Recently the United States Preventive Services Task Force instituted a new recommendation for breast cancer screening.  You may have seen information on the news and internet regarding the disagreement between different medical groups’ recommendations regarding when to start breast cancer screening.

Last Monday, the U.S. Preventive Task Force released a new recommendation that women with average breast cancer risk should have mammograms every two years starting at age 50.  They also issued a statement that self breast exams are not recommended due to causing excessive anxiety and unnecessary breast biopsies.  This is a break with the American Cancer Society’s long-standing recommendation to initiate yearly mammograms starting at age 40 and to perform monthly self breast exams.

This has caused a lot of confusion for women. For years, doctors have educated women on the importance of breast cancer prevention. With a breast cancer prevalence of 1 in 8 women, most women personally know someone diagnosed with breast cancer.  Women have also been encouraged by their physicians to learn how to perform a self breast exam.  They have cards hanging in their showers reminding them of the proper technique. After forty, they dutifully schedule their mammogram yearly with their birthday so they don’t forget.  Now they are told that they may have been doing all this in vain?    

First of all, if a woman has any question regarding when to initiate mammograms she should talk to her doctor.  Recommendations for cancer screening need to be individualized based on a patient’s set of risk factors.  What is appropriate for one woman may not appropriate for another.  As far as my patients with an average risk of breast cancer, I will continue to follow the recommendations of the American Cancer Society. I will continue to recommend yearly mammograms starting at age forty, as well as monthly self-breast exams. 

As far as the Task Force statement that self breast exams are not recommended, I disagree.  Most of my patients with breast cancer have come to me after feeling a breast lump on their own.  While feeling a breast lump may cause considerable anxiety for a woman, it is my job to alleviate that anxiety and provide appropriate education and rapid evaluation of the condition.  I think it is unreasonable not to recommend a free and easy test that may be life-saving just because it may cause anxiety at times.  I believe self breast exams empower women to be in control of their health, and reminds them to develop healthy habits overall.      

Many of my pregnant patients have recently expressed concern over the H1N1 flu virus, more commonly known as "swine flu." So, I thought I would answer some of their questions in this video blog entry.  If you have any other questions or comments, feel free to leave them below.

Last week I was sitting among a group of women who did not know I was a physician. The conversation eventually progressed to a discussion of personal health problems and the women’s interactions with their physicians. One woman exclaimed,” My physician always gets offended whenever I ask if I should take a medication advertised on T.V.” She then continued to describe her physician’s attempt to dissuade her from a particular medication. She perceived his reaction as offense to her request because she thought the physician felt his authority was threatened.

Direct-to-consumer marketing for prescription drug companies has become more common over the past 10 years. You can hardly watch television or thumb through a magazine without encountering multiple advertisements for high cholesterol, osteoporosis, contraception, and so on. Each ad has the same goal—convince you to ask your physician for a specific medication and expect to get the prescription if your physician knows “what’s best”.

For many physicians, direct-to-consumer marketing of medications is a sore topic. Physicians attend an average of 14 years of schooling after high school and spend hundreds of thousands of dollars to get to the point of being able to care for patients and prescribe appropriate medications. Compare that to the 4 years of schooling by marketing majors who write the advertisements that convince people they need certain medications. Doesn’t it just make sense that your physician is more qualified to determine the appropriate treatment of your condition as opposed to the marketers who get a bonus if you use their medication?

What patients often don’t understand is that for most medications advertised on television there is a generic version that provides equivalent results at a portion of the cost. In many cases, the difference in cost between a generic and branded medication is over one hundred dollars. A patient may not realize this difference in cost if she has prescription coverage with her insurance plan.

So, the next time you ask your physician about a medication advertised on television don’t forget to ask if there is a generic equivalent. It’s the economically responsible thing to do.

A new model of patient care for mothers in labor is being utilized around the country. It is called the “Laborist Model.” Essentially, there are obstetricians who work in shifts and their only responsibility during that time is to care for pregnant women who are hospitalized. This physician, called the laborist, would supervise the labor and delivery of infants, as well as evaluate and treat pregnant patients with complications, such as premature labor. When his or her shift is over, the laborist goes home and has no other patient care responsibilities.

This is quite different from the current way most ob/gyn physicians work. On a typical work day an ob/gyn wakes up early, performs several hours of surgery, rounds on his or her hospitalized patients at one or more hospitals, sees office patients for six to eight hours, delivers one or two babies, takes phone calls all night from patients and nurses, gets an average of 6 hours of interrupted sleep, and often less if he or she has to go into the hospital overnight to do a delivery or emergent surgery. Then the physician starts a new day with the same busy schedule.

The laborist model allows a physician to work a 12 hour shift, then go home and not have any further work obligations until the next shift. This would mean you would never have a cesarean section or vaginal delivery performed by a physician who did not sleep the night before. You would never have your clinic appointment rescheduled because your physician was called out to do a delivery. Patient care may be safer as physicians may make fewer mistakes that could have been attributed to sleep deprivation.

However, this would also mean that you may not see the same physician for all your prenatal visits, and you most likely would not know the physician who delivered your baby. So, how important is it for you to have the same physician perform your prenatal care and be present for the delivery of your newborn? Would you seek prenatal care at an obstetrician’s office who practiced the laborist model?

As an Obstetrician/Gynecologist I interact on a daily basis with approximately 30 patients one-on-one.  Each has a different issue or concern.  Each is in a different stage of her life.  Some women I meet for the first time, while others have already developed a long-term relationship with me as their physician.  However, the goals I have before I walk into each examination room are the same:  make her feel comfortable, listen to her concerns, and empower her to participate in the healing process. 

I have found that women most appreciate seeing a physician who expresses empathy for her condition, acknowledges the impact the condition has on her life, and educates her how to better care for and prevent the condition.  Do you agree?  What defining qualities of your physician keep you coming back?  What qualities have your former physicians possessed that sent you to look elsewhere? 

Hello, I am Dr. Erin Evans.  I am an Obstetrician/Gynecologist with Alegent Health Clinic, and this is my first contribution to the Alegent Women’s Health blog.   I was born and raised in Salt Lake City, Utah.  I came to Omaha 14 years ago to start my undergraduate training at Creighton University.  After receiving a bachelor degree in science, I started medical school at Creighton University School of Medicine.  Omaha just could not get rid of me, and after medical school, I completed a residency in Obstetrics and Gynecology at Creighton University Medical Center.  Now I work in the “real world” taking care of women’s health issues on a daily basis. 

When patients ask me, “Why did you go into this field?”  I reply, “Women are fascinating!”  We truly are.   We keep the world going.  Behind every strong man is a stronger woman (I am a little biased, but give me this one indulgence). We are so versatile.  Some of us bare children and care for every need of the family.  While some of us are CEOs of major corporations.  And then there are some of us who do both. 

As women, we are usually concerned with taking care of other people.  Whether it be the needs of our children, grandchildren, significant others, or aging parents, we are usually making sure all the needs of others are met.  Oftentimes, we get so caught up meeting the needs of others that we forget about our own needs.  And that is what I really like about my job.  I get to interact with women of every age and give them the tools to meet their own needs.  I get to remind them of their self-worth and the importance of taking care of themselves. 

As I make regular entries to this blog, I hope that I can touch upon topics that interest you and somehow fill your needs.  Don’t expect any profound messages or enlightened dogma, because you won’t find it here.  But do expect honesty and frankness. Until next time ...