BRCA

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According to retrospective studies of three nationwide cohorts in Europe, young women with BRCA1 and BRCA2 are at greater risk from diagnostic radiation. Any exposure before the age of 30, increased breast cancer risk 90%. In another study reported in BMJ, any mammography before the age of 30 raised the risk by 43% (question of statistical significance?) The American Cancer Society recommends MRI screening for BRCA mutation carriers. No mention was made of physician breast examination.

Mammography suffers in silence from a lack of sensitivity. Women are given to believe that mammography will protect them whereas it occasionally misses the diagnosis of a palpable lesion. In my practice, it angered me to find four patients with negative mammograms who came to me with palpable lesions much further advanced than they might have been but for a simple breast examination. Admittedly, four in my practice was probably a skewed series. The women involved, however, would not think so.

Sadly, today women are reluctant to remove their clothing for examination and providers are all to happy  to forgo the challenge out of expediency and for the sake of time. It comes to a sad state of affairs when providers and patients look to a machine for a diagnosis --- to say nothing of the widespread abusive application of CT scans.

Flora E. van Leeuwen, PhD, Netherlands Cancer Institute and reviewed by Dori F. Zaleznik, M.D.; Assoc. Clin. Professor of Medicine, Harvard Med Sch.

CDC: 35 Million Americans Have Uncontrolled Hypertension « CardioBrief

CDC: 35 Million Americans Have Uncontrolled Hypertension « CardioBrief

30.4% of US adults (about 66.9 million people) have hypertension.

53.5% have uncontrolled hypertension (about 35.8 million people).

39.4% with uncontrolled hypertension (about 14.1 million) are unaware that they have hypertension.

89.4% with uncontrolled hypertension have a “usual source of health care and insurance, representing a missed opportunity for hypertension control.”

The so called team approach accounts for the missed diagnosis of HT on a consistent basis. Taking a BP in most institutions is relegated to the lowest level assistant’s assistant or to an automated BP cuff that consistently records low readings. This "team approach" fails to give reliable readings.

When administrators make cost saving medical decisions, cutting corners that real doctors would never knowingly cut, a surprising level of negligence can grow unnoticed to a National scale.

I speak in part from personal experience. I’m a teaching clinical physician but old enough to have a number of problems that take me to the doctor’s office, ER or major clinic. Including Cleveland Clinic, I have yet to have my BP properly taken and never by the attending physician.

Assistants consistently ignore which arm to use, take the pressure through clothing, and utterly disregard arm position. I submit that the physician will never know who has HT unless he or she takes the BP themselves, nor will he or she know who is under control and who is not.
The Ophthalmologist can tell you but the assistant cannot. Relegating the BP to apothecaries, bathers and other so called providers will not help either and for the same reason — never mind an adequate HT work-up..