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What Your Doctor Might Not Tell You About Post-Surgery Recovery
After surgical procedures the recovery period represents a critical phase which determines the total success rate of the procedure. Doctors give essential recovery instructions yet important but underemphasized aspects play a major role in healing alongside long-term results. Some key points about post-surgical recovery which doctors typically do not address directly will help you achieve […]

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Ways the U.S. Healthcare System Lets Patients Down—And How to Push Back
The United States healthcare system operates with major difficulties, which create problems for patients who do not receive adequate service. High healthcare prices function as a significant obstacle that makes Americans avoid necessary medical care because of unaffordable costs. Access to quality healthcare services remains uneven which intensifies healthcare disparities mainly because rural areas experience […]
Between Hope and Hype: The Realities of Experimental Cancer Treatments
Experimental cancer treatments provide hope to patients with aggressive or rare cancers yet they present several unknown factors. Clinical trials demonstrate successful outcomes through their promising results which achieve high success rates in particular patient subgroups. These treatments carry potential dangers to patients due to their side effects and uncertain effectiveness across wider patient populations. […]
Ethics in Medicine: Are Patient Rights Being Respected
The recognition of patient rights depends heavily on medical ethical practices despite existing difficulties. Patients maintain their right to informed consent together with privacy and their freedom to make healthcare decisions. The understanding between healthcare providers and patients about care experiences differs from their actual perceptions. Research indicates that patients consider autonomy important but healthcare […]

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Top Aesthetic Treatments in Malaysia for Glowing, Youthful Skin
Over the years, Malaysia has emerged as a prime destination for advanced aesthetic treatments that promise radiant, youthful skin. If you’re seeking to enhance your complexion, you’ll find a range of options, from innovative laser therapies to effective chemical peels, tailored to your skin type and concerns. Understanding these top aesthetic treatments from trusted aesthetic specialists in KL, Malaysia can empower you to make informed decisions, ensuring your skincare journey is both safe and rewarding. Explore the best solutions available and learn how to maintain your skin’s vitality through professional expertise in Malaysia’s thriving beauty industry.
Key Takeaways:
- Malaysia offers a variety of advanced aesthetic treatments designed to enhance skin radiance and youthfulness.
- Popular treatments include laser therapy, chemical peels, and microneedling, each targeting different skin concerns such as pigmentation, texture, and elasticity.
- Professional consultation with certified dermatologists or aesthetic practitioners is necessary to customize treatment plans based on individual skin types and goals.
- Non-invasive and minimally invasive procedures are favored for their shorter recovery times and effective results.
- Regular maintenance sessions and proper skincare routines complement aesthetic treatments to sustain glowing, youthful skin.
- Advancements in technology have made treatments safer, more comfortable, and accessible in Malaysia’s urban centers.
- Patients should consider clinic reputation, practitioner expertise, and treatment reviews when selecting services to ensure quality and satisfaction.
Understanding Aesthetic Treatments in Malaysia
Before deciding on the right procedure for you, it’s important to understand what aesthetic treatments entail. These treatments are designed to enhance your skin’s appearance, targeting issues like aging, pigmentation, and texture to help you achieve a radiant, youthful glow. Knowing the basics will empower you to choose options that align with your skin goals and health.
What Are Aesthetic Treatments?
Treatments under the aesthetic umbrella range from non-invasive therapies like chemical peels and laser resurfacing to more advanced procedures such as microneedling or Botox injections. They work by stimulating collagen production, reducing imperfections, and improving overall skin vitality, helping you look refreshed and revitalized.
Benefits of Aesthetic Treatments for Skin
Behind the visible improvements, aesthetic treatments offer significant benefits beyond surface beauty. They can boost your skin’s health by increasing hydration, enhancing elasticity, and promoting cell renewal. This not only helps your skin look better but also strengthens its natural defenses against environmental damage.
Skin that undergoes regular aesthetic care experiences long-lasting rejuvenation, minimizing fine lines, wrinkles, and uneven tone. However, it is vital you seek treatments from qualified professionals to avoid risks like infections or adverse reactions. Properly administered, these procedures can give you a safe and effective path to a glowing, youthful complexion that lasts.
Popular Aesthetic Treatments in Malaysia for Glowing Skin
If you desire radiant and youthful skin, exploring popular aesthetic treatments in Malaysia can be a game-changer. These treatments are designed to enhance your skin’s natural glow, reduce imperfections, and boost collagen production. Options like chemical peels and microdermabrasion have gained tremendous popularity for their effectiveness and minimal downtime, providing you with noticeable improvements in texture and brightness. Choosing the right treatment tailored to your skin type will help you achieve that luminous complexion you have always wanted.
