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the same time that so many are underserved, many more are overserved. This is a hard concept for many Americans to wrap their minds around, the notion that they might be \"overtreated.\" It's against this backdrop that I spoke with Shannon Brownlee at \u003ca href=\"http://www.berkeleyideas.com\" target=\"_blank\">Berkeley Uncharted\u003c/a>, the annual ideas festival.\u003c/p>\n\u003cp>Brownlee literally wrote the book on the topic with \u003ca href=\"http://www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791\" target=\"_blank\">Overtreated: Why Too Much Medicine is Making us Sicker and Poorer\u003c/a>. Let's be clear about what overtreatment is not: it's not rationing. Rationing is denying care that people need to make them better. Overtreatment is about \"getting care you don't need and that can harm you,\" Brownlee told the audience.\u003c/p>\n\u003cp>She recounted the story of a friend's 89-year-old father, an active man and avid golfer. After he developed shortness of breath, his cardiologist determined he needed a heart valve replaced. The man \"sailed through the surgery,\" Brownlee said. But the pre-operative work-up had also revealed colon cancer.\u003c/p>\n\u003cp>His family tried to dissuade the man from doing anything, Brownlee went on. \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening\" target=\"_blank\">Current guidelines \u003c/a>say that people older than 85 do not need to be screened for colon cancer -- the cancer is so slow growing, a person is significantly more likely to die with it, not from it.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the man could not be dissuaded. He had the surgery and contracted an infection -- with C-difficile, an antibiotic-resistant bacteria that's very difficult to treat. It left him with chronic diarrhea.\u003c/p>\n\u003cp>\"He died six months later,\" Brownlee said, \"in a nursing home, having uncontrolled diarrhea for the last six months of his life, in despair.\"\u003c/p>\n\u003cp>It's tempting to think of these stories as isolated incidents, but they're disturbingly common. Analyses show \u003ca href=\"http://annals.org/article.aspx?articleid=744298\" target=\"_blank\">about one-third\u003c/a> of everything we do in medicine is unnecessary. It happens across the system -- in hospitals, nursing homes, in all specialties of care.\u003c/p>\n\u003cp>\"Overuse is pervasive,\" Brownlee says, \"it's in the air we breathe.\"\u003c/p>\n\u003cp>[contextly_sidebar id=\"37yGQs0b8Fd9UvYBhCRmXYOulu1j0uNn\"]Brownlee said multiple forces contribute to overuse, but most of the ones that spring promptly to mind are not the big drivers. Doctors often point to \"defensive medicine\" -- that they do more to leave no stone unturned to avoid a potential lawsuit -- or they say that it is patients who demand to do everything possible.\u003c/p>\n\u003cp>Brownlee says these are certainly factors, but they're small. The big driver is money. \"We treat health care like a business,\" Brownlee says. \"We don't treat it like a public good.\" The payment system -- \u003ca href=\"https://www.healthcare.gov/glossary/fee-for-service/\" target=\"_blank\">fee-for-service medicine\u003c/a> -- has always favored doing more, as opposed to doing things that might make the patient better.\u003c/p>\n\u003cp>And while medicine is based in science, that does not mean that everything your doctor recommends is based on scientific evidence. \"About 50 percent of what physicians do is backed up by valid evidence,\" Brownlee says. \"I think about that in the context of airplane safety: the pilot comes out from the cockpit and says, 'I don't know what half of these dials do, but I think I can fly the plane anyway.' \"\u003c/p>\n\u003cp>By this point I was flooded with questions from the audience -- sent up to me on index cards -- and plenty of people wanted to know how they were supposed to determine which half of the treatments their doctors recommended were actually backed up by evidence. After all, your doctor is the one who went to medical school. Most patients have not.\u003c/p>\n\u003cp>But even if you have no medical background, you \"can be informed, as most patients can, of what the tradeoffs are of different treatment choices,\" Brownlee said. She pointed to an approach called \u003ca href=\"http://www.informedmedicaldecisions.org/what-is-share%E2%80%A6\" target=\"_blank\">shared decision making\u003c/a>, a collaborative process between doctors and patients where they weigh together both the scientific evidence -- and a patients' values and preferences.\u003c/p>\n\u003cp>The easiest place to think of weighing evidence and values is in end-of-life care. But it applies in many areas of medicine from cancer screening to knee surgery to gall bladder surgery and more, Brownlee says.\u003c/p>\n\u003cp>There are\u003ca href=\"http://www.informedmedicaldecisions.org/patient-resources/\" target=\"_blank\"> online tools and other decision aids\u003c/a> where patients can review their choices and \"understand ... what the tradeoffs are, what the potential benefits are, what the potential harms are,\" Brownlee says, and then have a detailed conversation with their doctors about a treatment path.\u003c/p>\n\u003cp>The shared decision making approach is something patients themselves can start demanding, but fundamentally, Brownlee says, we need a different payment model. Right now, overall, the more doctors or hospitals do, the more they get paid. Hospitals \"don't know how to care for a population of patients within a budget,\" she says.\u003c/p>\n\u003cp>The U.S. national health care spend is an almost-impossible-to-imagine \u003ca href=\"http://www.cdc.gov/nchs/fastats/health-expenditures.htm\" target=\"_blank\">$3 trillion,\u003c/a> more than \u003ca href=\"http://www.cdc.gov/nchs/fastats/health-expenditures.htm\" target=\"_blank\">$9,200 per person\u003c/a>, and, again, half of that is not backed up by evidence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"By wasting money, resources and time on care people don't need,\" Brownlee says, \"we are robbing many, many Americans of care they really do need.\"\u003c/p>\n\n","blocks":[],"excerpt":"Let's be clear about what overtreatment is not: it's not rationing. Rationing is denying care that people need. Overtreatment is care you don't need that can harm you.","status":"publish","parent":0,"modified":1465860819,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":21,"wordCount":883},"headData":{"title":"How Overtreatment in Health Care Harms Us All | KQED","description":"Let's be clear about what overtreatment is not: it's not rationing. Rationing is denying care that people need. Overtreatment is care you don't need that can harm you.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"100605 http://ww2.kqed.org/stateofhealth/?p=100605","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/11/03/shannon-brownlee-how-overtreatment-in-health-care-harms-us-all/","disqusTitle":"How Overtreatment in Health Care Harms Us All","path":"/stateofhealth/100605/shannon-brownlee-how-overtreatment-in-health-care-harms-us-all","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>As Obamacare's open enrollment kicks off for the third year, in California, there are still almost \u003ca href=\"http://kff.org/uninsured/issue-brief/new-estimates-of-eligibility-for-aca-coverage-among-the-uninsured/\" target=\"_blank\">4 million people who are uninsured,\u003c/a> part of the many more millions nationally who lack reliable access to health care.\u003c/p>\n\u003caside class=\"pullquote alignright\">Let's be clear about what overtreatment is not: it's not rationing.\u003c/aside>\n\u003cp>But at the same time that so many are underserved, many more are overserved. This is a hard concept for many Americans to wrap their minds around, the notion that they might be \"overtreated.\" It's against this backdrop that I spoke with Shannon Brownlee at \u003ca href=\"http://www.berkeleyideas.com\" target=\"_blank\">Berkeley Uncharted\u003c/a>, the annual ideas festival.\u003c/p>\n\u003cp>Brownlee literally wrote the book on the topic with \u003ca href=\"http://www.amazon.com/Overtreated-Medicine-Making-Sicker-Poorer/dp/1582345791\" target=\"_blank\">Overtreated: Why Too Much Medicine is Making us Sicker and Poorer\u003c/a>. Let's be clear about what overtreatment is not: it's not rationing. Rationing is denying care that people need to make them better. Overtreatment is about \"getting care you don't need and that can harm you,\" Brownlee told the audience.\u003c/p>\n\u003cp>She recounted the story of a friend's 89-year-old father, an active man and avid golfer. After he developed shortness of breath, his cardiologist determined he needed a heart valve replaced. The man \"sailed through the surgery,\" Brownlee said. But the pre-operative work-up had also revealed colon cancer.\u003c/p>\n\u003cp>His family tried to dissuade the man from doing anything, Brownlee went on. \u003ca href=\"http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/colorectal-cancer-screening\" target=\"_blank\">Current guidelines \u003c/a>say that people older than 85 do not need to be screened for colon cancer -- the cancer is so slow growing, a person is significantly more likely to die with it, not from it.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the man could not be dissuaded. He had the surgery and contracted an infection -- with C-difficile, an antibiotic-resistant bacteria that's very difficult to treat. It left him with chronic diarrhea.\u003c/p>\n\u003cp>\"He died six months later,\" Brownlee said, \"in a nursing home, having uncontrolled diarrhea for the last six months of his life, in despair.\"\u003c/p>\n\u003cp>It's tempting to think of these stories as isolated incidents, but they're disturbingly common. Analyses show \u003ca href=\"http://annals.org/article.aspx?articleid=744298\" target=\"_blank\">about one-third\u003c/a> of everything we do in medicine is unnecessary. It happens across the system -- in hospitals, nursing homes, in all specialties of care.\u003c/p>\n\u003cp>\"Overuse is pervasive,\" Brownlee says, \"it's in the air we breathe.\"\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>Brownlee said multiple forces contribute to overuse, but most of the ones that spring promptly to mind are not the big drivers. Doctors often point to \"defensive medicine\" -- that they do more to leave no stone unturned to avoid a potential lawsuit -- or they say that it is patients who demand to do everything possible.\u003c/p>\n\u003cp>Brownlee says these are certainly factors, but they're small. The big driver is money. \"We treat health care like a business,\" Brownlee says. \"We don't treat it like a public good.\" The payment system -- \u003ca href=\"https://www.healthcare.gov/glossary/fee-for-service/\" target=\"_blank\">fee-for-service medicine\u003c/a> -- has always favored doing more, as opposed to doing things that might make the patient better.\u003c/p>\n\u003cp>And while medicine is based in science, that does not mean that everything your doctor recommends is based on scientific evidence. \"About 50 percent of what physicians do is backed up by valid evidence,\" Brownlee says. \"I think about that in the context of airplane safety: the pilot comes out from the cockpit and says, 'I don't know what half of these dials do, but I think I can fly the plane anyway.' \"\u003c/p>\n\u003cp>By this point I was flooded with questions from the audience -- sent up to me on index cards -- and plenty of people wanted to know how they were supposed to determine which half of the treatments their doctors recommended were actually backed up by evidence. After all, your doctor is the one who went to medical school. Most patients have not.\u003c/p>\n\u003cp>But even if you have no medical background, you \"can be informed, as most patients can, of what the tradeoffs are of different treatment choices,\" Brownlee said. She pointed to an approach called \u003ca href=\"http://www.informedmedicaldecisions.org/what-is-share%E2%80%A6\" target=\"_blank\">shared decision making\u003c/a>, a collaborative process between doctors and patients where they weigh together both the scientific evidence -- and a patients' values and preferences.\u003c/p>\n\u003cp>The easiest place to think of weighing evidence and values is in end-of-life care. But it applies in many areas of medicine from cancer screening to knee surgery to gall bladder surgery and more, Brownlee says.\u003c/p>\n\u003cp>There are\u003ca href=\"http://www.informedmedicaldecisions.org/patient-resources/\" target=\"_blank\"> online tools and other decision aids\u003c/a> where patients can review their choices and \"understand ... what the tradeoffs are, what the potential benefits are, what the potential harms are,\" Brownlee says, and then have a detailed conversation with their doctors about a treatment path.\u003c/p>\n\u003cp>The shared decision making approach is something patients themselves can start demanding, but fundamentally, Brownlee says, we need a different payment model. Right now, overall, the more doctors or hospitals do, the more they get paid. Hospitals \"don't know how to care for a population of patients within a budget,\" she says.\u003c/p>\n\u003cp>The U.S. national health care spend is an almost-impossible-to-imagine \u003ca href=\"http://www.cdc.gov/nchs/fastats/health-expenditures.htm\" target=\"_blank\">$3 trillion,\u003c/a> more than \u003ca href=\"http://www.cdc.gov/nchs/fastats/health-expenditures.htm\" target=\"_blank\">$9,200 per person\u003c/a>, and, again, half of that is not backed up by evidence.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"By wasting money, resources and time on care people don't need,\" Brownlee says, \"we are robbing many, many Americans of care they really do need.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/100605/shannon-brownlee-how-overtreatment-in-health-care-harms-us-all","authors":["240"],"categories":["stateofhealth_12","stateofhealth_13"],"tags":["stateofhealth_235"],"featImg":"stateofhealth_102640","label":"stateofhealth"},"stateofhealth_45506":{"type":"posts","id":"stateofhealth_45506","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"45506","score":null,"sort":[1436375471000]},"guestAuthors":[],"slug":"mammograms-may-not-reduce-breast-cancer-deaths-study-finds","title":"More Mammograms May Not Reduce Breast Cancer Deaths, Study Finds","publishDate":1436375471,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>Here's more evidence that mammograms don't always deliver the results that women want. They find more small cancers, but don't lower a woman's risk of dying of breast cancer, a study finds.\u003c/p>\n\u003cp>The study looked at data from 547 U.S. counties that reported the percentage of women over age 40 who had a screening mammogram between 1998 and 2000. More than 16 million women lived in those counties, and 53,207 were diagnosed with breast cancer in 2000.\u003c/p>\n\u003cp>Over the next 10 years, 15 percent of the women died of breast cancer.\u003c/p>\n\u003cp>There was a lot of county-to-county variation in the number of women who got screening mammograms, from 38 percent to 78 percent. So you'd think that the counties that did a better job at screening would have fewer breast cancer deaths.\u003c/p>\n\u003cp>That wasn't the case. The risk of death from breast cancer over 10 years was pretty much the same.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>But the scanning did find more cancers. For every 10 percent increase in screening, the number of cancers found rose by 16 percent, the study found. The \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=2363025\" target=\"_blank\">results \u003c/a>were reported Tuesday in \u003cem>JAMA Internal Medicine.\u003c/em> This, the authors write, means \"the most prominent effect of screening mammography is overdiagnosis.