DEAR DR. ROACH: Recently I read about a possible tragic consequence of traditional mammography. The article to which I refer states that there is the possibility of rupture of a tumor present in breast tissue during compression of the breast required for the mammogram, thus spilling any malignant cells into the system to take up residence in remote parts of the body. The article further expounds a “new” type technology, not widely available yet, that needs not compress the breast but that also has the additional capability to detect tissue changes before a mammogram is able to do so. Can you enlighten your female readers? C.K.
ANSWER: I believe the “new” technology you refer to is thermography, which is actually an old technology, with recent attempts to improve it.
Let’s start with an important point: To my knowledge, there has never been a cancer “ruptured” by mammography. Breast cancers do not normally have a capsule that can rupture. More importantly, in the many studies on mammography, there has never been good evidence that mammography could increase cancer risk. The controversy about mammograms is mostly around the fact that mammograms are more likely to find slower-growing tumors, some of which would never become problems even if untreated. Unfortunately, even the pathologists can’t really tell that, so anything that looks like a cancer is removed, causing some women to be treated unnecessarily. That being said, mammograms save lives.
The old studies on thermography dating back to the 1970s were disappointing. Unfortunately, a review in 2012 showed that thermography detects only about a quarter of the cancers detected by mammogram.
MRI is used in women who already have had cancer or who are at very high risk due to genetics. MRI is very sensitive but can’t always differentiate between cancer and benign lesions.
Mammograms aren’t perfect, but they remain the best screening test for breast cancer for most women.
DEAR DR. ROACH: I am an avid golfer. I had partial tears of my elbow tendon surgically repaired in both arms, one in 1998 and the other in 1999, a partial tear in my left hip, and a partial tear in a tendon in the left rotator cuff. I think golfing may be the cause, but I want to continue golfing.
Is there something that can help avoid soft-tissue injuries? Yoga? Anything else in the way of exercise? A.S.
ANSWER: Golf involves the use of very high forces, taking advantage of many body muscle groups, including legs, hips, torso and especially shoulders, elbows and wrists in a coordinated fashion to get maximum force onto a very small area. For many golfers, whose technique may not be perfect, these forces can distribute themselves in such a way as to cause injury. As in your case, elbow and shoulder injuries are frequent, but so are back injuries.
Injuries can be reduced through preparation. Keeping the body flexible is important, so yoga would be an excellent choice. As always, flexibility should be increased slowly. Men are at much higher risk for injury during yoga than are women, usually by trying to do too much too quickly, and an experienced and patient teacher is key. Strength is important for injury prevention, and we often forget that weightlifting exercise not only strengthens muscles, but also tendons, ligaments and bones. Muscles often get stronger more quickly than the connective tissue, so gradual increases in resistance and frequency are critical. A proper warm-up before playing, including stretching and exercise, will reduce injury risk.
Finally, proper technique keeps the forces going where they are supposed to, so your golf pro might help prevent injuries, as well as improving your score and enjoyment of the game.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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