Annual Mammograms
P age |1
(Informative Outline)
Are Annual Mammograms Really Necessary?
(Introduction)
It was supposed to be a regular, annual, woman’s wellness exam. My Aunt and I took my grandmother to the doctor for her appointment. We were present during all of the proceedings and testing that took place. We were confident that everything went well and my grandmother was in good health. When we left the doctor’s office that day, we were totally unprepared for the phone call that was to come. After my Aunt informed the family that grandmother had to be admitted to the hospital immediately for a biopsy, everyone was in total disbelief. Two words had become a part of our lives in one short day because of an exam that was supposed to be
routine. …show more content…
Because my grandmother is a Sr. citizen, this wasn’t supposed to happen to her.
According to the medical community, she did everything right. The chances of her getting breast cancer were supposed to be minimized. This experience proved none of us can ever be too informed about breast cancer and mammograms. So, let’s talk about the use of mammograms and some of the other issues regarding their use in fighting breast cancer.
Today I am going to share with you information about the current issues being debated in our society regarding mammograms. I have personal knowledge of some of the issues concerning mammograms because breast cancer has impacted my family. Additionally, as a LPN, I work with women and men who are being treated for this disease. For the purpose of this speech, I will make reference to women throughout the presentation. However, please be informed the information presented applies to men as well. Yes, breast cancer is not just a woman’s disease.
Men can be diagnosed with breast cancer according to research completed by the medical community. Many of us know or someday may know someone affected by breast cancer. The debate regarding the prevention and treatment of this disease is always changing. Thus, it is important for each of us to be aware of what is going on with discussions about breast cancer and the use of mammograms. Some aspects of the current debate surrounding annual mammograms are, 1.)
Are annual mammograms really necessary? 2.) Do mammograms really save lives? 3.) What are some of the comparisons between the old guidelines for mammograms and the new current guidelines released by the medical community?
(Body)
Are annual mammograms really necessary? Well the answer to this question depends on whom you ask it too.
In a PBS News Hour story, News Hour health correspondent Betty Ann Bowser did an interview with several patients and medical professionals that asked some very interesting questions and found the answers to these questions were not so simple. The medical community found annual mammograms have been seen as an important screening tool. They are very effective in helping find small, slow-growing cancers. But how good are they at finding fatal
P age |2
tumors? Health correspondent Betty Ann Bowser reported on a study published in the New
England Journal of Medicine that has reignited the debate.
The debate is raging because mammogram testing can also yield false positive and over diagnosis results. According to www.breastcancer.org, the main risk of mammograms is that they aren’t perfect. Normal breast tissue can hide a breast cancer so that it doesn 't show up on the mammogram. This is called a false negative. And, mammography can identify an abnormality that looks like a cancer, but turns out to be normal. This "false alarm", the false positive, means more tests and follow-up visits, which can be stressful. To make up for these limitations, more than mammography is often needed. Women also need to practice breast self-examination,
get regular breast examinations by an experienced health care professional, and, in some cases, also get another form of breast imaging, such as breast MRI or ultrasound. Some women wonder about the risks of radiation exposure due to mammography. Modern-day mammography only involves a tiny amount of radiation — even less than a standard chest x-ray.
Yes, mammograms can save your life. Finding breast cancer early reduces your risk of dying from the disease by 25-30% or more. Women should begin having mammograms yearly at age
40, or earlier if they 're at high risk, according to www.breastcare.org. Don 't be afraid.
Mammography is a fast procedure (about 20 minutes), and discomfort is minimal for most women. The procedure is safe: there 's only a very tiny amount of radiation exposure from a mammogram. To relieve the anxiety of waiting for results, get the best quality care you can. If you have dense breasts or are under age 50, try to get a digital mammogram. A digital mammogram is recorded onto a computer so that doctors can enlarge certain sections to look at them more closely.
Other tips:
A.
Bring your past mammogram films/results with you. If you’ve been to the same facility before, make sure your past results are available to whoever is reading the study.
B.
Once you find a facility you have confidence in, try to go there every year, so that your mammograms can be compared from year to year.
C.
Have more than one radiologist read your study, if your insurance covers this.
D.
Ask if your center has CAD — computer-aided detection — a tool that assists the radiologist in finding any areas of concern that need further attention.
E.
