Routine mammograms and the importance of rating preventive services

This week’s news from the U.S. Preventive Services Task Force (USPSTF) on routine breast cancer screening has caused quite the stir. The USPSTF shared their new ratings of preventive services for breast cancer: Mammograms work really well in women in their 60s, pretty well in women in their 50s and not so well in their 40s. If you want to have mammograms in your 40s prepare for more confusing results including additional imaging to clarify and in some cases, a biopsy to be certain. And their recommendations included a couple of small but important points: breast self exam doesn’t lead to early detection of breast cancer nor do breast exams by doctors (remember we are only talking about women who have NO symptoms). The big news: Doctors and patients in their 40s should talk to each other about what to do rather than just do the same thing all the time out of pure routing. What’s wrong with that?

We seem to have developed the view that more prevention is always better, more testing is better than less, and that more information is always helpful. But this week’s news challenges that notion…and that is what it was meant to do. Making decisions is hard, especially when we have a health problem. But it’s also true when there are health issues we may not have yet. Surprise, life isn’t simple.

The focus in the media has been on the USPSTF recommendations without sufficient attention to some important context issues. These include:

1) Breast cancer (and for that matter almost all cancers) is not one disease. They afflict us in multiple forms each with a different natural history. Some breast cancers are very aggressive and respond slowly if at all to our treatment options. Others are slower growing and very responsive treatment.

2) Mammography is a better test in some people and for some cancers than it is for others, especially when screening at an early stage is what we want from it.

3) The USPSTF focuses on recommendations for primary care doctors for patients with no symptoms getting routine care.

Q&A: Preventing shingles?

A friend recently had a painful outbreak of shingles. How can I avoid that condition? —F.J.S., Franklin, N.C.

If you’re age 60 or older, you can get the shingles vaccine. About one in four adults who’ve had chicken pox will eventually experience shingles, a painful, blistering rash that occurs when the herpes zoster virus—which lies dormant in the body after a case of the pox—is reactivated by weakened immunity from age, disease, or another factor. The vaccine cuts your risk of a first outbreak in half, and reduces discomfort by about two-thirds in the event you do get shingles. (The odds of a second outbreak are much smaller, only about 1 in 20.) Your doctor should be able to provide the shot, which costs about $150 and is partly covered by most forms of insurance.

Partners in crime: Diabetes and obesity

The number of Americans with type 2 diabetes has almost doubled in the past decade, to an estimated 24 million. That includes the one in four who don’t even know they have the disease. And some experts believe it won't be long before that number exceeds 30 million.

Why the explosion? Obesity. Up to a third of us are now clinically obese. And since the vast majority of people with type 2 diabetes are also overweight, it's no wonder those two disorders are often referred to as twin epidemics. Indeed, three out of four respondents to a Consumer Reports survey of 5,012 people with type 2 diabetes said they were overweight. And overweight respondents were more than twice as likely to say that they were unsuccessful at managing their diabetes.

The good news is that efforts to rein in excess weight can help prevent and control the condition. For example, a three-year study published in the New England Journal of Medicine showed that for people at high risk for type 2 diabetes, a 7 percent weight loss through diet and 30 minutes of exercise, five days per week, resulted in a 58 percent drop in the expected incidence of the disease. And our survey found that efforts to control weight, by improving diet and increasing activity, were effective strategies for helping people successfully manage their diabetes. Diabetes educators and dietitians were rated as being more helpful than primary-care physicians and endocrinologists in educating patients about nutrition.

The bottom line: The solution to tackling obesity and diabetes is simple. You can't choose your parents, but there are no barriers to eating right and exercising.

—Marvin M. Lipman, M.D., Consumer Reports’ chief medical adviser

Quit smoking today—and start looking better tomorrow

Fewer wrinkles. Better-smelling breath, hair, and clothing. Healthier teeth and gums. More money in your pocket. An improved sense of taste and smell. A reduced risk of heart disease, stroke, chronic obstructive pulmonary diseases, and cancer of the lungs, cervix, pancreas, throat, intestine, kidneys, and bladder. Most important, up to 10 years added to your life span. Despite these convincing reasons to quit smoking, Americans are not getting the message that smoking can not only shorten your life, but also increase the risk of death in those who come into contact with your secondhand smoke—including your children.