\"\u003c/p>\n\u003cp>By that they mean identifying abnormalities that will never cause illness or death in the patient's lifetime. Overdiagnosis has become an issue in screening for breast, \u003ca href=\"http://www.npr.org/sections/health-shots/2012/05/21/153234671/all-routine-psa-tests-for-prostate-cancer-should-end-task-force-says\" target=\"_blank\">prostate\u003c/a> and \u003ca href=\"http://www.npr.org/sections/health-shots/2014/02/21/280692601/overdiagnosis-could-be-behind-jump-in-thyroid-cancer-cases\" target=\"_blank\">thyroid cancer\u003c/a>.\u003c/p>\n\u003cp>So what's a woman supposed to do with this information? After giving a big fat dis to mammography, the authors write, \"Nonetheless, we do not believe that the right rate of screening mammography is zero.\" Focusing screening on higher-risk women would help, they say, as well as more watchful waiting instead of immediate treatment.\u003c/p>\n\u003cp>The study has its limitations, because it's comparing large groups of people, rather than tracking the health of individual women from mammogram on. Or it may be that even with this large number of cases, deaths are still rare enough that they're missed in this sort of study. Other studies have found a 20 percent reduction in breast cancer deaths as a result of mammography.\u003c/p>\n\u003cp>This is just the latest study pointing out the \u003ca href=\"http://www.npr.org/sections/health-shots/2014/04/01/297826238/review-finds-mammographys-benefits-overplayed-harms-dismissed\" target=\"_blank\">problem with overdiagnosis\u003c/a> of breast cancer.\u003c/p>\n\u003cp>\"This study shows that the more we look, the more you find,\" says Joann Elmore, a professor of medicine at the University of Washington who wrote a \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=2363022\" target=\"_blank\">commentary\u003c/a> accompanying the study. \"The more you screen, the more likely you are to detect early precancerous abnormalities like ductal carcinoma in situ and early-stage cancer.\"\u003c/p>\n\u003cp>It's not clear how many women are overdiagnosed; Elmore says 10 to 20 percent may be a good estimate. But with the current tests, there's no way for a woman to know if she's in that 10 to 20 percent or if she really does have a dangerous cancer. Thus most women who get a diagnosis of DCIS or early-stage invasive cancer opt for treatment, which can mean surgery, radiation or chemotherapy.\u003c/p>\n\u003cp>\"That is so hard,\" Elmore says. \"I really feel for those women. I need help both figuring out how to explain this to women, and I need better research helping me look at the tissue and figure out whether these women are overdiagnosed or not.\"\u003c/p>\n\u003cp>Elmore studies the reliability of breast cancer screening, and published a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25781441\" target=\"_blank\">study\u003c/a> in March that found that pathologists often misidentify DCIS and early-stage cancers when reading biopsies.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The medical community has come to accept that overdiagnosis exists, Elmore says. \"This is something that wasn't even considered when I was in med school years ago. We're slowly realizing that we are taking healthy people and maybe potentially giving them harm.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=More+Mammograms+May+Not+Always+Mean+Fewer+Cancer+Deaths&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"Getting more women in for screening mammograms didn't lower death rates from breast cancer. But more small cancers were found.","status":"publish","parent":0,"modified":1436375614,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":639},"headData":{"title":"More Mammograms May Not Reduce Breast Cancer Deaths, Study Finds | KQED","description":"Getting more women in for screening mammograms didn't lower death rates from breast cancer. But more small cancers were found.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"45506 http://ww2.kqed.org/stateofhealth/?p=45506","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/07/08/mammograms-may-not-reduce-breast-cancer-deaths-study-finds/","disqusTitle":"More Mammograms May Not Reduce Breast Cancer Deaths, Study Finds","nprByline":"Nancy Shute","nprStoryId":"420585286","nprApiLink":"http://api.npr.org/query?id=420585286&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2015/07/07/420585286/more-mammograms-may-not-always-mean-fewer-cancer-deaths?ft=nprml&f=420585286","nprRetrievedStory":"1","nprPubDate":"Wed, 08 Jul 2015 10:57:00 -0400","nprStoryDate":"Tue, 07 Jul 2015 11:57:00 -0400","nprLastModifiedDate":"Wed, 08 Jul 2015 10:57:16 -0400","path":"/stateofhealth/45506/mammograms-may-not-reduce-breast-cancer-deaths-study-finds","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Here's more evidence that mammograms don't always deliver the results that women want. They find more small cancers, but don't lower a woman's risk of dying of breast cancer, a study finds.\u003c/p>\n\u003cp>The study looked at data from 547 U.S. counties that reported the percentage of women over age 40 who had a screening mammogram between 1998 and 2000. More than 16 million women lived in those counties, and 53,207 were diagnosed with breast cancer in 2000.\u003c/p>\n\u003cp>Over the next 10 years, 15 percent of the women died of breast cancer.\u003c/p>\n\u003cp>There was a lot of county-to-county variation in the number of women who got screening mammograms, from 38 percent to 78 percent. So you'd think that the counties that did a better job at screening would have fewer breast cancer deaths.\u003c/p>\n\u003cp>That wasn't the case. The risk of death from breast cancer over 10 years was pretty much the same.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But the scanning did find more cancers. For every 10 percent increase in screening, the number of cancers found rose by 16 percent, the study found. The \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=2363025\" target=\"_blank\">results \u003c/a>were reported Tuesday in \u003cem>JAMA Internal Medicine.\u003c/em> This, the authors write, means \"the most prominent effect of screening mammography is overdiagnosis.\"\u003c/p>\n\u003cp>By that they mean identifying abnormalities that will never cause illness or death in the patient's lifetime. Overdiagnosis has become an issue in screening for breast, \u003ca href=\"http://www.npr.org/sections/health-shots/2012/05/21/153234671/all-routine-psa-tests-for-prostate-cancer-should-end-task-force-says\" target=\"_blank\">prostate\u003c/a> and \u003ca href=\"http://www.npr.org/sections/health-shots/2014/02/21/280692601/overdiagnosis-could-be-behind-jump-in-thyroid-cancer-cases\" target=\"_blank\">thyroid cancer\u003c/a>.\u003c/p>\n\u003cp>So what's a woman supposed to do with this information? After giving a big fat dis to mammography, the authors write, \"Nonetheless, we do not believe that the right rate of screening mammography is zero.\" Focusing screening on higher-risk women would help, they say, as well as more watchful waiting instead of immediate treatment.\u003c/p>\n\u003cp>The study has its limitations, because it's comparing large groups of people, rather than tracking the health of individual women from mammogram on. Or it may be that even with this large number of cases, deaths are still rare enough that they're missed in this sort of study. Other studies have found a 20 percent reduction in breast cancer deaths as a result of mammography.\u003c/p>\n\u003cp>This is just the latest study pointing out the \u003ca href=\"http://www.npr.org/sections/health-shots/2014/04/01/297826238/review-finds-mammographys-benefits-overplayed-harms-dismissed\" target=\"_blank\">problem with overdiagnosis\u003c/a> of breast cancer.\u003c/p>\n\u003cp>\"This study shows that the more we look, the more you find,\" says Joann Elmore, a professor of medicine at the University of Washington who wrote a \u003ca href=\"http://archinte.jamanetwork.com/article.aspx?articleid=2363022\" target=\"_blank\">commentary\u003c/a> accompanying the study. \"The more you screen, the more likely you are to detect early precancerous abnormalities like ductal carcinoma in situ and early-stage cancer.\"\u003c/p>\n\u003cp>It's not clear how many women are overdiagnosed; Elmore says 10 to 20 percent may be a good estimate. But with the current tests, there's no way for a woman to know if she's in that 10 to 20 percent or if she really does have a dangerous cancer. Thus most women who get a diagnosis of DCIS or early-stage invasive cancer opt for treatment, which can mean surgery, radiation or chemotherapy.\u003c/p>\n\u003cp>\"That is so hard,\" Elmore says. \"I really feel for those women. I need help both figuring out how to explain this to women, and I need better research helping me look at the tissue and figure out whether these women are overdiagnosed or not.\"\u003c/p>\n\u003cp>Elmore studies the reliability of breast cancer screening, and published a \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/25781441\" target=\"_blank\">study\u003c/a> in March that found that pathologists often misidentify DCIS and early-stage cancers when reading biopsies.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The medical community has come to accept that overdiagnosis exists, Elmore says. \"This is something that wasn't even considered when I was in med school years ago. We're slowly realizing that we are taking healthy people and maybe potentially giving them harm.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=More+Mammograms+May+Not+Always+Mean+Fewer+Cancer+Deaths&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/45506/mammograms-may-not-reduce-breast-cancer-deaths-study-finds","authors":["byline_stateofhealth_45506"],"categories":["stateofhealth_13"],"tags":["stateofhealth_46","stateofhealth_176","stateofhealth_235"],"featImg":"stateofhealth_45507","label":"stateofhealth"},"stateofhealth_33185":{"type":"posts","id":"stateofhealth_33185","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"33185","score":null,"sort":[1433356362000]},"guestAuthors":[],"slug":"surgery-doesnt-help-women-with-earliest-stage-breast-cancer","title":"Surgery Doesn't Help Women With Earliest-Stage Breast Cancer","publishDate":1433356362,"format":"standard","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>What to do about the non-invasive breast lesions called ductal carcinoma in situ, or \"stage zero\" cancer, is one of the hottest debates in breast cancer care.\u003c/p>\n\u003cp>Because of more widespread screening, more and more women are being diagnosed with DCIS. The condition now makes up 20 percent of new breast cancer cases, \u003ca href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-breast-cancer-types\" target=\"_blank\">according to the American Cancer Society\u003c/a>.\u003c/p>\n\u003cp>DCIS doesn't always progress to invasive breast cancer, which is the life-threatening kind. In fact, some physicians and researchers, including a \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1722196\" target=\"_blank\">working group convened by the National Cancer Institute\u003c/a>, say it's not accurate to call DCIS a form of cancer at all, and that the terminology is contributing to overly \u003ca href=\"http://www.npr.org/sections/health-shots/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more\" target=\"_blank\">aggressive treatment\u003c/a>.\u003c/p>\n\u003cp>\"We are certainly overtreating this disease, but we haven't figured out who can get less treatment, no treatment or active surveillance,\" says Mehra Golshan, a breast surgeon at Brigham and Women's Hospital in Boston. Surgery (lumpectomy and in some cases mastectomy) is the standard of care, but a \u003ca href=\"http://archsurg.jamanetwork.com/article.aspx?articleid=2300045\" target=\"_blank\">study\u003c/a> by Golshan and his colleagues may support some women's decision to skip the surgery, which comes with physical, emotional and financial costs.\u003c/p>\n\u003cp>The study, published Wednesday in \u003cem>JAMA Surgery\u003c/em>, relied on a National Cancer Institute registry covering 57,222 cases of DCIS in women treated in nine U.S. states between 1988 and 2011. The researchers looked at what happened to women who had surgery and to the small minority of those who didn't. They found that for women whose DCIS was classified as low-grade by a pathologist looking at the cells under the microscope, surgery didn't offer a significant survival advantage over 10 years.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>For the women who had cells that were closer on the continuum to invasive cancer — those with intermediate- or high-grade DCIS — surgery did provide a significant benefit. After 10 years, 98.6 percent of women with intermediate-grade DCIS and who had surgery had survived breast cancer, compared to 94.6 percent of women who didn't have surgery. And with high-grade DCIS, 98.4 percent of those who had surgery survived, compared to 90.5 percent of those who didn't.\u003c/p>\n\u003cp>This study relied on the historical data available in a registry and can't tell us why some women didn't get surgery. (For example, some might have been too sick to tolerate it.) There may have been other differences between those who opted for surgery and those who did not that affected the results. So the researchers can't say for sure that women with low-grade DCIS should not have surgery. There are \u003ca href=\"http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-comparing-surgery-with-active-monitoring-for-low-risk-dcis-loris\" target=\"_blank\">randomized clinical trials\u003c/a> comparing active monitoring to surgery for lower-risk DCIS going on in Europe that may help answer the question.\u003c/p>\n\u003cp>A \u003ca href=\"http://archsurg.jamanetwork.com/article.aspx?articleid=2300040\">commentary\u003c/a> accompanying the study says that molecular markers being developed are more promising than the cell grading system for figuring out who will and won't benefit from surgery. That may be true, but those tests aren't yet available and will cost much more, says Golshan, whereas the cell pathology reports are already standard.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For now, most doctors will still recommend surgery. But this research represents \"a first step in trying to tailor therapy to be in line with an individual patient's disease,\" says Golshan. He notes that women are already making a decision one way or the other. These results may make them and their physicians more comfortable with the idea of initially foregoing surgery for careful monitoring and possibly hormone therapy to block estrogen from fueling the growth of the abnormal cells.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Surgery+Doesn%27t+Help+Women+With+Early-Stage+Breast+Carcinoma&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n","blocks":[],"excerpt":"Only women with more advanced cases of ductal carcinoma in situ -- also called Stage 0 breast cancer -- benefited from lumpectomy, a study found. ","status":"publish","parent":0,"modified":1433356362,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":11,"wordCount":608},"headData":{"title":"Surgery Doesn't Help Women With Earliest-Stage Breast Cancer | KQED","description":"Only women with more advanced cases of ductal carcinoma in situ -- also called Stage 0 breast cancer -- benefited from lumpectomy, a study found. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"33185 http://ww2.kqed.org/stateofhealth/?p=33185","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/06/03/surgery-doesnt-help-women-with-earliest-stage-breast-cancer/","disqusTitle":"Surgery Doesn't Help Women With Earliest-Stage Breast Cancer","nprByline":"Katherine Hobson, NPR","nprStoryId":"411698622","nprApiLink":"http://api.npr.org/query?id=411698622&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"http://www.npr.org/sections/health-shots/2015/06/03/411698622/surgery-doesnt-help-women-with-early-stage-breast-carcinoma?ft=nprml&f=411698622","nprRetrievedStory":"1","nprPubDate":"Wed, 03 Jun 2015 12:21:00 -0400","nprStoryDate":"Wed, 03 Jun 2015 12:21:00 -0400","nprLastModifiedDate":"Wed, 03 Jun 2015 12:24:05 -0400","path":"/stateofhealth/33185/surgery-doesnt-help-women-with-earliest-stage-breast-cancer","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>What to do about the non-invasive breast lesions called ductal carcinoma in situ, or \"stage zero\" cancer, is one of the hottest debates in breast cancer care.