If you’ve been referred for a mammogram because of a suspicious lump or a finding on another test, make sure your doctor includes a detailed note as to why the mammogram has been ordered. For example, if the doctor felt a lump in the upper portion of the breast, closer to the underarm, the note might say, “palpable mass in the
P age |3
upper outer quadrant, left breast, and rule out abnormality.” Be prepared to talk about previous unusual findings or symptoms with the technologist who performs the mammogram.
F.
Work with your doctor to compare your mammogram results with any other tests you may have had done, such as ultrasound or MRI.
G.
On the day of the exam, wear a skirt or pants, rather than a dress, since you’ll need to remove your top for the test. Don’t wear deodorant or antiperspirant, since these can show up on the film and interfere with the test results.
H.
Avoid scheduling your mammogram at a time when your breasts are swollen or tender, such as right before your period.
I.
Discuss your family history of breast and other cancers — from both your mother 's AND father’s side — with your doctor.
J.
If you don’t receive any results within 30 days, call your doctor or testing facility to ask for the results.
Now let’s take a look at a different opinion about breast cancer and mammography. In an
Abstract from the Department of General Surgery at Methodist Dallas Medical Center in Dallas,
Texas, recent recommendations from the U.S. Preventative Services Task Force suggested screening mammography for women should be completed one time every two years, starting at age 50 years and continue to age 74 years. With these recommendations in mind, doctors at the medical center did a study to find out if the assumption that getting breast cancer screening every two years was a beneficial option to individuals who had previously been diagnosed as cancer free within 1 year of a previous annual mammogram.
An analysis of the time elapsed between the cancer free mammogram and the mammogram that was done two years later, included a total of 205 patients. The average age of the participants was 64 years old. From the results, researchers found, not getting the annual mammography caused breast cancers that could have been detected and treated before the disease progressed aggressively. In essence, the article stated the study raised concerns that 2 years between screening mammograms may delay diagnosis and possible treatment options for many women.
According to Reuters, controversial U.S. guidelines for mammography issued in 2009, calling for screening every two years rather than annually for women over 50 years old, can result in breast cancers being missed, according to U.S. researchers studying the hotly debated topic. In agreement with opponents of the two year examination guidelines, Modern Healthcare, published several studies questioning the revised mammography screening guidelines issued by the U.S. Preventive Services Task Force because the revised guidelines may result in missed cancers and declines in screening. According to two studies presented at the Radiological
Society of North America 's annual meeting in Chicago, both studies looked at changes in
P age |4
mammography screening data following the task force 's controversial recommendations in 2009.
The U.S. Preventive Services Task Force said women should begin routine screening at age 50, instead of age 40. The guidelines also recommended that women undergo routine screening every two years instead of every year and routine screening should end when women are 74 year
According to www.mammographysaveslives.org, in 2009, the United States Preventative
Services Task Force (USPSTF) advised against annual mammograms for women in their 40s.
These recommendations have been scientifically rejected by every major medical organization with demonstrated expertise in breast cancer care. The federal government has barred Medicare and private insurance companies from considering the recommendations when making coverage determinations for mammograms. The website included the USPSTF recommendations only to inform the public that they exist. By not getting annual mammograms starting at age 40, you increase your chances of dying from breast cancer and the likelihood that you will experience more extensive treatment for any cancers found
(Conclusion)
In summary, you may have read various news reports about when to get a mammogram and why.
The fact is that mammography is the best tool available to screen for breast cancer. It has helped reduce the breast cancer death rate in the United States by 30 percent. At present, there are no tests to replace mammography. Experts at the American Cancer Society (ACS), American
College of Radiology (ACR), and Society of Breast Imaging (SBI) all recommend that women receive an annual mammograms starting at age 40.
However, mammograms can still miss 20% of breast cancers that are simply not visible using this technique. Other important tools — such as breast self-exam, clinical breast examination, and possibly ultrasound or MRI — can and should be used as complementary tools, but there are no substitutes or replacements for a mammogram.
An unusual result requiring further testing does not always mean you have breast cancer.
According to the American Cancer Society, about 10% of women (1 in 10) who have a mammogram will require more tests. Only 8-10% of these women will need a biopsy, and about
80% of these biopsies will turn out not to be cancer. It’s normal to worry if you get called back for more testing, but try not to assume the worst until you have more information.
