<?xml version="1.0" encoding="UTF-8"?><rss version="2.0" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:wfw="http://wellformedweb.org/CommentAPI/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:atom="http://www.w3.org/2005/Atom" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:slash="http://purl.org/rss/1.0/modules/slash/" > <channel> <title>Screenings Archives - goldsteinmd</title> <atom:link href="https://www.goldsteinmd.com/category/screenings/feed/" rel="self" type="application/rss+xml" /> <link>https://www.goldsteinmd.com/category/screenings/</link> <description></description> <lastBuildDate>Thu, 23 Jan 2025 00:12:50 +0000</lastBuildDate> <language>en-US</language> <sy:updatePeriod> hourly </sy:updatePeriod> <sy:updateFrequency> 1 </sy:updateFrequency> <image> <url>https://www.goldsteinmd.com/wp-content/uploads/2017/12/cropped-header-logo-2-1-32x32.png</url> <title>Screenings Archives - goldsteinmd</title> <link>https://www.goldsteinmd.com/category/screenings/</link> <width>32</width> <height>32</height> </image> <item> <title>Information about Polycystic Ovarian Syndrome (PCOS)</title> <link>https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome</link> <comments>https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Thu, 12 Jan 2023 17:43:47 +0000</pubDate> <category><![CDATA[Fertility]]></category> <category><![CDATA[Screenings]]></category> <category><![CDATA[Ultrasounds]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=5626</guid> <description><![CDATA[<p>Recently, I have had a run of several young women who have presented (accompanied by their mothers) having received a diagnosis elsewhere of polycystic ovarian syndrome (PCOS). They have looked this up online and they are relatively distraught having learned about issues of infertility, insulin resistance, and a predilection later in life for diabetes. None … <a href="https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome" class="more-link">Continue reading<span class="screen-reader-text"> "Information about Polycystic Ovarian Syndrome (PCOS)"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome">Information about Polycystic Ovarian Syndrome (PCOS)</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Recently, I have had a run of several young women who have presented (accompanied by their mothers) having received a diagnosis elsewhere of polycystic ovarian syndrome (PCOS). They have looked this up online and they are relatively distraught having learned about issues of infertility, insulin resistance, and a predilection later in life for diabetes. None of these recent cases truly had the entity itself. What they had was not unusual for late adolescence (women in their teens and even early twenties) whose menstrual cycle is still slightly irregular because of the fact that the hypothalamic-pituitary-ovarian axis has not yet matured, and someone performed an ultrasound and they had multiple small follicles in their ovary, and thus, were told they had polycystic ovarian syndrome. </p> <p>The original description of the entity was called Stein-Leventhal syndrome and, basically, these patients looked a little like Humpty Dumpty – they were obese, they had male-pattern hair growth (chin especially), and blood work showed increased androgens (testosterone and an entity know as DHEA-S). The problem began in 2003 when an international conference in Rotterdam produced what was known as The Rotterdam Criteria for the Diagnosis of PCOS. At that time the consensus was if a women had two of the following three characteristics she could be labeled as having PCOS. They were 1) irregular menses, 2) increased androgens (either in their blood or clinical manifestations), and 3) more than twelve follicles in their ovary on ultrasound. The problem is, however, that many young women, as stated above, will be having slight irregularity to their menses as the cycle “matures,” and as the resolution of transvaginal ultrasound has increased, as many as 50% of women will have more than twelve follicles in their ovary. These recent patients that I saw were 1) not obese, 2) had no evidence of increased androgens, either clinically or in their blood, and 3) were extremely healthy. They have what I have now referred to as “multicystic ovaries,” which are common and not abnormal in younger women. It has been my experience that the overwhelming majority of such patients, as they get into their mid- and later twenties, ultimately have very normal menstrual cycles, normal fertility, and no increased risk of insulin resistance or diabetes. </p> <p>Too many healthcare providers are still functioning under these misconceptions. However, some papers have called for using a threshold of more than twenty-five follicles per ovary. Other groups have recommended a threshold of greater than twenty follicles per ovary. It is also, in my