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HOUSE Calls: Questions About Mammograms & Stopping Anti-Depressants

June 26, 2012 by Rose Hoban in Featured, HOUSE Calls

This week we respond to questions about mammograms and stopping antidepressants.

Dear HOUSE Calls,  

Doctors don’t seem to have as much confidence in mammograms as they used to.  Why?

House calls logoThat is a timely question. There have been a couple of important developments in breast cancer screening over the past several years that have helped physicians update their thinking, and the current guidelines.

Whenever a new screening test is introduced and evaluated, optimal screening intervals may not be well established. Until we have better guidance, we default to annual screening in the absence of knowing ideal intervals. But we have also seen patients experience no risk with less frequent screenings for tests such as pap smears, and more recently for bone density testing.

That’s why recently, national recommendations for mammograms changed from telling women to have yearly exams, to telling women that every other year is fine for many women between the ages of 50-74. For younger women, because of differences in breast characteristics and cancer risk, researchers are finding that most positive findings are false positive findings. These false positives create a lot of anxiety, unnecessary follow up studies and biopsies, all of which have very little benefit.

Doctors, therefore have recently become more ambiguous in our recommendations for younger women. As a result, your doctor may not recommend mammograms before 50 and may recommend them only every other year between 50 and 74. Furthermore – and importantly – these recommendations should be based on your personal and family history, and also your values and preferences.

Talk your primary clinician and understand his/her recommendations and make sure she/he understands your position on this test.

Dear HOUSE Calls,    

I am about to go to college and have been on Prozac for several years for depression.  Things are going great now.  What would you advise regarding stopping this medication?

We are so glad that you are doing better and it is a great idea to consider a trial off of medicine for depression.

We usually recommend staying on medicines like Prozac to treat depression for 9-12 months, and then consider a trial off of medicine.

However, there are several important considerations. If the current episode is a recurrence, or if there was a suicide attempt or very severe symptoms, we might recommend staying on the medicine. We are also concerned about the major transition you have coming and how you will respond. There could be significant academic and social stress, lack of support (no parents and fewer friends nearby), and lack of a physician or therapist.

We encourage you to settle in to college life, find a new physician, and get some guidance on discontinuing the medicine with some plan for follow up. Don’t just stop an antidepressant without the guidance of a physician, as that can cause it’s own problems. Some medications need to be tapered off, and monitoring your clinical response can be crucial.  Good luck.

HOUSE Calls is a weekly column by Dr. Adam Zolotor, Dr. Adam Goldstein, and Dr. Cristy Page on behalf of YOUR HEALTH™ and the UNC Department of Family Medicine.

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  1. breast cancer images mammogramsJul 6, 2012 at 2:19 pm

    […] Want to see your surgeon for breast cysts? HI had a sore arm for a while now. Occassionly, I felt &…ore arm for a while now. Occassionly, I felt "something" with a brush of my arm over my chest. It would come and go. I had an ultrasound and mammography is the last week. I received a letter by mail saying that I looked free of cancer and had a good result Mammo (which was the image of place), but my doctor called me and told me I had a cyst at 4 o'clock and 9 o'clock in my womb right and wanted to see a surgeon. Why not put that image to say something? It – is not it? Is my doctor just to be prudent? Will you try the first biospy visit? Julie, it is obvious that it was 2 different views of 2 different doctors who have seen the mammogram itself. They can not both be right. First instead call the doctor who declined to discuss his concern about the 2 cysts, and request a written copy of his report to you. Over 50% of all women develop what is called "fibrocystic changes in their breasts. This is perfectly harmless and very common. These cysts can feel like pieces appear to change the size of top to bottom in each monthly cycle. I hope there is some kind of doctor do a Pap test yearly breast exam on you. For suspecting a cyst in the doctor's office, the doctor often put a thin needle through the skin of the breast in the cyst and to remove (aspirate) the plunger of the syringe to see what kind of statement of liquids. No anesthesia is required and no pain this procedure takes a couple of minutes. If the liquid is clear, the liquid is clear and the cyst to collapse and disappear in May, may appear next month. Many times there are multiple cysts. If there is any suspicion, while the physician (gynecologist or surgeon or generalpractice) can be a fine or need for fine needle (again without anesthesia) and send the fragments of breast tissue to the pathologist for diagnosis. The possibilities are very in their favor, in favor of a benign lesion. Honk (official video) […]

About HOUSE Calls
Physicians from the UNC Department of Family Medicine’s YOUR HEALTH™ media bring you weekly information in response to your questions about health and medicine. Send us your questions or comments to YOURHEALTH@unc.edu

The HOUSE Calls staff:

Cristy Page Headshot Dr Cristy Page is an Assistant Professor of Family Medicine at the UNC School of Medicine. A former Morehead scholar, Dr. Page completed degrees in Medicine, Public Health and Family Medicine at UNC. Dr. Page practices full scope family medicine including obstetrics, and she is recognized for important innovations in maternal health, preventive medicine and group well-child care.

Adam Goldstein Headshot Dr. Adam Goldstein is a Professor of Family Medicine at the UNC School of Medicine. As a leading U.S. expert in primary care, Dr. Goldstein has a 20-year history in clinical practice, teaching, and research. He has published over 150 articles, essays, book chapters, and books.

Adam Zolotor Headshot Dr. Adam Zolotor is an Assistant Professor of Family Medicine at the UNC School of Medicine.  Dr. Zolotor Completed his training at the University of Michigan and the University of North Carolina.  He has been in practice for 10 years and and is a nationaly recognized expert in child abuse and child injury prevention.  He directs the Department of Family Medicine maternal and child health services. He is the author of more than 50 articles and book chapters.

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