Chemical Peels
At the core of chemical peels is the application of a specialized acid solution that exfoliates and removes dead skin cells, promoting new cell growth. This treatment can effectively minimize hyperpigmentation, fine lines, and acne scars, giving your skin a brighter and smoother appearance. With a variety of peel strengths available, your skincare professional can customize the procedure to your skin’s needs, ensuring optimal results with minimal irritation.
Microdermabrasion
The microdermabrasion procedure uses fine crystals or a diamond-tipped wand to gently exfoliate the outer layer of your skin. This non-invasive treatment stimulates collagen production and improves circulation, resulting in a refreshed, glowing complexion. It is suitable for most skin types and can address issues like dullness, uneven texture, and minor scars, making it a popular choice for those seeking subtle yet effective skin rejuvenation.
But with microdermabrasion, you should be aware that improper technique or excessive treatments can lead to skin irritation, redness, or even damage. It’s important that you have the procedure performed by a qualified professional who understands your skin type and condition. The positive aspect of this treatment is that it requires little to no downtime, allowing you to quickly return to your daily routine while enjoying a noticeable improvement in your skin’s clarity and glow.
Advanced Aesthetic Treatments for Youthful Appearance in Malaysia
To achieve a more youthful and radiant complexion, you can explore advanced aesthetic treatments that focus on rejuvenating your skin at a deeper level. These cutting-edge options are designed to tackle signs of aging, uneven texture, and loss of firmness effectively. Consider the following popular treatments to enhance your natural beauty:
- Laser Skin Resurfacing
- Injectable Treatments: Botox and Fillers
- Microneedling with PRP
- Radiofrequency Therapy
Treatment | Benefits |
Laser Skin Resurfacing | Reduces wrinkles, improves skin tone, and promotes collagen production |
Botox | Minimizes fine lines by relaxing facial muscles |
Dermal Fillers | Restores volume and smooths deep wrinkles |
Microneedling with PRP | Stimulates skin regeneration and enhances overall texture |
Radiofrequency Therapy | Tightens skin and boosts collagen without downtime |
Laser Skin Resurfacing
By using concentrated laser beams, laser skin resurfacing helps you remove damaged outer skin layers while triggering your skin’s natural healing process. This results in a smoother, firmer, and more luminous complexion, effectively reducing wrinkles, scars, and pigmentation for a refreshed youthful look.
Injectable Treatments: Botox and Fillers
On your journey toward younger-looking skin, Botox and fillers offer targeted solutions. Botox works by relaxing muscles that cause wrinkles, while fillers restore lost volume and contour facial features, giving you a naturally plumped and youthful face.
As injectable treatments, Botox and dermal fillers are highly effective when performed by experienced practitioners. Botox temporarily smooths lines caused by muscle movement, such as crow’s feet and frown lines, typically lasting 3-6 months. Fillers, made of substances like hyaluronic acid, replenish volume in cheeks and lips, lasting from 6 months to over a year. Although generally safe, you should be aware of possible side effects such as bruising or asymmetry, which highlight the importance of choosing certified professionals. When done correctly, these treatments provide immediate, natural-looking rejuvenation with minimal downtime, helping you maintain a youthful, glowing appearance.
Natural and Non-Invasive Aesthetic Treatment Options in Malaysia
Despite the availability of advanced medical procedures, many people in Malaysia prefer natural and non-invasive aesthetic treatments to maintain their skin’s radiance and youthfulness. These options offer a gentler approach, minimizing recovery time and risks while promoting healthy skin from within. By embracing these treatments, you can enjoy glowing skin without undergoing aggressive interventions, making them ideal for those new to aesthetics or with sensitive skin.
Skincare Regimens
Behind every glowing complexion is a consistent, tailored skincare regimen that acts as your first line of defense against aging and environmental damage. By using products rich in antioxidants, moisturizers, and sun protection, you nurture your skin daily for lasting vitality. You should focus on gentle exfoliation and hydration to remove dead cells and enhance your skin’s natural glow, which forms the foundation of any effective aesthetic treatment.
LED Light Therapy
Regimens that include LED Light Therapy harness specific wavelengths to stimulate collagen production and reduce inflammation, promoting youthful and vibrant skin. This non-invasive treatment is safe, painless, and suitable for all skin types, making it an excellent addition to your skincare routine. Regular sessions help improve texture, diminish fine lines, and combat acne by utilizing the power of light healing.
