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With many difficult situations, the first step in solving a problem is in acknowledging it exists. After that, you can understand it and, hopefully, fix it. Our health care system now, as it functions in most academic medical centers and dollar-strapped hospitals, doesn’t give doctors much of a break, or slack, or “joy,” as… See more Talking About Physician Burnout, and Changing the System 
In this new climate of shame, it’s easy to imagine a girl might feel really, really bad about herself simply for being sexually active. As many ML readers are aware, late this morning, the Susan G. Komen Foundation announced it will not cut current grants or funding to Planned Parenthood. This reversal comes as welcome news to those who support the agency and its work. The New York City branch issued this statement. Still, many breast cancer advocates, activists and others question Komen’s priorities. This episode draws attention to debate within the BC community about the relative merits of spending charity dollars on screening, education, awareness, research and other concerns. The long-term fallout from this week’s news and the agency’s reversal aren’t known. As I suggested earlier, Komen’s leadership might take this opportunity to reassess its mission and goals. —- Related Posts:A Note on the Komen FiascoTalking About Physician Burnout, and Changing the SystemWhat Does a Bikini Parade Have to Do with Breast Cancer?Harsh Words, and Women’s Health at RiskThe Iron Lady, a Film About an Aging Woman When I first heard the Susan G. Komen Foundation is nixing its financial support of Planned Parenthood, I thought it might be a mistake. Maybe a rogue affiliate or anti-choice officer had acted independently of the group’s core and mission, and the press got the early story wrong. I waited for Nancy G. Brinker, Komen’s surviving sister, to step in and deny the BC agency’s change of plans. That didn’t happen. Rather, in a stilted video released yesterday, Brinker defends her agency’s decision as part of a “strategic shift” having to do with funding for any organization under investigation. That’s a bogus excuse, as others have detailed. Komen, the world’s largest BC agency, has been under scrutiny for some time. Through its early fundraising campaigns and walks, the group raised public awareness — and discussion — of the disease. Since its inception in 1982, the agency has invested over See more A Note on the Komen Fiasco 
image, “the Iron Lady” Over the weekend I saw the Iron Lady, a movie about Margaret Thatcher, the former Prime Minister of England. I expected a top-notch, accented and nuanced performance by Meryl Streep, and got that. The film surprised me in several respects. It’s really about aging, and how a fiercely independent woman withers. The camera takes you within her elderly, blurry, husband-conjuring mind. She’s forgetful and rambling, but maintains an interest in current events, and ideas. She looks back on events in her life with pride and, seemingly, some regrets. Well done, worth seeing! — Advertisements: Related Posts:What Underlies the Costs of DementiaAnother Take On An Ordinary DayThe “Survivor” Term After Breast Cancer: Is There a Better Expression?Image Share Project (Finally) Enables People to Share and Access Radiology ResultsTalking About Physician Burnout, and Changing the On Friday I visited the Scar Project exhibit at Openhouse, on Mulberry Street just south of Spring. Photographer David Jay offers penetrating, large, wall-mounted images of young people with breast cancer. The photos reveal women who’ve have had surgery, radiation, reconstruction or partial reconstruction of the breasts. Some are strikingly beautiful. Some appear confused, others confident. Some look right at you, defiant or maybe proud. Some, post-mastectomy, adopt frankly or strangely sexual postures. Others hide a breast, or turn away from the lens. This collection is not for everyone. The photos of ravaged bodies of women with cancer might be upsetting, if not frankly disturbing, to some who look at them. Not everyone chooses to do so. The women’s scars and expressions are telling. Though not representative, these images reflect wounds not often-shown in medical journals, or elsewhere. — Related Posts:More News On Lymph Nodes and Breast Cancer SurgeryNew NY State Law on Information for Women Undergoing MastectomyDon’t Judge Her! An Essay on Angelina Jolie, BRCA, Cancer Risk and Informed Decision-MakingStudy Finds Wide Variation in Reoperation Rates after Lumpectomy for Breast CancerA Note on the Komen Fiasco With little fanfare, the NEJM published a feature on breast cancer screening in its Sept 15 issue. The article, like other “vignettes” in the Journal, opens with a clinical scenario. This time, it’s a 42 year old woman who is considering first-time mammography. The author, Dr. Ellen Warner, an oncologist at the University of Toronto, takes opportunity to review updated evidence and recommendations for screening women at average risk for the disease. She outlines the problem: Worldwide, breast cancer is now the most common cancer diagnosed in women and is the leading cause of deaths from cancer among women, with approximately 1.3 million new cases and an estimated 458,000 deaths reported in 2008.