Disclaimer: Gentlemen, the following contains information about a female health issue and preventative measure and the links provided may not be appropriate/necessary reading for males.
A friend from out of town sent a note of congratulations on our finally getting our move out of NY into gear. But she added this: "OOT is not immune to some of the shtick that goes on in the NY area. A New Yorker was in our area and had to use the mikvah while here. She went ballistic. We have available in each bathing room used by the women a chart that shows the correct way to do a monthly breast exam. She ripped the chart off the wall and was screaming at the mikvah attendant that how dare we put such a thing up. It was clearly untsniusdik and took away from the kedusha of going to the mikvah. She refused to pay the mikvah fee and even wrote a letter to the shul in which she yelled that we had put up dirty pictures of women fondling themselves and we shouldn't advertise our mikvah as kosher because it wasn't. It should have ended there but it didn't. One of the rabbonim decided to bring it up to a vote. Luckily saner minds said nonsense and the charts remain up."
Teaching women to be proactive about their health, particularly as regards breast cancer, has been a life saver, literally. Many cancers that would otherwise have spread and c"v caused death have been found early enough to respond to treatment. " In fact, women who perform regular breast self-exams find 90% of all breast masses" (Web MD). Such an exam is recommended once a month, and golly gee but women go to the mikvah once a month. The two would seem to be a match made in heaven--family purity and family health.
But the incident brought something to mind that is bothering me. Our local mikvah does not have such a chart up. I would imagine that many mikvaot don't. I know for a fact that my daughters' high school did not mention nor teach self breast examination to its students. I asked my gynecologist if she mentions self examination to her patients. She pointed to the chart on the wall--there's one in every examining room. She doesn't actually talk about it unless a patient asks a question. Most young single girls don't see a gynecologist until right before their weddings, if then. So, my question: who is teaching frum women about this important technique? Are frum mothers doing so? Or is tsnius trumping health education?
For those requiring some good information about how to perform the exam, please see the following:
http://www.breastcancer.org/symptoms/testing/types/self_exam/bse_steps.jsp?gclid=COT--cGtrZsCFdFL5QodTEP6Ag
http://www.cancer.org/docroot/CRI/content/CRI_2_6x_How_to_perform_a_breast_self_exam_5.asp
http://www.webmd.com/breast-cancer/guide/breast-self-exam
Addendum to the Posting: If you scroll through the comments below you will see some commentary stating that doctors/major medical organizations are not recommending the self exams any longer. This is not across the board and there are major medical groups that still DO recommend the exams. This, from a July 1, 2009 posting on the American Medical Association website, giving their position on Breast Cancer prevention techniques:
-55.993 Early Detection of Breast Cancer
(1) The AMA supports public education efforts to help women recognize their important role in breast self-examination and to encourage them to report immediately to their physicians any changes that they notice.
(2) The AMA encourages physicians to educate their patients in the process of breast cancer detection, emphasizing the technique of self-examination of their breasts.
(3) Physicians requesting mammographic examinations should refer their patients to radiologists who use properly functioning equipment that provides the best image resolution at the lowest level of radiation exposure (less than one rad to mid breast for two views of both breasts).
(4) Physicians are encouraged to recognize the importance of mammography as an effective screening device to detect early breast cancer.
(5)The AMA encourages pharmaceutical companies to include in the packaging of their contraceptives, and all female hygiene products, materials which promote the practice and correct techniques of breast self-examination, and which stress the importance of physician breast examinations and appropriate use of screening mammography. (CSA Rep. A, I-83; Reaffirmed: CLRPD Rep. I-93-1; Res. 501, I-95)
44 comments:
When I used the Riverdale mikvah, the breast self exam guide was posted. I was somewhat friendly with the young mikvah lady and we sometimes chatted. She said that a sh'aylah was asked of Rabbi Willig and he said that it could be posted. The concern was not tznius, but was that reminding someone of the unhappy spectre of cancer took away from the happiness of mikvah night and the mitzvah of taharas hamishpacha. But his psak reflected the importance of the self exam. I see both sides and I'm glad a sh'aylah was asked and that the psak was what it was.
