I have very distinct memories of sitting at the dinner table as a child long after everyone else had finished their meals. My mom and brother would be off watching TV, doing homework or reading, and there we’d sit: my dad, my dinner plate and me.

It’s not an unfamiliar scene. For me the great dinner adversary was whatever form of meat happened to be sitting on my plate at the time, but I’ve been told peas and broccoli can produce similar results.

Whatever the food culprit might be, these stories typically center on a parent’s promotion of health and nutrition and a child’s assertion of his or her eating independence. It’s been almost a decade since my last dinner-table feud, and I realize now that there’s merit to both sides. Parents teach their children food rituals, whether its eating lean meat and salads or pizza and potato chips, and kids go on to decide how those food rituals will act, or not act, in their lives. Healthy habits must be shared, but eventually they must be owned.

In The Omnivore’s Dilemma, Michael Pollan refers to the American paradox of “unhealthy people obsessed with the idea of eating healthily.” It’s no secret that Americans are behind the curve when it comes to eating choices, but truly healthy habits aren’t as hard to implement as one might think.

Paula Vandelicht, registered dietitian at the Hy-Vee on East Nifong, says that family mealtime is an important place to start. “The parents really are the positive role models in terms of what they’re eating,” she says. “You might not like something, but if you have it available for your child to at least try, then they have the option to make that choice themselves.” Vandelicht offers the following tips for incorporating vegetables into your family’s daily diets:

1. Make it convenient: Steam-in-the-bag and pre-cut vegetables are great options when you’re tight on time. Steam-in-the-bag varieties are a quick addition to any meal, and pre-cut veggies are a great grab-and-go snack. Frozen vegetables can also be used as a quick addition to regular dinners. Add them to soups, casseroles or slow-cooker meals. “Think of the value you’re getting out of that versus just having the meat portion,” Vandelicht says. “Plus, it’s less you have to do when you get home from work. We are all interested in ways to save time.”
2. Do three in one: Try to have three vegetables with every dinner. “That sounds like a lot,” Vandelicht says, “but it’s an easy way to give kids variety and choice and also give you options to vary up the diet a little bit.” The three-in-one plan can be especially simple this time of year. David Guthrie, produce manager at Schnucks in Columbia, says that during the winter months, more people are staying inside and cooking. “We see an big increase in potatoes, onions, cabbage, broccoli, carrots. All of the cooking vegetables.” Pick your family’s favorites, and cook them all in a one-pot meal.
3. Be creative: Do breakfast for dinner with veggie-filled omelets, or make salads creative with extra diversity. If you’re not a vegetable fan, try a 100-percent vegetable juice, which offers a full serving of vegetables. For kids who are picky eaters, try calling vegetables different things. “Broccoli might not sound good, but calling them trees or dinosaur feet makes it more fun,” Vandelicht says. “If they try it and don’t like it, keep introducing it. You don’t have to force them to eat it, but if you have it available, they’ll eventually try it.”
4. Spice it up: Season vegetables with lemon juice and herbs, and don’t be afraid to try different things. “I always have Italian seasoning, garlic and Mrs. Dash on hand, just to spice things up a little bit,” Vandelicht says.
5. Think variety: “The more color you can put in your basket, the more nutritious your meals and snacks will be,” Vandelicht says. Peppers are high in vitamins A and C; broccoli is high in calcium and vitamins B and C. Bright color variety translates to more vitamins and nutrients.
6. Go vegetarian: Prepare at least two vegetarian meals a week that incorporate proteins such as tofu or chickpeas. “It’s easier to avoid large amounts of red meat if you’re planning to use another protein source,” Vandelicht says. “Tofu, edamame, soy nuts, eggs in moderation. It’s about meal planning and sitting down with the family and saying, ‘Hey, what would you try?’”

Recipes

Macaroni and Cheese

This recipe puts a healthy spin on a kid favorite. A jar of baby food squash adds nutrients and blends easily with the creamy, homemade sauce. Recipe reprinted from Hy-Vee Seasonings, Health 2010.

Serves 4 (about ½ cup each)

2 cups whole-wheat bow-tie pasta

1 tablespoon unsalted butter

1 tablespoon flour

¼ teaspoon salt

1/8 teaspoon ground mustard

1/8 teaspoon white pepper

¾ cup skim milk

1 (4 ounce) jar baby food squash

1 ½ cups finely shredded 2% milk cheddar cheese

Prepare pasta according to package directions; set aside.

Meanwhile, melt butter in a large saucepan over medium heat. Whisk in flour, salt, ground mustard and pepper. Cook, stirring constantly, until a thick paste has formed. Whisk in milk and cook, stirring frequently, until thickened, about three to four minutes.

Add squash, and stir until smooth. Add cheddar cheese, and stir just until combined. Fold in drained pasta.

Nutrition facts per serving: 280 calories, 12 g fat, 7 g saturated fat, 0 g trans fat, 40 mg cholesterol, 510 mg sodium, 28 g carbohydrate, 2 g fiber, 4 g sugar, 16 g protein. Daily values: 50% vitamin A, 2% vitamin C, 35% calcium, 6% iron.

Stuffed Peppers

When it comes to choosing vegetables, color variety is key. Bell peppers are a great source of vitamin C, and their deep color shows they are nutrient-packed. Recipe reprinted from Hy-Vee Seasonings, Health 2010.