(1) On screening: The decision to screen either a particular population or a specific patient for a disease involves weighing benefits against costs. In the case of breast-cancer screening, the most important benefits are a reduction in the See more NEJM Publishes New Review on Breast Cancer Screening A post in yesterday’s Well column, about coverage of breast cancer by the media, focused on the first-person narrative of NBC’s Andrea Mitchell. Journalist Tara Parker-Pope writes: Her announcement has generated much discussion in the blogosphere, including an analysis by Gary Schwitzer, publisher of HealthNewsReview.org, who writes that Ms. Mitchell made some missteps in discussing her cancer. The Times column goes on to consider what was said, and how it might have been said better, and I agree with much of it. But mainly it’s a meta discussion, journalists talking about how other journalists consider breast cancer facts, figures and narratives. Buried deep is this number, that according to the NCI, one in 69, or for the sake of simplicity – approximately 1 in 70 — women in the U.S. will receive a diagnosis of BC in her forties. That is an astonishingly enormous proportion of women under 50 years See more 1 in 70 Women Develops Breast Cancer Before Reaching 50 Years An article caught my attention in the September AARP Bulletin: The Caregiver’s Dilemma considers the 61.6 million people in the U.S. who care for older relatives or friends. People with jobs are, understandably, unsure if they should let their boss or supervisor know they’re caring for someone who’s sick. This indirect cost of illness and aging in America is said to tally $33.6 billion each year. The pressure on workers is tough, writes Sally Abrahms: Many employees are in that elder care-giving boat, yet workers with work-family conflicts are often reluctant to raise the issue with superiors. They fear they’ll be viewed as not committed enough, or receive bad year-end reviews. They may also think that discussing their personal life is unprofessional or sense resentment from colleagues and the boss, who may have to pick up the slack during their absences… The article reminded me of the dilemma faced by See more Should You Tell Your Employer When a Loved One Is Ill? 
the character Celia, in “The Help” Last weekend I saw The Help, a movie on race relations in Jackson, Mississippi 50 years ago with lingering implications for people who hire “help” to take care of their children and tend to their personal business anywhere in the world, including now. It’s a heavy-handed, simple-message and nonetheless very enjoyable film, with fine acting and imagery, based on the book of the same title by Katherine Stockett. One element of the narrative interested me from the medical perspective, having to do with the plight of a pale, thin and sexy young woman who’s marginalized by the white Jackson social elite. The character Celia, portrayed with flair by Jessica Chastain, lives, isolated, on an out-of-town plantation. She spends her days alone while her husband’s at work. The nominally proper women in town, while playing bridge and otherwise gathering, call her “white trash,” and See more Medical Aspects of ‘The Help’: The Plight of a Woman with Recurrent Miscarriages 
I’m half-tempted to put down yesterday’s new NYT Magazine feature on crazy sexy cancer goddess Kris Carr. Her blog was one of the first I found when I started ML, and it was the most popular link on my fledgling site until I pulled it, fearful of somehow sponsoring a too-alternative oncology perspective. But I give Carr credit, sincerely: Crazy Sexy Cancer is a lot more appealing a title than, say, Medical Lessons. I’d read CSC, for sure, if I had a new diagnosis or, maybe, if I were alone and bored or suffering from a condition like chronic fatigue syndrome or insomnia and hadn’t gone to med school. Even for people who really have cancer, letting loose and being attractive sounds, well, like a lot of fun. Kris Carr has played her C-card like a Queen of Diamonds. You go, girl!