Light emitted during LED Light Therapy penetrates your skin at various depths, activating cellular processes that enhance natural repair and regeneration. Blue light targets bacteria causing acne, reducing breakouts effectively, while red light boosts collagen synthesis, minimizing wrinkles and improving elasticity. Importantly, this therapy is non-thermal and safe, unlike some laser treatments, reducing the risk of burns or hyperpigmentation. When integrated with your daily regimen, LED Light Therapy offers a powerful, non-invasive way to maintain radiant, youthful skin over time.
Choosing the Right Aesthetic Treatment in Malaysia
For achieving glowing, youthful skin, selecting the appropriate aesthetic treatment is important. You need to consider your skin condition, lifestyle, and desired results to find a treatment that fits your unique needs. Making an informed choice helps you avoid unnecessary side effects and ensures the best possible outcome, allowing you to enhance your natural beauty safely and effectively.
Assessing Your Skin Type
Type plays a significant role in determining which treatment will work best for you. Whether your skin is oily, dry, sensitive, or combination, understanding this allows you to select therapies tailored specifically to your skin’s requirements. This assessment minimizes risks such as irritation or allergic reactions and maximizes your skin’s ability to heal and rejuvenate.
Consulting with Professionals
Across Malaysia, experienced dermatologists and skincare specialists are readily available to guide you through the complex options of aesthetic treatments. Leveraging their expertise ensures you receive personalized advice based on your skin’s unique characteristics and health history.
With professional consultation, you gain access to not only expert diagnosis but also to personalized treatment plans designed to maximize results and minimize potential risks. These experts can identify any underlying issues that may impact your skin’s response, making it safer to proceed. Choosing to consult with a qualified professional rather than self-diagnosing is a powerful step towards protecting your skin and achieving the vibrant look you desire.
Aftercare and Maintenance
Unlike some quick fixes, achieving and maintaining glowing, youthful skin requires consistent aftercare and maintenance. Proper steps following aesthetic treatments are necessary to enhance results and avoid complications. By dedicating time to nurture your skin post-procedure, you can maximize the benefits and enjoy a radiant, healthy complexion for longer periods.
Post-Treatment Skincare
For optimal recovery, you should follow a gentle skincare routine tailored to your skin’s sensitivity after treatment. This means avoiding harsh products, using soothing moisturizers, and applying broad-spectrum sunscreen daily to protect your skin from harmful UV rays that can undermine your results. Hydration and patience are key during this delicate phase.
Long-Term Maintenance Strategies
To sustain your youthful glow, adopt a consistent regimen combining professional follow-ups with home care. Incorporate antioxidant-rich serums, retinoids if appropriate, and regular hydration into your daily routine. Additionally, lifestyle factors like balanced nutrition, adequate sleep, and stress management contribute significantly to prolonged skin vitality.
Another vital aspect of long-term care includes periodic touch-up treatments as recommended by your dermatologist or aesthetician. These sessions help you address aging signs early and reinforce your skin’s resilience. Staying proactive and attentive to changes in your skin ensures you maintain a radiant, youthful appearance while minimizing potential risks associated with neglecting routine maintenance.
Summing Up
Summing up, exploring top aesthetic treatments in Malaysia offers you effective options to achieve glowing, youthful skin tailored to your unique needs. From advanced laser therapies to rejuvenating facials, these treatments are designed to enhance your natural beauty and boost confidence. By choosing the right procedures and consulting qualified professionals, you can enjoy noticeable improvements in skin texture, tone, and overall radiance. Embracing these innovative solutions allows you to maintain a fresh, vibrant appearance that reflects your best self every day.
FAQ
What are some popular aesthetic treatments available in Malaysia for achieving glowing and youthful skin?
In Malaysia, popular aesthetic treatments for glowing and youthful skin include chemical peels, microneedling, laser skin resurfacing, hydrafacial, and injectable treatments such as Botox and dermal fillers. These treatments help improve skin texture, reduce fine lines, and enhance overall radiance.
How does microneedling work, and is it suitable for all skin types?
Microneedling involves using fine needles to create tiny punctures on the skin’s surface, stimulating collagen production and skin regeneration. It is generally suitable for most skin types, including sensitive skin, but a consultation with a qualified dermatologist or aesthetician is recommended to customize the treatment based on individual skin conditions.
Are laser skin resurfacing treatments painful, and what is the typical recovery time in Malaysia?
Laser skin resurfacing can cause mild discomfort during the procedure, often managed with topical anesthetics. Recovery time varies depending on the laser type and intensity but typically ranges from a few days to a week. Patients may experience redness, peeling, and sensitivity during the healing process, and proper post-treatment care is important.