And when I think about it, that objection has some logic. Don't some people stay away from the doctor because they're afraid of bad news? Isn't it possible that if it makes them think about cancer, they might stay away from mikvah too?
The Mikvah is the perfect place for this information because the time of the month for mikvah (mid-cycle) is also the best time for a breast exam.
DISCLAIMER: consult your local, board certified health care provider regarding this issue and all other medical advice.
"Such an exam is recommended once a month"
no it isn't. (at least not as of 3 years ago when i learned how to do it in school.) there is no direct clinical evidence demonstrating the overall utility of the exams. the american cancer sociery and other relevant medical organizations no longer include it as part of their monitoring protocol. (some organizations still leave it as an option if the pt decides to do it, but the MD must counsel the pt. on the exam's limitations/risks).
The breast self-exam poster is posted in every room at the Daughters of Israel mikva in Boston, which is overseen by the Bostoner Rebbe*, and is used by the entire frum community.
There is also a flyer for a domestic violence hotline in every room in the mikva, as well as in every bathroom stall of all the orthodox shuls I've visited (granted, just a representative sampling and not an exhaustive investigation.)
The reminder, in a private room, to do a self-test that is optimally performed monthly in the middle of the cycle, is more than appropriate, given that this is a place where one is naked and alone at exactly the correct time, and is engaged in other personal physical maintenance.
The domestic violence flyers bring up an unpleasant topic, too. Both provide life-saving information in a sensitive and effective manner.
If a diagram in a private women's preparation room of a self breast exam is so upsetting, then it is serving an important further purpose in raising awareness.
A person so sensitive as to react the way she did, is unlikely to be performing the self-test.
Similarly, I've heard similar (though less histrionic) comments about the domestic violence hotline numbers in the bathroom stalls at the shul.
Seriously, folks. Save the outrage for the actual cancer and violence, not the attempts to prevent/treat them.
May we all enjoy good health and have only good news to share.
(* The Bostoner Rebbe just this week suffered cardiac arrest and is in critical condition: http://www.theyeshivaworld.com/article.php?s=bostoner )
Lion: Do you have a reliable citation for the suggestion that self-exams are no longer recommended? Who is saying this? The American Cancer Society? The American College of Obstetricians and Gynecologysts?
You may be correct, but I have not heard this before and all OB/GYN's still perform breast exams as part of an annual exam.
Perhaps what the authorities are trying to say is that self-exams won't catch all breast cancers so you also need to follow the schedule for mammograms recommended by your Dr.
Lion,
You might find this interesting: "Breast self-exam remains the top method of breast cancer detection among young and high-risk women, according to two single-center studies reported at the American Society of Breast Surgeons meeting in San Diego.
"It is something that should be emphasized and well-taught to those at high risk, i.e., a selected patient population," said Lee G. Wilke, M.D., of Duke University in Durham, N.C., based on her group's findings." http://www.medpagetoday.com/HematologyOncology/BreastCancer/13868
If you read the full article, you will note that finding those at higher risk is still problematic because there is no regular test recommended that would tell women they are in this group. Until the time that there is such a regular test, a self exam, and any concerns it raises, will still get a woman into a doctor's office to be examined.
Medical practitioners are pushing for regular mammography for women. A couple of problems with this that need addressing. 1)the high cost keeps some women from having the mammography on a regular basis, 2)the wait time to get an appointment is incredible in some areas--3-6 months from time of making appointment to time of test is common.
Anonymous,
No less than the Surgeon General in October of 2008 made the recommendation against self exam. However, I'm flummoxed beyond belief as to WHY he said this.