So 
Flashfree, a super-hip blog on menopause and women’s health, has a new home on the Web. Health writer Liz Scherer started the blog in May, 2008, upon searching far and wide for straight talk on midlife women’s health issues. soybean (USDA image, WC) I found Flashfree early on in my exploration of on-line health sites. Liz is sharp and serious, curious, current and funny. What I most appreciate is that she routinely supports her reports with links to relevant medical journals. Today’s post is on soy; a new study in the Archives of Internal Medicine confirms that the proteinaceous stuff neither relieves hot flashes nor prevents bone thinning in women. Good luck to Liz in her new spot! I’ll be following - —- Related Posts:Talking About Physician Burnout, and Changing the SystemHarsh Words, and Women’s Health at RiskWeds Web Shoutout: A Cardiologist’s Blog on Heart Health, Doctoring and FitnessKomen See more Wednesday Web and Shoutout: Flashfree Moves to a New Site 
A short note on Good People, the title of a new play at the Manhattan Theatre Club starring Frances McDormand – It’s a simple story, at some level, about a middle-aged woman from south Boston who loses her job. She has a disabled, adult daughter who needs caregiving, and she needs money. She contacts some old friends, and scours the neighborhood for a job. She encounters a once-boyfriend, just for a summer at the end of her childhood, who’s become a doctor with a fancy office and a fancy house and a beautiful wife. Frances McDorman, in a photo for the MTC And she’s angry, angry because she’s never been able to leave her community despite, as she puts it, “being nice.” She put her daughter’s needs first and helped others when she could – or so she says, but she was too often late for work at one See more Good People, a New Play About Chance, Decisions and Fate 
When I was a medical resident in the late 1980s, we treated some patients with pancreatic cancer on a regimen nick-named the coffee protocol because it included infusions of intravenous caffeine. How absurd, we thought back then, because years earlier caffeine had been linked to pancreatic cancer as a possible cause. Now, two new studies suggest that coffee consumption reduces a woman’s risk for developing breast cancer, according to MedPage Today: Women who drank at least five cups of coffee daily had a significantly lower risk of postmenopausal breast cancer, an analysis of two large cohort studies suggested. …Coffee has a paradoxical relationship with breast cancer risk. The beverage’s complex mix of caffeine and polyphenols suggests a potential to confer both carcinogenic and chemopreventive characteristics, the authors noted… I’m incredulous, still. As with most compounds we ingest or otherwise absorb, it’s conceivable that caffeine could damage some cells or somehow See more Confusing Reports On Coffee and Cancer, and What To Do About Breakfast A recent audit of nine NYC’s Health and Hospitals Corporation found City Comptroller Liu described as dangerous delays in women’s health care. It takes too long for women to get screening and diagnostic mammograms. The 2009 audit found women at Elmhurst Hospital had the longest waits – 50 working days (that would be 10 weeks, i.e. 2.5 months) for diagnostic mammograms, on average. You can find more details here. According to the Times’ coverage: Ana Marengo, a spokeswoman for the city’s Health and Hospitals Corporation, which runs the public health system, said that the comptroller’s data was outdated… At Elmhurst, she said, the wait as of December 2010 was 20 days for screening and 23 days for a general diagnostic test, as opposed to an urgent one. Still, at Queens Hospital Center, the wait for a screening test was 56 days in December <2010>, Ms. Marengo said. “It’s due to 
