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Posts Tagged ‘guidelines’

Putting a Price on Life?

Wednesday, November 18th, 2009

Dr. Cynara Coomer

I am outraged with the recommendations from the U.S. Preventive Services Task Force. Not only does it send a mixed message to women about the benefits of a screening mammogram, it is also a dangerous practice to not screen women between the ages of 40-49 without an alternative test. Furthermore, early detection of breast cancer by mammograms has shown to have a significant decrease in the number of deaths. Although the numbers are more impressive for women over the age of 50, there is still a large impact for women in the 40-49 age group. For every 1,300 women screened between the ages of 50-59, one woman’s life is saved. For every 1,900 women screened between the ages of 40-49, one woman’s life is saved.  Is the difference in the ratio really worth denying women in their 40s a chance of survival?

Proponents of the task force’s recommendation argue that screening women in their 40s has led to a high number of false negatives, needless biopsies and unnecessary anxiety. However the impact of saving a woman’s life in my perspective outweighs these problems. Ultimately, we need to find more appropriate tests to screen women, but the mammogram is our best available modality at this time.

Because of the number of women under the age of 50 that I personally treat in my practice for breast cancer, I will not go against the American Cancer Society guidelines of starting mammograms at the age of 40. Depending on their risk factors, some women may need a baseline mammogram at the age of 35. The impact of these guidelines is not only about survival outcomes, it is also about the treatment options that are available when breast cancer is found early. When breast cancer is found at an early stage, there are more surgical options and it usually does not require the addition of chemotherapy. On the other hand, when cancer is found at a later stage, surgical options become more limited and treatment will most likely include radiation and chemotherapy. The prognosis is also worse when cancer is found at a later stage. So to think that costs will be lowered by decreasing the number of screening tests does not make sense when we risk diagnosing breast cancer at a later stage. In the end, the cost of treating advanced breast cancer is far more expensive.

I hope the task force reconsiders and reverses their recommendation so that women will continue to understand that mammograms starting at the age of 40 save lives.

Dr. Cynara Coomer is an assistant professor of surgery specializing in breast health and breast cancer surgery at Mount Sinai Medical Center in New York City. She is a FOX News Health contributor providing medical expertise on a variety of topics in cancer research with a focus on women’s health, breast diseases and tips for healthy breasts at any age.

For Octomom, the Challenge Has Just Begun

Tuesday, April 14th, 2009

dr_manny_blog2I was very happy to learn Tuesday that the last of the Suleman octuplets is finally home  to be with his brothers and sisters. Jonah ― the last to be sent home ― was the smallest of the bunch, weighing just 1 pound 8 ounces when they were born nine weeks early.

Click here to see pictures of Jonah and his siblings.

But now, the real challenge begins. Let us not forget that these infants were premature and that this last baby stayed in the hospital for almost 12 weeks. There is a lot of data that has been published and analyzed looking at some of the hurdles that premature babies must overcome in their early years.

To me ― as a person who delivers babies for a living ― I also have three of my own ― I am aware of the significance of paying attention to the way kids grow and develop, and how important that attention is in preventing some of these children from failing to meet their full potential.

For parents of full-term infants, paying close attention to developmental milestones is sometimes an afterthought. But for parents of premature babies, keeping track of movement, visual, social and developmental milestones could make a world of difference in identifying problems and finding solutions to meet their needs.

Most premature babies meet their milestones and catch up by the age of 2. But depending on how early an infant is born, their development may lag anywhere from 6-8 weeks in development usually during the first year of life.

It’s important to use your child’s adjusted age when tracking his or her development. For example, if your baby is 21 weeks old, but was born five weeks early, his or her adjusted age is 16 weeks (or 4 months).

Now let’s take a look at some of the milestones the American Academy of Pediatrics says parents can look out for around 16 weeks…

Motor:
o Brings hands together, or to mouth
o Lifts head and pushes on arms when on tummy
o Reaches for objects
o Turns or makes crawling movement when on tummy

Language:
o Turns head to follow familiar voices
o Laughs and squeals
o Combines sounds more often (for example, “aaah-oooh”, “gaaa-gooo”)

Activities:
o Grasps more and reaches for objects
o Brings objects to mouth
o Increases activity when sees a toy

Social/Emotional:
o Is increasingly interactive and comfortable with parents and caregivers
o Shows interest in mirrors, smiles and is playful
o Is able to comfort himself

For more guidelines and milestones at different ages, click here.

Remember: Always watch for progress and do not be afraid to ask for help from doctors, teachers or other family members.

Again, I am pleased that all eight of the children have made it home safe ― I just hope that Nadya Suleman pays as much attention to their progress as she has to publicizing their births, because it should always be about the kids.

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