"He has stated that women should no longer engage in breast self examinations and instead make regular visits to either their gynaecologist or family doctor, unless the doctor happens to be a woman....The study has shown us unequivocally that patients with male doctors are diagnosed more quickly and treatment is generally more successful leading to lower mortality rates. We ascribe this to the fact that men really like breasts and women are largely indifferent to them." http://scrapetv.com/News/News%20Pages/Health/Pages/Surgeon-General-recommends-against-breast-self-examination-Scrape-TV-The-world-on-your-side.html
I won't argue that self exam should not be a substitute for regular exams by a doctor,but honestly, I'm having a whole lot of trouble accepting/believing that male doctors make better examiners because they like breasts, as opposed to female doctors who are indifferent to them.
And yes, my doctors all still recommend the self exam, in concert with a regular exam by a doctor. They feel that the studies are not conclusive enough to abolish the practice and that lots more needs to be looked at.
ProfK: Excellent points. For those with health insurance, mammography is usually covered and in many cities, free clinics such as through mobile mammography vans that go to poorer neighborhoods may also be available.
No one should be deterred by the waiting time. A dear friend was recently diagnosed with breast cancer as the result of a mammogram. The cancer would not have been detected by self exam because there was no palpable lump or mass. The good news is that it was caught early -- it's localized -- and after a mastectomy she should be completely fine and not need any chemo or radiation.
ProfK, that is a bizarre statement by the former Surgeon General. When a dr. is performing a breast exam, it's just another body part -- there's nothing sexual or personal about it. Perhaps, however, male drs use a lighter or different touch because they are more afraid of the patient misperceiving the exam.
ProfK, the scrapeTV article is a spoof. The quote regarding the utility of self-exams may be partially correct, but the rest of the article is a spoof in the vein of The Onion.
Anonymous,
Just another lesson that the careful need to be even more careful. The link to the Surgeon General "spoof" was on a highly trusted medical website, with no disclaimer that the article linked was not to be taken seriously. Trust me, I've fired off an email to the medical site about this.
Reminder to self: repeat yet again, just because it's out there doesn't make it true.
One can only wonder what this woman thinks of the sign asking if women have make bedikot!
I am thankful for the examination signs because it gives a little push to actually do what should be done.
BTW: I think that the discussion of breast cancer takes away from the bigger issue... someone visiting from out of town, as a guest of a community member (presumably, or perhaps just in a hotel in the area and using their resources as a guest), felt it reasonable to go ballistic and destroy the Mikvah's private property, scream at someone working there, and then refuse to pay the fee (I assume she used the service despite the charts).
Basically, this person engaged in several acts of petty crime, and one act of bad behavior (the shouting), and not only felt no shame at her outburst, felt the privilege to write a letter to them criticizing them for doing something that she doesn't approve of.
Talk about horrendous (and criminal) behavior. The fact that her "objection" was brought to a vote after her vandalism, instead of her being sent a bill for the repairs plus use of the Mikvah, shows the willingness to engage and reward this behavior.
Completely agree with Miami Al. I was going to make the same point. It is shocking to me the behavior I see from supposed guests to a community. It seems anything and everything goes. Criticism of the rabbi, the way people dress, the kiddush, the way children behave, the lack of this, the fact that there's that, etc. It's not your community!!! You're a guest!!! Do people come into your house and tell you they don't like how you decorate and then tear down a painting or picture?
Also, just as serious if not more so, we need to look into our communal attitude and education about serious matters such as breast cancer (and on the male side, testicular or prostate cancer) and, for both sexes, colon cancer. Something is very wrong with our education system if we're ashamed of our bodies. There's a difference between tzniut and being ashamed of one's body. This is especially true when one's health is on the line; when it is literally a matter of life or death. People must be encouraged to get over their embarrassment and get the proper testing done.
Lion,
One of the three links I provided is to the American Cancer Society. It shows that the information was last approved in September of 2008, less than a year ago. The other two sites were updated in April and in June. All three are still recommending the self exam.
Yes, an important reminder that our health is something that we need to be a part of.
Re the mammography, I make my appointment for the next year when I'm in this year. I put it up on the calendar and regard it just like April 15 and the tax return deadline--everything else has to work around it.