opinion, important as to how the follicles are arranged in the ovary. In the original description of polycystic ovarian syndrome, the follicles were all very peripheral and often were referred to as a “string of pearls,” as opposed to just an increased randomly distributed number of follicles. </p> <p>Furthermore, there is a group known as the Androgen Excess and PCOS Society that has gone on record as saying that women who have irregular menses and multiple follicles, but no evidence of increased androgens should not be labeled as PCOS. Finally, an NIH workshop in 2012 recommended that the name “PCOS” be changed to “metabolic reproductive syndrome” because PCOS focuses on the polycystic ovarian appearance, which, as described in detail above, is the least sensitive factor for making such a diagnosis. However, it is highly unlikely that this “name change” will take hold. </p> <p>If you or a daughter or a niece or someone you know has received the diagnosis of polycystic ovarian syndrome, hopefully this information will be helpful. As always, I am available for consultation. </p> <p>Dr Steven R. Goldstein is a leading <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">gynecologist in NYC</a>, a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">menopause specialist in NYC</a>, <a href="https://www.goldsteinmd.com/services/best-obgyn-manhattan/" target="_blank" rel="noopener">obgyn Manhattan</a> and <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">NYC Gyn</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome">Information about Polycystic Ovarian Syndrome (PCOS)</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/about_pcos_polycystic_ovarian_syndrome/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Dr Goldstein comments on NY Times article on preventing breast cancer</title> <link>https://www.goldsteinmd.com/blog/dr-goldstein-comments-on-ny-times-article-on-preventing-breast-cancer</link> <comments>https://www.goldsteinmd.com/blog/dr-goldstein-comments-on-ny-times-article-on-preventing-breast-cancer#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Fri, 22 Nov 2019 19:10:42 +0000</pubDate> <category><![CDATA[Breast Health]]></category> <category><![CDATA[Bone Health]]></category> <category><![CDATA[Screenings]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2784</guid> <description><![CDATA[<p>To my patients, In last week’s Science Times, the weekly column on personal health by Jane Brody was entitled, “A New Focus Turns to Preventing Breast Cancer.” I have tremendous respect for Jane Brody and almost always agree with what she writes and the thoroughness with which she presents information. There are, however, some points … <a href="https://www.goldsteinmd.com/blog/dr-goldstein-comments-on-ny-times-article-on-preventing-breast-cancer" class="more-link">Continue reading<span class="screen-reader-text"> "Dr Goldstein comments on NY Times article on preventing breast cancer"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/dr-goldstein-comments-on-ny-times-article-on-preventing-breast-cancer">Dr Goldstein comments on NY Times article on preventing breast cancer</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[ <p>To my patients,</p> <p>In last week’s Science Times, the weekly column on personal health by Jane Brody was entitled, “A New Focus Turns to Preventing Breast Cancer.” I have tremendous respect for Jane Brody and almost always agree with what she writes and the thoroughness with which she presents information. There are, however, some points in that article that I feel I must comment on. </p> <p>She does mention, and rightly so, that if breast cancer is confined to the breast with no spread to regional lymph nodes, five-year survival rates are as high as 99%. Many of you have heard me extol the virtues of quality breast cancer surveillance with imaging (3D mammograms with ultrasound as well). Even with spread to regional lymph nodes, the five-year survival is still 85%. Clearly, breast cancer is not the same disease it was one or two generations ago. When caught early, it need not be lethal.</p> <p>There are and have been, however, a number of medications that are approved for breast cancer risk reduction. In her article, Jane Brody, in fact, quotes the United States Preventative Services Task Force, whose recommendations are that women who have more than a 3% chance of developing invasive breast cancer within the next five years be offered such risk reducing drugs. My concern with her article is that she mentions tamoxifen, raloxifene (also known as Evista) and the category of drugs known as aromatase inhibitors. Although all these drugs have been shown to reduce breast cancer risk, they’re very different in their side effect profile, in terms of both serious adverse events as well as nuisance side effects.