In fact, the University of British Columbia researchers report that in the midst of an argument, looking the other person in the eye won’t get them to agree with you. It actually may do the opposite.

The researchers tested the power of eye contact by asking 20 study participants to share their opinions of controversial issues such as affirmative action and assisted suicide, and then watch a video of a speaker chatting about various topics. The researchers used eye-tracking technology to determine when the participants were maintaining eye contact.

When the speaker in the video spoke about opinions the participant shared, the participant maintained eye contact more consistently. But when the speaker started covering topics the participant disagreed with, they looked away.

The participants were less likely to change their opinions if they were looking into the eyes of the speaker, especially when the speaker was also looking directly at the participant, rather than to the side of the screen. To test this again, the researchers had the participants watch more videos, but sometimes they were told to look into the speaker’s eyes, and other times they were instructed to look at the speaker’s lips. The participants who looked into the speaker’s eyes were once again less likely to change their opinions compared to participants focusing on the speaker’s lips.

“There is a lot of cultural lore about the power of eye contact as an influence tool,” said lead researcher Frances Chen, an assistant professor at University of British Columbia, in a statement. ”But our findings show that direct eye contact makes skeptical listeners less likely to change their minds, not more, as previously believed.”

Exercise As Effective As Drugs For Treating Heart Disease, Diabetes

Exercise As Effective As Drugs For Treating Heart Disease, Diabetes

2013-10-02

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Forget the pills — there’s new evidence that exercise may be as effective as medications in treating heart disease and diabetes.

Doctors now advise everyone, from young children to older adults, to become more physically active. It’s the best way to maintain a healthy weight, keep the heart muscle strong, and improve your mental outlook. But can exercise be as good as drugs in actually preventing disease and treating serious chronic illnesses?

That’s what researchers from the London School of Economics, Harvard Medical School and Stanford University School of Medicine wanted to find out. They compared the effect of exercise to that of drug therapy on four different health outcomes: heart disease, recovery from stroke, heart failure treatment and preventing diabetes.

The scientists pooled the results of 305 trials involving 339,274 people who were randomly assigned to either an exercise program or a drug-based therapy and found that there were no detectable differences between the two groups when it came to preventing diabetes and keeping additional events at bay for heart patients. And the physical activity was most powerful for participants who experienced a stroke. The only group that didn’t benefit from the exercise over drugs were patients with heart failure, likely because the strain of the physical activity wasn’t recommended for their condition.

The findings involving diabetes patients confirmed previous trials that documented how effective physical activity can be in bringing blood sugar levels down.

So why do most doctors prescribe drugs over exercise? There are more rigorous studies testing the effectiveness of drug therapies to treat common diseases, say the study authors, than there are studies that test the power of exercise. With these results, however, the researchers hope to see more work on how exercise can be a significant part of a treatment program for diseases ranging from heart problems to diabetes.

Those studies will need to analyze physical activity in the same way that drugs are studied, to determine how much exercise is needed to trigger beneficial changes in the body that can treat or prevent disease.

Currently, to maintain optimum health, federal experts recommend that people exercise at a moderate intensity for about 2.5 hours a week. But fewer than half of Americans meet that recommendation, and a third of Americans don’t get any exercise at all. The latest findings should encourage even those who aren’t active, however, since research shows even just talking a brisk walk can help lower the risk for high blood pressure, high cholesterol and diabetes, and be as powerful as medications in keeping the body healthy.

Stress less: Keys to a calmer existence

Stress less: Keys to a calmer existence

By Francesca Castagnoli, Health.com

It’s one of the greatest ironies of life: We’re too frantically busy to deal with the stuff that makes us feel frantically busy — the to-do’s that overwhelm us, the clutter that eats up our homes, the niggling personal and professional issues that preoccupy our minds.

Tackling them might feel like a someday project, the kind you’ll get around to when you have the time. Right.

The key to a calmer existence, experts say, is finding bite-size, everyday solutions for stressors and releasing what we can, be it physical or psychological clutter.

“When you start to let go, your life lightens up because you have less to think about and less to maintain,” says Geralin Thomas, a professional organizer in Cary, North Carolina. “You finally feel in control.”

The payoffs don’t end there — you can sharpen your focus and even lose weight, too. These are the strategies that will ease your load and let you enjoy life a lot more.

Clear your schedule

As we juggle it all, we’re often fueled by an I-can-do-it! sense of pride. But we might be deluding ourselves, suggests a study in the Journal of Communication that found that people misperceive the emotional high they get from multitasking as productivity.

