Screening Controversy and the Next Wave of Patient Empowerment

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Much of what patients heard about the new breast cancer screening guidelines in December of 2009 not only confused them, but also caused quite a debate. Do mammograms need to be done annually? Can patients get screened every other year safely? How does a woman know if she is at average risk or increased risk for breast cancer? On this episode of Patient Power Health Issues , Andrew and Peter discuss the screening guideline controversy, including the idea of a “conspiracy theory,” the source of this data, aggressive screening procedures and the importance of being an empowered patient. Andrew suggests creating forums and platforms welcoming advice and questions from patients and doctors alike could be the starting point to a solution.

You will hear Dr Connie Lehman, director of breast cancer imaging at the Seattle Cancer Care Alliance (SCCA), as she weighs in on the screening controversy. Also joining the discussion is Dr. Sunil Hingorani, a medical oncologist at the SCCA. He concludes the discussion with clearly defining the relationship between patient and doctor. In his own words: The relationship between patient and physician from my perspective has evolved over the last 50 years or so. It went from very much of a sort of almost patriarchal approach where the physician was “up here” and the patient was “here” and you heard from “on high” what they thought you needed…basically it really should be a collaboration, or if anything it should be the patient in the superior position and the physician there to provide the service.

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Andrew Schorr:

Welcome to Patient Power Health Issues. I’m Andrew Schorr way out here in Seattle, and with me is…

Mr. Frishauf:

Peter Frishauf in New York City.

Andrew Schorr:

Peter thank you. I’m so excited that we can kick off this series. There’s lots to talk about, so, so much in the news about cancer screening now. Breast cancer screening really touched a nerve. An advisory group of government appointees, actually, said that women don’t need to be screened so early nor so often for breast cancer. Then we have more news, maybe not touching a nerve so much, from an obstetrics and gynecology group saying in cervical cancer women don’t need to be screened so often; and then there’s always a controversy as you as I know about, what does screening mean for men with prostate cancer; and I’d also like to throw in that we’ll talk about along the way about lung cancer too, which is our biggest cancer, killer.

What do you think is going on about breast cancer screening? Why did it touch such a nerve do you think?

Mr. Frishauf:

I think all of these things have touched a nerve in many areas. It’s kind of the more we know about cancer the less we know about the certainty of our advice, and that’s not entirely a bad thing. Part of it is just the honest conversation. We don’t know a lot. We do know that cancer continues to be a much more complicated disease than anyone fully appreciates, and we also know that within each forms of cancer; whether it’s breast cancer, cervical, prostate, lung, or others; that the different variations of cancer behave very differently. Some go on to be very aggressive and will kill you, and others really won’t. I think more and more clinicians are having the honest conversation with their patients that they don’t really know what to make of all the data.

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