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Keep medical decisions between doctor, patient



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December 16, 2009 - Recent recommendations regarding breast cancer screenings have been subject to many misunderstandings, said Dr. Jeffery Forman of Independence Township.

"There is a lot of concern about it," said Forman, medical director of 21 Century Oncology. "A lot of patients view this as a money-saving scheme, when in fact it's really not. The recommendations were based on the data to give the best balance of risk and benefit."

The United States Preventative Services Task Force recommends yearly mammograms for women between ages 40 to 50, but against regular screenings between ages 40 to 49, saying it should be an individual choice for each patient.

"In the world of early detection, how early is early enough," Forman said. "Are there risks or downsides to over evaluation of the breast?"

Forman said the guidelines are based on data.

"I think the fact it came out at a time the White House was looking at modifying healthcare. It makes people think this was really driven by a desire of rationing of healthcare and cutting healthcare cost, when in fact the science that goes into a recommendation like this is totally independent of that," he said. "It's not a political issue or statement, it's a science statement."

Forman believes they should take the study and findings at face value, but whether or not to follow them exactly as indicated should be discussed individually with each patient. He said "it's a balancing between risk and benefits."

"I think what it comes down to me, is we do have the ability to identify some high risk women, women who have a family history of breast cancer or women who may be genetically predisposed to the development to breast cancer," Forman said. "When a patient falls into one of those categories, moving forward with earlier screenings or early detection in a high risk population absolutely still makes sense."

The task force recommends screenings for women between ages 50-74 every two years, and not doing them for women over age 75. Science supports the task force recommendations, but it should be on a patient to patient basis, he said.

"I think physicians now should be telling patients between 40 and 50 and over 75 that based on their unique situation of family history or genetics, based on their concern that they should either follow the past guidelines or the new guidelines, but understand what the pros and cons," he said. "More exposure to radiation for mammograms isn't necessarily benign."

There is a possibility of false positives or over diagnosis, or that patients will require operations that aren't needed, Forman said.

"I think if the patients are well informed of the pros and cons then you can make a rational decision of what kind of screening to move forward with," he said.

For women not in a "high risk" population, he felt recommendations concerning early screenings were "a reasonable approach."

"Patients with early diagnosis who choose a breast conserving option, still need a lumpectomy to remove the identified lump, and then go on to have radiation targeting the remaining breast issue," he said.

For more information about the USPTF study visit www.ahrq.gov for more information about Dr. Forman visit www.21stcenturyoncology.com

Trevor graduated with degrees in English and communications from Rochester College. He wrote for his college and LA View newspapers before joining The Clarkston News in May 2007.
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