There 's a lot of confusion out there about when and how often to get a mammogram. If you 're at high risk for breast cancer, with a strong family history of breast or ovarian cancer, or have had radiation treatment to the chest in the past, it 's recommended that you start having annual mammograms at a younger age (often beginning around age 30). This, however, is something that you should discuss with your health care provider.
P age |5
(Review/Central Idea)
Therefore, I strongly encourage all people, female and male to get the annual mammogram. In my community, the African American community, we should always be informed about the current debate on breast cancer issues. We should be continually asking ourselves questions and investigating aspects of the current debate surrounding annual mammograms, such as, 1.)
Are annual mammograms really necessary? 2.) Do mammograms really save lives? 3.)
What are some of the comparisons between the old guidelines for mammograms and the new current guidelines released by the medical community?
It is, without a doubt, necessary for my community to stay informed regarding breast cancer issues. Because the research from the medical community shows African American women get breast cancer at the same rates as other ethnic groups, however, our death rates from the disease are extremely high, compared to other groups. Also, if we are diagnosed with breast cancer, we tend to get the most aggressive forms of breast cancer that could have been treated successfully with early intervention and preventive measures.
(Closing Statement)
This is why I am so glad my family was able to get my grandmother to the doctor without incidence. Because we were proactive, we were able to get her the best, quality, care she needed, in a timely manner. Let me encourage all of you to do the same for yourselves and your loved ones. Additionally, please inform every man you know, breast cancer is not just a woman’s disease. According to the medical community, men can be diagnosed with it too. Therefore, make a wise choice. Always choose to be as healthy as you can. Endeavor to work toward maximum health daily. With good health, each of us will be able to live an abundant life.
Bibliography
MammographySavesLives…one of them may be yours. 2013. Online. Internet. 3 February
2013.
Available: http://www.mammographysaveslives.org/Facts/Guidelines.aspx
More Cancers May Be Missed Under Latest Mammogram Guidelines. 2012. Online. Internet.
3 February 2013.
Available: http://health.usnews.com/health-news/news/articles/2012/11/27/more-cancersmay-be-missed-under-latest-mammogram-guidelines
Preventive Mammogram Recommendations Could Result In Missed Cancer, Study Says. 2012.
Online. Internet. 3 February 2013.
Available: http://www.kaiserhealthnews.org/Daily-Reports/2012/November/28/publichealth-mammograms.aspx
P age |6
New Studies Show Effects of Mammography Guideline Changes. 2012. Online. Internet. 3
February 2013.
Available: http://www.eurekalert.org/pub_releases/2012-11/rson-nss111612.php
Doctors not happy about mammogram guidelines. 2012. Online. Internet. 3 February 2013.
Available: http://www.nbcnews.com/id/47889110/ns/health-health_care/t/doctors-not-happyabout-mammogram-guidelines/
American Cancer Society Guidelines for the Early Detection of Cancer: Breast Cancer. 2013.
Online. Internet. 3 February 2013.
Available: http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/ american-cancer-society-guidelines-for-the-early-detection-of-cancer New Mammogram Screening Guidelines FAQ. 2009. Online. Internet. 3 February 2013.
Available: http://www.webmd.com/breast-cancer/features/new-mammogram-screeningguidelines-faq
Mammogram. 2013. Online. Internet. 3 February 2013.
Available: http://www.mayoclinic.com/health/mammogram-guidelines/AN02052
Think Pink: Are Annual Mammograms Necessary?. 2012. Online. Internet. 3 February 2013.
Available: http://www.gatech.edu/newsroom/release.html?nid=162001
Mammography: Benefits, Risks, What You Need to Know. 2012. Online. Internet. 3 February
2013.
Available: http://www.breastcancer.org/symptoms/testing/types/mammograms/benefits_risks
Annual mammography screening: is it necessary?. 2012. Online. Internet. 3 February 2013.
Available: http://www.ncbi.nlm.nih.gov/pubmed/22273325
“PBS News Hour”. NewsHour health correspondent Betty Ann Bowser Reporting. Are Annual
Mammograms Necessary? Physicians Debate Tool 's Prevention Capability. PBS, 25 December
2012.
Gavin III, MD, PhD, James R. and Sherrye Landrum. Dr. Gavin’s Health Guide for African
Americans: How to Keep Yourself and Your Children Well. Virginia. Small Steps Press. 2004.
