Less Mammography in my future

[ny biker]

Actually the recommendation regarding self exams was that having a doctor instruct the patient on how to do them was not helpful. It did not say that doing self exams was useless. I guess that means we are able to figure out how to do them on our own??

Anyway, as I said, due to my own risk factors I will continue getting annual mammograms unless my doctor advises otherwise. And I will be very surprised if he advises against them for my situation.

[Thorn]

I'm trying to figure out why this has made me so, so angry. I think I'm getting a grasp on it.

This task force has said that all the false positives just make women unnecessarily worried. It's all so degrading -- women are just so fragile that they can't make up their own minds and take charge of their bodies and health. Don't do a self-exam because you might not be able to handle the results or the stress while determining if it's a cancerous growth that might be silently killing you.

Even some of the opinions here - you might not feel that you want to know what's going on in your body, but for the government to tell women not to worry about it until they're 50, when so, so many women are dying because their cancer wasn't caught earlier is infuriating. Don't tell women to put their heads in the sand and their hands in their pockets. Feel your boobs, learn them, and know what your options are. It's my body, and I'll be damned if I'll let a government task force decide what's best for me.

In the interest of full disclosure, I"ve had numerous suspicious lumps, some discovered by self-exam, some on mammogram. I've had biopsies on most of them, and wear the scars proudly, because I know they're a symbol of me taking charge of my body and proactively fighting for my life.

+ 10^infinite

Well said.

[OakLeaf]

PW, I'm glad you feel you came through your biopsies unscathed.

I'll just say that it wasn't the same for me, and leave it at that.

The potential damage from a false positive is far more than "worry." (Although the health effects of worry are significant in themselves.) PTSD, even a mild case, is not fun.

The potential damage from unnecessarily treating a cancer or abnormal cells is enormous. Didn't you read the other studies released this week - that 50% of women have chronic pain after breast cancer surgery, and some enormous fraction of men leave their wives after a cancer diagnosis. If only 1/3 of those cancers could benefit from treatment, that's a huge amount of damage.

The tissue trauma and the massive doses of radiation involved in biopsying abnormal cells has the potential to cause invasive cancer when none would have resulted otherwise.

It's not about "worry."

As I said - we each have to believe what we have to believe, but let's be gentle with each other.


But I guess I will say that this is all academic for me, not only because they'd recommend six-month mammos for me in any case, but also because I am never having another one. I spent a lot of time and energy researching the risks and benefits, and one thing is certain, no one is ever going to touch my breasts without love again. A life lived in a constant state of objectification, pain and terror is just not worth it, to me, especially when there's a 90% chance that I'd receive no benefit from it. Maybe someday I'll even be able to enjoy the touch again.

[lunacycles]

I'm 44, and I've had two. Such fun! But I do feel a little mixed, and I am really not pro-screening for the reasons they just upped the recommended age to 50. Having said that, I have a friend who had one in her late 40's (with little or no family history), and it literally saved her life (or we hope, double mastectomy and 3 rounds of chemo later...)

I also find it interesting that, even with all the new drugs and ways of testing for cancer, that survival rates haven't changed much in the last few decades.

[Pedal Wench]

I also find it interesting that, even with all the new drugs and ways of testing for cancer, that survival rates haven't changed much in the last few decades.

Margo, at the 3-Days, they've been saying that survival rates, with early detection, have gone from about 75% up to something like 98%

These stats stress the extreme importance of early detection:

Stage I:100%

Stage IIA: 92%

Stage IIB:81%

Stage IIIA:67%

Stage IIIB:54%

Stage IV:20%

[KnottedYet]

Have we seen any studies saying men shouldn't bother having their prostates looked at during their annual check-ups?

Have we seen any that say men shouldn't bother doing their self exams for testicular cancer, because they are too fragile to touch themselves and it would stress them out?