Serves 6

6 medium red bell peppers

1 pound 95% lean ground beef (or ground turkey)

½ white onion, diced

2 cloves garlic, minced

½ cup diced green bell pepper

½ cup shredded carrots

¼ cup quick-cooking barley

½ cup dry instant brown rice

1 cup vegetable broth

1 cup 2% milk shredded mozzarella cheese, divided

Preheat oven to 250˚F. Cut tops off peppers; remove seeds and membranes. Place peppers in a large pot; cover with salted water, and bring to a boil. Reduce heat, cover and simmer for five minutes. Drain peppers, and set aside.

In a large skillet, brown beef with diced onion and garlic. Stir in green bell pepper, carrots, barley, rice and broth. Simmer, covered, for 10 – 15 minutes. Stir in ½ cup cheese. Fill each pepper with beef mixture. Top each with remaining cheese, and bake for 25 minutes.

Nutrition facts per serving: 300 calories, 9 g fat, 4.5 g saturated fat, 0 g trans fat, 75 mg cholesterol, 270 mg sodium, 23 g carbohydrates, 6 g fiber, 8 g sugar, 31 g protein. Daily values: 140% vitamin A, 370% vitamin C, 15% calcium, 20% iron.

Quick tips:

• Canned vegetables, even the low-sodium varieties, have a high sodium content. A quick drain and rinse will eliminate about 40 percent of that sodium content.
• Typically, the lower the price, the more in-season the vegetable is.
• Expect prices to be up this time of year because most vegetables have to be imported from Mexico, says David Guthrie, produce manager of Schnucks in Columbia. “Prices come back down when we start getting produce from Florida and Texas sometime in April.”

By Katrina Tauchen • Photos by Rebecca Rademan

It’s a chilly Sunday evening, unseasonably cold for early December, and adults and children bundled in winter coats hurry across Fourth Street into the side entrance of Second Missionary Baptist Church. Upon entering the church, the smell of a home-cooked meal wafts through the hall and erases the chill from outside. Laughter and conversation fill the room as everyone gathers to eat. Tonight is a special evening, and spirits are high.

On this particular night, the parents, children and volunteers involved in For His Glory Incorporated, a youth mentoring program led by the Rev. Dr. Janice Dawson-Threat, gathered together for the first time to celebrate 10 years of service in the local community.

“This is the first time we have all of them together,” Rev. Threat says. “The program is so one-to-one, they (the kids) could be at the grocery store and not know the person next to them was in the program, too. That’s why it’s so important to get them all together — to show them they’re a part of something bigger.”

It takes a village

Founded in 1999 by Rev. Threat and the late Rev. Wesley G. Threat, For His Glory Incorporated is a charitable organization whose mission is “working together in the community with youth and their families.” For His Glory Incorporated provides one-to-one tutoring, mentoring, leadership and dance training opportunities for children enrolled in its programs, regardless of economic status, church involvement or family history. The program has four divisions of service: after-school tutoring, mentoring, a worship arts academy and dance outreach training. The mentoring program for boys is called Boyz 2 Godly Men, a name the youth came up with three years ago.

“We know it takes a village to raise a child,” Rev. Threat says, “and we want to be that village.”

In the case of For His Glory Incorporated, the village includes program parents, local volunteers and high-school and college students who give their time to help teach groups of energetic youths to become leaders in the community. The program runs background checks on volunteers and provides training on interacting with youths. “For His Glory Incorporated tries to provide as many of these opportunities within the framework of our programs as we can,” Rev. Threat says in an e-mail. “We have seen behavior and use of language change within semesters. We have changed youth who do not like school into people who enjoy thinking and problem solving… We have changed shy, low-confidence youth into public speakers, teachers…”

Brittany Arnold, a University of Missouri sophomore who volunteers every Tuesday afternoon with the after-school program, says the benefits of For His Glory Incorporated go beyond the kids.

“Children are the future, and what we invest in them is what we get back,” Arnold says. “Someday we’re going to be old, and they’re going to be the ones taking care of the world.”

Because the after-school program is one-to-one, student volunteers such as Arnold are assigned to specific children. This session, Arnold was paired with 3-year-old Da’Nya Edwards, whose mom, Nygia Edwards, is the after-school program coordinator. Before the evening meal, Da’Nya gave Arnold a handmade thank-you card.

“When you get something, you pay it forward,” Arnold says. “That’s what the kids are learning.”

Learning to love

After the meal, the crowd filters into the church sanctuary for the evening’s program, which includes performances by girls in the worship arts academy and dance outreach groups and a boys’ step routine.

Before the performances begin, the most-improved youth awards are given to two young men to acknowledge their growth in the program. “These boys are leaders,” says the Rev. Demetrius Davis, program coordinator for Boyz 2 Godly Men. “They might not think they are, but they are.” When 11-year-old brothers Malik and Michael Jackson hear their names called, proud smiles spread across their faces. Rev. Davis talks about how much the boys have changed since they started with the program at the beginning of the year, and as he recounts the young boys who used to run around the church without discipline or focus, laughter comes from the audience. Everyone remembers how the boys used to behave, but what’s important is how they’ve grown.

For His Glory Incorporated also teaches children the importance of positive attitudes. The worship arts academy, led by Rev. Threat and high-school and college volunteers, emphasizes self-esteem, discipline, poise and a variety of dance techniques. “We’re learning how to have fun, how to cheer each other on, how to value each other,” Rev. Threat says. “It’s about pouring in something positive, about learning to love. We don’t allow ugly talk.”

Mentoring is the overarching theme of For His Glory Incorporated, and it touches every aspect from the ground up. As the children grow in the program through the mentorship of volunteers, they are prepared to become mentors themselves. Sixteen-year-old Minnie Briscoe, who’s been a consistent member of the program since she was 13, has transitioned from a member of the dance outreach program to a leader in the worship arts academy, where she now mentors younger dancers who are starting where she did years before.