\u003c/p>\n\u003cp>Because of more widespread screening, more and more women are being diagnosed with DCIS. The condition now makes up 20 percent of new breast cancer cases, \u003ca href=\"http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-breast-cancer-types\" target=\"_blank\">according to the American Cancer Society\u003c/a>.\u003c/p>\n\u003cp>DCIS doesn't always progress to invasive breast cancer, which is the life-threatening kind. In fact, some physicians and researchers, including a \u003ca href=\"http://jama.jamanetwork.com/article.aspx?articleid=1722196\" target=\"_blank\">working group convened by the National Cancer Institute\u003c/a>, say it's not accurate to call DCIS a form of cancer at all, and that the terminology is contributing to overly \u003ca href=\"http://www.npr.org/sections/health-shots/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more\" target=\"_blank\">aggressive treatment\u003c/a>.\u003c/p>\n\u003cp>\"We are certainly overtreating this disease, but we haven't figured out who can get less treatment, no treatment or active surveillance,\" says Mehra Golshan, a breast surgeon at Brigham and Women's Hospital in Boston. Surgery (lumpectomy and in some cases mastectomy) is the standard of care, but a \u003ca href=\"http://archsurg.jamanetwork.com/article.aspx?articleid=2300045\" target=\"_blank\">study\u003c/a> by Golshan and his colleagues may support some women's decision to skip the surgery, which comes with physical, emotional and financial costs.\u003c/p>\n\u003cp>The study, published Wednesday in \u003cem>JAMA Surgery\u003c/em>, relied on a National Cancer Institute registry covering 57,222 cases of DCIS in women treated in nine U.S. states between 1988 and 2011. The researchers looked at what happened to women who had surgery and to the small minority of those who didn't. They found that for women whose DCIS was classified as low-grade by a pathologist looking at the cells under the microscope, surgery didn't offer a significant survival advantage over 10 years.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>For the women who had cells that were closer on the continuum to invasive cancer — those with intermediate- or high-grade DCIS — surgery did provide a significant benefit. After 10 years, 98.6 percent of women with intermediate-grade DCIS and who had surgery had survived breast cancer, compared to 94.6 percent of women who didn't have surgery. And with high-grade DCIS, 98.4 percent of those who had surgery survived, compared to 90.5 percent of those who didn't.\u003c/p>\n\u003cp>This study relied on the historical data available in a registry and can't tell us why some women didn't get surgery. (For example, some might have been too sick to tolerate it.) There may have been other differences between those who opted for surgery and those who did not that affected the results. So the researchers can't say for sure that women with low-grade DCIS should not have surgery. There are \u003ca href=\"http://www.cancerresearchuk.org/about-cancer/find-a-clinical-trial/a-trial-comparing-surgery-with-active-monitoring-for-low-risk-dcis-loris\" target=\"_blank\">randomized clinical trials\u003c/a> comparing active monitoring to surgery for lower-risk DCIS going on in Europe that may help answer the question.\u003c/p>\n\u003cp>A \u003ca href=\"http://archsurg.jamanetwork.com/article.aspx?articleid=2300040\">commentary\u003c/a> accompanying the study says that molecular markers being developed are more promising than the cell grading system for figuring out who will and won't benefit from surgery. That may be true, but those tests aren't yet available and will cost much more, says Golshan, whereas the cell pathology reports are already standard.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For now, most doctors will still recommend surgery. But this research represents \"a first step in trying to tailor therapy to be in line with an individual patient's disease,\" says Golshan. He notes that women are already making a decision one way or the other. These results may make them and their physicians more comfortable with the idea of initially foregoing surgery for careful monitoring and possibly hormone therapy to block estrogen from fueling the growth of the abnormal cells.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2015 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"http://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Surgery+Doesn%27t+Help+Women+With+Early-Stage+Breast+Carcinoma&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\" alt=\"\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/33185/surgery-doesnt-help-women-with-earliest-stage-breast-cancer","authors":["byline_stateofhealth_33185"],"categories":["stateofhealth_13"],"tags":["stateofhealth_46","stateofhealth_235"],"featImg":"stateofhealth_33186","label":"stateofhealth"},"stateofhealth_25122":{"type":"posts","id":"stateofhealth_25122","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"25122","score":null,"sort":[1430158763000]},"guestAuthors":[],"slug":"why-you-should-rethink-that-daily-dose-of-aspirin","title":"Why You Should Rethink That Daily Dose of Aspirin","publishDate":1430158763,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_25127\" class=\"wp-caption aligncenter\" style=\"max-width: 641px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg\">\u003cimg class=\"wp-image-25127\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg\" alt=\"(Getty Images)\" width=\"641\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-320x213.jpg 320w\" sizes=\"(max-width: 641px) 100vw, 641px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Maanvi Singh,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin\" href=\"http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>We've all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn't.\u003c/p>\n\u003caside class=\"pullquote alignleft\"> The chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects \u003c/aside>\n\u003cp>In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people who've already experienced such an event, or who are at extremely high risk.\u003c/p>\n\u003cp>The survey, published in the American Journal of Preventive Medicine, found that 52 percent of people age 45 to 75 are taking aspirin daily or every other day. And 47 percent are taking it even though they have never had a heart attack or stroke.\u003c!--more-->\u003c/p>\n\u003cp>\"That's very controversial in the medical community,\" says Craig Williams, a pharmacologist at Oregon State University, who led the study.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Aspirin thins the blood and can help prevent blood clots that can clog blood vessels and cause strokes and heart attacks. But long-term use of the drug also increases the risk of ulcers, gastrointestinal bleeding and bleeding in the brain.\u003c/p>\n\u003cp>\"Everyone agrees that for people who have already had a cardiac event, the benefits outweigh the risk,\" Williams says.\u003c/p>\n\u003cp>But for most other people, the chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects, research suggests.\u003c/p>\n\u003cp>The American Heart Association says aspirin should be used only for prevention when someone's risk for heart disease is especially high.\u003c/p>\n\u003cp>And Williams says that the U.S. Preventive Services Task Force is in the process of revising its recommendation, which currently holds that older men and women should generally take aspirin if their risk for heart attack outweighs the risk of bleeding due to the medication.\u003c/p>\n\u003cp>In the survey by Williams' team, about 43 percent of people said they were taking the drug for prevention without having consulted a physician. That's a bad idea, says Steve Nissen, a cardiologist at the Cleveland Clinic who wasn't involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The vast majority of people in America who take aspirin for prevention are what I like to call the 'worried well,' \" Nissen says. \"They are perfectly healthy. They may not even have a lot of risk factors. But, they're very health conscious. And somebody told them that aspirin was good for preventing heart attacks, so they just started taking it.\"\u003c/p>\n\n","blocks":[],"excerpt":"The FDA does not recommend taking aspirin for prevention of a first heart attack.","status":"publish","parent":0,"modified":1430158928,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":449},"headData":{"title":"Why You Should Rethink That Daily Dose of Aspirin | KQED","description":"The FDA does not recommend taking aspirin for prevention of a first heart attack.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"25122 http://blogs.kqed.org/stateofhealth/?p=25122","disqusUrl":"https://ww2.kqed.org/stateofhealth/2015/04/27/why-you-should-rethink-that-daily-dose-of-aspirin/","disqusTitle":"Why You Should Rethink That Daily Dose of Aspirin","path":"/stateofhealth/25122/why-you-should-rethink-that-daily-dose-of-aspirin","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_25127\" class=\"wp-caption aligncenter\" style=\"max-width: 641px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg\">\u003cimg class=\"wp-image-25127\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg\" alt=\"(Getty Images)\" width=\"641\" height=\"427\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized.jpg 1920w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-400x267.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-800x533.jpg 800w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-1440x960.jpg 1440w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-1180x787.jpg 1180w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-768x512.jpg 768w, https://ww2.kqed.org/app/uploads/sites/27/2015/04/iStock_000017414759_Large-sized-320x213.jpg 320w\" sizes=\"(max-width: 641px) 100vw, 641px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Maanvi Singh,\u003c/strong> \u003ca title=\"http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin\" href=\"http://www.npr.org/blogs/health/2015/04/27/402039544/maybe-you-should-rethink-that-daily-aspirin\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>We've all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn't.\u003c/p>\n\u003caside class=\"pullquote alignleft\"> The chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects \u003c/aside>\n\u003cp>In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people who've already experienced such an event, or who are at extremely high risk.\u003c/p>\n\u003cp>The survey, published in the American Journal of Preventive Medicine, found that 52 percent of people age 45 to 75 are taking aspirin daily or every other day. And 47 percent are taking it even though they have never had a heart attack or stroke.\u003c!--more-->\u003c/p>\n\u003cp>\"That's very controversial in the medical community,\" says Craig Williams, a pharmacologist at Oregon State University, who led the study.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Aspirin thins the blood and can help prevent blood clots that can clog blood vessels and cause strokes and heart attacks. But long-term use of the drug also increases the risk of ulcers, gastrointestinal bleeding and bleeding in the brain.\u003c/p>\n\u003cp>\"Everyone agrees that for people who have already had a cardiac event, the benefits outweigh the risk,\" Williams says.\u003c/p>\n\u003cp>But for most other people, the chance that aspirin will prevent a first heart attack is about equal to the chance that it will cause harmful side effects, research suggests.\u003c/p>\n\u003cp>The American Heart Association says aspirin should be used only for prevention when someone's risk for heart disease is especially high.\u003c/p>\n\u003cp>And Williams says that the U.S. Preventive Services Task Force is in the process of revising its recommendation, which currently holds that older men and women should generally take aspirin if their risk for heart attack outweighs the risk of bleeding due to the medication.\u003c/p>\n\u003cp>In the survey by Williams' team, about 43 percent of people said they were taking the drug for prevention without having consulted a physician. That's a bad idea, says Steve Nissen, a cardiologist at the Cleveland Clinic who wasn't involved in the study.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\"The vast majority of people in America who take aspirin for prevention are what I like to call the 'worried well,' \" Nissen says. \"They are perfectly healthy. They may not even have a lot of risk factors. But, they're very health conscious. And somebody told them that aspirin was good for preventing heart attacks, so they just started taking it.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/25122/why-you-should-rethink-that-daily-dose-of-aspirin","authors":["8344"],"categories":["stateofhealth_12","stateofhealth_13"],"tags":["stateofhealth_235"],"featImg":"stateofhealth_25127","label":"stateofhealth"},"stateofhealth_22916":{"type":"posts","id":"stateofhealth_22916","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"22916","score":null,"sort":[1418154840000]},"guestAuthors":[],"slug":"many-older-breast-cancer-patients-receive-unnecessary-radiation-treatment","title":"Many Older Breast Cancer Patients Receive Unnecessary Radiation Treatment","publishDate":1418154840,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_22920\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000016019343_Full-e1418153922812.jpg\">\u003cimg class=\"size-large wp-image-22920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000016019343_Full-640x426.jpg\" alt=\"New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2014/12/08/369346049/doctors-are-slow-to-adopt-changes-in-breast-cancer-treatment\" href=\"http://www.npr.org/blogs/health/2014/12/08/369346049/doctors-are-slow-to-adopt-changes-in-breast-cancer-treatment\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Cancer doctors want the best, most effective treatment for their patients. But it turns out many aren't paying attention to evidence that older women with early-stage breast cancer may be enduring the pain, fatigue and cost of radiation treatment even though it doesn't increase life expectancy.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Radiation had no impact on survival rates in older women with early-stage cancer.\u003c/aside>\n\u003cp>Researchers from Duke University Medical Center analyzed the impact of a \u003ca title=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" target=\"_blank\">large randomized trial\u003c/a> published in 2004 that compared treatment options for women over the age of 70 with early-stage breast cancer. That study compared cancer recurrence and survival rates among women who had surgery, chemotherapy and radiation with that of women who had surgery and chemotherapy only.\u003c/p>\n\u003cp>While there was a slight decrease in recurrence of cancer in the group who had radiation, there was no difference in survival, thus raising the question of whether radiation treatment for this group of patients is worthwhile.\u003c!--more-->\u003c/p>\n\u003cp>According to Dr. Rachel Blitzblau, a radiation oncologist at Duke University Medical Center and lead author of the study, which was published this week in the journal \u003cem>Cancer\u003c/em>, \"we should consider omitting radiation for these women, because the small observed benefits might not be worth the side effects and costs.