ETA: Because of family history of breast cancer and personal history of cancer, I've been getting mammos every year since I was 35. They are about as comfy as lying face-down on a hardwood floor, but not nearly as painful as all the excisions I had for cancer here, there, and everywhere. (I like my cancer fresh and little and REMOVED.) I get more radiation from my monthly flights to San Francisco than I do from my annual mammo, and even more if I have a whiskey and coke during the flight. (did you know a fifth of whiskey emits 400 beta rays per minute?)

I may glow in the dark, and I may have some entertainingly cheloided excision scars; but dammit I'm not dead yet (Knottedyet, get it?) and I'm going for the gusto!

[ny biker]

Interesting column in the Washington Post today:

http://www.washingtonpost.com/wp-dyn...703140_pf.html

[OakLeaf]

Have we seen any studies saying men shouldn't bother having their prostates looked at during their annual check-ups?

As a matter of fact, yes. This was the medical consensus over a year ago, and all along, it's been much easier for physicians to dispute the corporate wisdom on prostate cancer screening than breast cancer. (I could point out the massive amount of profit in breast cancer screening vis-a-vis prostate...)

None of this is new, and the only part of it that's "news" is that the public health authorities have decided to bring their recommendations more in line with a real risk/benefit analysis. This has been building for at least 15 years, and there have been several well-publicized studies this past year alone. I don't know why this seems like it's a new issue to so many people here.

If you want to analyze the gender issues, my take is that (1) in general, women tend to be more easily led by their physicians or any supposed "authority;" and (2) physicians in general love to practice "bikini medicine" on women, whereas a physical exam of a man usually takes a much closer look at the whole body, even de-emphasizing the sex organs.

I'll just repeat two things, and then I'm outa here.

Screening is not harmless. Screening has known and well-recognized harms that go far, far, far beyond "worry." In coming up with these recommendations, public health authorities try to balance the known/potential harm against the known/potential benefit. If an individual is asymptomatic and not in a risk group, then they stand a much, much greater chance of being harmed by screening than of receiving a benefit.

In any individual case, there is no way to know whether treatment for an identified cancer has been beneficial, harmful, or had no net effect. All the public health authorities have to go on is retrospective statistics. This is true of most procedures. But making an individual decision is more complex, and involves looking honestly at quality of life issues. People who have already been through the procedures believe what they need to about the decisions they've made in the past; people contemplating a future decision need to be smart about it.

Is it worth turning over complete control of your life to the medical establishment, being treated like a piece of meat without emotions, intellect, pain, or, indeed any body parts other than the one(s) being treated for cancer, in exchange for a 10% to 30% chance of extending the duration of one's life? That's a decision each individual has to make for herself.

[lunacycles]

pedal wench said:

Margo, at the 3-Days, they've been saying that survival rates, with early detection, have gone from about 75% up to something like 98%

These stats stress the extreme importance of early detection:

Stage I:100%

Stage IIA: 92%

Stage IIB:81%

Stage IIIA:67%

Stage IIIB:54%

Stage IV:20%

Thanks for that. I haven't heard that. I wasn't speaking specifically about breast cancer. I read, NYTimes I think (that's the only news source I really read regularly these days), but who knows for sure, that over the last few decades overall cancer survival rates have barely changed/improved...despite all the new treatments out there. Please understand I am not stating an opinion that I think screening is a bad idea AT ALL. Like I said, I think it saved the life of a friend of mine, and I bet we all know someone for whom it did.

[shootingstar]

Each healthy woman makes an individual choice how often she would like to have a mammo...regardless of what her country's health care system advises.

I figure my chances on the bike on the road, I have greater chance of being doored, falling on the road (I have already --twice on ice.) or hit by a car (was hit as a pedestrian in front of a life insurance company)...are higher than breast cancer, at this time.

So I don't want to get a mammo yearly. Every 2 years ..continues to be the norm up in our jurisdiction...if a woman wants it that often.