Can injectable treatments like Botox and fillers provide long-lasting results for youthful skin?
Injectable treatments such as Botox and dermal fillers can effectively reduce wrinkles and restore volume for a more youthful appearance. Results typically last between 6 to 12 months, depending on the type of product used and individual metabolism. Regular maintenance sessions are recommended to sustain the desired effect.
What factors should one consider when choosing an aesthetic clinic in Malaysia for skin treatments?
When choosing an aesthetic clinic in Malaysia, consider qualifications and experience of the medical professionals, clinic reputation, hygiene standards, available treatment options, and patient reviews. It is also important to schedule a consultation to discuss treatment goals and understand the expected outcomes and costs.

What Your Doctor Might Not Tell You About Post-Surgery Recovery
After surgical procedures the recovery period represents a critical phase which determines the total success rate of the procedure. Doctors give essential recovery instructions yet important but underemphasized aspects play a major role in healing alongside long-term results. Some key points about post-surgical recovery which doctors typically do not address directly will help you achieve a more comfortable path toward your complete health return.
1. The Importance of Mental Health
Surgical recovery requires patients to maintain both physical and mental health improvement. Patients commonly develop depressive or anxious feelings together with frustration during their healing period when their mobility becomes restricted and their recovery time exceeds expectations. Medical professionals concentrate on treating physical conditions yet patients need equal emphasis on mental health care. The combination of mindfulness practices and therapy along with support groups enables patients to handle emotional recovery challenges and develop positive mental perspectives.
2. Nutrition’s Role in Healing
Medical professionals usually provide standard dietary recommendations after surgery but they do not fully emphasize the direct impact of proper nutrition on recovery duration. The combination of protein with vitamins C and D and zinc in your diet helps both tissue healing and strengthens your immune system. Hydration remains essential because water helps remove harmful substances from the body while sustaining all necessary bodily operations. Your recovery time will shorten when you choose whole foods over processed foods as part of your diet.
3. Movement Matters More Than You Think
The need for postoperative rest is vital but too much bed rest leads to complications including blood clots or muscle stiffness. The gentle movements of walking and light stretching help improve blood circulation while reducing swelling which prevents the development of deep vein thrombosis (DVT). Your doctor will probably recommend rest but may not emphasize enough the importance of beginning safe movement activities. The correct exercises for your medical condition must always be approved by your healthcare provider.
4. Sleep Quality Impacts Recovery
The healing process depends heavily on sleep but postoperative pain frequently interrupts restful rest. When sleep quality suffers the body’s tissue repair process becomes slower and the immune system gets weaker. Although doctors typically avoid discussing sleep optimization for recovery they can help patients achieve better sleep by recommending supportive pillows and calm bedtime routines and pre-bedtime pain medication use.
5. Watch for Subtle Signs of Complications
Major complications receive attention when healthcare providers discuss them but subtle issues become apparent only when teams actively monitor patients. Wound dehiscence and delayed healing might manifest through persistent fatigue together with unusual swelling and minor changes in wound appearance. The prevention of minor complications depends on both routine self-checks and immediate medical updates about your symptoms.
6. Avoid Overexertion
After surgery it is common to wish for quick recovery but excessive physical activity leads to problems that delay healing. Doctors typically determine activity return timelines but they do not sufficiently stress the need to adjust your activity pace according to your physical sensations. A slow approach to activity increases allows you to advance steadily without creating opportunities for injuries to occur.
Conclusion
The recovery process extends beyond basic post-operative instructions because it requires active management of physical condition alongside mental state and dietary needs and sleep quality alongside detection of small complications. Your recovery plan will achieve better healing and lasting benefits by including these less common aspects. Your recovery success depends on both discussing your worries with your healthcare provider and participating actively in your recovery process.

Can AI Replace Your Doctor? Patients Weigh in on the Tech Takeover
Numerous debates continue to evolve about artificial intelligence (AI) taking over human medical practitioners in healthcare. Computational systems with artificial intelligence demonstrate outstanding capabilities for handling extensive medical information along with disease recognition abilities and occasionally produce responses showing empathy. Research demonstrates that AI system capability exceeds human doctors by providing effective diagnostic evaluation at equal or better accuracy levels. Patients demonstrate conflicting opinions about this matter. People split in their opinion about AI due to its ability to show precision yet others value human connection in doctor-patient trust relationships.