“We’ve given them a message they can take of from here,” Rev. Threat says. “They go out in the world, and they are good ambassadors of Columbia, Mo.”

For His Glory Incorporated holds it programs at available sites willing to partner with them for the benefit of the youth. Currently, program facilities are provided by Second Missionary Baptist Church, First Assembly of God Church and the Blind Boone Center. The group itself is a civic service organization, open to anyone who wants to participate (church affiliation is not necessary for participation). Rev. Threat says the group is driven by a desire to show love, and the ministry of the program comes out of the people who volunteer their time because they love God.

Giving back, giving thanks

As the celebration comes to a close, Rev. Clyde L. Ruffin, senior pastor of Second Missionary Baptist Church, where Rev. Threat is an associate minister and member of the ministerial leadership team, takes a moment to recognize Rev. Threat for her work. Soon after, an impromptu succession of people come forward to share their appreciation for For His Glory Incorporated, Rev. Threat and the numerous volunteers. There’s a passion in the speeches that shows the sincerity behind them. One after another, parents, grandparents and community members stand to share how their children and families are better because of what the program has done.

“We rely on volunteers to make all of these programs happen,” Rev. Threat says later by e-mail. “All we ask is for people to care about children, to be faithful and dependable and to walk with love and kindness in their voice and actions. … If I had to raise the funds to cover rent and utilities and salaries, we could never operate, and the kids would never grow and develop. We don’t have enough of these programs, and they should be scattered throughout neighborhoods where the kids actually live.”

For more information about For His Glory Incorporated, visit www.forhisgloryinc.com.

For parents raising budding musicians, Columbia offers many options, outside of public schools and private lessons, where miniature maestros can hone their musical voices. The following programs available to children vary in age, cost and focus, but all offer quality teaching from experienced instructors. We’ve done the legwork for you; now all that’s left to do is find the right fit for your family.

Missouri Symphony Children’s Chorus:

By teaching a diverse range of music literature, cultures and traditions, this program fosters musical literacy and instills vocal technique in young singers. According to the Missouri Theatre Web site, MOSSCC instructor Melissa Straw teaches “discipline, respect and pride,” but “never forgets that delight should be part of any education.”

Ages: Grades 6 – 9 with unchanged voices

Instructor: Melissa Straw holds bachelor’s and master’s degrees in education and has more than 15 years of experience teaching music.

Location: Smithton Middle School, 3600 W. Worley St.

Cost: $125 per semester (scholarships available)

Contact: For more information, contact Afton Thomas at 875.0600 or education@motheatre.org. Or visit motheatre.org.

Missouri Symphony Youth Orchestra Chamber Players and Junior Strings:

Chamber Players and Junior Strings offer a place for young musicians to hone their technical skills as well as participate in group performances. The program’s philosophy encourages “discipline, curiosity, teamwork, developing knowledge and improvisation,” and musicians get to play and experience music from multiple cultures and genres.

Ages: Grades 3 – 8 for Junior Strings, grades 8 – 12 for         Chamber Players

Instructor: Kirk Trevor, a trained cellist and conductor, is music director and conductor of the Missouri Symphony, Missouri Symphony Youth Orchestra Chamber Players and Junior Strings and music director of the Indianapolis Chamber Orchestra. Assistant instructor is Ned Horner.

Location: Missouri Theatre Center for the Arts, 203 S. Ninth St.

Cost: $125 per semester (scholarships available)

Contact: For more information, contact Afton Thomas at 875.0600 or education@motheatre.org. Or visit motheatre.org.

The Community Music Program:

Sponsored by the MU School of Music, this program aims to provide “opportunities for those who seek musical instruction purely for personal enrichment.” Through private instruction, students receive one-on-one attention regardless of their level of musical skills.

Ages: For students of all ages

Instructor: Instructors vary, but all are MU music majors who come recommended by the school faculty.

Location: School of Music buildings on the MU campus

Cost: Tuition varies by instructor and length of lesson.

Contact: Call Erica Manzo, Community Music Program coordinator, at 882.0934, or e-mail ManzoE@missouri.edu. Visit music.missouri.edu/communityprograms/communitymusic.html.

Experiencing Piano Group Classes:

In this program, young piano players participate in weekly performances as ensembles and duets. Students learn music theory and music history as well as improvisation and group performance skills. Each child receives a weekly one-on-one lesson in addition to the group practice.

Ages: 6 – 9

Instructor: Sara Ernst is a pianist, adjunct assistant professor of piano and piano pedagogy at MU and doctoral candidate in music education at the University of Oklahoma.

Location: School of Music buildings, MU campus

Cost: $65 per semester

Contact: For more information, contact Sara Ernst at 882.3348 or  ErnstS@missouri.edu, or visit music.missouri.edu/communityprograms/exppiano.html.

Creating Original Music Project:

C.O.M.P. is perfect for young composers with an interest in producing original works. This two-part program includes a statewide competition for original music composed by Missouri students and the Missouri Summer Composition Institute, where students compose an original piece to be performed by an MU ensemble at the end of the weeklong camp.

Ages: Grades K – 12 for the statewide competition, grades 9 – 12 and entering college freshmen for the Missouri Composition Institute

Instructor: Sponsored by the MU School of Music

Location: 140 Fine Arts Building, MU campus

Cost: Contact for cost.

Contact: For more information, call 882.2606, e-mail FreundS@missouri.edu, or visit music.missouri.edu/COMP/.

