By Chris Appleton

Most pathologists who work in laboratories at community hospitals like BMH don’t have direct contact with the public. Yet when you think about it, our duties actually bring us in contact with nearly all patients and every type of medical condition. Pathologists are frequently referred to as “the doctor’s doctor” because we are the physicians who conduct the laboratory tests ordered by family practitioners, surgeons and specialists who “see patients.”

Christopher Appleton, DO
Christopher Appleton, DO

This is in part why The College of American Pathologists introduced the slogan “Every number is a life” a few years ago. It reminds us that every specimen we analyze in hospital laboratories comes from a patient. Pathologists who take this creed to heart, like me, often get involved in matters of public health. One area we often work to raise public awareness is with regards to the impact of regular screening on direct patient care. We are the ones, after all, with the first look at the results of inadequate healthcare screening when we detect disease in the blood and tissue samples sent to the lab for analysis. Unfortunately, we are inundated with new and oftentimes conflicting information about preventative medicine.

The best example of this is with mammograms. The primary message heard every October when we observe National Breast Cancer Awareness month is that a mammogram is the most important screening test for the detection and prevention of breast cancer. The American College of Surgeons has released comments strongly supporting current American Cancer Society screening mammography guidelines, recommending women get a mammogram every year starting at the age of 40. The American College of Obstetricians and Gynecologists agrees, saying the recommendation to start screening at age 40 is based on the overall incidence of breast cancer, the time it takes for breast cancer to grow, and the potential to reduce the number of deaths from it.

The United States Preventative Services Task Force, on the other hand, recommends biannual screening mammography for women age 50 to 74 years. It also recommends against teaching breast self-examination. It should be noted that the task force says the decision to start regular mammography before the age of 50 is up to the individual, and that patient context should be taken into account. They also recommend breast self-awareness, which is less a technique for self-examination and more of an understanding of the normal appearance and feel of women’s breasts. But it seems these are the types of recommendations that get buried beneath the controversy of the conflicting age recommendations.

In a similar situation, the US Preventative Services Task Force recently recommended against prostate specific antigen-based screening, commonly known as PSA screening, for prostate cancer. Meanwhile, the American Urological Association issued a best practices statement in 2009 that says PSA testing should be offered to well-informed men who are ages 40 years and older and have a life expectancy of at least ten years.

The best way to reconcile these different sources of information is with your personal medical providers. Men should hear what their primary care provider thinks they should do with regards to their own lifestyle and health situation to determine the need for a PSA screening. Likewise, women should discuss their breast care with their personal providers, their OB/GYN or midwife, or even the director of BMH’s Comprehensive Breast Care program, Kelly McCue, who can help them find the resources they need for screenings or other services.

Chris Appleton, DO, is a board-certified pathologist at Brattleboro Memorial Hospital. He can be reached at 802-257-8372