Don't Cancel Your Mammogram Yet

As you’ve certainly heard or read, the USPSTF (United States Preventive Services Task Force) has issued updated guidelines for breast cancer screening. Here’s a summary of those recommendations and our comments.

Summary of USPSTF Recommendations

• The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.

• The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

• The USPSTF recommends against teaching breast self-examination (BSE). The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.

• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

Summary of American Cancer Society Recommendations

• Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.

• Clinical breast exam (CBE) should be part of a periodic health exam, about every 3 years for women in their 20s and 30s and every year for women 40 and over.

• Women should know how their breasts normally feel and report any breast change promptly to their health care providers. Breast self-exam (BSE) is an option for women starting in their 20s.

• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.

Phil Evans, a professor of radiology at the University of Texas Southwestern Medical Center and president of the Society for Breast Imaging, says he was "shocked" by the changes. "There's a ton of scientific data in this country and others on screening that shows a significant benefit for women between 40 and 49 to be screened," he says. (Quoted in the Wall Street Journal)

It is important to note that the American Cancer Society and other groups have not changed their recommendations (which uniformly include teaching breast self examination and routine mammography). Dr. Schrader, Dr. Bond and I will review the evidence supporting these changes as it becomes available, but for now we believe that it is premature to change screening procedures.

Comments / Posted by Scott W. Yates, MD, MBA, MS, FACP

ADHD - The Positive Side

The three major symptoms of ADHD: hyperactivity, impulsiveness and inattention can create many problems in people’s lives. They can interfere with relationships, school and work. But there are also many positive characteristics of adult ADD/ADHD.

Hyperactivity is most often described as “feeling as if driven by a motor.” It creates the inability to sit still for long periods. Children with hyperactivity are in constant motion, usually running or “bouncing” from one activity to another. Many times this will subside in adolescence and adulthood, but for most people, hyperactivity is still present. Maybe it has decreased to a feeling of restlessness or being fidgety. Or maybe adults have better learned to manage it in daily life. Hyperactivity, however, is also seen as a positive for adults. Some indicate they enjoy the endless energy and the ability to accomplish more and work longer hours. They prefer getting up and doing things rather than sitting in front of a television.

Impulsiveness is acting without thinking. It is rushing ahead without slowing down to think about the consequences of our actions. Children and teens often get into much trouble for their impulsive actions. Impulsiveness is also seen in blurting out answers or interrupting others while they are talking. Adding structure to our lives, and the daily lives of our children, help to reign in our carelessness. But spontaneity is also important. Allowing ourselves to be unpredictable adds variety to life. As adults, sometimes our lives become too structured. We often leave for work early in the morning and once we arrive home our evenings are filled with making dinner, helping with homework, household chores. We sometimes forget the pleasure of having the unexpected happen. Giving in to impulsiveness, at times, can create a more exciting and adventurous life. It can provide us with a different perspective on our problems and allow our minds to find creative solutions to what may have seemed impossible before. Impulsiveness can help to foster creativity.

Inattention, being easily distracted and not completing tasks are often some of the major complaints of both children and adults with ADD/ADHD. Many times these traits lead to uncompleted homework, lost items, and half finished projects. In life, we must learn to finish what we have started. We need to be able to focus on the task at hand to accomplish our goals. But having the ability to move from one task to another also has benefits. Allowing ourselves to experience many things adds to our perspective on life. It allows us to find what we do enjoy. It allows us to search for our interests and our passions. Although I do not condone teaching children to stop what they are doing as soon as their interest wanes, providing them with varied activities may help them determine what direction they want their lives to take. Allowing ourselves to experience many different things will increase our awareness of who we are and what we want to accomplish.

In addition to the main symptoms, some other positive traits of ADD/ADHD are included below. Several years ago, I took an informal survey of 50 adults, asking what their favorite ADD/ADHD characteristic was. Their top ten answers are as follows (in no particular order):

• Endless Energy
• Hyperfocus
• Energy and hyperfocus combined
• Great imagination
• Creativity
• Humor
• Ahead of “establishment” thinking
• Creative thinking and problem solving
• Spontaneity
• Great passion for interests

So go ahead, enjoy your life, enjoy your ADHD and live life to it’s fullest.