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Short-term side effects of radiation include skin blistering and fatigue. \u003ca title=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" target=\"_blank\">Long-term effects \u003c/a>can include nerve damage and lymphedema, or swelling of the hand and arm.\u003c/p>\n\u003cp>Blitzblau and colleagues looked at practice patterns among cancer doctors, comparing the number of women who received radiation therapy prior to the 2004 findings and after. There was little difference, just a 7 percent drop in the number of women receiving radiation.\u003c/p>\n\u003cp>About 69 percent of patients treated between 2000 and 2004 got some form of radiation, compared with 62 percent between 2005 and 2009.\u003c/p>\n\u003cp>\"The publication of the trial had only a very small impact on practice patterns,\" she says. \"Our findings demonstrate the potential difficulty of incorporating clinical trial data that involves omitting a treatment that has been considered the standard of care.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It may be that doctors are simply uncomfortable suggesting that patients forgo treatment even when high-quality studies show little advantage, Blitzblau says, adding that it's important to improve \"evidence-based medical practice in all medical specialties.\"\u003c/p>\n\n","blocks":[],"excerpt":"Radiation had no impact on survival rates in older women with early-stage cancer.","status":"publish","parent":0,"modified":1418278066,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":12,"wordCount":406},"headData":{"title":"Many Older Breast Cancer Patients Receive Unnecessary Radiation Treatment | KQED","description":"Radiation had no impact on survival rates in older women with early-stage cancer.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"22916 http://blogs.kqed.org/stateofhealth/?p=22916","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/12/09/many-older-breast-cancer-patients-receive-unnecessary-radiation-treatment/","disqusTitle":"Many Older Breast Cancer Patients Receive Unnecessary Radiation Treatment","path":"/stateofhealth/22916/many-older-breast-cancer-patients-receive-unnecessary-radiation-treatment","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_22920\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000016019343_Full-e1418153922812.jpg\">\u003cimg class=\"size-large wp-image-22920\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/12/iStock_000016019343_Full-640x426.jpg\" alt=\"New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)\" width=\"640\" height=\"426\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Patti Neighmond\u003c/strong>, \u003ca title=\"http://www.npr.org/blogs/health/2014/12/08/369346049/doctors-are-slow-to-adopt-changes-in-breast-cancer-treatment\" href=\"http://www.npr.org/blogs/health/2014/12/08/369346049/doctors-are-slow-to-adopt-changes-in-breast-cancer-treatment\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>Cancer doctors want the best, most effective treatment for their patients. But it turns out many aren't paying attention to evidence that older women with early-stage breast cancer may be enduring the pain, fatigue and cost of radiation treatment even though it doesn't increase life expectancy.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Radiation had no impact on survival rates in older women with early-stage cancer.\u003c/aside>\n\u003cp>Researchers from Duke University Medical Center analyzed the impact of a \u003ca title=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" target=\"_blank\">large randomized trial\u003c/a> published in 2004 that compared treatment options for women over the age of 70 with early-stage breast cancer. That study compared cancer recurrence and survival rates among women who had surgery, chemotherapy and radiation with that of women who had surgery and chemotherapy only.\u003c/p>\n\u003cp>While there was a slight decrease in recurrence of cancer in the group who had radiation, there was no difference in survival, thus raising the question of whether radiation treatment for this group of patients is worthwhile.\u003c!--more-->\u003c/p>\n\u003cp>According to Dr. Rachel Blitzblau, a radiation oncologist at Duke University Medical Center and lead author of the study, which was published this week in the journal \u003cem>Cancer\u003c/em>, \"we should consider omitting radiation for these women, because the small observed benefits might not be worth the side effects and costs.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Short-term side effects of radiation include skin blistering and fatigue. \u003ca title=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" href=\"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691356/\" target=\"_blank\">Long-term effects \u003c/a>can include nerve damage and lymphedema, or swelling of the hand and arm.\u003c/p>\n\u003cp>Blitzblau and colleagues looked at practice patterns among cancer doctors, comparing the number of women who received radiation therapy prior to the 2004 findings and after. There was little difference, just a 7 percent drop in the number of women receiving radiation.\u003c/p>\n\u003cp>About 69 percent of patients treated between 2000 and 2004 got some form of radiation, compared with 62 percent between 2005 and 2009.\u003c/p>\n\u003cp>\"The publication of the trial had only a very small impact on practice patterns,\" she says. \"Our findings demonstrate the potential difficulty of incorporating clinical trial data that involves omitting a treatment that has been considered the standard of care.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>It may be that doctors are simply uncomfortable suggesting that patients forgo treatment even when high-quality studies show little advantage, Blitzblau says, adding that it's important to improve \"evidence-based medical practice in all medical specialties.\"\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/22916/many-older-breast-cancer-patients-receive-unnecessary-radiation-treatment","authors":["8344"],"categories":["stateofhealth_13"],"tags":["stateofhealth_46","stateofhealth_235"],"featImg":"stateofhealth_22920","label":"stateofhealth"},"stateofhealth_21565":{"type":"posts","id":"stateofhealth_21565","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"21565","score":null,"sort":[1410900058000]},"guestAuthors":[],"slug":"put-down-the-heating-pad-physical-therapists-say-it-doesnt-help","title":"Put Down the Heating Pad: Physical Therapists Say It Doesn't Help","publishDate":1410900058,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_21570\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/MD001555-e1410899799974.jpg\">\u003cimg class=\"size-large wp-image-21570\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/MD001555-640x422.jpg\" alt=\"Physical therapy is about being, well, physical, new guidelines say. (Getty Images)\" width=\"640\" height=\"422\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Physical therapy is about being, well, physical, new guidelines say. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute,\u003c/strong> \u003ca title=\"Farewell, Heating Pad\" href=\"http://www.npr.org/blogs/health/2014/09/16/348757697/farewell-heating-pad-physical-therapists-say-it-doesnt-help\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>I have fond memories of listening to NPR while lounging at the physical therapist's with a heating pad on my shoulder. Don't do that, the nation's physical therapists' association says.\u003c/p>\n\u003cp>Heat therapy, electrical stimulation, ultrasound and other \"passive physical agents\" almost never help, according to a list released Monday by the \u003ca title=\"Choosing Wisely campaign\" href=\"http://www.choosingwisely.org\" target=\"_blank\">Choosing Wisely \u003c/a>campaign. Instead, they siphon time and money away from what you really want from a physical therapist — an exercise program that will restore strength and mobility.\u003c/p>\n\u003cp>Well, this is certainly going to make physical therapy less restful.\u003c/p>\n\u003cp>But seeing as I've been to several physical therapists over the years and they've all used this stuff, the fact that the American Physical Therapy Association put passive physical agents on top of their list of things not to do seems like big news.\u003c!--more-->\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>So I called up Tony Delitto, chairman of the department of physical therapy at the University of Pittsburgh, to find out what gives. He was chairman of the group that wrote the \"what not to do\" list for Choosing Wisely. It's aimed at getting health care professionals and civilians to pick medical treatments that are proven to do good.\u003c/p>\n\u003cp>Heating pads in the PT's office, alas, are not on the list.\u003c/p>\n\u003cp>\"The evidence for any beneficial effect is almost nil,\" Delitto told Shots. \"When I graduated with my physical therapy degree in 1979, these physical agents were a large part of practice. We've had a hard time getting rid of them.\"\u003c/p>\n\u003cp>One reason why, Delitto says, is that insurers continue to pay for passive physical agents. I know my health insurer did. The Choosing Wisely campaign, which is run by the American Board of Internal Medicine Foundation, aims to put pressure on insurers to change their ways, too.\u003c/p>\n\u003cp>Also on the physical therapists' list:\u003c/p>\n\u003cul>\n\u003cli>Don't underprescribe exercise for older adults.\u003c/li>\n\u003cli>Don't prescribe bed rest for people with acute deep vein thrombosis once they're properly medicated.\u003c/li>\n\u003cli>Don't use continuous passive motion machines for people who have had knee replacements.\u003c/li>\n\u003cli>Don't use whirlpool baths for wound management.\u003c/li>\n\u003cli>If you detect a pattern there, you're right. The emphasis is on physical activity, and on doing it yourself with the guidance of a physical therapist so you work hard enough to get stronger and don't get hurt.\u003c/li>\n\u003c/ul>\n\u003cp>\"You're leaning on the physical therapist's expertise to see what activities you can do and how to carry them out on your own,\" Delitto says. \"What to look for so you don't overdo it, and how to progress.\"\u003c/p>\n\u003cp>Many physical therapists are hesitant to give older people challenging exercises, but as a result the exercises don't do any good. \"We underestimate what they can do,\" Delitto says. It's a bit trickier to hit the right balance between challenge and safety, he notes, but \"it can be done safely.\"\u003c/p>\n\u003cp>The continuous passive motion machines were thought to prevent stiff knees in people who had knee replacements, but \u003ca title=\"NIH studies\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/2743665\" target=\"_blank\">studies have found\u003c/a> that they don't help. \"It turned out to be a very expensive device that was not adding any quality,\" Delitto says. \"But people make money on the machines.\"\u003c/p>\n\u003cp>Physical therapy can be a cost-effective first stop for people, Delitto says, because therapists are trained to recognize when a person needs to see a doctor instead. \"We're sort of an inexpensive route for patients.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Without the heating pad, that is. I guess I'm going to have to find another place to listen to NPR.\u003c/p>\n\n","blocks":[],"excerpt":"Physical therapy means exactly that -- being physical. ","status":"publish","parent":0,"modified":1410900058,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":612},"headData":{"title":"Put Down the Heating Pad: Physical Therapists Say It Doesn't Help | KQED","description":"Physical therapy means exactly that -- being physical. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"21565 http://blogs.kqed.org/stateofhealth/?p=21565","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/09/16/put-down-the-heating-pad-physical-therapists-say-it-doesnt-help/","disqusTitle":"Put Down the Heating Pad: Physical Therapists Say It Doesn't Help","path":"/stateofhealth/21565/put-down-the-heating-pad-physical-therapists-say-it-doesnt-help","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_21570\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/MD001555-e1410899799974.jpg\">\u003cimg class=\"size-large wp-image-21570\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/09/MD001555-640x422.jpg\" alt=\"Physical therapy is about being, well, physical, new guidelines say. (Getty Images)\" width=\"640\" height=\"422\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Physical therapy is about being, well, physical, new guidelines say. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>By Nancy Shute,\u003c/strong> \u003ca title=\"Farewell, Heating Pad\" href=\"http://www.npr.org/blogs/health/2014/09/16/348757697/farewell-heating-pad-physical-therapists-say-it-doesnt-help\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cp>I have fond memories of listening to NPR while lounging at the physical therapist's with a heating pad on my shoulder. Don't do that, the nation's physical therapists' association says.\u003c/p>\n\u003cp>Heat therapy, electrical stimulation, ultrasound and other \"passive physical agents\" almost never help, according to a list released Monday by the \u003ca title=\"Choosing Wisely campaign\" href=\"http://www.choosingwisely.org\" target=\"_blank\">Choosing Wisely \u003c/a>campaign. Instead, they siphon time and money away from what you really want from a physical therapist — an exercise program that will restore strength and mobility.\u003c/p>\n\u003cp>Well, this is certainly going to make physical therapy less restful.\u003c/p>\n\u003cp>But seeing as I've been to several physical therapists over the years and they've all used this stuff, the fact that the American Physical Therapy Association put passive physical agents on top of their list of things not to do seems like big news.\u003c!--more-->\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So I called up Tony Delitto, chairman of the department of physical therapy at the University of Pittsburgh, to find out what gives. He was chairman of the group that wrote the \"what not to do\" list for Choosing Wisely. It's aimed at getting health care professionals and civilians to pick medical treatments that are proven to do good.\u003c/p>\n\u003cp>Heating pads in the PT's office, alas, are not on the list.\u003c/p>\n\u003cp>\"The evidence for any beneficial effect is almost nil,\" Delitto told Shots. \"When I graduated with my physical therapy degree in 1979, these physical agents were a large part of practice. We've had a hard time getting rid of them.\"\u003c/p>\n\u003cp>One reason why, Delitto says, is that insurers continue to pay for passive physical agents. I know my health insurer did. The Choosing Wisely campaign, which is run by the American Board of Internal Medicine Foundation, aims to put pressure on insurers to change their ways, too.\u003c/p>\n\u003cp>Also on the physical therapists' list:\u003c/p>\n\u003cul>\n\u003cli>Don't underprescribe exercise for older adults.\u003c/li>\n\u003cli>Don't prescribe bed rest for people with acute deep vein thrombosis once they're properly medicated.\u003c/li>\n\u003cli>Don't use continuous passive motion machines for people who have had knee replacements.\u003c/li>\n\u003cli>Don't use whirlpool baths for wound management.\u003c/li>\n\u003cli>If you detect a pattern there, you're right. The emphasis is on physical activity, and on doing it yourself with the guidance of a physical therapist so you work hard enough to get stronger and don't get hurt.\u003c/li>\n\u003c/ul>\n\u003cp>\"You're leaning on the physical therapist's expertise to see what activities you can do and how to carry them out on your own,\" Delitto says. \"What to look for so you don't overdo it, and how to progress.\"\u003c/p>\n\u003cp>Many physical therapists are hesitant to give older people challenging exercises, but as a result the exercises don't do any good. \"We underestimate what they can do,\" Delitto says. It's a bit trickier to hit the right balance between challenge and safety, he notes, but \"it can be done safely.