Recently I read the short story, A Jury of Her Peers by Susan Glaspell, with a group of women in my community. The author, with whom I wasn’t previously familiar, first reported on the real 1901 trial of Margaret Hossack, as a journalist writing for the Des Moines Daily News. Later she adapted the story as a one-act drama, Trifles, and then in 1917 as a short narrative published in Everyweek, a long-defunct magazine of the Crowell Publishing Company. Original performance of “Trifles,” (from the Billy Rose Theatre Collection, New York Public Library at Lincoln Center) There’s a lot you might take from this swift, rich read. It goes like this: A man and his son came upon a couple’s house in rural area. The man’s been killed, clearly; his wife sits in a chair, oddly, and can’t say what happened to her husband. The local authorities and a See more Noting Depression in Susan Glaspell’s 1917 Story: A Jury of Her Peers The American Society of Breast Surgeons held its 2011 annual meeting in D.C. from April 27 – May 1. Among the papers presented was Abstract #1754: “Mammography in 40 Year Old Women: The Potential Impact of the U.S. Preventative Services Task Force (USPSTF) Mammography Guidelines.” You can find the press release, followed by the abstract, here. The main result was that screening women ages 40–49 by mammography was associated with finding smaller tumors, with less spread to the lymph nodes, than clinical breast exams alone, and this correlates with improved survival at 5 years. The study, put forth by a group at the University of Missouri-Columbia in Columbia, MO, is based on a 10-year retrospective chart review, from 1998 – 2008, of 1581 women treated for breast cancer at that institution. In this author’s opinion, a retrospective, chart-review type analysis of a medical intervention is about as low as you 
Last weekend I went to see a strange, slightly unnerving play, The Milk Train Doesn’t Stop Here Anymore by Tennessee Williams. It’s a sad take on the end of life, and desperation in some lonely characters. Olympia Dukakis plays an aging, vain, older woman who’s dying of an unnamed condition. She takes morphine injections help her “neuralgia,” and uses liquor to entertain guests and, without success, to blunt her emotional pain. A handsome young man, presenting himself as a poet and sculptor of mobiles, climbs up the hill on which rests her Italian villa. She’s no fool and quickly learns of his moniker, “the angel of death.” It’s said he has a particular fondness for terminal, moneyed women. Still he is impoverished; he shows up essentially starving and with nearly nothing in his sack; he has not exactly benefited from his exploits. Darren Pettie and Olympia Dukakis Dying alone See more Portrait of a Peculiar Relationship at the End of Life A worrisome report on breast cancer trends in the U.S. appeared on-line today, ahead of print in an AACR journal, Cancer Epidemiology, Biomarkers & Prevention. The analysis, based on the NCI’s SEER data from 2000 — 2007, shows that the incidence of breast cancer in the U.S. is no longer declining. (A drop after 2002 in BC incidence is generally attributed to an abrupt reduction in HRT around that time.) Since 2003 the overall BC rate has been steady overall, with a few exceptions: The incidence of BC in non-Hispanic white women ages 60–69 rose by 4.8% in this period. “It remains to be seen if this trend will continue,” according to the study authors. Among white women ages 40–49 rates of estrogen receptor (ER) positive (ER+) breast cancer significantly increased by an average of 2.7% per year during this period. In contrast, the rate of ER– breast tumors decreased, See more Breast Cancer Rate in the U.S. is No Longer Declining There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines. The stated purpose of the research,* published in the journal Radiology, was to see how radiologists’ interpretive volume – essentially the number of mammograms read per year – affects their performance in breast cancer screening. The investigators collected data from six registries participating in the NCI’s Breast Cancer Surveillance Consortium, involving 120 radiologists who interpreted 783,965 screening mammograms from 2002 to 2006. So it was a big study, at least in terms of the number of images and outcomes assessed. First — and before reaching any conclusions — the variance among seasoned radiologists’ everyday experience reading mammograms is striking. From the paper: …We studied 120 radiologists with a median age of 54 years (range, 37–74 years); most worked See more Radiologists’ Experience Matters in Mammography Outcomes |
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