Missouri Strings Project:

Started in 1977, this program follows a two-part mission: “To prepare university music students for their future as public school and private teachers and to introduce third-, fourth- and fifth-grade students to music by giving them the opportunity to study the violin, viola or cello.” Students practice with a group and participate in performances during the semester.

Ages: Grades 3 – 5

Instructors: Classes are taught by MU music education and performance majors and are overseen by Leslie Perna, MU viola professor and Missouri Strings Project director.

Location: Fine Arts Building, MU campus

Cost: $150 per semester

Contact: For more information, contact Leslie Perna at 882.2748 or mostring@missouri.edu. Or visit music.missouri.edu/communityprograms/mostrings.html

Missouri Youth Orchestra:

Sponsored by the MU School of Music, this program carries the mission, “to promote and inspire excellence in orchestral performance in an educational setting for young musicians from the mid-Missouri area.” The senior ensemble is open to wind, string, brass and percussion musicians by audition; junior ensemble is a string orchestra. Students participate in individual, ensemble and group instruction and perform from a challenging selection of music.

Ages: Grades 8 – 12 for the senior ensemble, grades 7 and under for the junior ensemble

Instructor: Carrie Turner is director of the Missouri Youth Orchestra. Turner holds a Ph.D. in musical arts from Texas Tech University.

Location: School of Music, MU campus

Cost: $250 for Senior MYO per year, $150 for Junior MYO per year

Contact: For more information, contact Carrie Turner at 999.6080 or TurnerCaro@missouri.edu. Or visit missouriyouthorchestra.org.

Kindermusik with Brenda:

Working under the philosophy that “music and movement nurtures a child’s cognitive, emotional, social, language and physical development” and that “every parent is the child’s most important teacher,” this program uses music as a catalyst for promoting better learning behaviors. Parents can interact with their children in a classroom setting while promoting music appreciation and skills.

Ages: Birth to age 7

Instructor: Brenda Haynes, Kindermusik owner and director, holds a bachelor’s degree in special education and a master’s degree in education.

Location: Youzeum, 608 E. Cherry St.

Cost: Cost varies by class.

Contact: Register online at kindermusikwithbrenda.yourvirtuoso.com/Register.html or by phone at 881.1574. For more information about the program, visit kindermusikwithbrenda.yourvirtuoso.com/index.html.

TRYPS Children’s Theater Vocal Academy:

The Vocal Academy is a place for young singers to work on their vocal technique — breath support, pitch, harmony and range — while learning to sing and harmonize with a group. The academy includes a senior quartet (ages 15 – 18), junior sextet (ages 12 – 14) and a junior octet (ages 8 – 11).

Ages: 8 – 18 years (age requirements vary by group)

Instructors: TRYPS instructors are Nollie Moore, who holds bachelor’s and master’s degrees in music education from MU, and Audrea Sergel, who holds a bachelor’s degree in vocal music education from MU.

Location: Columbia Mall, 2300 Bernadette Drive #918

Cost: $80 – 160 (prices vary by group)

Contact: For more information, call 449.4536, e-mail tryps@mac.com or visit tryps.missouri.org/TRYPS/Vocal.html.

Columbia Parks and Recreation:

The City offers music classes for children in a variety of instruments, such as guitar and percussion, as well as monthly “jam sessions” for adults and kids.

Location: 1 S. Seventh St.

Contact: For upcoming classes and events, call 874.7460, or visit GoColumbiaMo.com/ ParksandRec/Activities_and_Programs/Leisure_Times/.

By Bondi Wood

Laura Turner has had one of her four daughters in Columbia Public Schools for the past 16 years. With her youngest two daughters currently attending Hickman High School, Turner has two years left in her relationship with the school system. Although she is a hands-on mom and perennial parent volunteer, she was unaware of the upcoming bond issue and is struggling with whether to support it.

“I thought we already voted on the new high school,” Turner says, echoing the concerns of many voters who didn’t fully understand the three-pronged nature of the 2007 bond issue.

The current 2010 bond issue refigures and combines what were to have been the second and third parts of a three-part bond, the first of which successfully passed in 2007. The upcoming $120 million bond will appear on the April 6 municipal ballot.

According to Columbia Public Schools Superintendent Chris Belcher, the bulk of the money will be spent on the new high school in the northeast edge of the city, a potential new elementary school and major repairs and maintenance to the system’s oldest schools.

“Virtually every building will be touched by this proposal,” Belcher says. “Right now, when it rains in Columbia, it is leaking all over the district.” New roofs, and the warranties that come with them, are a high priority for Belcher. “Why would we want to put new technology or equipment in rooms that leak? Fix the roofs first.”

In addition to roof repairs, other maintenance projects include upgrading HVAC systems, installing air conditioning at schools still without it and adding auxiliary gyms at Rock Bridge and Hickman.

“We are working toward maintaining equity among the schools through upkeep,” says School Board Vice-President Tom Rose, who is also chair of the board’s Finance and Long-Range Facility Planning committees.

In addition to asking for bricks and mortar, the district is also reconfiguring the grade levels and attendance areas of some schools. However, the reconfiguration can only work if Columbia has three rather than two high schools. “To pull this off, we have to build a third high school,” Rose says.

The new configuration will not change the grade levels attending Columbia’s elementary schools. However, the three current middle schools will become “intermediate schools,” as will the three junior highs. So there will be six intermediate schools for grades six, seven and eight. The six intermediate schools will then feed the three high schools that will house students in grades nine through 12.

Feedback from parents, says Belcher, speaks directly to the reorganization plan. “Parents want fewer transitions among schools,” he says. Rose confirms, adding that the six intermediate schools will also decrease current overcrowding in the middle and junior high schools.