</p> <p>The only one approved for use in premenopausal women is tamoxifen. Many of you are aware, however, that it results in formation of benign uterine polyps in 10-17% of women as well as a small but real number of uterine cancers in postmenopausal women. Evista, which is now generically available as raloxifene, has similar breast cancer prevention results as tamoxifen but does not have cancer or polyp producing potential in the uterus. In addition, however, both tamoxifen and raloxifene prevent bone loss because of their selectivity in which they act like estrogen in bone, while being estrogen blockers in breast. Both of these drugs may exacerbate hot flashes and night sweats making their use in younger, more recently menopausal women less desirable.</p> <p>The aromatase inhibitors are pure anti-estrogens (unlike the first two drugs, which are selective for the breast but not in all aspects of the body) these drugs contribute to osteoporosis, joint pain, vaginal atrophy, etc. Thus, in my opinion, while the aromatase inhibitors are excellent drugs for women with advanced breast cancers and can be lifesaving in such cases, their use for prevention of breast cancer, in women who don’t already have that disease, is inappropriate and unnecessary, especially in light of the high treatability when breast cancers are detected early.</p> <p>Furthermore, <a href="https://www.goldsteinmd.com/conditions/osteoporosis-specialist-nyc-menopause-bone-loss/">bone health</a>, in my opinion, is as, if not more, important of an issue for long term healthy aging and quality of life as breast health. Allow me to expand on this: since early detection of breast cancer will almost always result in a favorable outcome, and since women are routinely living much longer lives than previous generations, a fracture, especially of the hip, of a woman can be a much more life threatening and devastating event than an early breast cancer. A woman who suffers a hip fracture has a 20-30% chance of being dead within one year, and a 25% chance of never living independently again. Thus, drugs to prevent breast cancer that actually cause <a href="https://www.goldsteinmd.com/conditions/osteoporosis-specialist-nyc-menopause-bone-loss/">bone loss</a>, like the aromatase inhibitors, in my opinion, make no sense for this purpose. Since its introduction in 1997, many of my patients have been excellent candidates for Evista (raloxifene) because of its dual effect of reducing breast cancer risk and preventing and treating osteoporosis. Thus, for certain patients, it is an excellent choice and remains thus so. </p> <p>If you think this is of value to you or any of your family or friends, feel free to pass this information along. Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist in NYC</a> working with women on healthy aging, including their bone health. </p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/dr-goldstein-comments-on-ny-times-article-on-preventing-breast-cancer">Dr Goldstein comments on NY Times article on preventing breast cancer</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/dr-goldstein-comments-on-ny-times-article-on-preventing-breast-cancer/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Important News About Pap Smears</title> <link>https://www.goldsteinmd.com/blog/important-news-about-pap-smears</link> <comments>https://www.goldsteinmd.com/blog/important-news-about-pap-smears#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Wed, 22 Aug 2018 13:36:40 +0000</pubDate> <category><![CDATA[Screenings]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2517</guid> <description><![CDATA[<p>“If it ain’t broke why are we fixing it?” This week the United States Preventative Services Task Force (USPSTF) published a recommendation statement in the Journal of the American Medical Association (JAMA) They made updated recommendations for screening for cervical cancer using Pap smears (which they call cervical cytology) and high risk HPV testing or both … <a href="https://www.goldsteinmd.com/blog/important-news-about-pap-smears" class="more-link">Continue reading<span class="screen-reader-text"> "Important News About Pap Smears"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/important-news-about-pap-smears">Important News About Pap Smears</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>“If it ain’t broke why are we fixing it?”</p> <p>This week the United States Preventative Services Task Force (USPSTF) published a recommendation statement in the Journal of the American Medical Association (JAMA)</p> <p>They made updated recommendations for <a href="https://www.goldsteinmd.com/services/abnormal-pap-smear-results/">screening for cervical cancer using Pap smears</a> (which they call cervical cytology) and high risk HPV testing or both in combination.