\"\u003c/p>\n\u003cp>The continuous passive motion machines were thought to prevent stiff knees in people who had knee replacements, but \u003ca title=\"NIH studies\" href=\"http://www.ncbi.nlm.nih.gov/pubmed/2743665\" target=\"_blank\">studies have found\u003c/a> that they don't help. \"It turned out to be a very expensive device that was not adding any quality,\" Delitto says. \"But people make money on the machines.\"\u003c/p>\n\u003cp>Physical therapy can be a cost-effective first stop for people, Delitto says, because therapists are trained to recognize when a person needs to see a doctor instead. \"We're sort of an inexpensive route for patients.\"\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Without the heating pad, that is. I guess I'm going to have to find another place to listen to NPR.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/21565/put-down-the-heating-pad-physical-therapists-say-it-doesnt-help","authors":["8344"],"categories":["stateofhealth_12"],"tags":["stateofhealth_235"],"featImg":"stateofhealth_21570","label":"stateofhealth"},"stateofhealth_19855":{"type":"posts","id":"stateofhealth_19855","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"19855","score":null,"sort":[1404162771000]},"guestAuthors":[],"slug":"new-guidelines-say-many-women-can-skip-pelvic-exam","title":"New Guidelines Say Many Women Can Skip Pelvic Exam","publishDate":1404162771,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_9590\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233.jpg\">\u003cimg class=\"size-full wp-image-9590\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233.jpg\" alt=\"(Maigh/Flickr)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">If this picture makes you shudder, you'll want to understand the new guideline. (Maigh/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>No more dreaded pelvic exam? New guidelines say most healthy women can skip the yearly ritual.\u003c/p>\n\u003cp>Routine pelvic exams don't benefit women who have no symptoms of disease and who aren't pregnant, and they can cause harm, the American College of Physicians said Monday as it recommended that doctors quit using them as a screening tool.\u003c/p>\n\u003cp>It's part of a growing movement to evaluate whether many longtime medical practices are done more out of habit than necessity, and the guideline is sure to be controversial.\u003c/p>\n\u003cp>Scientific evidence \"just doesn't support the benefit of having a pelvic exam every year,\" said guideline coauthor Dr. Linda Humphrey of the Portland Veterans Affairs Medical Center and Oregon Health & Science University.\u003c!--more-->\u003c/p>\n\u003cp>\"There will be women who are relieved, and there are women who really want to go in and talk with their doctor about it and will choose to continue this,\" she added.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The recommendations aren't binding to doctors — or insurers.\u003c/p>\n\u003cp>Indeed, a different doctors' group, the American College of Obstetricians and Gynecologists, still recommends yearly pelvic exams even as it acknowledges a lack of evidence supporting, or refuting, them.\u003c/p>\n\u003cp>Pelvic exams have long been considered part of a \"well-woman visit,\" and some 62 million were performed in the United States in 2010, the latest available data.\u003c/p>\n\u003cp>Here's what put the test under the microscope: Pap smears that check for cervical cancer used to be done yearly but now are recommended only every three to five years. So if women weren't going through that test every year, did they still need the pelvic exam that traditionally accompanied it?\u003c/p>\n\u003cp>During a pelvic exam, a doctor feels for abnormalities in the ovaries, uterus and other pelvic organs. But two years ago, scientists at the Centers for Disease Control and Prevention reported that the internal exams weren't a good screening tool for ovarian cancer and shouldn't be required before a woman was prescribed birth control pills.\u003c/p>\n\u003cp>The American College of Physicians, specialists in internal medicine, took a broader look.\u003c/p>\n\u003cp>Pelvic exams are appropriate for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction, the ACP said. And women should get their Pap smears on schedule — but a Pap doesn't require the extra step of a manual pelvic exam, it said.\u003c/p>\n\u003cp>For symptom-free women, years of medical studies show routine pelvic exams aren't useful to screen for ovarian or other gynecologic cancers, they don't reduce deaths, and there are other ways, such as urine tests, to detect such problems as sexually transmitted infections, the doctors' group reported in the journal Annals of Internal Medicine.\u003c/p>\n\u003cp>Moreover, pelvic exams can cause harm — from unnecessary and expensive extra testing when the exam sparks a false alarm, to the anxiety, embarrassment and discomfort that many women report, especially survivors of sexual abuse, the guidelines said.\u003c/p>\n\u003cp>No one knows how many women postpone a doctor's visit for fear of a pelvic exam, Humphrey said.\u003c/p>\n\u003cp>Dr. Ranit Mishori, a family physician and associate professor at Georgetown University School of Medicine, said the new guideline \"gets rid of an unnecessary practice\" that takes up valuable time that could be put to better use.\u003c/p>\n\u003cp>\"Many women will be happy to hear that, and I think also, frankly, many physicians will be happy to hear it. Many of us have stopped doing them for a long time,\" said Mishori, who wasn't involved with the recommendations.\u003c/p>\n\u003cp>Despite its continued recommendation for annual pelvic exams, the American College of Obstetricians and Gynecologists \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/18/et-tu-pelvic-exams/\" target=\"_blank\">said in 2012\u003c/a> that patients should decide together with their providers whether to have them.\u003c/p>\n\u003cp>Sometimes that exam lets the doctor spot, say, problems around the uterus that might lead to questions about incontinence that the supposedly asymptomatic patient was too embarrassed to bring up, said ACOG vice president Dr. Barbara Levy.\u003c/p>\n\u003cp>\"Women have an expectation that they're going to have an exam\" if they choose a gynecologist, Levy said.\u003c/p>\n\u003cp>An editorial published alongside the guidelines Monday cautioned that pelvic exams also look for noncancerous uterine and ovarian growths, and the scientific review didn't address whether that's beneficial.\u003c/p>\n\u003cp>Still, editorial coauthors Drs. George Sawaya and Vanessa Jacoby of the University of California, San Francisco, said that whether the new guideline changes doctors' practice or not, it could lead to better evaluation of what \"has become more of a ritual than an evidence-based practice.\"\u003c/p>\n\u003cp>\"Clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow,\" they wrote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"Pelvic exam has no benefits, lots of harms, for healthy, asymptomatic women.","status":"publish","parent":0,"modified":1404331818,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":815},"headData":{"title":"New Guidelines Say Many Women Can Skip Pelvic Exam | KQED","description":"Pelvic exam has no benefits, lots of harms, for healthy, asymptomatic women.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"19855 http://blogs.kqed.org/stateofhealth/?p=19855","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/06/30/new-guidelines-say-many-women-can-skip-pelvic-exam/","disqusTitle":"New Guidelines Say Many Women Can Skip Pelvic Exam","path":"/stateofhealth/19855/new-guidelines-say-many-women-can-skip-pelvic-exam","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_9590\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233.jpg\">\u003cimg class=\"size-full wp-image-9590\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233.jpg\" alt=\"(Maigh/Flickr)\" width=\"640\" height=\"480\" srcset=\"https://ww2.kqed.org/app/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233.jpg 640w, https://ww2.kqed.org/app/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233-400x300.jpg 400w, https://ww2.kqed.org/app/uploads/sites/27/2012/12/PelvicExamStirrups_Maigh_Flickr-e1404162693233-320x240.jpg 320w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">If this picture makes you shudder, you'll want to understand the new guideline. (Maigh/Flickr)\u003c/figcaption>\u003c/figure>\n\u003cp>No more dreaded pelvic exam? New guidelines say most healthy women can skip the yearly ritual.\u003c/p>\n\u003cp>Routine pelvic exams don't benefit women who have no symptoms of disease and who aren't pregnant, and they can cause harm, the American College of Physicians said Monday as it recommended that doctors quit using them as a screening tool.\u003c/p>\n\u003cp>It's part of a growing movement to evaluate whether many longtime medical practices are done more out of habit than necessity, and the guideline is sure to be controversial.\u003c/p>\n\u003cp>Scientific evidence \"just doesn't support the benefit of having a pelvic exam every year,\" said guideline coauthor Dr. Linda Humphrey of the Portland Veterans Affairs Medical Center and Oregon Health & Science University.\u003c!--more-->\u003c/p>\n\u003cp>\"There will be women who are relieved, and there are women who really want to go in and talk with their doctor about it and will choose to continue this,\" she added.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The recommendations aren't binding to doctors — or insurers.\u003c/p>\n\u003cp>Indeed, a different doctors' group, the American College of Obstetricians and Gynecologists, still recommends yearly pelvic exams even as it acknowledges a lack of evidence supporting, or refuting, them.\u003c/p>\n\u003cp>Pelvic exams have long been considered part of a \"well-woman visit,\" and some 62 million were performed in the United States in 2010, the latest available data.\u003c/p>\n\u003cp>Here's what put the test under the microscope: Pap smears that check for cervical cancer used to be done yearly but now are recommended only every three to five years. So if women weren't going through that test every year, did they still need the pelvic exam that traditionally accompanied it?\u003c/p>\n\u003cp>During a pelvic exam, a doctor feels for abnormalities in the ovaries, uterus and other pelvic organs. But two years ago, scientists at the Centers for Disease Control and Prevention reported that the internal exams weren't a good screening tool for ovarian cancer and shouldn't be required before a woman was prescribed birth control pills.\u003c/p>\n\u003cp>The American College of Physicians, specialists in internal medicine, took a broader look.\u003c/p>\n\u003cp>Pelvic exams are appropriate for women with symptoms such as vaginal discharge, abnormal bleeding, pain, urinary problems or sexual dysfunction, the ACP said. And women should get their Pap smears on schedule — but a Pap doesn't require the extra step of a manual pelvic exam, it said.\u003c/p>\n\u003cp>For symptom-free women, years of medical studies show routine pelvic exams aren't useful to screen for ovarian or other gynecologic cancers, they don't reduce deaths, and there are other ways, such as urine tests, to detect such problems as sexually transmitted infections, the doctors' group reported in the journal Annals of Internal Medicine.\u003c/p>\n\u003cp>Moreover, pelvic exams can cause harm — from unnecessary and expensive extra testing when the exam sparks a false alarm, to the anxiety, embarrassment and discomfort that many women report, especially survivors of sexual abuse, the guidelines said.\u003c/p>\n\u003cp>No one knows how many women postpone a doctor's visit for fear of a pelvic exam, Humphrey said.\u003c/p>\n\u003cp>Dr. Ranit Mishori, a family physician and associate professor at Georgetown University School of Medicine, said the new guideline \"gets rid of an unnecessary practice\" that takes up valuable time that could be put to better use.\u003c/p>\n\u003cp>\"Many women will be happy to hear that, and I think also, frankly, many physicians will be happy to hear it. Many of us have stopped doing them for a long time,\" said Mishori, who wasn't involved with the recommendations.\u003c/p>\n\u003cp>Despite its continued recommendation for annual pelvic exams, the American College of Obstetricians and Gynecologists \u003ca href=\"http://ww2.kqed.org/stateofhealth/2012/12/18/et-tu-pelvic-exams/\" target=\"_blank\">said in 2012\u003c/a> that patients should decide together with their providers whether to have them.\u003c/p>\n\u003cp>Sometimes that exam lets the doctor spot, say, problems around the uterus that might lead to questions about incontinence that the supposedly asymptomatic patient was too embarrassed to bring up, said ACOG vice president Dr. Barbara Levy.\u003c/p>\n\u003cp>\"Women have an expectation that they're going to have an exam\" if they choose a gynecologist, Levy said.\u003c/p>\n\u003cp>An editorial published alongside the guidelines Monday cautioned that pelvic exams also look for noncancerous uterine and ovarian growths, and the scientific review didn't address whether that's beneficial.\u003c/p>\n\u003cp>Still, editorial coauthors Drs. George Sawaya and Vanessa Jacoby of the University of California, San Francisco, said that whether the new guideline changes doctors' practice or not, it could lead to better evaluation of what \"has become more of a ritual than an evidence-based practice.\"\u003c/p>\n\u003cp>\"Clinicians who continue to offer the examination should at least be cognizant of the uncertainty of benefit and the potential to cause harm through a positive test result and the cascade of events that follow,\" they wrote.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/19855/new-guidelines-say-many-women-can-skip-pelvic-exam","authors":["237"],"categories":["stateofhealth_12","stateofhealth_13"],"tags":["stateofhealth_235","stateofhealth_461","stateofhealth_397"],"featImg":"stateofhealth_9590","label":"stateofhealth"},"stateofhealth_18171":{"type":"posts","id":"stateofhealth_18171","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"18171","score":null,"sort":[1395166191000]},"guestAuthors":[],"slug":"yes-its-a-headache-no-i-didnt-need-that-brain-scan","title":"Yes, It's A Headache. No, I Didn't Need That Brain Scan","publishDate":1395166191,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cfigure id=\"attachment_18177\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/stk116189rke-e1395165944260.jpg\">\u003cimg class=\"size-large wp-image-18177\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/stk116189rke-640x425.jpg\" alt=\"Headaches are almost never caused by a tumor, say neurologists. (Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Headaches are almost never caused by a tumor, say neurologists. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Over at NPR, the Shots blog reports that Americans get $1 billion (yes, with a \"B\") worth of brain scans every year -- because they have a headache. That's according to research at the University of Michigan.\u003c/p>\n\u003cp>Headaches are one of the most common reasons people go to the doctor -- up to a quarter of all doctor visits, says Shots.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Sending a billion dollars \"down the drain.\" Annually.\u003c/aside>\n\u003cp>Presumably people are getting the scans because they're worried that headache is a sign of something much more scary -- say a brain tumor.\u003c/p>\n\u003cp>There's just one problem. Most headaches are just that -- a headache.