The best news for mid-Missouri voters is that the April bond issue does not require any new taxation but is a continuation of the current tax. “Instead of paying off our debit service earlier, we’ll be paying it off later,” Belcher says.

Like Turner, new home owners Kris and Blair Mitchell vote regularly and generally support school bond issues but were unaware of the April bond issue. Although they don’t have children yet, Blair Mitchell says neighborhood schools were an important factor in where they decided to build their new home.

“One of the reasons we built where we did is due to the quality of the schools,” she says. “It is very important to us.”

Upon learning that the new bond issue would not raise taxes, Blair Mitchell says, “If a bond issue raises taxes to help schools, I am generally open to it. If the money is promised but not followed through with, I’m less likely to be supportive of the raise on future issues.”

Both Rose and Belcher are adamant that the current plan saves significant amounts of money from the previously pitched three-phase plan. “We’re going to save 5 percent on the architects’ fees alone by having them do all the work at once rather than in three phases,” Belcher says.

“It just makes more sense to build a building all at once,” Belcher says. “The cost of moving and removing equipment, putting up and tearing down walls, changes in finishes over the years.” The board estimates a savings of at least $7.5 million.

According to Belcher, the new high school will be completed 30 months after the April 2010 election and ready for students by fall 2013. With the construction occurring all at once, so will the reconfiguration, also in fall 2013.

Belcher says the grade reconfiguration, especially for the high schools, will save parents the hassle of having a ninth-grader attending a junior high but involved in activities at a high school.

Building the new high school should also help reduce the number of trailers huddled around Columbia’s school buildings, according to Rose, and will reduce that number from the current 164 to around 110, maybe fewer. “Right now 20 percent of our students are receiving their education in trailers,” Belcher says.

Belcher is confident the bond issue will pass, and anticipated high voter turnout in April’s election improves its chances. The open seat for the Columbia mayoral race will draw more voters than in most years. Rose, too, believes that people will vote for this proposal, as it is basically what they approved before.

“The main thing to be aware of is the continuation of what voters fully supported three years ago, which was a reconfiguration of the secondary grade system and a new high school,” Rose says.

Although wary of the bond issue, Turner concludes, “I guess I’ll vote for it as long as I don’t have to give them any more money.”

Interested voters may access the following resources to gather more information on the bond issue:

• www.columbia.k12.mo.us: You can sign up for the free electronic newsletter, “Key News,” for the latest district news and event information. Click on “Key News” on the district’s home page to register.
• If anyone has questions, comments or would like a representative from the school to meet with you or a civic group regarding the bond issues, contact the main board office at 214-3400, or contact the Community Relations Office at 214-3960.

10 things you need to know about this school bond issue

1. It won’t raise your taxes.
2. It reduces the number of transitions among schools from four to three.
3. The number of trailers will decrease from 164 to 110, potentially fewer.
4. It puts a priority on upgrading old buildings and works toward equity among all buildings.
5. Elementary school will be for grades K – 5, intermediate school for 6 – 8 and high school for 9 – 12.
6. The new high school and all the grade configurations will occur in fall 2013.
7. Auxiliary gymnasiums will be added to Rock Bridge and Hickman.
8. All schools will be equipped with air conditioning.
9. Another elementary school might be built.
10. Some new technology will be purchased.

By Nancy Yang

Breast cancer advocacy starts with a tear. It gathers strength in solidarity and marches to the drumbeat of awareness in torrents of pink ribbons. No other medical condition, with the possible exception of HIV, has rallied more support for screening and prevention. Now, USPSTF recommendations are questioning the effectiveness of some breast-cancer screening and stirring up a political and emotional storm.

…I hear your anger. I’m angry, too. But not for the same reason. I’m angry because we’ve oversold the benefits of mammography to the extent that there is no longer room to look objectively at the evidence.

— excerpt from the Dr. Susan Love Research Foundation blog, Nov. 20, 2009

Dr. Michael LeFevre and his colleagues are an island in a swirling stream of controversy. Much has been generated by the media, says the professor and associate chair of Family Medicine at the University of Missouri, but he’s willing to take part of the blame. LeFevre serves on the U.S. Preventive Services Task Force and is one of 16 medical and public health professionals from across the country responsible for the new recommendations for breast-cancer screening.

“The recommendations could not have come out at a worse time,” LeFevre says. “The notion that this was part of somebody’s health reform package or was politically motivated or was a cost-savings reduction is unequivocally false. It couldn’t be more untrue.”

Back in the summer of 2008, the USPSTF voted on the recommendations without knowing when they would be published. Fifteen months later, in the midst of a debate on health care reform, they appeared in the Annals of Internal Medicine. (See “To Screen or not to Screen.”) The recommendations, some of which were meant to encourage discussion between patient and doctor, have set off a divisive national dialogue.

Three recommendations sparked controversy: eliminating routine mammograms for patients 40 to 49; biennial rather than yearly mammograms for ages 50 to 74; and eliminating a systematic program of breast self-exam. The departure from the 2002 recommendations advising routine mammograms beginning at 40 has polarized the breast-cancer community. Responses from organizations such as the American Cancer Society, the National Cancer Institute and the American Congress of Obstetricians and Gynecologists range from outright rejection to full acceptance, which leaves many women in no man’s land.

LeFevre says that, ironically, the recommendations were meant to empower women. “We’re not saying women shouldn’t have mammograms in their 40s,” he says. “We are saying that the net benefit is small and that a woman and her physician should make that decision together based on her individual circumstances and her own values. We didn’t think turning 40 should trigger a mammogram. It should trigger a discussion.”