According to a recent study by the Centers for Disease Control, the rate of U.S. smokers in 2008 (20.6 percent) has remained virtually unchanged since 2004, when 20.9 adults reported being smokers. And 20.6 percent translates to 46 million U.S. smokers, 443,000 preventable deaths each year, and $96 billion in annual health-care costs. Hardest hit by the tobacco epidemic are vulnerable populations, including people with lower levels of education.

If you smoke cigarettes, choose to quit today as part of the 34th Great American Smokeout. It’s true that quitting is no simple task—and you may have made several honest attempts before. But considering the damage cigarette smoke does to your looks, on top of your health and the health of those around you, it’s worth another try. Consider these practical ways to help you get started:

Lasting legacy of breast cancer

Surgery for breast cancer undoubtedly saves lives—but for some women, it also leaves a legacy of long-term pain. Now doctors are being urged to identify the women most at risk, so they can treat pain quickly after surgery.

A recent study showed that almost one half of all women who had surgery for breast cancer in Denmark over a two-year period still had pain two to three years later. The pain was mostly in their breast area, although it extended to the armpit, arm, and side of the body for some women.

Half of these women classed their pain as moderate or severe, and many had pain every day. So it’s clearly a major issue that needs to be tackled.

Surprisingly, the main factor that predicted whether a woman had pain was how old she was. Under-40s were the most likely to have pain, with 64 in 100 women saying they still had pain on average of 26 months after surgery. By comparison, only 40 in 100 women aged 60 to 69 said they had pain.

Q&A: H1N1 vaccine and Guillain-Barré risks?

Should I get the swine flu (H1N1) vaccine if I’ve had Guillain-Barré syndrome? —J.M., Irvington, N.Y.

That depends in part on your risk of getting swine flu and becoming seriously ill if you do. It’s true that some studies have associated flu vaccines with a slight increase (about one person per million) in the risk of developing Guillain-Barré syndrome (GBS), a neurological disorder. And some evidence suggests that a previous case of GBS increases your risk of getting it again. But the flu itself can also cause GBS as well as such complications as pneumonia and in rare cases, death. If you’re among the priority groups for H1N1 vaccination—including pregnant women, health-care workers, and people ages 25 to 64 with underlying conditions such as diabetes and heart or lung disease—the shot’s benefits probably outweigh its risks.

Q&A: Viagra and eye problems?

I take sildenafil (Viagra), which temporarily gives a blue tint to my vision. Recently I was also diagnosed with macular degeneration. Will taking sildenafil worsen that? —Name and address withheld

Probably not, but few studies have looked into it. Sildenafil affects vision by blocking an enzyme that helps the eyes process color. But the limited studies available, mostly funded by drug manufacturers, show that effect is transient and appears to have no long-term effect on eye function. A few small studies of patients with macular degeneration or glaucoma taking sildenafil have shown the drug doesn’t worsen either condition within up to five hours of taking it. 

The only eye condition that’s been associated with sildenafil use is a rare blockage of blood flow to the optic nerve that causes a sudden, permanent decrease in vision in one eye—though it’s not clear what role the drug plays, if any, in the condition. If you experience such an impairment, contact your eye doctor right away.

Read more on the side effects of sildenafil, find out if women should take Viagra, and see our Treatment Ratings for macular degeneration (subscribers only).

Avoid dangerous combination: Blood thinner Plavix with some heartburn drugs

The Food and Drug Administration warned today that people who take the blood thinner clopidogrel (Plavix) should not take the heartburn drugs omeprazole (Prilosec, Prilosec OTC, and generics) and esomeprazole (Nexium) because two new studies confirm that the combination could have dangerous consequences. The studies show that omeprazole and esomeprazole—both members of a class of stomach acid-reducing drugs called proton pump inhibitors, or PPIs—can lower the effectiveness of Plavix , putting people at risk of heart attacks or strokes.