And Al and JS, I'm out of town and this story is mild by comparison to some things we've had happen.
My doctor also no longer teaches or advocates breast self exam for her patients.
We had a long talk about it and she said that she doesn't stop her patients who are already doing it but that the medical community no longer recommends breast self exam because it leads to more unnecessary biopsies and interventions than can be justified. That is NOT to say that manual exams conducted by a health professional are not HIGHLY RECOMMENDED, but monthly self exams are no longer encouraged.
See this article on the subject.
G6,
Let me point out a flaw in the thinking about how self exams result in more unnecessary biopsies. Okay, a woman does a self exam and believes she has found a lump. Does she schedule herself for a biopsy on the lump? Can she? No and no. A biopsy can only be ordered by a medical professional. So the woman goes to her doctor and tells him she found a lump. Does the doctor, on the basis of the woman's discovery, order a biopsy? Not if he is a "real" doctor. He does an exam himself. And if after he does the exam he feels that there is a need for a biopsy, he orders it. So please explain to me how there is any real connection between self exams and excess biopsies.
If the point being made is that women doing self exams and finding "something" are pushing their doctors into doing biopsies, and doctors are giving in and ordering the biopsies, this speaks more to the condition of medical practitioners than it does to self exams as causative.
The recommendation is that a woman get a yearly gynecological exam. So the doctor does a breast exam then. So does that mean that a problem will not develop at some point in the year between those exams? There is no harm to the monthly exams and there could be a lot of good.
I found a lump that hadn't been there before during one of my self exams. I immediately scheduled a doctor's appointment. Thank God it turned out to be a cyst that had develo9ped rather than a tumor. But my doctor agreed that if I had waited for my regular appointment for an exam, which would have been some 9 months later, that cyst could have caused some problems too.
I'm only reporting what many medical professionals are saying.
And frankly, in this world of the internet, where lay people do their own research and often come to their doctors (sometimes for good / sometimes for bad)with lists and treatment plans and orders, the doctors have often NO CHOICE but to acquiesce.
So regardless of the underlying causes, the fact remains that there is much unnecessary intervention, much of which are not without risks of their own.
Once again, I am not here to argue the point. I am merely reporting what my doctor and the greater portion of the medical community is now recommending.......
Wishing everyone good health.
the doctors have often NO CHOICE but to acquiesce.
But they do have a choice G6.They can choose to tell a patient that the test is not necessary, based on their knowledge of and training in medicine. They can tell a patient that there has been a change in medical protocol based on newer information. They can tell a patient that there is more than one approach to a certain condition or disease and they use approach X based on their experience. Most people don't change their regular docotors based on one test that the doctor might not want to perform. But here's a far better reason why doctors order lots and lots of tests that may be unnecessary--they are covering themselves in case of law suits. The courts have made it easier to sue a doctor then to get a passport or register a house title. For a lot of those doctors it's self interest that makes them order the tests.
My GP's advice about the self exams is like this--you don't HAVE to do the exams but it's a good idea to do them anyway, as long as you don't substitute those exams for seeing me once a year.
Debbie,
I agree about doctors over-testing to avoid a lawsuit down the line. However, imagine if, God forbid, you conducted a self-exam and found a lump. You go to your doctor, your doctor examines you, and then tells you "Don't worry about it." You say "Excuse me? Aren't you going to do a biopsy?" The doctor says "Don't worry, you're in a low risk group, it doesn't feel like a cancerous growth, and a new study recently came out advising doctors not to biopsy in these scenarios as there is only a 5% risk."
What are you gonna do? Go home and be happy or find a doctor that will do the biopsy just in case?
Our government, through the National Institutes of Health, says this about the self exams.
"Breast cancer is easier to treat the earlier it is found. For that reason, some experts recommend that women over age 20 perform a monthly breast self exam to look for new lumps and other changes. The self exam has limitations, however, and is NOT a substitute for regular breast examinations from your doctor or screening mammograms."