\u003c/p>\n\u003cp>From the \u003ca href=\"http://www.npr.org/blogs/health/2014/03/18/291044766/yes-its-a-headache-no-you-dont-need-a-brain-scan\" target=\"_blank\">Shots post\u003c/a>:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>(S)ince headaches are almost never caused by a tumor or other serious brain problem, that $1 billion is money down the drain, according to Dr. Brian Callaghan, the assistant professor of neurology who led the study.\u003c/p>\n\u003cp>\"It's such a big number,\" Callaghan told Shots. \"It's just an incredible number of MRIs and CTs that people get.\"\u003c/p>\n\u003cp>From 2007 to 2010, people visited the doctor 51 million times for headache-related problems, according to a national database of outpatient visits. And 12 percent of the time, the doctors sent their patients for a brain scan. Those numbers are on the rise, the analysis found, even though \u003ca href=\"http://www.choosingwisely.org/doctor-patient-lists/imaging-tests-for-headaches/\" target=\"_blank\">guidelines \u003c/a>urge doctors to shun the scans. The \u003ca href=\"https://archinte.jamanetwork.com/article.aspx?articleid=1835347\" target=\"_blank\">results \u003c/a>were published Monday in \u003cem>JAMA Internal Medicine\u003c/em>.\u003c/p>\u003c/blockquote>\n\u003cp>I'm guilty of sending part of that billion down the drain. A few years ago, I was driving on the highway with my two children in the back seat. I glanced down, then back at the road, and suddenly was seeing double. I managed to pull over but was very shaken. I didn't know if I was having a stroke. But over a few minutes, the symptoms subsided. I won't drag you through everything I did next, but in short, I got home safely and made an appointment with the doctor.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>She listened to my story, then pointed out that this episode was likely a version of the migraines I get. Migraines are often preceded by an aura, a visual effect that can include \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/migraine-with-aura/basics/definition/con-20030404\" target=\"_blank\">flashing lights or blind spots\u003c/a>, according to the Mayo Clinic.\u003c/p>\n\u003cp>But I was freaked out. She referred me to an ophthalmologist with whom I had a long conversation about getting an MRI. He said he wouldn't do it.\u003c/p>\n\u003cp>I did it.\u003c/p>\n\u003cp>I was lucky -- not because the MRI came back normal (which I'm sure you expected by now) but also because it didn't turn up any false positives as can happen, often, with MRIs. If the MRI turns up something suspicious, it can \"prompt a cascade of tests and invasive procedures,\" Shots says, over things that will never cause any harm.\u003c/p>\n\u003cp>But that's not as bad as a CT scan -- in that case, you're exposing your brain to needless radiation. Personally, I like my brain not irradiated, if at all possible.\u003c/p>\n\u003cp>Patients like me certainly bear some responsibility, but doctors are guilty as well, says Callaghan. Ordering a scan both gets the patient out the door quickly and it does make the patient feel like someone is taking care of them.\u003c/p>\n\u003cp>Still, there are times you should worry. Again, from Shots:\u003c/p>\n\u003cblockquote>\u003cp>When should we worry? If a \u003ca href=\"http://www.nlm.nih.gov/medlineplus/headache.html\" target=\"_blank\">severe headache\u003c/a> strikes suddenly, the neurologists say. People also should seek medical help for \u003ca href=\"http://www.npr.org/blogs/health/2014/03/18/291044766/Different%20from%20other%20headaches%20you've%20had%20in%20the%20past,%20especially%20if%20you're%2050%20or%20older.%20Brought%20on%20by%20exertion.%20Accompanied%20by%20fever,%20seizure,%20vomiting,%20a%20loss%20of%20coordination,%20or%20a%20change%20in%20vision,%20speech,%20or%20alertness.\" target=\"_blank\">headaches \u003c/a>that are markedly different than ones in the past, are brought on by exertion, or come with fever, vomiting, loss of coordination, or a change in vision, speech or alertness.\u003c/p>\u003c/blockquote>\n\u003cp>In retrospect, my doctor was taking care of me by pointing out the correct problem: the migraine. In the weeks after that first episode, I had a few more episodes of double vision. It turns out if I stopped what I was doing, closed my eyes and took some deep breaths, my vision returned to normal.\u003c/p>\n\u003cp>That's a lot cheaper and easier than an MRI.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"JxVXk0bjis5QvOXUSNT42V5dBltPTkye\"]\u003c/p>\n\n","blocks":[],"excerpt":"Americans spend $1 billion on brain scans annually, but headaches are almost always nothing serious. ","status":"publish","parent":0,"modified":1396988305,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":22,"wordCount":690},"headData":{"title":"Yes, It's A Headache. No, I Didn't Need That Brain Scan | KQED","description":"Americans spend $1 billion on brain scans annually, but headaches are almost always nothing serious. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"18171 http://blogs.kqed.org/stateofhealth/?p=18171","disqusUrl":"https://ww2.kqed.org/stateofhealth/2014/03/18/yes-its-a-headache-no-i-didnt-need-that-brain-scan/","disqusTitle":"Yes, It's A Headache. No, I Didn't Need That Brain Scan","path":"/stateofhealth/18171/yes-its-a-headache-no-i-didnt-need-that-brain-scan","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cfigure id=\"attachment_18177\" class=\"wp-caption aligncenter\" style=\"max-width: 640px\">\u003ca href=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/stk116189rke-e1395165944260.jpg\">\u003cimg class=\"size-large wp-image-18177\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2014/03/stk116189rke-640x425.jpg\" alt=\"Headaches are almost never caused by a tumor, say neurologists. (Getty Images)\" width=\"640\" height=\"425\">\u003c/a>\u003cfigcaption class=\"wp-caption-text\">Headaches are almost never caused by a tumor, say neurologists. (Getty Images)\u003c/figcaption>\u003c/figure>\n\u003cp>Over at NPR, the Shots blog reports that Americans get $1 billion (yes, with a \"B\") worth of brain scans every year -- because they have a headache. That's according to research at the University of Michigan.\u003c/p>\n\u003cp>Headaches are one of the most common reasons people go to the doctor -- up to a quarter of all doctor visits, says Shots.\u003c/p>\n\u003caside class=\"pullquote alignleft\">Sending a billion dollars \"down the drain.\" Annually.\u003c/aside>\n\u003cp>Presumably people are getting the scans because they're worried that headache is a sign of something much more scary -- say a brain tumor.\u003c/p>\n\u003cp>There's just one problem. Most headaches are just that -- a headache.\u003c/p>\n\u003cp>From the \u003ca href=\"http://www.npr.org/blogs/health/2014/03/18/291044766/yes-its-a-headache-no-you-dont-need-a-brain-scan\" target=\"_blank\">Shots post\u003c/a>:\u003c!--more-->\u003c/p>\n\u003cblockquote>\u003cp>(S)ince headaches are almost never caused by a tumor or other serious brain problem, that $1 billion is money down the drain, according to Dr. Brian Callaghan, the assistant professor of neurology who led the study.\u003c/p>\n\u003cp>\"It's such a big number,\" Callaghan told Shots. \"It's just an incredible number of MRIs and CTs that people get.\"\u003c/p>\n\u003cp>From 2007 to 2010, people visited the doctor 51 million times for headache-related problems, according to a national database of outpatient visits. And 12 percent of the time, the doctors sent their patients for a brain scan. Those numbers are on the rise, the analysis found, even though \u003ca href=\"http://www.choosingwisely.org/doctor-patient-lists/imaging-tests-for-headaches/\" target=\"_blank\">guidelines \u003c/a>urge doctors to shun the scans. The \u003ca href=\"https://archinte.jamanetwork.com/article.aspx?articleid=1835347\" target=\"_blank\">results \u003c/a>were published Monday in \u003cem>JAMA Internal Medicine\u003c/em>.\u003c/p>\u003c/blockquote>\n\u003cp>I'm guilty of sending part of that billion down the drain. A few years ago, I was driving on the highway with my two children in the back seat. I glanced down, then back at the road, and suddenly was seeing double. I managed to pull over but was very shaken. I didn't know if I was having a stroke. But over a few minutes, the symptoms subsided. I won't drag you through everything I did next, but in short, I got home safely and made an appointment with the doctor.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She listened to my story, then pointed out that this episode was likely a version of the migraines I get. Migraines are often preceded by an aura, a visual effect that can include \u003ca href=\"http://www.mayoclinic.org/diseases-conditions/migraine-with-aura/basics/definition/con-20030404\" target=\"_blank\">flashing lights or blind spots\u003c/a>, according to the Mayo Clinic.\u003c/p>\n\u003cp>But I was freaked out. She referred me to an ophthalmologist with whom I had a long conversation about getting an MRI. He said he wouldn't do it.\u003c/p>\n\u003cp>I did it.\u003c/p>\n\u003cp>I was lucky -- not because the MRI came back normal (which I'm sure you expected by now) but also because it didn't turn up any false positives as can happen, often, with MRIs. If the MRI turns up something suspicious, it can \"prompt a cascade of tests and invasive procedures,\" Shots says, over things that will never cause any harm.\u003c/p>\n\u003cp>But that's not as bad as a CT scan -- in that case, you're exposing your brain to needless radiation. Personally, I like my brain not irradiated, if at all possible.\u003c/p>\n\u003cp>Patients like me certainly bear some responsibility, but doctors are guilty as well, says Callaghan. Ordering a scan both gets the patient out the door quickly and it does make the patient feel like someone is taking care of them.\u003c/p>\n\u003cp>Still, there are times you should worry. Again, from Shots:\u003c/p>\n\u003cblockquote>\u003cp>When should we worry? If a \u003ca href=\"http://www.nlm.nih.gov/medlineplus/headache.html\" target=\"_blank\">severe headache\u003c/a> strikes suddenly, the neurologists say. People also should seek medical help for \u003ca href=\"http://www.npr.org/blogs/health/2014/03/18/291044766/Different%20from%20other%20headaches%20you've%20had%20in%20the%20past,%20especially%20if%20you're%2050%20or%20older.%20Brought%20on%20by%20exertion.%20Accompanied%20by%20fever,%20seizure,%20vomiting,%20a%20loss%20of%20coordination,%20or%20a%20change%20in%20vision,%20speech,%20or%20alertness.\" target=\"_blank\">headaches \u003c/a>that are markedly different than ones in the past, are brought on by exertion, or come with fever, vomiting, loss of coordination, or a change in vision, speech or alertness.\u003c/p>\u003c/blockquote>\n\u003cp>In retrospect, my doctor was taking care of me by pointing out the correct problem: the migraine. In the weeks after that first episode, I had a few more episodes of double vision. It turns out if I stopped what I was doing, closed my eyes and took some deep breaths, my vision returned to normal.\u003c/p>\n\u003cp>That's a lot cheaper and easier than an MRI.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>[contextly_auto_sidebar id=\"JxVXk0bjis5QvOXUSNT42V5dBltPTkye\"]\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/18171/yes-its-a-headache-no-i-didnt-need-that-brain-scan","authors":["240"],"categories":["stateofhealth_12","stateofhealth_13"],"tags":["stateofhealth_235","stateofhealth_461"],"featImg":"stateofhealth_18177","label":"stateofhealth"},"stateofhealth_14082":{"type":"posts","id":"stateofhealth_14082","meta":{"index":"posts_1591205157","site":"stateofhealth","id":"14082","score":null,"sort":[1375720844000]},"guestAuthors":[],"slug":"when-treating-stage-zero-breast-cancer-can-less-be-more","title":"When Treating ‘Stage Zero Breast Cancer,’ Can Less Be More? ","publishDate":1375720844,"format":"aside","headTitle":"State of Health | KQED News","labelTerm":{"site":"stateofhealth"},"content":"\u003cp>By Patti Neighmond and Richard Knox, \u003ca href=\"http://www.npr.org/blogs/health/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_14089\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-14089\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/tonigreaves_npr-peggymacdonald-0068-3000_custom-b670792b14b188500fd97e8ce18ac89bef6425bb-s40-620x412.jpg\" alt=\"Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.\" width=\"620\" height=\"412\">\u003cfigcaption class=\"wp-caption-text\">Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cp>When Sally O'Neill's doctor told her she had an early form of cancer in one of her breasts, she didn't agonize about what she wanted to.\u003c/p>\n\u003cp>The 42-year-old mother of two young girls wanted a double mastectomy.\u003c/p>\n\u003caside class=\"pullquote alignleft\">In many cases it doesn't ever progress to invasive cancer, the type that can be life-threatening.\u003c/aside>\n\u003cp>\"I decided at that moment that I wanted them both taken off,\" says O'Neill, who lives in a suburb of Boston. \"There wasn't a real lot of thought process to it. I always thought, 'If this happens to me, this is what I'm going to do.' Because I'm not taking any chances. I want the best possible outcome. I don't want to do a wait-and-see.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today, 10 years later, O'Neill has no regrets about what most people would consider a radical decision. And as it turns out, she was at the leading edge of a \u003ca href=\"http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it\">trend\u003c/a>.\u003c/p>\n\u003cp>O'Neill had \u003ca href=\"http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page4\">ductal carcinoma in situ, or DCIS\u003c/a>. The number of women who get double mastectomies because of DCIS is small – around one in 16 women (see accompanying chart). But the rate has doubled in the past 10 years.\u003c!--more-->\u003c/p>\n\u003cp>DCIS is an abnormality that most specialists call \"stage zero\" breast cancer – on a scale of 1 to 4. In many cases it doesn't ever progress to invasive cancer, the type that can be life-threatening.\u003c/p>\n\u003cp>These women are in a very different position than actress Angelina Jolie,who recently chose to have a double mastectomy. She has a gene mutation that gives her a very high risk of breast cancer. \u003ca href=\"http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it\">Research shows\u003c/a>\u003cdel>\u003c/del> many of the women choosing double mastectomy have the same diagnosis as O'Neill, not Jolie.\u003cdel>\u003c/del>\u003c/p>\n\u003cp>The debate over appropriate treatment for DCIS is part of an even bigger debate about what many specialists call the \"over\u003cdel>\u003c/del>diagnosis\" of cancer, especially cancers of the breast, prostate and thyroid.\u003c/p>\n\u003cp>This means the discovery of growths that look like cancer, but are not destined to cause the patient a problem if they go untreated.\u003c/p>\n\u003cp>The National Cancer Institute recently convened a group to look at overdiagnosis and overtreatment of cancer. \u003cem>JAMA\u003c/em>, the journal of the American Medical Association, last week \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/07/29/cutting-down-on-cancer-overdiagnosis-national-panel-weighs-in/\" target=\"_blank\">published a summary\u003c/a> of its conclusions.\u003c/p>\n\u003cp>Overdiagnosis is a product of widespread screening programs that look for cancers before they cause symptoms, on the assumption that early treatment will invariably reduce the chance that a cancer will kill. There's growing evidence that's not necessarily true.\u003c/p>\n\u003cp>Routine mammography and PSA screening for prostate cancer are thought to reveal many malignancies that wouldn't show up otherwise. And many doctors worry that a federal task force's new recommendation to increase\u003ca href=\"http://www.npr.org/blogs/health/2013/07/31/206693913/panel-urges-lung-cancer-screening-for-millions-of-americans\"> screening with CT scans to look for early lung cancer\u003c/a> will also lead to overdiagnosis.