Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation

Abstract

Description: Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for breast cancer in the general population.

Methods: The USPSTF examined the evidence on the efficacy of 5 screening modalities in reducing mortality from breast cancer: film mammography, clinical breast examination, breast self-examination, digital mammography, and magnetic resonance imaging in order to update the 2002 recommendation. To accomplish this update, the USPSTF commissioned 2 studies: 1) a targeted systematic evidence review of 6 selected questions relating to benefits and harms of screening, and 2) a decision analysis that used population modeling techniques to compare the expected health outcomes and resource requirements of starting and ending mammography screening at different ages and using annual versus biennial screening intervals.

Recommendations: The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation)

The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation)

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement)

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination beyond screening mammography in women 40 years or older. (I statement)

The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)

The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement)

Happy Diwali

Dear readers, wishing you a very happy diwali and a great new year

Two doctors: Hysterias and Posteriors

""Two doctors, a psychiatrist and a proctologist, opened an office in a
small town and put up a sign reading: "Dr. Smith and Dr. Jones: Hysterias
and Posteriors"

The town council was not happy with the sign, so the doctors changed it to
read, "Schizoids and Hemorrhoids."

This was not acceptable either, so in an effort to satisfy the council,
they changed the sign to "Catatonics and High Colonic'."

No go. Next, they tried "Manic Depressives and Anal Retentive's." Thumbs
down again.

Then came "Minds and Behinds." Still no good.

Another attempt resulted in "Lost Souls and Butt Holes." Unacceptable
again!

So they tried "Analysis and Anal Cysts." Not a chance.

"Nuts and Butts?" No way.

"Freaks and Cheeks?" Still no go.

"Loons and Moons?" Forget it.

Almost at their wit's end, the doctors finally came up with:
"Dr. Smith and Dr. Jones, Odds and Ends."

Everyone loved it !!!""

with thanks to Dr. Sita Bhatt from her posting in forum at pathoindia.com

Kayser-Fleischer ring

Kayser-Fleischer rings (KF rings) are rings that appear to encircle the iris of the eye. They are due to copper deposition as a result of particular liver diseases.

Appearance-The rings, which consist of copper deposits where the cornea meets the sclera, in Descemet's membrane, first appear as a crescent at the top of the cornea. Eventually, a second crescent forms below, at 6 o'clock, and ultimately completely encircles the cornea.

C/F- abnormalities of the basal ganglia of the brain, liver cirrhosis, splenomegaly, involuntary movements, muscle rigidity, psychiatric disturbances, dystonia and dysphagia. The combination of neurological symptoms, a low blood ceruloplasmin level and KF rings is diagnostic of Wilson's disease
Other causes- cholestasis (obstruction of the bile ducts), primary biliary cirrhosis and "cryptogenic" cirrhosis.

lesson to learn- KF rings r not seen only in wilsons disease, it can also be seen in chronic liver diseases.
Serum ceruloplasmin- 27-37mg/dl.
Serum copper- 70-140ug/dl

What is protocols before thyroid function test in known thyroid pt on medicine?

Is there any need of stop medicine in patient taking external thyroxin [eg. eltroxin] before blood is drawn for a thyroxine function test.?

What should precautions be taken before sample collection for TFT?

please gives yours comments....

Toxic granules and Polymorph count (updated)

What is more important in predicting acute bacterial infection?

presence of toxic granules or

neutrophilia

many patients have neutrophilia without any changes in granules while some patients presents with toxic granules in neutrophils with normal counts

In my personal observation most patients with toxic granules in neutrophils also have increased numbers of large granular lymphocytes, does it suggest some specific group of infections?

kindly give your comments...

Exam Papers - 4

Paper 4 - Recent Advances
Marks - 100

Q. 1 Describe recent advances in salivary gland tumors. Discuss role of FNAC and Histopathology in diagnosing various lesions of salivary glands. -30

Q. 2 Discuss about blastemal tumors. Discuss recent updates with clinical significance. -30

Q. 3 Write notes on: -20

a) IHC in breast tumors.
b) Frozen section versus FNAC

Q. 4 Write notes on: -20

a) Newer techniques and instruments in hormone assessment.
b) Recent advances in blood-banking.