"Talk to your health care provider about the pros and cons of performing self exams. If you do perform monthly exams, do them 3-5 days after your period, when your breasts are the least tender and lumpy."
In other words there is no right or wrong on the issue of the exams. Some doctors/organizations say yes and some say no.
My personal feeling is that if there is a machlokes among experts so that the exams could be doing some good, then why not do them? They cost nothing, they are not invasive procedures and they could get women to doctors to be checked out early if they find something and don't know what it is.
JS--our modern world lives and dies on the percentages we toss around. Why do people play the lottery? There's a one in 10 million chance that they will be the big winner, and yet they play, because someone has to be the winner so why not them. Ever see people in a casino. The percentages are against them by tons, and yet they put down their money.
Now look at your 5% chance that you mentioned. Five out of 100 women will have a biopsy come back positive? Heck of a better odds then you'll get in any other gamble. And by the way, the government statistics are that one out of every 8 women will contract breast cancer at some point in their life. That's 12.5 of 100.
Next time you sit at a table at a simcha do this. Are you at a table for 10? Someone at your table has had or will have breast cancer. Do you have 8 female first cousins? Statistically one of them is a candidate for breast cancer. With odds like that why not push for a definitive answer? Better safe than sorry.
I hate percentages that get thrown around about health problems. Those aren't numbers out there--those are people. And when those aren't numbers but people then why not err on the side of caution?
The figure out there is that 50% of biopsies on the breast are unnecessary because they show no cancer. So we point at women pushing their doctors to do unnecessary tests, and somehow the discussion comes back to breast exams as the cause of all of this. Could we look at the other side a minute?
If 50% of biopsies aren't necessary then that means that the other 50% of all biopsies are necessary, because they do come back showing a problem. So who pointed to those 50% and insisted that a biopsy be done? Were all of them because a doctor discovered something and insisted that a biopsy be done? I can't find a study anywhere that shows that doctors have kept records of their success rate, if you can call it that, re the biopsies. (And how many of the biopsies do they blow, where they insisted and nothing was there?) How many of the biopsies that show a problem were originally brought to the attention of a doctor by a woman who found something she was suspicious of? I don't believe that those biopsies were 100% as a result of the doctors. They haven't got a 100% record in anything else so why assume they do here?
Be generous and let the doctors have credit for pushing 80% of those biopsies. That still means that women were the ones pushing for the other 20%. 1 out of 5 biopsies that showed a problem were found and pushed for by the patient. Or be more realistic and give the doctors credit for 50-60%. Seems to me that 1 out of 5 or even one out of 10 should be enough of a reason to encourage women to do self exams, and then get to a doctor asap if they think they found something.
In my opinion, not only is it a good thing to do a breast exam periodically, it is, in fact, a mitzvah, and is probably required. Therefore there is every reason for the poster to be on the wall in the mikvah (and in the doctors office, and in the changing rooms at the gym, etc).
Mark
Marsha,
"And Al and JS, I'm out of town and this story is mild by comparison to some things we've had happen."
Would love to hear some stories.
I looked at your disclaimer at the top and ignored it. Out here there are more like me, the only in-house parent for our children. And yes, I have daughters. It is sometimes hard and sometimes impossible to speak with my girls about things they need to know about that are more female then male.
I did not know about the self exams and have been reading the comments with interest. I spoke to my mother in law about this and she doesn't feel comfortable raising the topic with my oldest. I gave the links you gave to my brother's wife and she has agreed to discuss this with my daughter.
My wife died of cancer, not of breast cancer, and I worry about my children. From thye little I now know I can't see why this exam should not be included as part of a woman's health plan. To be honest, my doctor tells his male patients that they should be aware of any changes in the genitals and also warns that males should know what their normal is so they can go to a doctor if normal is not present any longer.
An awful lot of preventative health practices come and go, sometimes because they just couldn't find any real value in the practice and sometimes because there was something harmful in the practice. For a long while everyone was on the disinfectant kick, with every household cleanser containing antimicrobials, and hand soaps and shampoos and things like that. Now what they have found is that we've caused ourselves some problems, that people don't have a natural immunity or resistance to certain common bacteria because they haven't been exposed to them. Look on grocery shelves and you won't find all these products any more.