</p> <p>I have some real problems with these kinds of recommendations. Their goals are to prevent cervical cancer and reduce the mortality from this disease. Obviously these are desirable goals. However, I have a slightly different agenda for you as my patient. For instance if a woman, done with her childbearing, were to have a total hysterectomy for a very advanced pre-cancerous lesion of her cervix, the Secretary of Health and Human Services would consider that a victory for the system. She never developed invasive cancer and thus the whole process of screening was successful. I have very different goals for you as my patient. If one of my patients, under my medical supervision, were to develop such an advanced pre-cancerous lesion that required a hysterectomy I would feel that I had failed her miserably. My goal is to prevent the development of lesions that cannot be easily taken care of for instance here in an office setting with something as simple as an outpatient laser treatment.</p> <p>As I have told many of you, guidelines are created for populations not individuals. I still believe that patients should be cared for one patient at a time with their individual risk factors, personal history, and family history taken into account when decisions are made for her health care regardless of the medical situation that we may be discussing.</p> <p>Unfortunately so many women believe that they are only coming to the gynecologist for their “Pap Test”. Nothing could be further from the truth. In my practice although obviously I am concerned that no one develop an advanced abnormality of their cervix, that is a very small part of what I do gynecologically. For instance, in women who are menopausal, bone health, breast health, vaginal health, and what’s going on in their pelvis with my transvaginal ultrasound in terms of their ovaries and their uterus are of the utmost importance.</p> <p>In women prior to the menopause issues like <a href="https://www.goldsteinmd.com/services/abnormal-uterine-bleeding/">abnormal uterine bleeding</a>, abnormal findings on pelvic examination, painful periods, pelvic pain, fertility, vaginitis, urinary tract issues, birth control are just a few of the many areas that we constantly want to deal with in addition to Pap smears and/or HPV testing.</p> <p>While we are at it, let’s talk about <a href="https://www.goldsteinmd.com/conditions/human-papilloma-virus-hpv/">HPV testing</a>: there are over 100 strains of HPV virus. It is ubiquitous. It can be passed by skin to skin contact and does not come out in semen. Thus condoms don’t necessarily protect against it. Virtually all sexually active individuals will be exposed to various strains of HPV virus. Unfortunately, the medical establishment seems to be turning HPV into the disease. The disease is cervical cancer and the precursors of cervical cancer. In my opinion the Pap smear, done in a reputable lab like NYU, is still among the best ways to screen for and protect against the development of advanced pre-cancerous lesions.</p> <p>As always if you have any concerns about this for yourself or members of your family, feel free to call me and discuss this.</p> <p> </p> <p>I remain yours in health,</p> <p>Dr. Goldstein</p> <p>The post <a href="https://www.goldsteinmd.com/blog/important-news-about-pap-smears">Important News About Pap Smears</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/important-news-about-pap-smears/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Breast Cancer Screening</title> <link>https://www.goldsteinmd.com/blog/todays-new-york-times-article</link> <comments>https://www.goldsteinmd.com/blog/todays-new-york-times-article#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Thu, 20 Feb 2014 19:14:36 +0000</pubDate> <category><![CDATA[Screenings]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1780</guid> <description><![CDATA[<p>2/12/2014 In today’s New York Times on the front page there is an article about a long-term Canadian study involving mammographic screening for breast cancer. It looked at over 90,000 women randomized to get mammographic screening vs. those who only had a breast exam by a nurse without mammography. It lasted 25 years. It was … <a href="https://www.goldsteinmd.com/blog/todays-new-york-times-article" class="more-link">Continue reading<span class="screen-reader-text"> "Breast Cancer Screening"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/todays-new-york-times-article">Breast Cancer Screening</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p style="text-align: right;"><strong><span style="color: #000000;">2/12/2014</span></strong></p> <p><strong><span style="color: #000000;">In today’s New York Times on the front page there is an article about a long-term Canadian study involving mammographic screening for breast cancer. It looked at over 90,000 women randomized to <span style="text-decoration: underline;">get</span> mammographic screening vs. those who only had a breast exam by a nurse without mammography. It lasted 25 years. It was published in the British Medical Journal. It found that there was no difference in <span style="text-decoration: underline;">deaths</span> from breast cancer in either group (about 1 death per 90 women enrolled over the 25 year period). While I have not yet seen the full article I feel compelled to make some observations.