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Are you confused about breast cancer screening recommendations? If you are, you are not alone.

Multiple organizations have come out with conflicting studies, data, and recommendations. Those advocating for reduced screening argue that screening does not improve the death rate from breast cancer; that women who have biopsies that are found to be benign suffer significant psychological harm; and that cancers are found that would never cause death.

Significant flaws have been found in these arguments by physicians who have committed their careers to understanding and treating breast cancer. There are multiple problems with the scientific methodology, assumptions, endpoints and analyses used in these critiques of mammogram screening recommendations. One problem is that medical science currently does not have the ability to distinguish between lethal cancers and those that will not cause death. Based on rigorous scientific data, we do know that the best way to improve survival from breast cancer is to detect it before it becomes clinically obvious and to treat it early.

None of the major oncology organizations support the guidelines calling for reduced screening. A letter to the New England Journal of Medicine ....

As a genetic counselor with 30 years of experience, I have met with many families who have been concerned about their hereditary risks to develop cancer and other disorders. I have found that the complexity of genetics can sometimes cause misunderstandings about some critical information.

A common question that patients ask is this: I already have cancer, it makes no sense for me to have genetic testing, so why don’t you test my family instead?

As it turns out, the best strategy for most families is to for genetic testing to start with a relative who has already been diagnosed with cancer.

1. If that person has a normal genetic test result, there is usually no need to test any other healthy family members.
2. Because of the complicated nature of cancer genetics, accurate interpretation of a negative result usually requires an affected relative to have a positive genetic test.
3. If a patient has a positive genetic test, the cost of testing all other family members will usually be considerably less expensive and increases the likelihood that health insurers will cover the test.

Let’s clarify this with a specific example.

Three sisters, all in their 30s, want to undergo genetic testing because their mother is a breast cancer survivor, and ...

What do I tell my boss? Will I have to quit? How will I afford my future?

A multiple sclerosis diagnosis can come with a lot of uncertainty and questions about the future. But it does not have to be career-ending. Learning about your employment options and planning ahead can help you make informed decisions about your career.

Beginning May 8, 2013, the Multiple Sclerosis Center at Swedish Neuroscience Institute will offer free workshops to help people navigate their employment options. Employment Matters is a monthly series  designed to prepare people with the knowledge to confidently approach challenges, build a career plan and strengthen their employment options.

Shaheen Virani, CRC, leads the Employment Matters workshops. Shaheen is a rehabilitation counselor who specializes in helping people with MS make plans and decisions to support their individual employment needs--whether it is to continue working, make a career change or apply for disability.

Here are a few Employment Matters topics coming up this spring (or click here for the full 2013 schedule):

Recovering from major surgery is an active process that typically takes 6 weeks. Surgical pain is normal and expected, but the pain experience may be different for individuals. Since pain can interfere with your ability to participate in activities to prevent complications (coughing, deep breathing, walking), treating pain is critically important for a successful surgical recovery. Many patients are afraid to take prescription narcotics or “pain killers” because they do not want to become “addicted.” However, untreated pain can lead to the development of permanent pain pathways to the brain, which can delay your recovery and possibly even result in chronic pain.

Narcotic use varies among individuals and there is a big difference between drug dependence and addiction. Dependence is when the body has become accustomed to the medication. This can occur anywhere from a couple of days to a couple of weeks after you start taking pain killers regularly, like after surgery. Addiction, however, generally implies that the medication or substance is interfering with your life in some way. You can become dependent on pain killers during your surgical recovery, but with medical management of your withdrawal from these medications, you will avoid addiction. It is important to use your prescription pain killers as directed to avoid overuse. On the other hand, you do not want to avoid using pain killers when you need them to remain comfortable and active. Stopping your pain killers “cold turkey” can be dangerous and it may cause considerable discomfort. The surgical team will work with you to develop a plan to wean you off your pain killers gradually and safely, at a time when you are ready.

The universal goal is to taper as quickly as your physical, mental and emotional status allows. Since there is ....

Recently, there has been increasing media attention to the risks of heart damage associated with adjuvant breast cancer radiotherapy.

This observation and debate has been ongoing for a long time in medical literature. Most recently, an article in the New England Journal of Medicine concluded that adjuvant radiotherapy for breast cancer increases the rate of ischemic heart disease. The authors conclude that the risk is associated with the dose of radiotherapy to the heart and begins a few years after the treatment. Dr. Kesarwala, an expert radiation oncologist from Bethesda, reviewed the data and provided a report in the April issue of the ACR Journal Advisor. She noted that “nearly 80% of patients in this study had mastectomies and over 90% had adjuvant chemotherapy with regimens very different from those currently used. This study mixed lymph node-positive patients (48%) with lymph node-negative patients, two sub-populations with different expected overall survival who would also have received different types of radiotherapy.” Other variables such as stage, presence of internal mammary nodes, type of surgery, or details of radiotherapy were not matched between the control and treated patients.

Because the study does not provide details regarding the radiotherapy specifically, it is difficult to interpret the conclusions. The doses of radiotherapy delivered ...

Many people suffer from difficulty swallowing (dysphagia) acutely or chronically. Difficulty with swallowing may be a result of a problem anywhere from the lips to the stomach. It may be identified by weight loss, coughing or choking when eating, delayed cough or regurgitation, or outright obstruction. This is more likely to be an issue after a stroke or in elderly and frail individuals. In the inpatient population, symptoms suggesting some level of dysphagia may be as high as 34%. So what do you do if you feel like your swallow isn’t quite right?

In recent years, there has been a surge in the popularity of robotic surgery. This is an exciting new technology that is being actively used by many specialists here at Swedish. In General Surgery, we have been using a minimally invasive approach called laparoscopy for many years. This allows us to use smaller incisions, giving the patient much less pain and a quicker recovery.  Robotic surgery is very similar.

Here are the answers to some frequently asked questions about robotic surgery:

Are incisions smaller with robotic surgery than with laparoscopy?

No. The incisions are pretty much the same. As a patient, you might not be able to tell much of a difference from the surface.

Do the robotic instruments allow the surgeon to perform a better operation?