Plavix is given to people after a heart attack to help reduce the risk of blood clots that can trigger another attack. The drug can be hard on the stomach and cause gastrointestinal bleeding, so people are often prescribed a PPI treatment, which reduces the amount of acid in the stomach and lowers the risk of stomach bleeding. But previous studies suggested this drug combination may actually increase the risk of having another heart attack. The FDA’s warning is based on two new studies from the makers of Plavix that show that both omeprazole and esomeprazole reduce the drug’s effectiveness because they block an enzyme in the body called CYP 2C19.

The agency said it does not have enough information to draw a conclusion about whether any other PPIs can be safely used with Plavix, but studies into this issue are being conducted. However, a different type of acid-reducing drug called cimetidine (Tagamet, Tagamet HB, and generics) also inhibits the CYP 2C19 enzyme and should not be taken with Plavix.

What your walking speed can tell your doctor

Doctors are trained fortune-tellers of sorts. But instead of divining the future through tea leaves or Tarot cards, they look to our bodies for clues. If our blood pressure is high, they may warn of heart and circulation problems that could be down the road. Ditto for high cholesterol. But doctors can also draw upon subtler signs — even, for example, our walking speed.

As odd as it may sound, studies show that healthy older adults who walk slowly are at higher risk of falls, disabilities, frequent hospital visits, and other health problems. And, according to a new study, slow walkers also have triple the chance of dying from heart disease, although the reasons aren't yet clear.

The study included 3,208 seniors ages 65 to 85 in France. Each person's walking speed was clocked over 6 meters (almost 20 feet). The researchers then checked on the participants every couple of years. All were in reasonably good health at the start of the study, and didn't have any conditions that could have substantially affected how fast they walked, such as Parkinson disease, dementia, or a disabling stroke.

After five years, 209 people had died, including 99 from cancer, 59 from heart disease, and 51 from other causes (such as infections and respiratory failure). The researchers found that the slowest walkers were three times more likely to have died of heart disease than those who walked at a faster clip. However, they didn't find a link between slow walking and other causes of death, including cancer.

People with depression get strong painkillers, but do they work?

If you have chronic pain, such as back or neck aches, and also suffer from depression, you may want to think twice about the treatment your doctor has prescribed.

A new study shows that people with chronic aches who are also depressed are more likely than others to get a potent painkiller, such as morphine or codeine, but there’s no evidence these drugs are effective or safe for those who suffer from depression. The medicines also pose a risk of addiction and serious side effects.

In the study, which appears in the November-December issue of General Hospital Psychiatry, researchers examined medical records of more than 14,000 people who were prescribed opioids for three months or longer between 1997 and 2005 for chronic pain. The result: people with a history of depression were three times more likely to have been prescribed the potent painkillers. They were also more likely to receive a higher dose, and to be put on opioids that carry a higher potential for abuse or addiction, such as morphine and oxycodone (OxyContin, Percocet, and others, including generics).

Q&A: How does cognitive behavioral therapy improve sleep?

How does cognitive behavioral therapy help improve sleep? —V.L.J., Union City, Calif.

The therapy teaches you to change the thoughts and behaviors that may contribute to poor sleep. Cognitive strategies you learn might include designating a certain time of day for addressing worries and concerns so you can put them aside at bedtime, or using mind-body techniques such as guided imagery to help you wind down. Behavioral techniques might include avoiding naps; using your bed for sleep or sex only; going to bed and waking at the same time each day; and getting up and doing something relaxing if you can’t fall asleep. You might also modify your sleep area by installing light-blocking curtains, playing soft music, or using a sound machine to drown out noise.

New heartburn drug available without a prescription. But beware—you may not need it

If you haven’t seen the new ads for the latest heartburn drug, Prevacid 24HR, chances are you probably will soon. According to a story in the Wall Street Journal, the drug’s manufacturer, Novartis AG, announced an enormous $200 million advertising campaign, just in time for the belt-busting holidays.