The integration of AI with medical practice should be seen as an enhancement of doctors’ work by offering better decision support and improved workflow management. Ultimately, the art of healing relies on empathy—a uniquely human trait.

Health Misinformation Online: How Patients Can Find Reliable Answers
Health misinformation found online creates major threats because it weakens trust in vaccines while spreading dangerous methods. Patients can fight misinformation by verifying statements through respected sources that include peer-reviewed studies and government health agencies. The use of sensational language through terms like “miracle cure” or “secret remedy” indicates information that should not be trusted. Patients should base their choices on scientific evidence instead of relying on personal stories and they should verify possible sponsor bias in content they access. WHO platforms advocate reporting false medical claims while users should utilize verified tools to verify information. Patients who remain watchful and knowledgeable about digital health resources can efficiently use correct medical information to make well-informed decisions about their healthcare.
In a digital age where information is just a click away, navigating the sea of health content online can be overwhelming. While the internet offers valuable resources, it also hosts a growing amount of misinformation. By relying on reputable sources such as PatientPOV.org, consulting qualified healthcare professionals, and using critical thinking when evaluating health claims, patients can better protect themselves from false information. Empowering yourself with the right tools and a cautious mindset is key to making informed decisions about your health in the online world.

Ways the U.S. Healthcare System Lets Patients Down—And How to Push Back
The United States healthcare system operates with major difficulties, which create problems for patients who do not receive adequate service. High healthcare prices function as a significant obstacle that makes Americans avoid necessary medical care because of unaffordable costs. Access to quality healthcare services remains uneven which intensifies healthcare disparities mainly because rural areas experience frequent provider shortages. Patients face additional obstacles to necessary treatment because of insurance complexities which include denied claims and restricted coverage. Medical errors that should be prevented and inefficient delivery of care lead patients to experience dissatisfaction along with poor healthcare results.
Patients must fight for full healthcare cost transparency as they work to obtain fair medical care access and support cost reduction reforms that optimize system efficiency.

Between Hope and Hype: The Realities of Experimental Cancer Treatments
Experimental cancer treatments provide hope to patients with aggressive or rare cancers yet they present several unknown factors. Clinical trials demonstrate successful outcomes through their promising results which achieve high success rates in particular patient subgroups. These treatments carry potential dangers to patients due to their side effects and uncertain effectiveness across wider patient populations. The actual treatment results demonstrate substantial differences compared to controlled study conditions.
Patients need to evaluate treatment advantages versus disadvantages by working with healthcare providers to review trial procedures. Experimental treatments show promise but healthcare providers should use caution when deploying them since patients need realistic assessments about survival and life quality expectations.

Ethics in Medicine: Are Patient Rights Being Respected
The recognition of patient rights depends heavily on medical ethical practices despite existing difficulties. Patients maintain their right to informed consent together with privacy and their freedom to make healthcare decisions. The understanding between healthcare providers and patients about care experiences differs from their actual perceptions. Research indicates that patients consider autonomy important but healthcare workers sometimes fail to put it at the forefront of care. Medical facilities must build their programs around ethical education alongside patient-centered services as a solution to this problem. Medical professionals should implement shared decision-making combined with transparency which enhances their ability to protect patient rights. Such an approach both improves patient satisfaction and establishes ethical medical practice standards which deliver effective respectful healthcare.

Nursing Homes for People of Color: Still Segregated, Still Unequal
If Martin Luther King, Jr. was alive today, he would be 86. If he was like many elderly black Americans, he might well end up in a nursing home ranked lower in quality and with less well-trained nursing staff than a nursing home that many white Americans reside in. The facility would likely house a disproportionately larger proportion of people of color and on Medicaid than higher-quality nursing homes.
The disparities are easy to miss. After all, what happens in nursing homes stays in nursing homes, invisible to the rest of us. The only ones who see what’s going on are the patients, family and friends, and staff. If people report lousy conditions in the homes, nursing homes often vilify them. In fact, some would argue that the industry hides behind a smokescreen of patient privacy. Yes, there are inspections. Are they sufficient to drive equal care? Apparently not. Overall, the nursing home industry has changed little in terms of providing quality care for minority elders on par with what white elders get.
Documentation of inequality in long term care for minority elders dates back to enactment of Title VI of the Civil Rights Act and the passage of Medicare in 1966, which prohibited segregation in health facilities that accepted federal funds. In 1981, an Institute of Medicine report addressed the issue of segregated care in nursing homes. The hospital industry was forced to integrate to some degree at least, but nursing homes have been left largely alone.
