Less Mammography in my future

[shootingstar]

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?

Have wondered about this for a long time, Trek with respect to U.S. present health care system.

But that's another long, long separate discussion.

[SLash]

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

Karen

The Natonal Women's Law Center has ranked each state's policy. See: http://hrc.nwlc.org/Policy-Indicator....aspx#footnote

"States that require private insurers to cover annual mammograms for women age 40 and older (1) are considered to have comprehensive breast cancer screenings and therefore receive a "meets policy." States receive a "limited policy" if they require private insurers to cover annual mammograms for women age 50 or older, or "if required by a physician." States receive a "weak policy" if they only require insurers to offer mammogram coverage as a benefit in employer-sponsored insurance plans, but have not required that it be a mandated benefit in all of these insurance plans. States that do not have any requirements regarding insurance coverage for mammograms receive a "no policy."

They show 20 states "meet policy", 27 states "limited policy" and 3 states "weak policy". The data is from 2007.

[Trek420]

Have wondered about this for a long time, Trek with respect to U.S. present health care system.

But that's another long, long separate discussion.

I'm not in the medical field, no training in it whatsoever etc. I do work in a busy call center where most of the folks I talk to are both poor and disabled and have done so over 13 years, so I've heard a lot.

Difficulties like being unable to get to preventative and after care appointments are common challenges. Some live in areas with no public transportation, one illness where suddenly you can't drive and preventative and after care is out of the question if you do not have an awesome support network. Others can't afford the time off required to do all that.

You'd be surprised the number of tales I hear of one disease or diagnosis, a lost job or being on disability and a spiral into poverty or maybe you wouldn't.

If I had $5.00 for every time I've heard "I used to be like you with a good job, never thought this could happen to me ...." I'd be retired .... and probably being an activist for this cause full time.

I'd really like to see figures on cancer survivorship by income level but you are right .... that's a whole 'nother discussion.

[nc tam]

http://www.acr.org/HomePageCategorie...TFDetails.aspx

The fact that this is from the American College of Radiology will automatically make it suspect for some of you. Just thought you might be interested in what radiologists think of the recommendations since radiologists are reading the mammograms.

And from the American Cancer Society:
http://www.cancer.org/docroot/MED/co...Guidelines.asp

As far as other possibilities for screening... ultrasound is very operator dependent and is too insensitive for microcalcifications, a common presentation of both in situ and invasive ductal cancers. MRI is too time consuming, requires IV contrast and has too many false positives (more than mammography in some series) to be a screening study. Researchers are working on all sorts of things. Only time will tell.

[SLash]

I'm not sure if this is allowed, if not I'll remove the link/post, but I think it tells a side of the story on the new mammography/self-exam guidelines better than anything else I have read (or written). The link is to a FB page (I know, FB ), it is the Young Survival Coalition fan page. It appears to be open to everyone because I logged out and tried the link and it worked. It starts about mid-page.

I think their stories and comments help us to understand why there is the outrage toward the new guidelines and also maybe help those younger than 50 understand the risk of following them. http://bit.ly/3S1Wy6

I hope this isn't viewed as political or something, but I think it is just too important a subject not to post this.

[Tuckervill]

Ultimately, the public needs to set aside automatic enthusiasm for screening and develop a new kind of savvy—one that balances hope with a certain dose of healthy skepticism and leads people to embark on testing only after considering a host of variables, both personal and scientific. As it turns out, in cancer screening, as in so much else, there really isn't a free lunch.

link

Pretty much sums up how I think about it.

Karen

[OakLeaf]

New meta-analysis on the risks of radiation - mammography more than doubles rates of breast cancer in high-risk women.

[KnottedYet]

I'm always a little hesitant to embrace met-analysis "results."

The farther you get from the actual research, the less faith you can have in your findings.

Summaries of meta-analyses even more so. Once this is published in a journal, peer reviewed, original articles are listed, and the students explain how they made the jump from "early cancer found by mammogram in women with a family history" to "cancer caused by mammogram;" then I'll be glad to read it. Tumors don't wear a little banner saying "I was caused by ---"

Original research is grindingly slow and frustrating work. (2 years down and results presented at an international conference, now the long process of getting published) But at least I know my data, and every single one of the subjects in my study, and exactly what I did, and how I came to my conclusions. I stand behind my results. If instead I had done a re-structuring and re-filtering and re-assessing book report of the published work of 5 other groups... well, I couldn't in good faith stand behind that.