But the self breast exams fall in a different class. There is no active harm that comes from them (sorry, I just don't see any real logical connection to the biopsies and doctors being forced to do things against their will) and there can be some real good.
I think every mikvah should have the posters up. We'd all like to think that every woman--and every man--gets yearly checkups from the doctor, but we also know it isn't true that they do. Plenty who can't afford it or who just put it off. At least this way the women would have a health tool they could use.
Sorry JS, I didn't see your question before. Not going to take up the Prof's blog but this story is pretty typical. We get a lot of snow out here in the winter and sometimes the airport can get snowed in for a while. We had a group of religious Jews who got stranded at the airport and it was clear that they wouldn't get home before Shabbos. They called the Rav of our shul and they were placed with some of us for over Shabbos.
Okay, the two men who came to my house had no idea of our religiousness and I can even understand them asking what kind of shechita we use. I showed them the meat and food and they were fine with it.
We're sitting at the table Friday night, my family, my neighbors and these two strangers. My neighbor's daughter has MD and for some reason my husband always manages to make her feel better when she's having a bad time of it. Well, she started not to feel good during the meal and she headed straight for my husband's lap. He massaged her shoulders and got her calmed down and feeling a bit better. None of us thought anything about it but you should have seen the looks on the stranger's faces. Shock is too mild a word for it. This daughter is almost 9. One of the men, trying to be "helpful" mentioned to the Rav in shul that perhaps he needed to look into what was going on between our two families because it was so not right for such a big girl to be sitting in a strange man's lap and cuddling with him. Such things are not done in NY. Without knowing any of the facts and its not being their business, they still felt they could comment. Even when they were told the child was severely sick it made no difference--it was not tsniusdik for her to be held by a man.
Okay, not all the stories are about people quite this demented, but they come close. Remind me to tell you about the strangers who ended up with us for Shabbos a different time and wanted me and my daughters to eat in the kitchen on Shabbos instead of the dining room because they don't eat with strange women at the table.
Marsha - Even when they were told the child was severely sick it made no difference--it was not tsniusdik for her to be held by a man.
These are the people who are turning our beautiful religion into a sickness.
Mark
Marsha - Remind me to tell you about the strangers who ended up with us for Shabbos a different time and wanted me and my daughters to eat in the kitchen on Shabbos instead of the dining room because they don't eat with strange women at the table.
This one has a very easy solution. Have them (the strangers) eat on the porch. Especially in the winter.
Mark
Marsha, I think any of us oot have our stories of when the Easterners end up among us. But we had a story with a better ending. Someone was doing business in our city a few years ago and ended up spending almost a dozen shabbosim here. True, at the beginning he kind of looked at us strangely. But the more time he spent here the more he came to appreciate just what we have. Last summer he and his family moved here. Not everyone who comes here leaves shaking their head.
ANON:
"Who is saying this? . . .
american cancer society, NIH (cancer institute), US preventive services task force
"all OB/GYN's still perform breast exams as part of an annual exam."
you are referring here to a clinical breast exam (CBE), rather than the self breast exam (SBE) we are discussing.
PROFK:
"All three are still recommending the self exam."
i followed the links you provided. i don't see where they *recommend* the SBE. (in any case, webmd is not a source for clinical guidelines. i'm pretty sure that cancer.org also is not such a source.)
Lion,
Cancer.org is the American Cancer Society website.
As to webmed "WebMD Health Corporation (NASDAQ: WBMD) is an American provider of health information services. It is primarily known for its public Internet site, which has information regarding health and health care, including a symptom checklist, pharmacy information, blogs of physicians with specific topics and a place to store personal medical information.[1] The site was reported to have received over 17.1 million average monthly unique visitors in Q1 2007[2] and is the leading health portal in the United States.[3] The site receives information from accredited individuals and is reviewed by a medical review board consisting of four physicians to ensure accuracy.