As for being safe while cycling, that's why I would like my city to keep on building cycling infrastructure to make it safer. Meanwhile I continue to cycle my favourite routes that are quiet, etc.

Yes, it's all a risk. Meanwhile we all vigorously defend why we cycle so often on the road while other people think we are risking our lives/health.

[OakLeaf]

The National Women's Health Network has a detailed discussion.

(Posting a link doesn't count as jumping back into the thread after I said I was out. )

[Tuckervill]

Thanks for posting that link, Oak. I was listening to Dr. Laura Berman on Oprah Radio today (only got to listen to a little bit), talking about this issue. The amount of misapplication of the facts, and lack of critical thinking and logic, even on the part of the host, is really astounding. I'm looking forward to reading the link.

Karen

[Trek420]

These stats stress the extreme importance of early detection:

Stage I:100%

Stage IIA: 92%

Stage IIB:81%

Stage IIIA:67%

Stage IIIB:54%

Stage IV:20%

That can depend on who you are, if you have access to health care. From http://www.sistersnetworkinc.org/news.html

"An estimated 19,540 new cases of breast cancer are expected to occur among African American women in 2009

The overall incidence rate of breast cancer is 10% lower in African American women than white women.

African American women have a five year survival rate of 77% after diagnosis as compared to 90% for white women."

I don't know the statistics for other communities.

Access to health care, making it available & affordable, promoting a culture of wellness saves lives (not to politicize the board).

If I was uninsured and a clinic offers free exams if I fear that if something is found I could not get care or worse would never be insurable in the future would I go?

[SLash]

I am high-risk for breast cancer and yet no family member has ever been diagnosed with breast cancer. I emailed my breast doc yesterday to see what he thought about the findings of the task force. I learned that prior to 1993; the National Cancer Institute endorsed mammography every 1-2 years in women age 40-49. Then in 1993 the NCI changed their policy and recommended mammograms at age 50. In 1996 the NCI changed its tune yet again and decided on “no policy”, then in 1997 they reinstated their original policy of mammograms ever 1-2 years for women in their 40s in accordance with the pre-1993 standards. Reportedly, none of these changes were based on new clinical trials either. Interesting huh…

In contrast, the American Cancer Society has maintained age 40 as the starting point for screening mammography from the beginning.

It is important to remember many women diagnosed with breast cancer have no known family history of breast cancer; and under the new guidelines if they are under the age of 50 they will not be targeted for a screening mammogram. According to the Task Force it is not statistically valid to screen women under age 50 because of the infrequency of cancer. I would say to the 1 woman per 1900 women in their 40’s that is found to have breast cancer, it is.

Dr. Otis Brawley, American Cancer Society's chief medical officer said it this way: the Task Force advice is based on its conclusion that screening 1300 women in their 50's to save one life is worth it, but that screening 1900 women in their 40's to save one life is not."

If you are a conspiracy theorist like myself you have to wonder what is behind this change. For one thing there is a lot of money spent each year on biopsies generated often by mammograms and often resulting in a negative finding. The woman looks at that as great news, her insurance company may look at it as proof of an unnecessary and more importantly to them, expensive test. So, to avoid the cost of the mammogram, plus the potential costs generated from further tests and procedures, you stop doing the test that identifies the problem in the first place.

One of the real dangers is that because of this change in mammogram guidelines that in time some insurance companies will either not cover mammograms for women under the age of 50, or will cover them in very limited situations and that will result in fewer women getting them.

The fact is, coverage of mammograms expanded when the guidelines for mammograms changed to recommend them annually for women 40 years of age and older it is not unreasonable to think they will change again with the new guidelines.

When insurance companies do not cover preventative tests, people are not nearly as apt to get them, and when people do not get the preventative tests diseases such as cancer are not caught as early and the survival rate goes down. That's the real shame in all this.

Getting off soapbox now...

[Tuckervill]

I heard on the radio today that every state except Utah has laws that require insurance companies to cover mammograms for women 40+.

Karen