By Eileen Bailey on ADHDCentral.com

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP

The Benefits of Flax Seed

Some call it one of the most powerful plant foods on the planet. There’s some evidence it can help reduce your risk of heart disease, cancer, stroke, and diabetes. That’s quite a tall order for a tiny seed that’s been around for centuries: flaxseed.

Flaxseed was cultivated in Babylon as early as 3000 BC, according to the Flax Council of Canada. By the 8th century, King Charlemagne believed so strongly in the health benefits of flaxseed that he passed laws requiring his subjects to consume it. Fast-forward 13 centuries, and some experts would say we have preliminary research to back up what Charlemagne suspected all those years ago.

These days, flaxseed is found in all kinds of foods, from crackers to frozen waffles to oatmeal. In the first 11 months of 2006, 75 new products were launched that listed flax or flaxseed as an ingredient. Not only has consumer demand for flaxseed gone up, agricultural use has also increased -- to feed all those chickens laying eggs that are higher in omega-3 fatty acids.

Although flaxseed contains all sorts of healthy components, it owes its healthy reputation primarily to three ingredients:

Omega-3 essential fatty acids, "good" fats that have been shown to have heart-healthy effects. Each tablespoon of ground flaxseed contains about 1.8 grams of plant omega-3s.

Lignans, which have both plant estrogen and antioxidant qualities. Flaxseed contains 75- 800 times more lignans than other plant foods.

Fiber. Flaxseed contains both the soluble and insoluble types.

The Health Benefits of Flax

Although Lilian Thompson, PhD, an internationally known flaxseed researcher from the University of Toronto, says she wouldn’t call any of the health benefits of flax "well established," research indicates that flax’s possible health benefits include reducing the risks of certain cancers as well as cardiovascular disease and lung disease. Here are more details:

Cancer

Recent studies have suggested that flaxseed may have a protective effect against cancer, particularly breast cancer, prostate cancer, and colon cancer. At least two of the components in flaxseed seem to contribute, says Kelley C. Fitzpatrick, M.Sc., director of health and nutrition with the Flax Council of Canada.

In animal studies, the plant omega-3 fatty acid found in flaxseed, called ALA, inhibited tumor incidence and growth.

Further, the lignans in flaxseed may provide some protection against cancers that are sensitive to hormones. Some studies have suggested that exposure to lignans during adolescence helps reduce the risk of breast cancer, Thompson says.

Lignans may help protect against cancer by:

Blocking enzymes that are involved in hormone metabolism.

Interfering with the growth and spread of tumor cells.

Some of the other components in flaxseed also have antioxidant properties, which may contribute to protection against cancer and heart disease.

Cardiovascular Disease

Research suggests that plant omega-3s help the cardiovascular system via several different mechanisms, including anti-inflammatory action and normalizing the heartbeat, Fitzpatrick says.

Several studies have suggested that diets rich in flaxseed omega-3s help prevent hardening of the arteries and keep plaque from being deposited in the arteries, partly by keeping white blood cells from sticking to the blood vessels’ inner linings.

"Lignans in flaxseed have been shown to reduce atherosclerotic plaque buildup by up to 75%," Fitzpatrick says.

Because plant omega-3s may also play a role in maintaining the heart’s natural rhythm, they may be useful in treating arrhythmia (irregular heartbeat) and heart failure, although more research is needed on this.

Eating flaxseed daily may help your cholesterol levels, too. Small particles of LDL or "bad" cholesterol in the bloodstream have been linked to an increased risk of heart disease, obesity, diabetes, and metabolic syndrome. A French-Canadian study in menopausal women reported a decrease in these small LDL particles after the women ate 4 tablespoons of ground flaxseed daily for a year. Fitzpatrick says the cholesterol-lowering effects of flaxseed are the result of the synergistic benefits of omega 3 ALA; fiber and lignans.

Diabetes

Preliminary research also suggests that daily intake of the lignans in flax may modestly improve blood sugar (as measured by hemoglobin A1c blood tests in adults with type 2 diabetes).

Inflammation

Two components in flaxseed, ALA and lignans, may reduce the inflammation that accompanies certain illnesses (such as Parkinson's disease and asthma) by helping to block the release of certain pro-inflammatory agents, Fitzpatrick says.