The headline could just as easily be: "mammography more than doubles rates of early cancer detection in high-risk women." As time passes and technology advances it is inevitable that we begin finding cancers earlier in one generation than it was found in the previous generation.

Detection method does not imply cause. Kind of like if my Grandma never went to a dentist until she was 50, and they found a bad cavity and the tooth had to be pulled. She tells me I'm at high risk of cavities, so I go to the dentist every year. He finds a small cavity when I'm 30. Do I turn around and say that seeing the dentist early and regularly caused my cavity? Nope. But I could do a meta-analysis that would "prove" exactly that. And should I stop flossing my teeth and looking at my teeth until I'm 50, and then start going to the dentist? Nope.

[OakLeaf]

All points well taken.

But no one disputes that radiation causes cancer, and that there is no safe dose. The only question they're trying to resolve is the precise degree of the harm.

When I had my biopsy, I asked about the radiation dose. At that point I had decided to have it done, but I wanted the information so I could make decisions about future radiation exposure. The surgeon told me the radiologist would tell me. The radiologist told me the radiation physicist would tell me.

And the radiation physicist - I do not exaggerate - called me up four or five months later and tried to explain to me that radiation is actually good for me, because there's some village in Eastern Europe located on a radioactive lake where the cancer rate is lower than that of the entire United States. And despite my telling him several times that I wasn't particularly upset about it or interested in arguing costs vs. benefits, he never did give me the information.

[KnottedYet]

Radiation dose of a digital mammogram: 0.7 msv
Normal background radiation dose: 2.4 msv

Your exposure to daily background radiation is nearly 4x what you get from a digital mammo.

This is like the difference between standing outside in the sun waiting for the bus vs. standing in a dark room while someone shines a flashlight in your face. What's the sunburn risk? I don't get a sunburn waiting for a bus. Someone with severe light sensetivity will get sunburned from a flashlight.

Your exposure is even higher if you live at high elevation or where there are high radon concentrations in the ground or groundwater. The background radiation in Denver CO is higher than what the gov't deems safe. If Denver followed the lowest safe dose reccommendations set by the government, it would be evacuated as dangerously radioactive. Yet Denver has an extraordinarily low cancer rate.

Women with a genetic tendency to develop cancers have a genetically moderated problem in which their bodies don't correct the normal everyday damage/rogue cell we all experience every single day. Every single day of your life, your body is killing mutated cells. (apoptosis) You have "cancer" in your body at all times. Every moment.

Women whose bodies don't recognize damaged/mutated cells as well as everyone else will have more cells slip through the cracks. If those mutated cells get a foothold, they will become a tumor. Younger tissue has a higher radiosensitivity, meaning it is more susceptible to damage from any source of radiation. Cigarettes. Airplane rides. Trips to Denver. Clutching a book (paper is radioactive) to your bosom. Even though mammo radiation is much less than background radiation, most doctors will tell younger women with a history of poor apoptosis control to have breast MRI instead until they are older.

Of 1,000,000 women getting mammograms over their lifetime, there will be an estimated 2-10 tumors induced by the radiation (which are found in the next mammo and treated). 1,000,000 lifetimes of mammograms saves 1,000 lives.

[OakLeaf]

0.7 msv per view (more for dense or large breasts). Two views (minimum) per breast, two breasts per most women. 2.8 msv. And that's just the screening mammos.

Background radiation is unavoidable, but that doesn't mean that doubling it is good, or even that it's okay.

Here's Barbara Ehrenreich (a breast cancer survivor herself) weighing in today.

[KnottedYet]

I've got it all covered!
http://www.infabcorp.com/index.php/c...brassiere.html

And this:
http://www.huffingtonpost.com/marty-..._b_359451.html

[OakLeaf]

Now even A-cups can have muscle imbalances like large-chested women!

[KnottedYet]

Get down and dance!

http://www.youtube.com/watch?v=OEdVfyt-mLw

Yay, rockin' hospital librarians! Pink glove dance!