\u003c/p>\n\u003cp>Stepping back further, the issues of cancer over\u003cdel>\u003c/del>diagnosis and overtreatment are part of an even bigger concern about unnecessary medical care. It's a problem NPR intends to explore in coming months as part of a series we're calling \"Less Is More.\" The series will focus on situations when less treatment may actually be better for patients.\u003c/p>\n\u003cp>DCIS is a touch point of the over\u003cdel>\u003c/del>diagnosis debate. Nearly 70,000 women are diagnosed with it each year. Before mammography screening, only about 3 percent of breast cancers were DCIS. Now the condition accounts for \u003ca href=\"http://www2.mdanderson.org/depts/oncolog/articles/10/1-jan/1-10-compass.html\">about a third\u003c/a> of all \"breast cancers.\"\u003c/p>\n\u003cp>The reason for those quote marks is that, while most cancer doctors view DCIS as a very early stage of breast cancer, a growing number say it really shouldn't be called \"cancer\" at all.\u003c/p>\n\u003cp>DCIS is an overgrowth of cells within the lining of a woman's milk ducts. Such growths are not dangerous unless and until they break through and invade other breast tissue and ultimately spread to lymph nodes and other organs.\u003c/p>\n\u003cp>\"Many of these precancerous lesions are not going to go on to become cancer,\" says Dr. Laura Esserman, a breast cancer surgeon at the UC San Francisco. \"I don't think we should label it as cancer. I think we should call it a 'ductal lesion.' I think people would be much more willing to be calm about it.\"\u003c/p>\n\u003cp>We'll come back to Esserman's ideas about how woman and their doctors should address DCIS. But first, let's go back to Sally O'Neill; her case capsulizes the dilemma.\u003c/p>\n\u003cfigure id=\"attachment_14087\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003cimg class=\"size-full wp-image-14087\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/breast-cancer-300.png\" alt=\"Treatment options by women diagnosed with DCIS. Source: Laura Esserman, UC San Francisco (Chart/NPR)\" width=\"300\" height=\"165\">\u003cfigcaption class=\"wp-caption-text\">Treatment options by women diagnosed with DCIS. Source: Laura Esserman, UC San Francisco (Chart/NPR)\u003c/figcaption>\u003c/figure>\n\u003cp>Her decision to have a double mastectomy, even though she had DCIS in only one breast, was so radical that the first surgeon she consulted refused to do it without a letter from a psychiatrist. \"His exact words were, 'You're cancer-phobic,'\" she says.\u003c/p>\n\u003cp>So she found a different surgeon, Dr. Kevin Hughes at Massachusetts General Hospital. When it comes to treating DCIS, Hughes errs on the side of caution.\u003c/p>\n\u003cp>\"We don't know what percent are not deadly, and we have no idea which patients do or do not have a deadly form of cancer,\" Hughes says. \"So as a surgeon I need to treat every cancer as if it might be deadly, because I don't know which ones are and which ones aren't.\"\u003c/p>\n\u003cp>Hughes does not advocate removing a healthy breast that doesn't have any DCIS. But he'll do it if he thinks a woman wants it for the right reasons.\u003c/p>\n\u003cp>\"If they want to take the opposite breast off to never experience breast cancer again, that ... is a good reason to do it,\" Hughes says. \"If they are taking their opposite breast off so they will live longer, that's not a good reason to take the opposite breast off.\"\u003c/p>\n\u003cp>This is a critical point. Many women – perhaps assuming all breast cancers are dangerous – may believe that removing the healthy breast after a diagnosis of DCIS improves their chances of survival.\u003c/p>\n\u003cp>But DCIS is nearly 100 percent curable. Typically, the treatment is a small operation called \u003ca href=\"http://www.breastcancer.org/treatment/surgery/lumpectomy\">lumpectomy\u003c/a>, often but not always followed by radiation to the area. (About a quarter of women with DCIS have a single mastectomy, usually because the abnormal growth occupies too great a percentage of the breast to make lumpectomy feasible.)\u003c/p>\n\u003cp>The chance of DCIS later appearing in the opposite breast is not precisely known, but is thought to be well under 1 percent per year. And Hughes points out that if DCIS does appear in the second breast – or even if invasive cancer turns up –it would likely be highly curable, too.\u003c/p>\n\u003cp>\"We normally find it at a very early, very curable stage,\" Hughes says. \"We very seldom have patients die from cancer in the opposite breast.\"\u003c/p>\n\u003cp>Some say concern about survival is not the only thing that's driving some women to seek a double mastectomy.\u003c/p>\n\u003cp>Patients may be distressed about the experience of breast cancer diagnosis and treatment and have a \"very strong aversion\" to going through it again, Seema Khan of Northwestern University writes in a \u003ca href=\"http://jco.ascopubs.org/content/29/16/2132.full.pdf\">commentary\u003c/a> in the \u003cem>Journal of Clinical Oncology\u003c/em>.\u003c/p>\n\u003cp>Whatever their reasons, some patients and some doctors are pushing back against what they consider too much treatment for DCIS.\u003c/p>\n\u003cp>Peggy MacDonald of Portland, Ore., is one of those patients. She was stunned after she recently got a diagnosis of DCIS and discovered that all the doctors she saw thought she should have surgery to remove it – right away.\u003c/p>\n\u003cp>\"Quite honestly,\" she says, \"I just didn't like the options being presented to me. It didn't ... make sense to me.\"\u003c/p>\n\u003cp>None of the surgeons recommended that MacDonald should remove her healthy breast, but all agreed she should have surgery. She was almost ready to give in when one of her sisters sent her an article quoting Esserman, the San Francisco breast surgeon.\u003c/p>\n\u003cp>MacDonald made an appointment to see Esserman, and discovered a different approach.\u003c/p>\n\u003cp>\"She said, 'OK, I've looked at your MRI, I've looked at your mammograms, I've looked at your blood tests. Here's what I will tell you – this is not an emergency and you have options,'\" MacDonald says.\u003c/p>\n\u003cp>Esserman stresses there's no need for women to rush into surgery after a DCIS diagnosis.\u003c/p>\n\u003cp>\"I think we all need to take a step back and not be so hysterical,\" Esserman says. \"When I see people who've been told they've got to make a decision within two weeks, that's just crazy! No one has shown a progression [from DCIS] to invasive cancer in a two-week period of time – ever.\"\u003c/p>\n\u003cp>After seeing Esserman, MacDonald decided not to have surgery, at least for now. Instead, the doctor put her on \u003ca href=\"http://www.breastcancer.org/treatment/hormonal\">hormone suppression therapy\u003c/a>. McDonald now takes a drug that blocks estrogen. Because her DCIS cells are fueled by estrogen, the hope is that once they are starved of the hormone the cells will shrink and perhaps even disappear.\u003c/p>\n\u003cp>MacDonald says she realizes she may end up needing surgery anyway, but if so she'll be clearer about the decision.\u003c/p>\n\u003cp>She's hoping her case will turn out like another of Esserman's patients, Barbara Mann. Mann took an estrogen-blocking medication as well, for six months. Today, an MRI scan and biopsy show no trace of DCIS in her breast.\u003c/p>\n\u003cp>\"It's amazing,\" Mann says. \"It's not even a case of less-is-more. This is a case of less-is-best. I am just hugely relieved, absolutely thrilled. And what I would really like is for every other woman in my position to know this is an option.\"\u003c/p>\n\u003cp>But it's an option that will require lifelong vigilance. Anyone who chooses not to have surgery will have to be watched carefully and have routine mammograms and maybe even MRI scans and biopsies.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>And women who choose this alternate route must be willing to live with the risk, however tiny, that DCIS might return, and might turn into invasive cancer.\u003c/p>\n\n","blocks":[],"excerpt":"DCIS is a touch point of the overdiagnosis debate. Nearly 70,000 women are diagnosed with it each year. Before mammography screening, only about 3 percent of breast cancers were DCIS. Now the condition accounts for about a third of all \"breast cancers.\"\r\n\r\nThe reason for those quote marks is that, while most cancer doctors view DCIS as a very early stage of breast cancer, a growing number say it really shouldn't be called \"cancer\" at all.","status":"publish","parent":0,"modified":1375758538,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":46,"wordCount":1713},"headData":{"title":"When Treating ‘Stage Zero Breast Cancer,’ Can Less Be More? | KQED","description":"DCIS is a touch point of the overdiagnosis debate. Nearly 70,000 women are diagnosed with it each year. Before mammography screening, only about 3 percent of breast cancers were DCIS. Now the condition accounts for about a third of all "breast cancers."\r\n\r\nThe reason for those quote marks is that, while most cancer doctors view DCIS as a very early stage of breast cancer, a growing number say it really shouldn't be called "cancer" at all.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"14082 http://blogs.kqed.org/stateofhealth/?p=14082","disqusUrl":"https://ww2.kqed.org/stateofhealth/2013/08/05/when-treating-stage-zero-breast-cancer-can-less-be-more/","disqusTitle":"When Treating ‘Stage Zero Breast Cancer,’ Can Less Be More? ","path":"/stateofhealth/14082/when-treating-stage-zero-breast-cancer-can-less-be-more","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>By Patti Neighmond and Richard Knox, \u003ca href=\"http://www.npr.org/blogs/health/2013/08/05/208239545/when-treating-abnormal-breast-cells-sometimes-less-is-more\" target=\"_blank\">NPR\u003c/a>\u003c/p>\n\u003cfigure id=\"attachment_14089\" class=\"wp-caption aligncenter\" style=\"max-width: 620px\">\u003cimg class=\"size-large wp-image-14089\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/tonigreaves_npr-peggymacdonald-0068-3000_custom-b670792b14b188500fd97e8ce18ac89bef6425bb-s40-620x412.jpg\" alt=\"Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.\" width=\"620\" height=\"412\">\u003cfigcaption class=\"wp-caption-text\">Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.\u003c/figcaption>\u003c/figure>\n\u003cp> \u003c/p>\n\u003cp>When Sally O'Neill's doctor told her she had an early form of cancer in one of her breasts, she didn't agonize about what she wanted to.\u003c/p>\n\u003cp>The 42-year-old mother of two young girls wanted a double mastectomy.\u003c/p>\n\u003caside class=\"pullquote alignleft\">In many cases it doesn't ever progress to invasive cancer, the type that can be life-threatening.\u003c/aside>\n\u003cp>\"I decided at that moment that I wanted them both taken off,\" says O'Neill, who lives in a suburb of Boston. \"There wasn't a real lot of thought process to it. I always thought, 'If this happens to me, this is what I'm going to do.' Because I'm not taking any chances. I want the best possible outcome. I don't want to do a wait-and-see.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today, 10 years later, O'Neill has no regrets about what most people would consider a radical decision. And as it turns out, she was at the leading edge of a \u003ca href=\"http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it\">trend\u003c/a>.\u003c/p>\n\u003cp>O'Neill had \u003ca href=\"http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page4\">ductal carcinoma in situ, or DCIS\u003c/a>. The number of women who get double mastectomies because of DCIS is small – around one in 16 women (see accompanying chart). But the rate has doubled in the past 10 years.\u003c!--more-->\u003c/p>\n\u003cp>DCIS is an abnormality that most specialists call \"stage zero\" breast cancer – on a scale of 1 to 4. In many cases it doesn't ever progress to invasive cancer, the type that can be life-threatening.\u003c/p>\n\u003cp>These women are in a very different position than actress Angelina Jolie,who recently chose to have a double mastectomy. She has a gene mutation that gives her a very high risk of breast cancer. \u003ca href=\"http://www.npr.org/blogs/health/2012/11/28/166064484/more-women-choose-double-mastectomy-but-study-says-many-dont-need-it\">Research shows\u003c/a>\u003cdel>\u003c/del> many of the women choosing double mastectomy have the same diagnosis as O'Neill, not Jolie.\u003cdel>\u003c/del>\u003c/p>\n\u003cp>The debate over appropriate treatment for DCIS is part of an even bigger debate about what many specialists call the \"over\u003cdel>\u003c/del>diagnosis\" of cancer, especially cancers of the breast, prostate and thyroid.\u003c/p>\n\u003cp>This means the discovery of growths that look like cancer, but are not destined to cause the patient a problem if they go untreated.\u003c/p>\n\u003cp>The National Cancer Institute recently convened a group to look at overdiagnosis and overtreatment of cancer. \u003cem>JAMA\u003c/em>, the journal of the American Medical Association, last week \u003ca href=\"http://ww2.kqed.org/stateofhealth/2013/07/29/cutting-down-on-cancer-overdiagnosis-national-panel-weighs-in/\" target=\"_blank\">published a summary\u003c/a> of its conclusions.\u003c/p>\n\u003cp>Overdiagnosis is a product of widespread screening programs that look for cancers before they cause symptoms, on the assumption that early treatment will invariably reduce the chance that a cancer will kill. There's growing evidence that's not necessarily true.\u003c/p>\n\u003cp>Routine mammography and PSA screening for prostate cancer are thought to reveal many malignancies that wouldn't show up otherwise. And many doctors worry that a federal task force's new recommendation to increase\u003ca href=\"http://www.npr.org/blogs/health/2013/07/31/206693913/panel-urges-lung-cancer-screening-for-millions-of-americans\"> screening with CT scans to look for early lung cancer\u003c/a> will also lead to overdiagnosis.\u003c/p>\n\u003cp>Stepping back further, the issues of cancer over\u003cdel>\u003c/del>diagnosis and overtreatment are part of an even bigger concern about unnecessary medical care. It's a problem NPR intends to explore in coming months as part of a series we're calling \"Less Is More.\" The series will focus on situations when less treatment may actually be better for patients.\u003c/p>\n\u003cp>DCIS is a touch point of the over\u003cdel>\u003c/del>diagnosis debate. Nearly 70,000 women are diagnosed with it each year. Before mammography screening, only about 3 percent of breast cancers were DCIS. Now the condition accounts for \u003ca href=\"http://www2.mdanderson.org/depts/oncolog/articles/10/1-jan/1-10-compass.html\">about a third\u003c/a> of all \"breast cancers.\"\u003c/p>\n\u003cp>The reason for those quote marks is that, while most cancer doctors view DCIS as a very early stage of breast cancer, a growing number say it really shouldn't be called \"cancer\" at all.\u003c/p>\n\u003cp>DCIS is an overgrowth of cells within the lining of a woman's milk ducts. Such growths are not dangerous unless and until they break through and invade other breast tissue and ultimately spread to lymph nodes and other organs.\u003c/p>\n\u003cp>\"Many of these precancerous lesions are not going to go on to become cancer,\" says Dr. Laura Esserman, a breast cancer surgeon at the UC San Francisco. \"I don't think we should label it as cancer. I think we should call it a 'ductal lesion.' I think people would be much more willing to be calm about it.\"\u003c/p>\n\u003cp>We'll come back to Esserman's ideas about how woman and their doctors should address DCIS. But first, let's go back to Sally O'Neill; her case capsulizes the dilemma.