The USPSTF concluded that the biggest drawback to mammography for women in their 40s is the relatively high incidence of false positives, which can result in unneeded biopsies, tests or unnecessary treatment. These figures range from 1 percent to as high as one-third, says LeFevre. But he doubts the resulting recommendations will change access to mammograms. “It’s a political football,” he says. “I’d be very surprised if health reform and insurance will deny mammograms to women in their 40s if they want them.”

Regarding recommendations for women 50 to 74, the USPSTF found that biennial mammograms garnered a greater net benefit than yearly tests. Reducing mammograms by one-half resulted in a slightly lower detection rate, but it was offset by the fact that fewer screenings overall resulted in fewer negatives.

The job of the task force was to come up with recommendations that would give patients the greatest chance of benefiting from breast-cancer screening while reducing the drawbacks. In short, the USPSTF measured potential benefits against human costs, which they called harms. This resulted in a net benefit, which they graded according to magnitude and level of certainty.

“It’s something that’s fairly unique about the USPSTF,” LeFevre says. “Most people choose to look mainly at the benefit side. When you do look at the harms, it becomes a qualitative judgment rather

than quantitative.”

Applying science to qualitative information can be a challenge, and LeFevre says that personally, he has never been engaged in a more rigorous scientific process. “This was really about when to start, how often to screen and when to stop.”

In the end, the task force didn’t answer the question of when to stop. There were no trials of women older than 70, so evidence didn’t allow a fair comparison of benefits and harms. What researchers do know is that though the ability for mammography to make a difference increases with age, it takes 10 to 12 years for a woman to benefit. When breast cancer is detected in this age group, there’s a good chance something else will take a woman’s life.

These sobering conclusions challenge

the belief that early detection and technology always improve health and prolong lives. They might even suggest that screening as the solution to breast cancer has been oversold.

“The notion that early detection is the answer to cancer has almost become a faith,” LeFevre says. “We need better prevention and better and less toxic treatment. Understanding which diseases need to be treated and which don’t is an important piece of that.”

As a family physician, LeFevre advises his patients against obsessing over breast cancer. “If you’re trying to stay healthy, there are bigger fish to fry,” he says. “Heart disease is a far bigger killer of women than breast cancer.”

LeFevre says he believes that women are best served when members of the breast-cancer community look for areas of agreement. One area might be the recommendation against breast self-exam, which was targeted at health care workers teaching rote monthly exams. When all is said and done, the USPSTF supports the spirit of the exam: Women should be aware of their bodies and report any lumps or changes. Nearly everyone agrees. And where there’s common ground, there’s a beginning.

If there’s a 5 percent chance of rain, and it’s raining on you, you’re 100 percent wet. Get it?

— a blogger in response to recent USPSTF recommendations for breast-cancer screening

Radiologist Terry Elwing, M.D., wants her patients to know that along with the twinkling promise of research and technology, some things are better left unchanged. As director of Women’s Imaging at Boone Hospital’s Harris Breast Center, Elwing takes issue with the new USPSTF recommendations for breast-cancer screening. Some replace early detection with what she and others might consider a shot in the dark.

“The way they looked at the data is very questionable,” Elwing says. Some of the best data, they didn’t use; some of the worst data, they did use. So their statistics are flawed, and I think they’re blowing out of proportion these potential risks.”

Elwing says the task force excluded data from an important study in Sweden while including trials in which patients weren’t rigorously screened. The Swedish study reported a 40 percent reduction in mortality when mammograms were introduced to women in their 40s. In comparison, the USPSTF estimates a 15 percent mortality reduction in the same age group.

The disparity raises questions because the USPSTF recommends against routine mammograms for women in their 40s. (See “To Screen or not to Screen.”) These younger patients develop fewer but more aggressive cancers that can also be tricky to diagnose. They tend to have dense breasts, which increases potential harms such as false positives, biopsies, anxiety and over-treatment.

“I think in a good breast center, the harms can be minimized significantly,” Elwing says. “We minimize harms by talking to patients and being very diligent on the technologist side, finding the problems so we don’t have to recall the patient. A radiologist always talks to a patient when they have a problem. Most patients come and go without any concern. When we do find something, we’re going to take care of you.”

Elwing believes that for all its diligence, what’s lacking on the highly credentialed task force is practicality. Its members include academicians and public-health professionals but no radiologists or oncologists, who deal with breast-cancer patients on a daily basis. This perhaps explains what she sees as a disconnect between some of the recommendations and their implementation. For example, the USPSTF suggests that women in their 40s make individual decisions about screening based on “patient context,” or risk. But 75 percent of the people who get breast cancer aren’t high-risk.

“I thought this was over and done with,” Elwing says. After much debate back in 2002, the panel came out in favor of annual mammograms for all women older than 40. “We should go on to studying digital mammography, tomosynthesis or MRI — or how we stratify risk. There are so many things we could look at besides who should get a mammogram. Oncologists will tell you that it’s not new drugs or radiation that are the forces behind decreased mortality. It’s early detection. It’s finding the cancer when it’s still small and contained in the breast so we can remove it.”

Dr. Paul Dale, chief of Surgical Oncology at Ellis Fischel Cancer Center, says new technology offers hope in detecting increasingly smaller cancers. Because mammographic images are getting clearer due to digital technology, physicians have more confidence in what they deem benign. One of the most promising technologies is tomosynthesis, which is like a CAT scan of the breast without the additional radiation, time or cost. Once approved by the FDA, it will allow doctors to view multiple slices of the breast and see through dense breast tissue.