Contrary to stereotypes, a large Commonwealth Fund analysis led by Vincent Mor, PhD, from the Department of Community Health at Brown University, found that segregation was lowest in the South and highest in the Midwest (Wisconsin, Missouri, Michigan, Indiana, and Ohio). The study found that Cleveland, Ohio, followed closely by Gary, Indiana, were the most segregated cities for nursing homes. Additionally, black elders tended to be in nursing homes in the lowest quarter of quality ratings. Blacks were 1.7 times as likely as white Americans to reside in a nursing home that was subsequently thrown out of the Medicare and Medicaid programs because of poor quality and 2.64 times as likely to be in a facility housing predominantly Medicaid residents. Elderly black Americans are not the only groups at increased risk of going to a poor-quality nursing home. So are elderly Hispanics and probably many other groups not cited here.
The proliferation of for-profit nursing homes in an industry that was once largely nonprofit has also had adverse impacts. In this study, for-profit nursing homes have been found to have lower RN staff intensity and lower RN skill mix than nonprofits, jeopardizing patient care. Poor people on Medicaid are going to for-profit nursing homes at far greater rates in many parts of the country.
This post is a snapshot of one part of long term care, which is an immense, complex topic.
Readers would be misguided if they thought that disparities are concentrated in the Midwest and do not persist elsewhere. These two anecdotes, though not data, are telling. Friends of mine recently watched in tears as a dear African American male friend landed for a long stay in a one-star nursing home in New Jersey. The nursing home housed people of color on Medicaid primarily. My friends were inconsolable when they returned from a visit, quick to call it a “crowded, smelly, dumping ground.” I learned of another story from an older African American woman from Queens NY, a New York City government retiree. I worked with her for many years. When she felt that she could no longer keep up her house, she could not find a satisfactory long term care residence to move into. She never left home: her health deteriorated and eventually, she died at home.
These stark realities are shameful. It’s 2015. We can quibble about statistics, question cause, effect, or association, but outrage, remedies, and stiff penalties and incentives for change are desperately needed.

Are Dense-Breast, Right-to-Know Laws Helpful?
In a victory for the dense-breast patient movement, Governor Jerry Brown (D-CA) signed legislation last week requiring that doctors who discover that women have dense breasts on mammography must inform women that:
- dense breasts are a risk factor for breast cancer;
- mammography sees cancer less well in dense breasts than in normal breasts; and
- women may benefit from additional breast cancer screening.
The California law goes into effect on April 1, 2013. It follows four states (Connecticut, Texas, Virginia, and New York) with similar statutes. All have enjoyed solid bipartisan support. Rarely do naysayers or skeptics speak up about healthcare issues.
Young women who are leading the charge often bring lawmakers the story of a young constituent, diagnosed with a very aggressive, lethal cancer that was not shown on film-screen mammography. The Are You Dense? patient advocacy group engages patients on Facebook, where women share their experiences with breast cancer, organize events, and lobby for legislation. Individual radiologists work with the advocacy groups, but many radiology groups and breast surgeons do not endorse these laws.
A Closer Look at Breast Cancer Data
Living in an age when information is viewed as an entitlement, knowledge, and power, many physicians find it hard to argue against a patient’s right to know. Can sharing information be a mistake? Some epidemiologists think so. Otis W. Brawley, MD, FACP, Chief Medical & Scientific Officer, American Cancer Society, says: “I really worry when we legislate things that no one understands. People can get harmed.” Numerous issues have to be worked out, according to Brawley. For one, he explains: “There is no standard way to define density.” Additionally, “even though studies suggest that density increases the risk of cancer, these cancers tend to be the less serious kind, but even that is open to question,” Brawley says. “We in medicine do not know what to do for women who have increased density.”
A study of more than 9,000 women in the Journal of the National Cancer Institute revealed that women with very dense breasts were no more likely to die than similar patients whose breasts were not as dense. “When tumors are found later in more dense breasts, they are no more aggressive or difficult to treat,” says Karla Kerlikowske, MD, study coauthor, and professor of medicine and epidemiologist at the University of California San Francisco. In fact, an increased risk of death was only found in women with the least dense breasts.
The trouble is what is known about dense breasts is murky. Asked whether he backs advising women that dense breasts are a risk factor for breast cancer, Anthony B. Miller, MD, Co-Chair of the Cancer Risk Management Initiative and a member of the Action Council, Canadian Partnership Against Cancer, and lead investigator of the Canadian National Breast Cancer Screening Study, says: “I would be very cautious. The trouble is people want certainty and chances are whatever we find, all we can do is explain.”