\u003c/p>\n\u003cfigure id=\"attachment_14087\" class=\"wp-caption alignright\" style=\"max-width: 300px\">\u003cimg class=\"size-full wp-image-14087\" title=\"\" src=\"http://ww2.kqed.org/stateofhealth/wp-content/uploads/sites/27/2013/08/breast-cancer-300.png\" alt=\"Treatment options by women diagnosed with DCIS. Source: Laura Esserman, UC San Francisco (Chart/NPR)\" width=\"300\" height=\"165\">\u003cfigcaption class=\"wp-caption-text\">Treatment options by women diagnosed with DCIS. Source: Laura Esserman, UC San Francisco (Chart/NPR)\u003c/figcaption>\u003c/figure>\n\u003cp>Her decision to have a double mastectomy, even though she had DCIS in only one breast, was so radical that the first surgeon she consulted refused to do it without a letter from a psychiatrist. \"His exact words were, 'You're cancer-phobic,'\" she says.\u003c/p>\n\u003cp>So she found a different surgeon, Dr. Kevin Hughes at Massachusetts General Hospital. When it comes to treating DCIS, Hughes errs on the side of caution.\u003c/p>\n\u003cp>\"We don't know what percent are not deadly, and we have no idea which patients do or do not have a deadly form of cancer,\" Hughes says. \"So as a surgeon I need to treat every cancer as if it might be deadly, because I don't know which ones are and which ones aren't.\"\u003c/p>\n\u003cp>Hughes does not advocate removing a healthy breast that doesn't have any DCIS. But he'll do it if he thinks a woman wants it for the right reasons.\u003c/p>\n\u003cp>\"If they want to take the opposite breast off to never experience breast cancer again, that ... is a good reason to do it,\" Hughes says. \"If they are taking their opposite breast off so they will live longer, that's not a good reason to take the opposite breast off.\"\u003c/p>\n\u003cp>This is a critical point. Many women – perhaps assuming all breast cancers are dangerous – may believe that removing the healthy breast after a diagnosis of DCIS improves their chances of survival.\u003c/p>\n\u003cp>But DCIS is nearly 100 percent curable. Typically, the treatment is a small operation called \u003ca href=\"http://www.breastcancer.org/treatment/surgery/lumpectomy\">lumpectomy\u003c/a>, often but not always followed by radiation to the area. (About a quarter of women with DCIS have a single mastectomy, usually because the abnormal growth occupies too great a percentage of the breast to make lumpectomy feasible.)\u003c/p>\n\u003cp>The chance of DCIS later appearing in the opposite breast is not precisely known, but is thought to be well under 1 percent per year. And Hughes points out that if DCIS does appear in the second breast – or even if invasive cancer turns up –it would likely be highly curable, too.\u003c/p>\n\u003cp>\"We normally find it at a very early, very curable stage,\" Hughes says. \"We very seldom have patients die from cancer in the opposite breast.\"\u003c/p>\n\u003cp>Some say concern about survival is not the only thing that's driving some women to seek a double mastectomy.\u003c/p>\n\u003cp>Patients may be distressed about the experience of breast cancer diagnosis and treatment and have a \"very strong aversion\" to going through it again, Seema Khan of Northwestern University writes in a \u003ca href=\"http://jco.ascopubs.org/content/29/16/2132.full.pdf\">commentary\u003c/a> in the \u003cem>Journal of Clinical Oncology\u003c/em>.\u003c/p>\n\u003cp>Whatever their reasons, some patients and some doctors are pushing back against what they consider too much treatment for DCIS.\u003c/p>\n\u003cp>Peggy MacDonald of Portland, Ore., is one of those patients. She was stunned after she recently got a diagnosis of DCIS and discovered that all the doctors she saw thought she should have surgery to remove it – right away.\u003c/p>\n\u003cp>\"Quite honestly,\" she says, \"I just didn't like the options being presented to me. It didn't ... make sense to me.\"\u003c/p>\n\u003cp>None of the surgeons recommended that MacDonald should remove her healthy breast, but all agreed she should have surgery. She was almost ready to give in when one of her sisters sent her an article quoting Esserman, the San Francisco breast surgeon.\u003c/p>\n\u003cp>MacDonald made an appointment to see Esserman, and discovered a different approach.\u003c/p>\n\u003cp>\"She said, 'OK, I've looked at your MRI, I've looked at your mammograms, I've looked at your blood tests. Here's what I will tell you – this is not an emergency and you have options,'\" MacDonald says.\u003c/p>\n\u003cp>Esserman stresses there's no need for women to rush into surgery after a DCIS diagnosis.\u003c/p>\n\u003cp>\"I think we all need to take a step back and not be so hysterical,\" Esserman says. \"When I see people who've been told they've got to make a decision within two weeks, that's just crazy! No one has shown a progression [from DCIS] to invasive cancer in a two-week period of time – ever.\"\u003c/p>\n\u003cp>After seeing Esserman, MacDonald decided not to have surgery, at least for now. Instead, the doctor put her on \u003ca href=\"http://www.breastcancer.org/treatment/hormonal\">hormone suppression therapy\u003c/a>. McDonald now takes a drug that blocks estrogen. Because her DCIS cells are fueled by estrogen, the hope is that once they are starved of the hormone the cells will shrink and perhaps even disappear.\u003c/p>\n\u003cp>MacDonald says she realizes she may end up needing surgery anyway, but if so she'll be clearer about the decision.\u003c/p>\n\u003cp>She's hoping her case will turn out like another of Esserman's patients, Barbara Mann. Mann took an estrogen-blocking medication as well, for six months. Today, an MRI scan and biopsy show no trace of DCIS in her breast.\u003c/p>\n\u003cp>\"It's amazing,\" Mann says. \"It's not even a case of less-is-more. This is a case of less-is-best. I am just hugely relieved, absolutely thrilled. And what I would really like is for every other woman in my position to know this is an option.\"\u003c/p>\n\u003cp>But it's an option that will require lifelong vigilance. Anyone who chooses not to have surgery will have to be watched carefully and have routine mammograms and maybe even MRI scans and biopsies.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And women who choose this alternate route must be willing to live with the risk, however tiny, that DCIS might return, and might turn into invasive cancer.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/stateofhealth/14082/when-treating-stage-zero-breast-cancer-can-less-be-more","authors":["8344"],"categories":["stateofhealth_13"],"tags":["stateofhealth_46","stateofhealth_235","stateofhealth_461"],"featImg":"stateofhealth_14089","label":"stateofhealth"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. 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Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. Michel Martin hosts on the weekends.","airtime":"MON-FRI 1pm-2pm, 4:30pm-6:30pm\u003cbr />SAT-SUN 5pm-6pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/All-Things-Considered-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/all-things-considered/","meta":{"site":"news","source":"npr"},"link":"/radio/program/all-things-considered"},"american-suburb-podcast":{"id":"american-suburb-podcast","title":"American Suburb: The Podcast","tagline":"The flip side of gentrification, told through one town","info":"Gentrification is changing cities across America, forcing people from neighborhoods they have long called home. Call them the displaced. Now those priced out of the Bay Area are looking for a better life in an unlikely place. American Suburb follows this migration to one California town along the Delta, 45 miles from San Francisco. But is this once sleepy suburb ready for them?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/American-Suburb-Podcast-Tile-703x703-1.jpg","officialWebsiteLink":"/news/series/american-suburb-podcast","meta":{"site":"news","source":"kqed","order":"13"},"link":"/news/series/american-suburb-podcast/","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=1287748328","tuneIn":"https://tunein.com/radio/American-Suburb-p1086805/","rss":"https://ww2.kqed.org/news/series/american-suburb-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkMzMDExODgxNjA5"}},"baycurious":{"id":"baycurious","title":"Bay Curious","tagline":"Exploring the Bay Area, one question at a time","info":"KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg","imageAlt":"\"KQED Bay Curious","officialWebsiteLink":"/news/series/baycurious","meta":{"site":"news","source":"kqed","order":"4"},"link":"/podcasts/baycurious","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/bay-curious/id1172473406","npr":"https://www.npr.org/podcasts/500557090/bay-curious","rss":"https://ww2.kqed.org/news/category/bay-curious-podcast/feed/podcast","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93dzIua3FlZC5vcmcvbmV3cy9jYXRlZ29yeS9iYXktY3VyaW91cy1wb2RjYXN0L2ZlZWQvcG9kY2FzdA","stitcher":"https://www.stitcher.com/podcast/kqed/bay-curious","spotify":"https://open.spotify.com/show/6O76IdmhixfijmhTZLIJ8k"}},"bbc-world-service":{"id":"bbc-world-service","title":"BBC World Service","info":"The day's top stories from BBC News compiled twice daily in the week, once at weekends.","airtime":"MON-FRI 9pm-10pm, TUE-FRI 1am-2am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.bbc.co.uk/sounds/play/live:bbc_world_service","meta":{"site":"news","source":"BBC World Service"},"link":"/radio/program/bbc-world-service","subscribe":{"apple":"https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2","tuneIn":"https://tunein.com/radio/BBC-World-Service-p455581/","rss":"https://podcasts.files.bbci.co.uk/p02nq0gn.rss"}},"code-switch-life-kit":{"id":"code-switch-life-kit","title":"Code Switch / Life Kit","info":"\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />","airtime":"SUN 9pm-10pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg","meta":{"site":"radio","source":"npr"},"link":"/radio/program/code-switch-life-kit","subscribe":{"apple":"https://podcasts.apple.com/podcast/1112190608?mt=2&at=11l79Y&ct=nprdirectory","google":"https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy","spotify":"https://open.spotify.com/show/3bExJ9JQpkwNhoHvaIIuyV","rss":"https://feeds.npr.org/510312/podcast.xml"}},"commonwealth-club":{"id":"commonwealth-club","title":"Commonwealth Club of California Podcast","info":"The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.","airtime":"THU 10pm, FRI 1am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.commonwealthclub.org/podcasts","meta":{"site":"news","source":"Commonwealth Club of California"},"link":"/radio/program/commonwealth-club","subscribe":{"apple":"https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2","google":"https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw","tuneIn":"https://tunein.com/radio/Commonwealth-Club-of-California-p1060/"}},"considerthis":{"id":"considerthis","title":"Consider This","tagline":"Make sense of the day","info":"Make sense of the day. Every weekday afternoon, Consider This helps you consider the major stories of the day in less than 15 minutes, featuring the reporting and storytelling resources of NPR. Plus, KQED’s Bianca Taylor brings you the local KQED news you need to know.","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Consider-This-Podcast-Tile-703x703-1.jpg","imageAlt":"Consider This from NPR and KQED","officialWebsiteLink":"/podcasts/considerthis","meta":{"site":"news","source":"kqed","order":"7"},"link":"/podcasts/considerthis","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1503226625?mt=2&at=11l79Y&ct=nprdirectory","npr":"https://rpb3r.app.goo.gl/coronavirusdaily","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM1NS9wb2RjYXN0LnhtbA","spotify":"https://open.spotify.com/show/3Z6JdCS2d0eFEpXHKI6WqH"}},"forum":{"id":"forum","title":"Forum","tagline":"The conversation starts here","info":"KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.","airtime":"MON-FRI 9am-11am, 10pm-11pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED Forum with Mina Kim and Alexis Madrigal","officialWebsiteLink":"/forum","meta":{"site":"news","source":"kqed","order":"8"},"link":"/forum","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz","npr":"https://www.npr.org/podcasts/432307980/forum","stitcher":"https://www.stitcher.com/podcast/kqedfm-kqeds-forum-podcast","rss":"https://feeds.megaphone.fm/KQINC9557381633"}},"freakonomics-radio":{"id":"freakonomics-radio","title":"Freakonomics Radio","info":"Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. 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One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.","airtime":"MON-FRI 7pm-8pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/fresh-air/","meta":{"site":"radio","source":"npr"},"link":"/radio/program/fresh-air","subscribe":{"npr":"https://rpb3r.app.goo.gl/4s8b","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Fresh-Air-p17/","rss":"https://feeds.npr.org/381444908/podcast.xml"}},"here-and-now":{"id":"here-and-now","title":"Here & Now","info":"A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.","airtime":"MON-THU 11am-12pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Here-And-Now-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"http://www.wbur.org/hereandnow","meta":{"site":"news","source":"npr"},"link":"/radio/program/here-and-now","subsdcribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?mt=2&id=426698661","tuneIn":"https://tunein.com/radio/Here--Now-p211/","rss":"https://feeds.npr.org/510051/podcast.xml"}},"how-i-built-this":{"id":"how-i-built-this","title":"How I Built This with Guy Raz","info":"Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.","imageSrc":"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png","officialWebsiteLink":"https://www.npr.org/podcasts/510313/how-i-built-this","airtime":"SUN 7:30pm-8pm","meta":{"site":"news","source":"npr"},"link":"/radio/program/how-i-built-this","subscribe":{"npr":"https://rpb3r.app.goo.gl/3zxy","apple":"https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2","tuneIn":"https://tunein.com/podcasts/Arts--Culture-Podcasts/How-I-Built-This-p910896/","rss":"https://feeds.npr.org/510313/podcast.xml"}},"inside-europe":{"id":"inside-europe","title":"Inside Europe","info":"Inside Europe, a one-hour weekly news magazine hosted by Helen Seeney and Keith Walker, explores the topical issues shaping the continent. No other part of the globe has experienced such dynamic political and social change in recent years.","airtime":"SAT 3am-4am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Inside-Europe-Podcast-Tile-300x300-1.jpg","meta":{"site":"news","source":"Deutsche Welle"},"link":"/radio/program/inside-europe","subscribe":{"apple":"https://itunes.apple.com/us/podcast/inside-europe/id80106806?mt=2","tuneIn":"https://tunein.com/radio/Inside-Europe-p731/","rss":"https://partner.dw.com/xml/podcast_inside-europe"}},"latino-usa":{"id":"latino-usa","title":"Latino USA","airtime":"MON 1am-2am, SUN 6pm-7pm","info":"Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg","officialWebsiteLink":"http://latinousa.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/latino-usa","subscribe":{"npr":"https://rpb3r.app.goo.gl/xtTd","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/Latino-USA-p621/","rss":"https://feeds.npr.org/510016/podcast.xml"}},"live-from-here-highlights":{"id":"live-from-here-highlights","title":"Live from Here Highlights","info":"Chris Thile steps to the mic as the host of Live from Here (formerly A Prairie Home Companion), a live public radio variety show. 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Updated Monday through Friday at about 3:30 p.m. PT.","airtime":"MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.marketplace.org/","meta":{"site":"news","source":"American Public Media"},"link":"/radio/program/marketplace","subscribe":{"apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=201853034&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/APM-Marketplace-p88/","rss":"https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"}},"mindshift":{"id":"mindshift","title":"MindShift","tagline":"A podcast about the future of learning and how we raise our kids","info":"The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. 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