For now, most doctors rely on mammography. Although it’s imperfect, it has been responsible for a steady decline in breast-cancer deaths since it was introduced in the 1980s. “A mammogram is uncomfortable for some women,’” Dale says, “but most of them get through it just fine. It does provoke anxiety if there’s an abnormality — as does a test of any type. But it’s better if it’s found early.”

Dale believes the USPSTF recommendations could influence the future of health care legislation. Women outside the recommended parameters might have to pay out-of-pocket for breast-cancer screening, which could create a chilling effect on early detection. Breast cancer in otherwise healthy older women can become life-threatening, he says.

“If a woman is healthy and has a good chance of living five years or longer, she should continue getting mammograms,” Dale says. “It’s very treatable. In this age group, they often do exceptionally well. Two of the biggest risk factors for breast cancer are being a woman and getting older.”

Dr. Mary Muscato, a hematologist medical oncologist and Susan G. Komen board member, views the recommendations from two perspectives. “It’s a tough problem,” she writes in a recent e-mail. “But just thinking of this as a population problem (need many tested to find one positive) rather than a personal problem (I have many patients in their 30s and 40s with breast cancer), it’s doomed to be rejected by people, even if accepted by public health officials.” Muscato’s remarks illustrate some of what’s fueling the controversy. Although research might tell us what’s best for the general population, personal and anecdotal stories can be more powerful.

Elwing says that when it comes to the general population, about two-thirds of patients who should get mammograms do. She would like these figures to increase. Lately she’s noticed that in the wake of the USPSTF recommendations, women are asking if they really need to come in.

“Our response is, ‘Yes,’” Elwing says. “We have not changed our position about breast-cancer screening. When you put out something like this, it gives people on the fence more ammunition not to do their screening.”

Once cancers become palpable, their prognoses worsen, which costs patients and society, she says. “I’m all for cost containment — as long as it doesn’t cost someone their life.”

SIDEBAR:

To Screen or Not to Screen: USPSTF recommendations for breast-cancer screening

• The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context including the patient’s values regarding specific benefits and harms. (Grade C recommendation)

• The USPSTF recommends biennial screening mammography for women between the ages of 50 and 74 years. (Grade B recommendation)

• The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. (I statement)

• The USPSTF recommends against clinicians teaching women how to perform breast self-examination. (Grade D recommendation)

• The USPSTF concludes that the current evidence is insufficient to assess additional benefits and harms of either digital mammography or magnetic resonance imaging instead of film mammography as screening modalities for breast cancer. (I statement)

Ratings grade the magnitude of net benefit, with B representing moderate; C representing small; D representing zero or negative; I representing insufficient evidence. Annals of Internal Medicine, Nov. 17, 2009.

February 9
Peking Acrobats
7 p.m., Jesse Auditorium, $17 – 29, children $14
University Concert Series, 882-3781 or concertseries.org/performances

February 10
The Band of Irish Guards
7 p.m., Jesse Auditorium, $17 – 32, children $14
University Concert Series, 882-3781 or concertseries.org/performances

February 11
Kris Kristofferson
7 p.m., Jesse Auditorium, $22 – 32
University Concert Series, 882-3781 or concertseries.org/performances

February 13
An Evening with Branford Marsalis Quartet
8 p.m., Missouri Theatre Center for the Arts, $24 – 34
Presented by the “We Always Swing” Jazz Series and MU College of Arts & Sciences
449-3001 or wealwaysswing.org

February 14
Valentine’s Day

February 16
Ladysmith Black Mambazo
7 p.m., Jesse Auditorium, $20 – 27, children $14
University Concert Series, 882-3781 or concertseries.org/performances

February 19 – 21, 26 – 27
Much Ado About Nothing
7:30 p.m. Feb. 19 – 20 and 26 – 27; 2 p.m. Feb. 21, Macklanburg Playhouse, $6 – 12
Presented by Stephens College, 876-7199 or stephens.edu/performingarts

February 24
“Tall Stories” Opening Reception
6 – 8 p.m., Columbia Art League
This juried, True/False tie-in show runs through April 17.

Staff Picks

Feb. 13: Support the Missouri Special Olympics at the 3rd Annual Polar Plunge at Stephens Lake Park. 256-6367 or www.somo.org/columbiaplunge

Valentine’s Day Specials: Bleu: Special menu Feb. 13, 14 and 15. Each guest will get an extra thank you from the restaurant, too, just for dining.

Sycamore: Special dessert or appetizer Feb. 14.

Emmet’s Kitchen & Tap: Four-course Valentine’s Day dinner Feb. 14.

Feb. 27: Hosted by the American Heart Association, the Dr. Hugh Stephenson Heart Ball raises money to support cardiovascular research and education. The event includes dinner and a live auction as well as the opportunity to hear from heart disease survivors and professionals in the field of cardiovascular medicine. Reynolds Alumni Center, auction/social time begins at 5:30 p.m., program begins at 7 p.m., heart.org/columbiamoheartball.

