Tuesday, May 19, 2009
Mammograms, or Not
A major practical reason for the slight decline in women having mammograms is that some women have abandoned hormone replacement therapy because of the controversies surrounding it ["Mammogram Rates Seem To Be Slipping," May 12]. Gynecologists routinely recommended mammograms as a precondition for refilling a woman's hormone prescription. This segment of patients has lost the incentive to get an annual screening mammogram.
In an effort to improve access and compliance with this life-saving screening test, Sibley Memorial Hospital is waiving the requirement for a woman to have a prescription in hand to get a screening mammogram. If one thinks the cost of a mammogram is expensive, the cost of treating an advanced disease is far greater.
Rebecca A. Zuurbier
Director of Breast Imaging
Sibley Memorial Hospital
Last fall, I had my routine yearly mammogram. It found a four-millimeter cancer. There was nothing there the year before. It was too small and too deep in my breast to be found by breast exam. A lumpectomy, oral medication and radiation were all I needed. It helped that it was a digital mammogram, which tends to find smaller lesions.
Please keep urging women to get their mammograms. I am sure a mammogram saved my life.
Mount Calm, Tex.
If you are poor and qualify for Medicaid, you can have free mammograms, one of the best early-detection tests in the medical arsenal. However, if you earn a moderate income and have a health insurance plan with a high co-pay, or you have a health savings account that could have a $4,000 family deductible, you may decide to forgo mammograms or other forms of preventive care. Something must be done to guarantee that money is not an issue when it comes to obtaining this examination every year after the age of 40.
Alan R. Melton, Radiologist
New York-Presbyterian Hospital/
Columbia University Medical Center
Another possibility for the diminished numbers of mammograms is that the test can result in false positives and false negatives. The taking and reading of mammograms is an art. For those who are recalled to check the initial mammogram with a second one, it represents an anxious period of waiting for the additional results to confirm or deny the presence of a cancerous growth.
A false positive can result in unnecessary exploratory surgery, and a false negative might lead to failure to diagnose a life-threatening cancer. But, as in any medical procedure, there is a risk-reward balance.
Learning About Disabilities
Although I am quite pleased that Quinn Bradlee has raised public awareness of velocardiofacial syndrome (VCFS), I am concerned that he gives an incomplete picture of this serious disorder ["Learning Disabilities Prompt Author to Offer Aid to Others," April 28].
Many VCFS patients suffer from mental illness in addition to medical problems and learning disabilities. My sister, for example, endured a serious psychosis in which she experienced auditory, visual and olfactory hallucinations from age 20 until her death early this year due to complications of VCFS. Once her psychosis began, a normal life was no longer an option for her or the immediate family. She lost most of her friends, was forced to drop out of the community college that she had worked so hard to attend, and moved back home with my parents for nearly a decade, until she was eventually admitted to a mental health group home and then to a state mental hospital.
The overall message of the article is that VCFS patients can live a normal life and they don't suffer from learning disabilities, only "differences." This is extremely discouraging. VCFS is often not an illness with a happy ending.
Thank you for reporting on Quinn Bradlee's book about growing up with learning differences. I note that his education at the Lab School played a big role in his success, which is great.
But the problem, even for middle-class parents, is the costs associated with schools like Lab as well as for services designed to meet the needs of students with learning differences. These costs are typically in excess of $30,000 per year.
Public schools are not always a viable alternative. Montgomery County, for instance, is contracting, not expanding, services for students with special needs, trying to "mainstream" whenever possible. Mainstreaming works best for mainstream students. Students like Quinn are, by definition, not mainstream.
Quinn Bradlee overcame his learning obstacles to achieve success. Many parents may not be able to overcome the financial obstacles that would give their children the same opportunity he had.