</span></strong></p> <p><strong><span style="color: #000000;"> </span></strong></p> <ul> <li><strong><span style="color: #000000;">Clearly breast cancer is not “one disease”. Some forms are clearly more virulent than others.</span></strong></li> </ul> <p><strong><span style="color: #000000;"> </span></strong></p> <ul> <li><strong><span style="color: #000000;">In this study, the death rate in the non-screened group was probably lower than it might have been because of improved treatments that we now have even for later stage breast cancers that present because they are large enough to feel.</span></strong></li> </ul> <p><strong><span style="color: #000000;"> </span></strong><strong><span style="color: #000000;"> </span></strong></p> <ul> <li><strong><span style="color: #000000;">In the screened group, my biggest concern is that people (i.e. patients, the government) think mammography is a “laboratory test”. What do I mean? If I order a blood count on my patient and she goes downstairs and has blood run through a machine called a Coulter Counter that is well calibrated, and let’s say her blood count is 39.4, and I were to send her for a similar test at Hackensack Hospital with a well calibrated machine perhaps it would be 39.7, but it would not be 25 or 48. <p>Those are highly reproducible laboratory tests. Mammography is only as good as the equipment employed and the people performing and interpreting the study. I know little about the Canadian system of health care, but I guarantee that the 45,000+ women were not getting the quality of mammographic screening that most of my patients are receiving. The mammography facilities that I recommend do not simply have a technician do a study and then later have a physician come by and read images, and then having to decide if it is necessary to call the patient back for further evaluation. </p> <p>The best facilities (the ones I recommend) do not let the patient leave until <span style="text-decoration: underline;">all</span> issues have been reconciled and this often involves a spot film or compression film or ultrasound when necessary. Most good facilities will have a “double read” (two physicians) and some even include a clinical breast exam and the doctor speaking to the patient. I have no doubt that some of the deaths that occurred in the screened group in this study were “false negative” studies where people with early cancers went undetected. That has not been my experience when patients of mine are in the hands of top mammography facilities.</span></strong></li> </ul> <p><strong><span style="color: #000000;"> </span></strong></p> <p><strong><span style="color: #000000;">This is not unlike my concerns about those who feel that transvaginal ultrasound cannot detect early ovarian cancer. Transvaginal ultrasound is even <span style="text-decoration: underline;">more</span> operator and equipment dependent than mammography. So while the United States Preventative Services Task Force (USPSTF) may recommend against routine screening of ovaries that recommendation is based on very flawed <span style="text-decoration: underline;">population</span> data. I take care of patients myself, one at a time, and perform my own transvaginal ultrasound exams with top-of-the-line equipment. </span></strong></p> <p><strong><span style="color: #000000;"> </span></strong></p> <p><strong><span style="color: #000000;">So…bottom line is do not consider changing your mammographic screening…unless the facility you use is not one of the highest quality.</span></strong></p> <p><strong><span style="color: #000000;"> Dr Steven R. Goldstein is a leading <a href="https://www.goldsteinmd.com/services/best-obgyn-manhattan/" target="_blank" rel="noopener">Gynecologist in Manhattan</a> <br /> </span></strong></p> <p><strong><span style="color: #000000;"> </span></strong></p> <p>The post <a href="https://www.goldsteinmd.com/blog/todays-new-york-times-article">Breast Cancer Screening</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/todays-new-york-times-article/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Gynecologic Ultrasound has refined Diagnosis of masses</title> <link>https://www.goldsteinmd.com/blog/letter-to-the-new-york-times</link> <comments>https://www.goldsteinmd.com/blog/letter-to-the-new-york-times#comments</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Wed, 01 May 2013 19:30:43 +0000</pubDate> <category><![CDATA[Screenings]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1723</guid> <description><![CDATA[<p>05/01/2013 