March 4
Moscow State Radio Symphony Orchestra
7 p.m., Jesse Auditorium, $17 – 32
University Concert Series, 882-3781 or concertseries.org/performances

March 7
Rufus Reid Trio
7 p.m., The Blue Note, $21-30
We Always Swing Jazz Series, 449-3001 or wealwaysswing.org

March 9
Saint Louis Symphony Orchestra
7 p.m., Jesse Auditorium, $17 – 37
University Concert Series, 882-3781 or concertseries.org/performances

March 14
In the Mood
2 p.m., Jesse Auditorium, $17 – 26
University Concert Series, 882-3781 or concertseries.org/performances

March 15
MU Chancellor’s Concert
7:30 p.m., Jesse Auditorium, $10
University Concert Series, 882-3781 or concertseries.org/performances

March 17
St. Patrick’s Day

March 21
The Doobie Brothers
7 p.m., Jesse Auditorium, $45 – 55
University Concert Series, 882-3781 or concertseries.org/performances

Staff Picks

The Avett Brothers, Seth and Scott, bring their acoustic sounds to the Missouri Theatre Center for the Arts on March 2. Presented by The Blue Note. 8 p.m., $25, 875-0600 or motheatre.org.

Stephens College Performances

• Playhouse Creatures 7:30 p.m., March 3 – 6, Warehouse Theatre, $6 – 8.

• Annual Dance Company Spring Concert 7:30 p.m. March 5 – 6 and 12 – 13; 2 p.m. March 7. Macklanburg Playhouse, $7 – 14.

• Playing for Time 7:30 p.m. March 19 – 20 and 25 – 26; 2 p.m. March 21. Warehouse Theatre, $6 – 12.

• Bach’s Lunch 12:30 p.m. March 25. Historic Senior Hall Recital Hall, 100 Waugh St., Free.

For information about Stephens College performances, call 876-7199, or visit stephens.edu/performingarts.

Features

One Room, 4 Ways

By Katrina Tauchen

Neutrals never looked so good. Studio Home designers Aaron Dolan and Jon Trigg transform a plain room into four distinct styles.

Housing a Legacy

By Dianna Borsi O’Brien

Ragtime musician John Williams “Blind” Boone is making news in Columbia through a renewed interest in the man, his home and his music.

departments

SHOP LOCAL

A Custom Business

By Chari Severns

Frameworks Gifts and Interiors owners Gary and Sharon Duncan travel the globe to bring their customers exotic finds and personal style.

Call Me Cupid

With CHL’s Valentine’s Day gift ideas, shopping for your sweetie is a piece of cake.

HEALTH

Heart Health Facts

By Jill Orr

According to the American Heart Association, heart disease is the leading cause of death among women in America. Here’s what you need to know about cholesterol, exercise and heart attack risk.

Picture Imperfect

By Nancy Yang

New USPSTF recommendations are questioning the effectiveness of some breast-cancer screening and stirring up a political and emotional storm.

BEAUTY

Good Hair Day

By Jill Orr

At Salon 4 Spa, beautiful hair means healthy hair, and stylist Betrina Murphy teaches clients how to follow that philosophy with routine maintenance.

COOKING AND WINE

Going Greens

By Katrina Tauchen

Establish healthy habits, and improve your family’s health with our guide to incorporating vegetables in your daily diet.

A Heart for the Red

By Jennifer Larmie

With its blood-thinning and stress-reducing effects, red wine can be great for your heart. Our wine connoisseur offers her top red-wine picks from Glazer’s Mid-West and Major Brands.

ARTS

No Small Stories, No Small Jobs

By Marilyn Cummins

Female filmmakers, workers and volunteers make an impact when the True/False Film Fest returns to Columbia Feb. 25.

Artist Profile: Susan Salzer

By Sarah Handelman

An award-winning historical fiction writer, Susan Salzer blends her talent for writing with her passion for the West.

COMMUNITY

Building Leaders

By Katrina Tauchen

Led by the Rev. Dr. Janice Dawson-Threat, the For His Glory Incorporated mentoring programs teach children the value of leadership and love.

Columbia Builds Youth

By Keija K. Parssinen

Job Point’s carpentry and construction training program Columbia Builds Youth helps students find success in work and school.

EDUCATION

A Firm Foundation

By Bondi Wood

On April 6 Columbia voters will decide on the $120 million school bond, though many are unsure of what this reconfiguration of the previous plan entails.

Playing Well with Others

For parents raising budding musicians, Columbia offers many options where miniature maestros can find their musical voices.

In Every Issue

BEING SEEN

Alley A Open House

Columbia Art League

First Night Columbia

Business Times Holiday Party

REFLECTIONS

Coming Full Circle

By Marilyn Cummins

Longtime residents Celestine and Raymond Hayes remember growing up in a changing Columbia during the 1960s and ’70s.

This February is a big month for me. I turn 40. I mention this not to bemoan my emerging wrinkles and the hold that gravity has taken on my physique but because I think more and more about my long-term health. As a women’s magazine, CH&L is committed to women’s health, and as always, we are devoting February to matters of the heart. I promised in these pages two years ago to start walking every morning, and I have held true to my promise. The heart health tips in this issue encourage me to keep working at it, and I hope they encourage other women to keep their cardiovascular systems in tip-top shape.

And let’s not forget the other people in our lives. My husband also turns 40 in February (Happy birthday, honey!). Like many of our readers, I’m responsible for most of the shopping and cooking for the family. I do my best to make sure we eat healthful meals. Getting the whole family to eat their vegetables is extremely difficult; it’s as tough to persuade the other adult in the house to eat his broccoli as it is persuading the children. In fact, I don’t even serve broccoli at home. Or peas. Or Brussels sprouts. Or … Well, I hope to use our food article (Page 45) for inspiration, and I hope it helps you, too.

The big Four-Oh is significant for women as it usually signals the beginning of yearly mammograms. Recent guidelines suggest that perhaps this is not necessary. Nancy Yang has explored the controversy in depth to help our readers begin discussions with their doctors about what is right for them.

Here’s to our hearts and our health,

Christina George
Publisher