(Informative Outline)
Are Annual Mammograms Really Necessary?
(Introduction)
It was supposed to be a regular, annual, woman’s wellness exam. My Aunt and I took my grandmother to the doctor for her appointment. We were present during all of the proceedings and testing that took place. We were confident that everything went well and my grandmother was in good health. When we left the doctor’s office that day, we were totally unprepared for the phone call that was to come. After my Aunt informed the family that grandmother had to be admitted to the hospital immediately for a biopsy, everyone was in total disbelief. Two words had become a part of our lives in one short day because of an exam that was supposed to be
routine. …show more content…
Because my grandmother is a Sr. citizen, this wasn’t supposed to happen to her.
According to the medical community, she did everything right. The chances of her getting breast cancer were supposed to be minimized. This experience proved none of us can ever be too informed about breast cancer and mammograms. So, let’s talk about the use of mammograms and some of the other issues regarding their use in fighting breast cancer.
Today I am going to share with you information about the current issues being debated in our society regarding mammograms. I have personal knowledge of some of the issues concerning mammograms because breast cancer has impacted my family. Additionally, as a LPN, I work with women and men who are being treated for this disease. For the purpose of this speech, I will make reference to women throughout the presentation. However, please be informed the information presented applies to men as well. Yes, breast cancer is not just a woman’s disease.
Men can be diagnosed with breast cancer according to research completed by the medical community. Many of us know or someday may know someone affected by breast cancer. The debate regarding the prevention and treatment of this disease is always changing. Thus, it is important for each of us to be aware of what is going on with discussions about breast cancer and the use of mammograms. Some aspects of the current debate surrounding annual mammograms are, 1.)
Are annual mammograms really necessary? 2.) Do mammograms really save lives? 3.) What are some of the comparisons between the old guidelines for mammograms and the new current guidelines released by the medical community?
(Body)
Are annual mammograms really necessary? Well the answer to this question depends on whom you ask it too.
In a PBS News Hour story, News Hour health correspondent Betty Ann Bowser did an interview with several patients and medical professionals that asked some very interesting questions and found the answers to these questions were not so simple. The medical community found annual mammograms have been seen as an important screening tool. They are very effective in helping find small, slow-growing cancers. But how good are they at finding fatal
P age |2
tumors? Health correspondent Betty Ann Bowser reported on a study published in the New
England Journal of Medicine that has reignited the debate.
The debate is raging because mammogram testing can also yield false positive and over diagnosis results. According to www.breastcancer.org, the main risk of mammograms is that they aren’t perfect. Normal breast tissue can hide a breast cancer so that it doesn 't show up on the mammogram. This is called a false negative. And, mammography can identify an abnormality that looks like a cancer, but turns out to be normal. This "false alarm", the false positive, means more tests and follow-up visits, which can be stressful. To make up for these limitations, more than mammography is often needed. Women also need to practice breast self-examination,
get regular breast examinations by an experienced health care professional, and, in some cases, also get another form of breast imaging, such as breast MRI or ultrasound. Some women wonder about the risks of radiation exposure due to mammography. Modern-day mammography only involves a tiny amount of radiation — even less than a standard chest x-ray.
Yes, mammograms can save your life. Finding breast cancer early reduces your risk of dying from the disease by 25-30% or more. Women should begin having mammograms yearly at age
40, or earlier if they 're at high risk, according to www.breastcare.org. Don 't be afraid.
Mammography is a fast procedure (about 20 minutes), and discomfort is minimal for most women. The procedure is safe: there 's only a very tiny amount of radiation exposure from a mammogram. To relieve the anxiety of waiting for results, get the best quality care you can. If you have dense breasts or are under age 50, try to get a digital mammogram. A digital mammogram is recorded onto a computer so that doctors can enlarge certain sections to look at them more closely.
Other tips:
A.
Bring your past mammogram films/results with you. If you’ve been to the same facility before, make sure your past results are available to whoever is reading the study.
B.
Once you find a facility you have confidence in, try to go there every year, so that your mammograms can be compared from year to year.
C.
Have more than one radiologist read your study, if your insurance covers this.
D.
Ask if your center has CAD — computer-aided detection — a tool that assists the radiologist in finding any areas of concern that need further attention.
E.