WebMD also offers services to physicians and private clients. For example, they publish WebMD the Magazine, a patient-directed publication distributed bimonthly to 85 percent of physician waiting rooms.[4] Medscape is a professional portal for physicians with 30 medical specialty areas and over 30 physician discussion boards."
Maybe this will finally clear things up. Most medical providers are not saying you MUST do the monthly exam yourself, except in the narrow instance of being young and at risk. The sites referenced are also not saying DON'T do the exams. They are saying it's okay to do the exams but don't rely on them exclusively--make sure to get a yearly exam.
I don't think patients push biopsies, the doctors do. I have had several biopsies as the result of cysts/abnormalities in the breasts that the doctors said "look like nothing but let's be safe." What was I supposed to say, "no let's gamble with my life." ? Don't forget we live in a litigious society and the doctors have to cover themselves. I'd rather have had the negative/benign biopsies, bh, than have had something missed.
This woman reminds me of what the bostoner rebbetzin said when she was asked about domestic violence generations ago-- we knew it was there, we heard it, but we just closed our windows and didn't listen.. Does this woman think if she rips down posters and pretends this doesn't exist she is in some way advancing the cause of tznius? Or is she ignoring the real risk of women ignoring their own physical health because it's not "tznius"? what about v'shmartem es nafshoseichem?
my mom, in the community where i grew up, organized a womens health seminar for frum women. they expected maybe 100-200 people, when over 400 showed up, they realized the tremendous need for education of basic medical issues. They followed up, by adding more seminars, in bigger locations, and still continued to get standing room only crowds.
Also to note, the majority of women who showed were of chasidic background/orientation.
Breast Cancer information should be left in mikvahs. BRACS2 is in one of the Ahskenazi lines and if you have it, you are highly likely to get breast or uterine cancer.
Same thing with Domestic Violence Screening. You should train people to talk about sexuality openly in a place like the Mikvah to see if a bruise is really harmless fun and games that went really far, a bag in the same place (that one happens to me all the time when I was in high school) or domestic violence.
Teaching people how to teach via modeling is good behavior and does cause societal change. That's One Dr. Bandura for you.
I keep hearing that Drs. order "unnecessary" tests for fear of lawsuits. if these tests never uncovered anything, how would they protect the doctor from a lawsuit? I had a tumor removed after it was found in one of these "unnecessary, cover your rear" tests. Thankfully, it was found before it was too serious. Sure there was only a small chance that the test would have found a tumor; it is still good medicine to check.
One thing I have found, both as a patient and as a referee of scientific journals: Clinicians tend to be poor at statistics. Depending on the consequences, a test can be worth doing even if 99 times out of a hundred the result is negative.
MIKE S:
"Clinicians tend to be poor at statistics."
even the researchers publishing in your peer-reviewed journals consult with outside statisticians to design their studies.
"a test can be worth doing"
unfortunately, from an economics model not every test is really "worth" doing.
PROFK:
"Cancer.org is the American Cancer Society website."
yes it is. i meant to write that i was pretty sure that breastcancer.org is not a source for clinical guidelines. (although in any case, ACS/cancer.org doesn't actually come out and recommend BSE)
same with webmd. it is not a source for clinical guidelines. the site even contains this disclaimer: "WebMD does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site." (i could never have cited from webmd in school (not a med school))
"They are saying it's okay to do the exams"
they're also saying it's ok not to do them.
again, obviously one should consult her primary health care provider
Lion,
This is one reason why "regular people" get a little testy with the medical establishment. The joke should move out of "two Jews, four opinions" to "two doctors, nine opinions." Consulting your own doctor is certainly a good idea, but he/she may be following one set of guidelines, and there may be otherd out there, there may be a machlokes.
So, tell me this. Is the AMA a group whose stated opinions could be quoted? Because if you'll notice the addendum to the posting, the AMA does recommend that women do BSE as part of a 3-step approach.
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