And we’re not even as good at it as we may think. Another study, published in Psychological Science, revealed that women’s ability to keep track of several tasks at once dipped significantly during ovulation, when estrogen levels are high (and can mess with brain function).

Technology sometimes hampers us more than it helps, adds Laura Vanderkam, author of the book “168 Hours: You Have More Time Than You Think.”

“Time speeds by when you’re on your smartphone e-mailing,” she says, “even if you’re really not doing anything important.”

How to lighten up:

Suss out time sucks. For one day, every couple of hours, note down exactly what you just did, including things like “Read Facebook updates for a half-hour” or “Scanned catalogs for 15 minutes after opening mail,” says Vanderkam. “You start to see the time periods that you’re not using as well as you’d like.”

Stop the auto-yes. “Everyone lives in an optimistic world and thinks that if we say yes we will find the time, but the truth is we are in denial,” says Julie Morgenstern, one of the top organization and productivity experts in the country. Instead, experiment with saying, “Let me think about how I can do that,” says Morgenstern. “This way you can step back and evaluate if you really can do what is being asked.”

Have a plan. “Most people’s to-do lists actually create fatigue, because they don’t clarify how, exactly, they are going to handle Mom’s birthday, so tasks feel bigger than they are,” says David Allen, a productivity expert and author of the best-selling book “Getting Things Done.” Take a second to jot down how you’ll tackle something. Feel better already?

Just do it. Allen regularly tells clients to follow his Two-Minute Rule: If something can be done in two minutes, go ahead and get it done. Explains Allen, “It will take you longer to look at it again than it would take to finish it the first time you think of it.”

Reconsider rewards. Carefully examine your commitments, says Morgenstern, and decide which ones energize you — and which deplete you. For the tasks that send your misery Geiger counter off the charts, pinpoint whatever reward you get from them and find a better way of scoring it.

One client of Morgenstern’s wasn’t really enjoying volunteering for the PTA because it took time away from her kids, but she kept at it because she thought it showed her children she considered school important.

Ultimately, she switched over to running the occasional fun class activity and giving her kids more hands-on help with homework. “These things took less time,” Morgenstern notes, “and she and her family got more out of them.”

Health.com: 8 reasons to make time for family dinner

Clear your clutter

Dusting, mopping, vacuuming: That’s easy. Getting rid of all the junk you have to dust, mop and vacuum around? Not so much.

“Giving things up is tough because it’s not so clear-cut when they’re no longer useful,” says Morgenstern, author of the book “Shed Your Stuff, Change Your Life.” You don’t stop wearing jeggings on a Tuesday at 4 p.m.; you just gradually stop doing so, even as they languish on a hanger.

The thing is, those pile-ups of possessions can create anxiety; a study at UCLA found that just looking at clutter elevated women’s stress hormones (although, no surprise, the men’s cortisol levels remained unchanged).

Motivation to get going on cleaning house: You may look better, too. As Thomas points out, “One big change I see in clients who have de-cluttered is weight loss. Once they have shaped their environment, they’re ready to shape up themselves.”

Health.com: 7 steps to organizing clutter

How to lighten up:

Think small. “We know from research that little acts of neatness cascade into larger acts of organization,” says Christine Carter, a sociologist at UC Berkeley’s Greater Good Science Center. Forget about organizing the entire kitchen; focus on, say, the plastic containers taking over your cabinets.

“With random de-cluttering, there’s always more that you can do,” notes Thomas. “When one category is tackled, there’s definitely an end point.”

Be a regular. Perhaps you dedicate, say, 10 minutes a weekday to an organizing project. Or you commit to doing a couple of hours for a few weekends in a row. The point is, be consistent and attentive; turn off your cell phone and schedule child care.

Thomas does a weekly “Trash Eve” de-clutter: “The garbage in my neighborhood is picked up on Wednesdays, which makes Tuesdays the night I make an easy supper and clear the decks!”

Decide what’s treasure and what’s toss-able. Ask yourself just one question before you start purging any collection of stuff, recommends Morgenstern: “If everything was stolen, what pieces would I go out and buy the very next day?” There you go — the costume jewelry, canned goods and linens you truly want and need.

Pre-arrange pickups. About 40% of people who purge never manage to get the stuff out of their homes, per a poll of 23,000 people on Morgenstern’s website. Avoid becoming a hoarder statistic by scheduling a pickup before you start to clean your house. Try salvationarmyusa.org, goodwill.org or excessaccess.org, a not-for-profit that connects people with local schools and charities in need of specific goods.

