Letters to the Editor


Taking the USPSTF to Task
This letter is in response to the article, “To Screen, And When To Screen” [Clinician Reviews. 2009;19(12):cover, 9]. Despite new emerging technologies, the same test of radiation mammography has been used for years in the diagnosis of breast cancer. The American Cancer Society currently reports on their current Web site: “Ultrasound may be most helpful in women with very dense breasts. Clinical trials are now looking at the benefits and risks of adding breast ultrasound to screening mammograms in women with dense breasts….”

It is a known fact among health care providers that younger women (ages 20 to 40) have denser breast tissue compared to older women. My question is, what took us so long to look at ultrasound technology (which does not use radiation) in screening for breast cancer? With proper research, I suspect that in addition to its usefulness in diagnosing what is on the inside of tumors, it will become the gold standard screening tool of the future!

When I was 26, I had a mass in my right breast the size of a quarter. Since I was young and the doctor told me that younger women have more dense breast tissue, the use of an ultrasound was employed. The mass was diagnosed as a fluid-filled cyst. Since then, I have not had a problem. I am living proof that ultrasound can be an effective diagnostic tool!

It is time for all of us as providers, patients, and family members to step up and let our senators, representatives, and assembly members from each state know that funding needs to be redirected for ultrasound research in screening for breast cancer in the free marketplace.
Lisa Lineweaver, RN, BSN, MS, Virginia Beach, VA

I would like to know how many women compose the USPSTF team—and if there are any, then shame on them. I will tell any female, without family history of breast cancer, to get a baseline mammogram between ages 35 and 40 and then yearly from age 40 on. I have seen too many young women in their 30s with metastatic breast cancer. I have noted that USPSTF’s recommendations in the past have also been very archaic and antiquated.
Ladan Foruraghi, FNP-BC, Bethesda, MD

As far as I’m concerned, after 12 years in oncology as a PA, 15 years in podiatry, and another few years as a general PA, I think [the USPSTF recommendations are] a ploy by insurance companies to get out of reimbursements. How much did they pay the USPSTF to come out with this moronic research?

Here we stand on the brink of a cure for breast and possibly prostate cancer, and these dimwits want to turn around and make preventive medicine a folly? When years of effort to get women to realize what is happening with their bodies and men to realize that problems can occur, by teaching self-exam and vigilance, have finally started to pay off with early detection for those and colon cancer … these lunkheads want to defeat all we have done?

I am so happy I’m retired and out of this health care chaos. I, personally, was diagnosed with non-Hodgkin’s lymphoma accidentally after it was picked up on a CT scan for abdominal discomfort following a hernia repair. I found my own cardiac problems at 39 because I asked to have a stress test before I started an intense exercise program. I ended up with triple CABG at age 39. I am now 63 and on no meds for my heart except a statin. Now they are telling me the concept of preventive medicine and patient education is a bunch of “hooey”?

Sorry, folks. My family will remain in a preventive medicine mode, and I will perpetuate that mode with my daughter. We don’t smoke or drink in my house, we exercise and eat right, we don’t eat junk food or fast food—and we don’t hesitate to speak about our bodies if something seems abnormal to us.

God Bless America and health care ... We are going to need it!
Paul Fogel, DPM, PA-C, Philadelphia, PA

Not Much Alternative on Price
I recently read the article by Melissa Knopper on medical foods [Trends in Health Care. 2009;19(12):3-4]. I agree with her wholeheartedly but find these “foods” unaffordable for most of my patients.

I am a family NP in west central Florida. Most of my patients are on fixed incomes. Many in the younger age-group are unemployed. I am constantly fighting the battle of economics versus medical necessity.

I have had personal experience with Metanx, mentioned in the article, and I am impressed with the results. The problem is again cost. After the samples have been tried and results are seen, too many times I find that the patients can no longer use it, as it costs $1.00 per tablet. The usual dose is one tablet twice a day.

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