If you’ve been referred for a mammogram because of a suspicious lump or a finding on another test, make sure your doctor includes a detailed note as to why the mammogram has been ordered. For example, if the doctor felt a lump in the upper portion of the breast, closer to the underarm, the note might say, “palpable mass in the
P age |3
upper outer quadrant, left breast, and rule out abnormality.” Be prepared to talk about previous unusual findings or symptoms with the technologist who performs the mammogram.
F.
Work with your doctor to compare your mammogram results with any other tests you may have had done, such as ultrasound or MRI.
G.
On the day of the exam, wear a skirt or pants, rather than a dress, since you’ll need to remove your top for the test. Don’t wear deodorant or antiperspirant, since these can show up on the film and interfere with the test results.
H.
Avoid scheduling your mammogram at a time when your breasts are swollen or tender, such as right before your period.
I.
Discuss your family history of breast and other cancers — from both your mother 's AND father’s side — with your doctor.
J.
If you don’t receive any results within 30 days, call your doctor or testing facility to ask for the results.
Now let’s take a look at a different opinion about breast cancer and mammography. In an
Abstract from the Department of General Surgery at Methodist Dallas Medical Center in Dallas,
Texas, recent recommendations from the U.S. Preventative Services Task Force suggested screening mammography for women should be completed one time every two years, starting at age 50 years and continue to age 74 years. With these recommendations in mind, doctors at the medical center did a study to find out if the assumption that getting breast cancer screening every two years was a beneficial option to individuals who had previously been diagnosed as cancer free within 1 year of a previous annual mammogram.
An analysis of the time elapsed between the cancer free mammogram and the mammogram that was done two years later, included a total of 205 patients. The average age of the participants was 64 years old. From the results, researchers found, not getting the annual mammography caused breast cancers that could have been detected and treated before the disease progressed aggressively. In essence, the article stated the study raised concerns that 2 years between screening mammograms may delay diagnosis and possible treatment options for many women.
According to Reuters, controversial U.S. guidelines for mammography issued in 2009, calling for screening every two years rather than annually for women over 50 years old, can result in breast cancers being missed, according to U.S. researchers studying the hotly debated topic. In agreement with opponents of the two year examination guidelines, Modern Healthcare, published several studies questioning the revised mammography screening guidelines issued by the U.S. Preventive Services Task Force because the revised guidelines may result in missed cancers and declines in screening. According to two studies presented at the Radiological
Society of North America 's annual meeting in Chicago, both studies looked at changes in
P age |4
mammography screening data following the task force 's controversial recommendations in 2009.
The U.S. Preventive Services Task Force said women should begin routine screening at age 50, instead of age 40. The guidelines also recommended that women undergo routine screening every two years instead of every year and routine screening should end when women are 74 year
According to www.mammographysaveslives.org, in 2009, the United States Preventative
Services Task Force (USPSTF) advised against annual mammograms for women in their 40s.
These recommendations have been scientifically rejected by every major medical organization with demonstrated expertise in breast cancer care. The federal government has barred Medicare and private insurance companies from considering the recommendations when making coverage determinations for mammograms. The website included the USPSTF recommendations only to inform the public that they exist. By not getting annual mammograms starting at age 40, you increase your chances of dying from breast cancer and the likelihood that you will experience more extensive treatment for any cancers found
(Conclusion)
In summary, you may have read various news reports about when to get a mammogram and why.
The fact is that mammography is the best tool available to screen for breast cancer. It has helped reduce the breast cancer death rate in the United States by 30 percent. At present, there are no tests to replace mammography. Experts at the American Cancer Society (ACS), American
College of Radiology (ACR), and Society of Breast Imaging (SBI) all recommend that women receive an annual mammograms starting at age 40.
However, mammograms can still miss 20% of breast cancers that are simply not visible using this technique. Other important tools — such as breast self-exam, clinical breast examination, and possibly ultrasound or MRI — can and should be used as complementary tools, but there are no substitutes or replacements for a mammogram.
An unusual result requiring further testing does not always mean you have breast cancer.
According to the American Cancer Society, about 10% of women (1 in 10) who have a mammogram will require more tests. Only 8-10% of these women will need a biopsy, and about
80% of these biopsies will turn out not to be cancer. It’s normal to worry if you get called back for more testing, but try not to assume the worst until you have more information.