Women in their forties, who are most likely to have dense breasts (density declines with age) may want to seek out digital mammography. In studies comparing digital mammography to film-screen mammography in the same women, digital mammography has been shown to improve breast cancer detection in women with dense breasts. Findings from the Digital Mammographic Imaging Screening Study, showed better breast cancer detection with digital mammography. But digital mammography is not available in many areas. Moreover, Miller explains: “We do not know if this will benefit women at all. It is very probable that removal of the additional small lesions will simply increase anxiety and health costs, including the overdiagnosis of breast cancer, and have no impact upon mortality from breast cancer.”
Additional imaging studies sound attractive to people convinced that there is something clinically significant to find. But as I pointed out in my last post, many radiologists and breast physicians contend that there is no evidence that magnetic resonance imaging or any other imaging study aids breast cancer screening in women with dense breasts. Brawley notes: “These laws will certainly lead to more referral for MRI and ultrasound without clear evidence that women will benefit (lives will be saved.) It’s clear that radiologists will make more money offering more tests.” Miller adds: “A number of doctors are trying to capitalize on this and some of them should know a lot better.”
Many Advocates Question More Tests, Statutes
Even though the “Are You Dense?” campaign has been instrumental in getting legislation on the books across the county, other advocacy groups and patient advocates want research, enhanced patient literacy about risks and benefits of procedures. Many recall mistakes made that led women down the path of aggressive procedures. In that group is the radical Halsted mastectomy, used widely before systematic study, but once studied, found no better than breast-conserving surgery for many cancers, and bone marrow transplants, also found to be ineffective, wearing, and costly.
Jody Schoger, a breast cancer social media activist at @jodyms who engages women weekly on twitter at #bcsm, had this to say on my blog about the onslaught of additional screening tests:
“What is needed is not another expensive modality… but concentrated focus for a biomarker to indicate the women who WILL benefit from additional screening. Because what’s happening now is an avalanche of screening, and its subsequent emotional and financial costs, that is often far out of proportion to both the relative and absolute risk for invasive cancer. I simply don’t think more “external” technology is the answer but one that evolves from the biology of cancer.”
Eve Harris @harriseve, a proponent of patient navigation and patient literacy, challenged Peter Ubel, MD, professor of business administration and medicine, at Duke University, on his view of the value of patient empowerment on the breast density issue. In a post on Forbes, replicated in Psychology Today, Ubel argued that in cases where the pros and cons of a patient’s alternatives are well known, for example, considering mastectomy or lumpectomy, patient empowerment play an important role. “But we are mistaken to turn to patient empowerment to solve dilemmas about how best to screen for cancer in women with dense breasts,” he writes.
Harris disagrees, making a compelling case for patient engagement:
“I think that we can agree that legislative interference with medical practice is not warranted when it cannot provide true consumer protection. But the context is the biggest culprit in this situation. American women’s fear of breast cancer is out of proportion with its incidence and its mortality rate. Truly empowering people—patients would mean improving health literacy and understanding of risk…”
But evidence and literacy take time, don’t make for snappy reading or headlines, and don’t shore up political points. Can we stop the train towards right-to-inform laws and make real headway in women’s health? Can we reallocate healthcare dollars towards effective treatments that serve patients and engage them in their care? You have to wonder.

Is the Bar High Enough for Screening Breast Ultrasounds for Dense Breasts?
If the approval did not take place in the setting of intense pressure to both inform women that they have dense breasts and lobbying to roll out all sorts of imaging studies quickly, no matter how well they have been studied, it would not be worth posting.
Dense breasts are worrisome to women, especially young women (in their 40s particularly) because they have proved a risk factor for developing breast cancer. Doing ultrasound on every woman with dense breasts, though, who has no symptoms, and a normal mammogram potentially encompasses as many as 40% of women undergoing screening mammography who also have dense breasts, according to the FDA’s press release. Dense breast tissue is most common in young women, specifically women in their forties, and breast density declines with age.
The limitations of mammography in seeing through dense breast tissue have been well known for decades and the search has been on for better imaging studies. Government appointed panels have reviewed the issue and mammography for women in their forties has been controversial. What’s new is the “Are You Dense?” patient movement and legislation to inform women that they have dense breasts.
Merits and Pitfalls of Device Approval
The approval of breast ultrasound hinges on a study of 200 women with dense breast evaluated retrospectively at 13 sites across the United States with mammography and ultrasound. The study showed a statistically significant increase in breast cancer detection when ultrasound was used with mammography.