Health.com: Secrets to a healthy (happy!) home

Clear your mind

It’s not just that we have a lot to keep track of — it’s our DIY mentality, says Dr. Orit Avni-Barron, director of Women’s Mental Health at Brigham and Women’s Hospital in Boston. “I hear women say, ‘My husband is so great, he helps me,'” as if our partners are our sous chefs instead of co-cooks.

Another issue: Women worry twice as much as men, research shows. “Worrying impairs concentration and memory,” says Robert Leahy, director of the American Institute for Cognitive Therapy in New York City. “You can’t tend to the present and worry about the future at the same time. It’s overwhelming.”

Health.com: 9 things to stop worrying about

How to lighten up:

Pop annoying thought bubbles. Psychologists talk of the Zeigarnik effect, named after a Russian shrink who realized that a waiter could more easily recall incomplete orders than served ones. The follow-up study showed that people are 90% more likely to remember undone tasks than those they completed. “Tell your brain when you’ll get a task done,” says Carter. “It kills the worry loop.”

Control what’s possible. “When we don’t know how something will work out, we worry to get certainty,” says Leahy. Yet one study at Penn State University found that 85% of things people fretted about had neutral or positive outcomes. To quell anxiety, throw yourself into what you can accomplish — say, writing the introduction to the PowerPoint document instead of ruminating on the presentation. “You’ll feel good about the present and put other thoughts on pause,” says Leahy.

Be hands-on. Weed, knead dough, do a craft, says Dr. Gayatri Devi, associate professor of neurology at New York University. “When you think about something tangible, you stop thinking about the theoretical.”

Grade perfection on a curve. “We have reached a tipping point in perfection. People are realizing we can’t do it all at the level that we used to,” says Morgenstern.

That means you, sister! Start with the obvious: Divvy up more responsibilities with your partner, even if he does them differently. And try Morgenstern’s Minimum, Moderate, Maximum strategy: Decide what level of effort you can give tasks (and get away with). As she says, “You may be surprised to find that everything works out OK.”

Fewer Drugs Being Prescribed to Treat Mental Illness Among Kids

Fewer Drugs Being Prescribed to Treat Mental Illness Among Kids

2013-10-01

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?As rates of behavioral disorders like attention deficit-hyperactivity disorder (ADHD) and anxiety rose among children, so did concerns about treating them with psychotropic drugs.

From the early 1990s to the early 2000s, the number of young children on psychotropic drugs, which include anti-depressants, stimulants, mood stabilizers and anti-anxiety agents, increased by two- to three- fold. Some drugs, including several ADHD medications, have been approved for use in children ages six to 12, while others have not studied long term in younger patients.

But in a new study published in the journal Pediatrics, researchers report that psychotropic drug treatments among children is stabilizing, according to data from a national sample of more than 43,000 kids between the ages of two and five. These drug prescriptions peaked between 2002 and 2005, and leveled off from 2006 to 2009.

While more refined guidelines for diagnosing mood and behavioral disorders among children may explain some of the change in medication use, more stringent warnings about the potential risks of psychotropic drugs on youngsters probably also played a role. In the mid-2000s, the Food and Drug Administration started adding its strictest black box warning to alerting doctors and patients to the serious risks these treatments could pose for children and adolescents. For those reasons, more pediatric groups advise doctors to start their youngest patients on behavioral therapies first, before relying on medications to treat their symptoms. “Our findings underscore the need to ensure that doctors of very young children who are diagnosing ADHD, the most common diagnosis, and prescribing stimulants, the most common kind of psychotropic medications, are using the most up-to-date and stringent diagnostic criteria and clinical practice guidelines,” the authors conclude.

However, some recent research showed that more than one in five specialists who diagnose and recommend treatment for preschoolers with ADHD turn to drug therapy first, either alone or in tandem with behavior therapy. But it’s not because these pediatric specialists think that the drugs are more effective or aren’t concerned about the long term effects of the medications. That study also revealed that drug approaches may be the only practical or accessible ones to some parents, since behavior-based methods require a lengthy time commitment and can be costly.

Currently, the American Academy of Pediatrics (AAP) supports behavior therapy as the first strategy for treating preschoolers diagnosed with ADHD, and suggests that medication should be used only if the behavior therapies were unsuccessful. That approach, pediatric experts hope, will continue to direct psychotropic medications only where they are needed.