The plant omega-3 ALA has been shown to decrease inflammatory reactions in humans. And studies in animals have found that lignans can decrease levels of several pro-inflammatory agents.

Reducing inflammatory reactions associated with plaque buildup in the arteries may be another way flaxseed helps prevent heart attack and strokes.

Hot Flashes

One preliminary study on menopausal women, published in 2007, reported that 2 tablespoons of ground flaxseed (taken twice each day) cut the women's hot flashes in half. And, the intensity of their hot flashes dropped by 57%. The women noticed a difference after talking the daily flaxseed for just one week, and achieved the maximum benefit within two weeks.

Who Shouldn’t Use Flaxseed?

Until more is known, Thompson says pregnant women and possibly breastfeeding mothers should not supplement their diets with ground flaxseed.

"Our own animal studies showed that flaxseed exposure during these stages may be protective against breast cancer in the offspring, but a study of another investigator showed the opposite effect," Thompson says.

Tips for Using Flaxseed

Many experts believe it's better to consume flaxseed than flax oil (which contains just part of the seed) so you get all the components. But stay tuned as researchers continue to investigate.

"Ground flaxseed, in general, is a great first choice but there may be specific situations where flax oil or the lignans (taken in amounts naturally found in flaxseed) might be as good," Thompson says.

And how much flaxseed do you need? The optimum dose to obtain health benefits is not yet known. But 1-2 tablespoons of ground flaxseed a day is currently the suggested dose, according to the Flax Council of Canada.

Here are more tips for using, buying, and storing flaxseed:

Buy it ground or grind it yourself. Flaxseed, when eaten whole, is more likely to pass through the intestinal tract undigested, which means your body doesn't get all the healthful components. If you want to grind flaxseed yourself, those little electric coffee grinders seem to work best.

Milled = ground = flax meal. Don’t be confused by the different product names for ground flaxseed. Milled or ground flaxseed is the same thing as flax meal. Buy either brown or golden flaxseed. Golden flaxseed is easier on the eyes, but brown flaxseed is easier to find in most supermarkets. There is very little difference nutritionally between the two, so the choice is up to you. Find it in stores or on the Internet. Many supermarket chains now carry ground flaxseed (or flaxmeal). It’s usually in the flour or "grain" aisle or the whole-grain cereal section, often sold in 1-pound bags. You can also find it in health food stores, or order it through various web sites. Check the product label. When buying products containing flaxseed, check the label to make sure ground flaxseed, not whole flaxseed, was added. Flaxseed is a featured ingredient in cereals, pasta, whole grain breads and crackers, energy bars, meatless meal products, and snack foods. Add flaxseed to a food you habitually eat. Every time you have a certain food, like oatmeal, smoothies, soup, or yogurt, stir in a couple tablespoons of ground flaxseed. Soon it will be a habit and you won’t have to think about it, you’ll just do it. Hide flaxseed in dark, moist dishes. The dishes that hide flaxseed the best usually have a darkly colored sauces or meat mixtures. No one tends to notice flaxseed when it's stirred into enchilada casserole, chicken Parmesan, chili, beef stew, meatloaf or meatballs. For a 4-serving casserole, you can usually get away with adding 2-4 tablespoons of ground flaxseed. For a dish serving 6-8, use 4-8 tablespoons. Use it in baking. Substitute ground flaxseed for part of the flour in recipes for quick breads, muffins, rolls, bread, bagels, pancakes, and waffles. Try replacing 1/4 to 1/2 cup of the flour with ground flaxseed if the recipe calls for 2 or more cups of flour. Keep it in the freezer. The best place to store ground flaxseed is the freezer. Freeze pre-ground flaxseed in the bag you bought it in, or in a plastic sealable bag if you ground it yourself. The freezer will keep the ground flax from oxidizing and losing its nutritional potency. Whole flaxseed keeps longer. The outside shell in whole flaxseed appears to keep the fatty acids inside well protected. It’s a good idea to keep your whole flaxseed in a dark, cool place until you grind it. But as long as it is dry and of good quality, whole flaxseed can be stored at room temperature for up to a year.

From WebMD by Elaine Magee, MPH, RD

Reviewed / Posted by: Scott W. Yates, MD, MBA, MS, FACP