Approval of a device of this nature (noninvasive, already approved in general, but not for this indication) does not require the company to demonstrate that use of the device reduces morbidity or mortality, or that health benefits outweigh risks.
Eitan Amir, MD, PhD, medical oncologist at Princess Margaret Hospital, Toronto, Canada, said: “It’s really not a policy decision. All this is, is notice that if you want to buy the technology, you can.”
That’s clearly an important point, but not one that patients in the US understand. Patients hear “FDA approval” and assume that means a technology most certainly is for them and a necessary add-on. This disconnect in the FDA medical device approval process and in what patients think it means warrants an overhaul or at the minimum, a clarification for the public.
Materials for FDA submission are available on the FDA website, including the study filed with FDA and a PowerPoint presentation, but lots of luck, finding them quickly. “In the submission by Sunnyvale CA uSystems to FDA, the company stated that screening reduces lymph node positive breast cancer,” noted Amir. “There are few data to support this comment.”
Is Cancer Detection A Sufficient Goal?
In the FDA study, more cancers were identified with ultrasound. However, one has to question whether breast cancer detection alone is meaningful in driving use of a technology. In the past year, prostate cancer detection through PSA screening has been attacked because several studies and epidemiologists have found that screening is a poor predictor of who will die from prostate cancer or be bothered by it during their lifetime. We seem to be picking up findings that don’t lead to much to worry about, according to some researchers. Could new imaging studies for breast cancer suffer the same limitation? It is possible.
Another question is whether or not the detected cancers on ultrasound in the FDA study would have been identified shortly thereafter on a routine mammogram. It’s a question that is unclear from the FDA submission, according to Amir.
One of the problems that arises from excess screening is overdiagnosis, overtreatment, and high-cost, unaffordable care. An outcomes analysis of 9,232 women in the US Breast Cancer Surveillance Consortium led by Gretchen L. Gierach, PhD, MPH, at the National Institutes of Health MD, and published online in the August 21 Journal of the National Cancer Institute, revealed: “High mammographic breast density was not associated with risk of death from breast cancer or death from any cause after accounting for other patient and tumor characteristics.” –Gierach et al., 2012
Proposed Breast Cancer Screening Tests
Meanwhile, numerous imaging modalities have been proposed as an adjunct to mammography and as potential replacements for mammography. In 2002, proponents of positron emission tomography (PET) asked Medicare to approve pet scans for imaging dense breast tissue, especially in Asian women. The Medicare Coverage Advisory Commission heard testimony, but in the end, Medicare did not approve it for the dense-breast indication.
PET scans are far less popular today, while magnetic resonance imaging (AKA MR, MRI) and imaging have emerged as as adjuncts to mammography for women with certain risk factors. Like ultrasound, the outcomes data is not in the bag for screening with it.
In an interview with Monica Morrow, MD, Chief of Breast Surgery at Memorial Sloan-Kettering Cancer Center, New York, several months ago concerning the rise in legislation to inform women about dense breasts, which frequently leads to additional imaging studies, she said: “There is no good data that women with dense breasts benefit from additional MR screening.” She is not the only investigator to question potentially deleterious use of MR ahead of data collection and analysis. Many breast researchers have expressed fear that women will opt for double mastectomies, based on MR, that in the end, may have been absolutely unnecessary.
“There is one clear indication for MR screening,” stressed Morrow, explaining that women with BRCA mutations should be screened with MRI. “Outside of that group, there was no evidence that screening women with MR was beneficial.”
At just about every breast cancer meeting in the past two years, the benefits and harms of MR and other proposed screening modalities come up, and there is no consensus in the field. It should be noted, though, that plenty of breast physicians are skeptical about broad use of MR– not just generalists outside of the field. In other words, it is not breast and radiology specialists versus the US Preventive Services Task Force – a very important message for patients to understand.
One thing is clear: as these new technologies gain FDA approval, it will be a windfall for industry. If industry is successful and doctors are biased to promoting these tests, many may offer them on the estimated 40% of women with dense breasts who undergo routine mammograms, as well as other women evaluated as having a high lifetime risk. The tests will be offered in a setting of unclear value and uncertain harms. Even though FDA has not approved breast MRI for screening dense breasts, breast MR is being used off label and it is far more costly than mammography.
When patients raise concerns about the unaffordability of medical care, they should be counseled about the uncertain benefit and potential harms of such a test. That may be a tall bill for most Americans to consider: it’s clear that the more is better philosophy is alive and well. Early detection of something, anything, even something dormant, going nowhere, is preferable to skipping a test, and risking who-knows-what, and that is something, most of us cannot imagine at the outset.


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