An article appeared in yesterday’s NY Times Science section about the lack of benefit and even potential harm of the routine bimanual pelvic examination in gynecology. It is so inaccurate and one sided that I have sent a letter to the Times which I have reproduced for you. (I am not optimistic that they … <a href="https://www.goldsteinmd.com/blog/letter-to-the-new-york-times" class="more-link">Continue reading<span class="screen-reader-text"> "Gynecologic Ultrasound has refined Diagnosis of masses"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/letter-to-the-new-york-times">Gynecologic Ultrasound has refined Diagnosis of masses</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p style="text-align: right;">05/01/2013</p> <p><span style="color: #000000;"><strong><i>An article appeared in yesterday’s NY Times Science section about the lack of benefit and even potential harm of the routine bimanual pelvic examination in gynecology. It is so inaccurate and one sided that I have sent a letter to the Times which I have reproduced for you. (I am not optimistic that they will choose to run it.) This is such important information you may want to share it with friends, colleagues and family…</i></strong></span></p> <p><span style="color: #000000;"><strong>All reporters and most readers appreciate there are two sides to every story. So usually if I disagree with some of a given story I accept a divergence of opinion. But some of the misstatements and glaring inaccuracies of “An Exam with Poor Results” by Jane Brody (4/30/13) mandate a response.</strong></span></p> <p><span style="color: #000000;"><strong>I can agree that a blindly performed bimanual pelvic examination is extremely crude and may yield limited information. However, the statement by Dr. George Sawaya of UCSF that after finding an enlargement during a bimanual pelvic examination he gets “follow-up with a sonogram which shows a mass but I can’t tell what the mass is without surgical exploration. Yet nearly always it is benign.” must be commented on. </strong></span></p> <p><span style="color: #000000;"><strong>The field of gynecologic ultrasound with the introduction of vaginal probe sonograms in the last 30 years has refined gynecologic diagnosis to the point where the overwhelming majority of masses detected are <i>clearly</i> benign and can be left alone without surgery. It seems that Dr. Sawaya, and unfortunately many other physicians and patients, do not understand that benign ovarian growths do not <span style="text-decoration: underline;">become</span> malignant. </strong></span></p> <p><span style="color: #000000;"><strong>Perhaps this misconception is a result of the fact that virtually all other gynecologic cancers (cervix, uterus, and breast) have well defined premalignant stages that we attempt to identify before they become frank malignances. I also believe that another major reason that the rate of surgery for ovarian cysts and hysterectomy in the United States is twice as high as European countries is because their ability to better understand that gynecologic ultrasound can reliably suggest “benign” is far ahead of most doctors in the United States. </strong></span></p> <p><span style="color: #000000;"><strong>Further proof of this is underscored by the United States Preventive Services Task Force’s (USPSTF) refusal to recommend routine ultrasound screening for early detection of ovarian cancer partly because there were 30 surgeries for every malignancy detected in the PLCO (prostate, lung, colon, ovary) study. This stems from that study having used a definition of a “positive” screen for entities that many of us, even in 1993 when it was designed, and surely today, would clearly recognize as benign and avoid surgery.</strong></span></p> <p><span style="color: #000000;"><strong>You can click here for the original NYT article. <a href="http://well.blogs.nytimes.com/2013/04/29/an-exam-with-poor-results/?smid=pl-share" target="_blank" rel="noopener"><span style="color: #000000;">http://well.blogs.nytimes.com/2013/04/29/an-exam-with-poor-results/?smid=pl-share</span></a></strong></span></p> <p>Dr Steven R. Goldstein is a Transvaginal Ultrasound Specialist in NYC</p> <p>The post <a href="https://www.goldsteinmd.com/blog/letter-to-the-new-york-times">Gynecologic Ultrasound has refined Diagnosis of masses</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/letter-to-the-new-york-times/feed/</wfw:commentRss> <slash:comments>4</slash:comments> </item> <item> <title>Importance of annual Pap Smear Screening</title> <link>https://www.goldsteinmd.com/blog/pap-smear-screening</link> <comments>https://www.goldsteinmd.com/blog/pap-smear-screening#comments</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Sat, 10 Nov 2012 21:27:34 +0000</pubDate> <category><![CDATA[Screenings]]></category> <guid