HEALTH MATTERS: New developments in mammography

• Dr. Joshua Wynne

Dr. Joshua Wynne

Talk about it

Q. In a previous column, you talked about the use of mammography for breast cancer screening. A recent story in the news questioned its value. Can you help me understand this latest development?

A. I’ll try. A study over more than 30 years involving thousands of women aged 40 years or older undergoing screening mammography looked at whether screening reduced the frequency of late-stage cancer.

The rationale of the study was simple — if screening works, it means cancer is being detected early and treated; thus late-stage disease has to be less. But that isn’t what the study found — it found only a relatively small decrease in the frequency of advanced breast cancer, raising a question as to the true benefit of mammography.

So what does this mean for you? Your decision as to whether and how often to undergo screening mammography needs to follow a discussion with your health care provider during which both the merits and risks of screening are discussed. I would think many women will still choose to undergo mammography despite the results of this study, but they need to understand that mammography is an imperfect tool to prevent advanced breast cancer and breast cancer mortality.

Q. I’m hearing a lot about sepsis — that it’s the tenth-leading cause of deaths in older people, so it concerns me. What can you tell me about it?

A. Sepsis refers to a condition where an infection in the body, typically associated with bacteria in the blood stream, leads to an inflammatory response of the immune system, low blood pressure leading to shock, and often multi-organ failure. The mortality rate is high, and treatment is only partially effective. Many patients who contract sepsis while in a hospital intensive care unit die.

The root cause often is an infection in the lungs, urinary tract or abdomen. Because infections can be transmitted from patient to patient who are in the hospital, one important way to reduce the risk of sepsis is for all hospital workers (doctors, nurses, and others) to carefully wash their hands before and after touching patients, or use bacteria-killing foam. If your doctor or nurse comes in to examine you without washing or foaming first, don’t let them touch you until they do! There are other procedures we use in the hospital to reduce the risk of sepsis (such as the way we now care for intravenous catheters used to give fluid and medicines to patients), and these precautions work. Beyond that, early treatment of sepsis is critical. So if you feel really sick, have a temperature, and think you might have an infection, be sure to visit with your health care provider right away.

n Correction: I misstated the contribution the state of North Dakota makes to our Medicaid program; the actual figure is almost 50 percent (the other roughly 50 percent comes from the federal government).

Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

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The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column

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