There 's a lot of confusion out there about when and how often to get a mammogram. If you 're at high risk for breast cancer, with a strong family history of breast or ovarian cancer, or have had radiation treatment to the chest in the past, it 's recommended that you start having annual mammograms at a younger age (often beginning around age 30). This, however, is something that you should discuss with your health care provider.
P age |5
(Review/Central Idea)
Therefore, I strongly encourage all people, female and male to get the annual mammogram. In my community, the African American community, we should always be informed about the current debate on breast cancer issues. We should be continually asking ourselves questions and investigating aspects of the current debate surrounding annual mammograms, such as, 1.)
Are annual mammograms really necessary? 2.) Do mammograms really save lives? 3.)
What are some of the comparisons between the old guidelines for mammograms and the new current guidelines released by the medical community?
It is, without a doubt, necessary for my community to stay informed regarding breast cancer issues. Because the research from the medical community shows African American women get breast cancer at the same rates as other ethnic groups, however, our death rates from the disease are extremely high, compared to other groups. Also, if we are diagnosed with breast cancer, we tend to get the most aggressive forms of breast cancer that could have been treated successfully with early intervention and preventive measures.
(Closing Statement)
This is why I am so glad my family was able to get my grandmother to the doctor without incidence. Because we were proactive, we were able to get her the best, quality, care she needed, in a timely manner. Let me encourage all of you to do the same for yourselves and your loved ones. Additionally, please inform every man you know, breast cancer is not just a woman’s disease. According to the medical community, men can be diagnosed with it too. Therefore, make a wise choice. Always choose to be as healthy as you can. Endeavor to work toward maximum health daily. With good health, each of us will be able to live an abundant life.
Bibliography
MammographySavesLives…one of them may be yours. 2013. Online. Internet. 3 February
2013.
Available: http://www.mammographysaveslives.org/Facts/Guidelines.aspx
More Cancers May Be Missed Under Latest Mammogram Guidelines. 2012. Online. Internet.
3 February 2013.
Available: http://health.usnews.com/health-news/news/articles/2012/11/27/more-cancersmay-be-missed-under-latest-mammogram-guidelines
Preventive Mammogram Recommendations Could Result In Missed Cancer, Study Says. 2012.
Online. Internet. 3 February 2013.
Available: http://www.kaiserhealthnews.org/Daily-Reports/2012/November/28/publichealth-mammograms.aspx
P age |6
New Studies Show Effects of Mammography Guideline Changes. 2012. Online. Internet. 3
February 2013.
Available: http://www.eurekalert.org/pub_releases/2012-11/rson-nss111612.php
Doctors not happy about mammogram guidelines. 2012. Online. Internet. 3 February 2013.
Available: http://www.nbcnews.com/id/47889110/ns/health-health_care/t/doctors-not-happyabout-mammogram-guidelines/
American Cancer Society Guidelines for the Early Detection of Cancer: Breast Cancer. 2013.
Online. Internet. 3 February 2013.
Available: http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/ american-cancer-society-guidelines-for-the-early-detection-of-cancer New Mammogram Screening Guidelines FAQ. 2009. Online. Internet. 3 February 2013.
Available: http://www.webmd.com/breast-cancer/features/new-mammogram-screeningguidelines-faq
Mammogram. 2013. Online. Internet. 3 February 2013.
Available: http://www.mayoclinic.com/health/mammogram-guidelines/AN02052
Think Pink: Are Annual Mammograms Necessary?. 2012. Online. Internet. 3 February 2013.
Available: http://www.gatech.edu/newsroom/release.html?nid=162001
Mammography: Benefits, Risks, What You Need to Know. 2012. Online. Internet. 3 February
2013.
Available: http://www.breastcancer.org/symptoms/testing/types/mammograms/benefits_risks
Annual mammography screening: is it necessary?. 2012. Online. Internet. 3 February 2013.
Available: http://www.ncbi.nlm.nih.gov/pubmed/22273325
“PBS News Hour”. NewsHour health correspondent Betty Ann Bowser Reporting. Are Annual
Mammograms Necessary? Physicians Debate Tool 's Prevention Capability. PBS, 25 December
2012.
Gavin III, MD, PhD, James R. and Sherrye Landrum. Dr. Gavin’s Health Guide for African
Americans: How to Keep Yourself and Your Children Well. Virginia. Small Steps Press. 2004.