isPermaLink="false">http://www.copperfoxmarketing.com/dev/goldstein/?p=1579</guid> <description><![CDATA[<p>There was an article in the New York Times by Tara Parker-Pope entitled “The annual appointment loses some relevance”. It was about the highly publicized, but not so very different, pap smear guidelines by the USPSTF (United States Preventative Services Task Force). The guidelines had already been changed several years ago making the recommendation for … <a href="https://www.goldsteinmd.com/blog/pap-smear-screening" class="more-link">Continue reading<span class="screen-reader-text"> "Importance of annual Pap Smear Screening"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/pap-smear-screening">Importance of annual Pap Smear Screening</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p><span style="color: #000000;"><strong>There was an article in the <em>New York Times</em> by Tara Parker-Pope entitled “The annual appointment loses some relevance”. It was about the highly publicized, but not so very different, pap smear guidelines by the USPSTF (United States Preventative Services Task Force). The guidelines had already been changed several years ago making the recommendation for less screening in some women. At that time, as a member of the Editorial Board of Contemporary ObGyn, I wrote a piece entitled “If it ain’t broke, why are we fixing it”. </strong></span></p> <p><span style="color: #000000;"><strong>The pap smear is one of the single biggest success stories of modern medicine (barely behind the discovery of polio vaccine). The number of cases of invasive cervical cancer in this country has fallen dramatically over the last 60 years mainly because of the pap smear. Currently, 50% of new cases of cervical cancer today are in women who have never had a pap smear and another 10% in women whose pap smear is abnormal, but have never bothered to follow-up! In my 25 years of practice I have had two cases of invasive cervical cancer and both of those women walked into my office with the disease already. No one who has been under my care has developed invasive cancer.</strong></span><br /> <span style="color: #000000;"><strong> <span id="more-1579"></span></strong></span></p> <p><span style="color: #000000;"><strong>The decision to reduce pap smear frequency is strictly a financial one, called a cost-benefit ratio. They did this in England years ago. They knew that there would be more cases of cervical cancer, but it was felt that it was cheaper to treat the small incremental increase in the number of cases of cancer than it would be to screen every woman annually. I suppose if I were the Secretary of HHS (Health and Human Services) I too might be looking at the population as a whole, but as your physician I’m only concerned with you. Let me explain:</strong></span></p> <p><span style="color: #000000;"><strong>If a woman has a hysterectomy for an advanced pre-cancer then the system considers that a victory because she never developed invasive cervical cancer. If one of my patients were to have such an advanced premalignant lesion that she required a hysteroscopy, I would feel that I had failed her miserably. My goal is to pick up abnormalities at a stage where they can be treated much more simply than with surgery as radical as a hysteroscopy. I guess it depends on whether you believe my job is to 1) put out forest fires, 2) put out brush fires, or 3) blow out matches. I prefer to blow out matches.</strong></span></p> <p><span style="color: #000000;"><strong>Finally back to the title of Tara Parker-Pope’s article … my biggest concern is that if the message is “you do not need a pap smear,” many women will assume that they do not need a visit to the gynecologist. Many women have come equate the pap smear with the visit. Thus, if there is no need for a pap, they would feel that there is no need for a visit. Nothing is further from the truth. A visit to me is important for a myriad of reasons including the breast exam, blood pressure check, concerns about bone health, vaginal health, contraception, menstrual function, and in my opinion, perhaps most importantly, a transvaginal ultrasound evaluation of your ovaries and uterus.</strong></span></p> <p><span style="color: #000000;"><strong>If you have any questions or concerns, please do not hesitate to call.</strong></span></p> <p><span style="color: #000000;"><strong>Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/blog/pap-smear-screening" target="_blank" rel="noopener">gynecologist for abnormal pap smear in nyc</a> . <br /> </strong></span></p> <p>The post <a href="https://www.goldsteinmd.com/blog/pap-smear-screening">Importance of annual Pap Smear Screening</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/pap-smear-screening/feed/</wfw:commentRss> <slash:comments>1</slash:comments> </item> </channel> </rss>