Mammography Debates Do Not Influence Screening Decision For Women and Doctors
Despite the recent hullabaloo over when mammography screenings should be done, consumers and clinicians are still not swayed, according to a recent Medscape study on 500 medical professionals and consumers.
In fact, the prevailing fear is financial, according to the online database of medical and healthcare information: 80 percent of clinicians and 86 percent of consumers worried that third-party payers and HMOs would use the panel's conflicting recommendations to refuse reimbursement for mammography screenings for women in their 40s.
Regardless of the recent panel findings, when consumers considered the low incidence of breast cancer in women under 40 against the dangers of radiation exposure, the risks of false-positive mammograms in young women with dense breast tissue, and the possibility of false-negatives, 73 percent said the benefits for breast cancer screening starting at 40 outweighed the potential risks.
Similarly, when clinicians were asked whether the panel findings would influence their recommendations, 72 percent said no. (Medscape, Wendy Schwimmer, 212/546-1617)
Are Girls Growing Up Too Fast?
If you thought puberty in American girls blossomed in the pre-teen to early teen years, think again.
Many American girls are reaching puberty much earlier than commonly thought, with nearly half of black girls and 15 percent of white ones starting to develop sexually as early as age 8, according to a study by the University of North Carolina (Chapel Hill) that will be published in the American Academy of Pediatrics' journal Pediatrics.
The study raises disturbing questions about the role of environmental estrogens (byproducts of products like pesticides, plastic wrap and hair products) that may escalate puberty's early onset and if sex education should begin sooner.
"I don't think parents, teachers or society in general have been really thinking of children that young -- second- and third- graders -- having to deal with puberty," said Marcia E. Herman-Giddens, lead author of the study.
The study of 17,000 girls ages 3-12 (10 percent of which were African-American), found that by age 8, 48 percent of the African-American girls and 15 percent of white girls had begun developing breast, pubic hair or both. (UNC-Chapel Hill, 919/966-2253)
Patients' End-of-Life Directives Are Seldom Realized
For patients who have directives on dying -- living wills, health care proxies, and durable powers of attorney -- adherence is abysmal, according to the largest study of their impact on seriously ill patients in U.S hospitals. In fact, only 3 percent of patient directives were found to be specific enough to impact the care of dying patients.
Why do the directives fail? Firstly, of the 4,800 patients in the study only 14 percent wrote directives and seldom told their doctors and secondly, most directives are too vague (3 percent).
The study suggests that the process of writing and implementing advanced directives must be improved to ensure the desirable care, according to the study's lead author, Joan Teno, M.D., associate director of George Washington University's Center to Improve Care for the Dying.
"Patients must give instructions about things that matter, discuss them with their physician and family members, and get them written down.
The instructions must be clear and relevant, and they must be available at the right time," she said. (Burness Communications, Mollie Katz, 301/652-1558)