For consumers, this may actually be good news. This new drug in the class of medications known as proton-pump inhibitors, or PPIs, further expands the choice of low-cost drugs available without a prescription to treat frequent heartburn and GERD, or gastroesophgeal reflux disorder, also sometimes known as acid reflux.

Indeed, the suggested price of Prevacid 24HR, according to the WSJ, is similar to the price of another over-the-counter drug of the same type, Prilosec OTC (about $24 or less for a month’s supply). The two drugs are also nearly identical in terms of how well they work and their overall safety profile. Even more cost-conscious consumers could save bigger bucks if they turn to the generic version of Prilosec OTC, called omeprazole. Many pharmacies offer it as a store brand for even less.

Prilosec OTC, omeprazole, and Prevacid 24HR were recently named Consumer Reports Best Buy Drugs for how well they worked, because they are as safe as other drugs in the PPI class and are significantly less expensive. For more detail about heartburn, GERD, and understanding these drugs, see our latest Consumer Reports Best Buy Drugs report.

Which houseplants are best for better air quality?

I work in a small home office with a napping cat and a large potted plant for company. I'm always grateful for my cat's quiet camaraderie, but I never give my plant a second thought, other than to begrudgingly water it when it looks droopy (as it does now). But after reading a new study on houseplants and air quality, I'm ready to boost its water rations and dole out some long-overdue fertilizer.

Scientists have long-known that plants improve outdoor air quality by removing pollutants (a process known as phytoremediation), but their effect on indoor air hasn't been as widely studied. However, this is a topic of some interest, as more of us are spending most of our time inside, where the air quality can be poor thanks to pollutants arising from paints, furnishings, cleaning supplies, and other indoor sources. In fact, studies show that indoor air can be up to 12 times more polluted than outdoor air in some areas. And this can increase the risk of asthma, cancer, and other serious health problems.

For the study, researchers rounded up 28 popular houseplants and put them in gas-tight jars. They then infused the air around the plants with the following common pollutants:

Q&A: Can a low diastolic pressure be harmful?

You recently said that lower-than-normal systolic blood pressure is safe as long as it causes no symptoms. Can a low diastolic pressure be harmful? —C.W., by e-mail

Probably not if your systolic level is normal. But if that level is high, the wide pulse pressure—or the difference between the diastolic and systolic levels— can indicate heart-valve problems, a weakened heart muscle, severe anemia, an overactive thyroid, and other problems. And some research suggests that a low diastolic, by itself, might be dangerous in people with coronary disease. A study of more than 20,000 such people found that a diastolic of 60 millimeters of mercury (mm Hg) or less tripled the risk of death compared with pressures between 71 and 90 mm Hg, independent of the pulse pressure. Diastolics between 60 to 70 mm Hg doubled the risk. If your diastolic is 70 or less, ask your doctor if you should be concerned, especially if you also have a high systolic level or are being treated for coronary disease.

It’s about time for a school lunch makeover

When I read that the Institute of Medicine (IOM) had released new guidelines to improve the nutrition of school lunches, my first reaction was "It’s about time!" The guidelines include setting a maximum number of calories in a meal, lowering the sodium, saturated fat and starchy vegetables, and increasing the amount of fruit, vegetables and whole grains.

Having lived through school lunches of chicken fried steak with cream gravy, mashed potatoes, and a big cup of ketchup as the "vegetable" (thank you Ronald Reagan), I realize that many school cafeterias have made some strides. But placing a largely ignored bowl of apples at the end of the line does little to negate the greasy pizza, and fried chicken patties that usually precede that bowl. And my children have been known to throw at me that a meal of macaroni and cheese with French fries can’t be that bad, since it’s served at the school cafeteria.

One of my brothers tells me that I worry too much. We ate it, and it didn’t kill us. But it is killing us. And it’s setting up our children for a lifetime of poor health. A new national survey released by the Preventive Cardiovascular Nurses Association found that most Americans don’t realize that heart disease risk doesn’t wait until adulthood. The American Heart Association even held a conference this year looking at the dangers of the growing girth of our children. And they are growing—some estimates say that 1 in 3 of our kids are overweight.