The U. S. Preventive Services Task Force came out this week with new recommendations for women and mammography. Their new guidelines call for mammograms to be initiated at age fifty (versus age forty), to be repeated every two years (versus every year) and state that breast self-examination is of dubious value. These new rules, a response to the plethora of false positives, unnecessary exposure to potentially dangerous levels of radiation, way too many mistaken biopsies/surgeries and an incredible amount of anxiety caused by these “preventive” measures, needed to be updated. This is not about the insurance companies trying to deny coverage and reduce their costs. NO. This measure is about integrating new information into our current practices and was long overdue.
Be cognizant that if a woman has a familial history of breast cancer, if she has the breast cancer gene, if she has dense breast tissue, or if she is a breast cancer survivor, a mammogram will be performed in her forties, or perhaps even earlier. But my fellow females, please do not block out the reality of x-ray exposure. It is significant and does build up over the years. The implication of a radiation overdose during one’s lifetime should not be ignored and could prove even more dangerous and lethal than any other serious disease. Just the solar flares and the dissipating ozone layer is cause for concern. The radiation one is exposed to on an airplane trip is also significant. Add to that mixture annual mammograms and the picture is not so good. I personally feel that way about the cumulative effects of dental x-rays. Even though they entail only a very small amount of radiation, what decay or injury to a tooth was found on x-ray that the dentist did not discover herself upon examination? Granted I have had a fantastic dentist for the last 25 years, but if your dentist relies solely on x-rays for diagnosis, go get a more competent dentist. Why is it that Americans automatically believe “more” is always the answer? More radiation because it is available and easy is a mistake. Furthermore, doctors should not be using x-rays as a means to routinely “cover their asses”. The number and severity of disclaimers on a mammogram report is phenomenal. Likewise, a dentist should not overuse x-rays just to avoid any liability.
The only part of this task force’s recommendations that I object to is the doing away of breast self-examination. This is usually the way most women discover any suspicious lumps. Even though the consequences of finding a mass through this process can also produce a false positive, the follow-up of which can lead to unnecessary radiation, surgery and stress, I think that self exams are a responsibility each and every woman should maintain. Furthermore, this self-screening is a good way for a woman to familiarize herself with her body, a routine that is certainly beneficial to her health status. By recognizing what is “normal”, she will be able to detect something “abnormal”. Imagine if we advised young males, who are the population group that experiences the majority of testicular cancers, to stop self-examining themselves. Not a good scenario.
When I was in my forties, I did have a false positive gleaned from a regular mammogram. First of all, never have a mammogram on a Friday because you will have a weekend from hell. No doctor will be present to do his analysis on the test before Monday. The ensuing tests proved nothing to be amiss. It was at that point that I began stretching out my mammograms to eighteen months. The last couple of years I have been waiting two years in-between tests.
A good reference on unnecessary testing is “Matters of Life and Death: Risks vs. Benefits of Medical Care” written by Eugene D. Robin, M.D. Dr. Robin wrote this in 1984 while employed at Stanford University. The timeliness and pertinence of this little book has not faded over the years. Even Dr. William Catalona, who developed the PSA blood test for prostate cancer, admits that the test should have never been invented due to the false positives and often unreliable results of the test. Risk versus reward, reason over fear.
So my fellow females, the new guidelines for mammography are reasonable and long overdue. This is not a ploy by the insurance industry to lower their costs to the detriment of their policyholders. As time and research progresses, of course old rules will be changed to take into consideration what we have learned. These new guidelines should not be politicized as another slap in the face to women’s rights. I find it extremely relevant to know the risks of radiation in relation to breast cancer detection. Perhaps the best tack is for physicians to take a complete history from the patient and actually listen to the patient’s concerns. Imagine how many unneccessary tests that would obviate. On the other hand, patients should not demand tests, simply because they exist, to assuage their generalized fears.
The critics of these new guidelines have been quite vocal. Some say that if even one woman dies from breast cancer in their forties as a result of these new rules, it is too much. I agree. But one must also weigh the long-term health and economic effects of the actual testing. Each case, each person, must decide for themselves on the merit of when and how often they should have these tests. Of course payment is a big influence in this process. If a woman can not afford to have a mammogram when she chooses, despite the oppositional recommendations, the test is a moot point anyway. Can you imagine the economic pressure on our health care system if each person was allowed every test they wanted, often based on a whim, an emotion or irrational fear? The system would self-implode. Risks, rewards and costs must all be factored into the equation.
Any woman who has sat in the radiologist’s office waiting for a “yea” or “nay” on their mammogram results knows the feeling in the pit of her stomach that accompanies all the possibilities. The fear is real and detection is imperative. Everything has a cost though, and moderation must play into the process. These new guidelines are not aimed at rationing; rather, they are tenets of reason based on what we already know and what new information that has come to light. What good is it if we do not put into practice all the research that has added to our knowledge? “More” is not automatically better and, in fact, less just might do a better job. As a woman, I am grateful that attention is finally being paid to the risks and rewards of our breast health and the guidelines have been updated to reflect our current expertise.
Please, please go to my diary site on DailyKOS for more information. This was a very difficult entry for me to write. I am not a medical professional nor have I read most of the pertinent research; I can only write from my own limited experience. The people who commented on this entry can lend a lot of insight into this subject. Very insightful.
The comments and information on my DailyKOS diary just keep getting better and better. Go there.
Tags: breast biopsies, breast self-examination, cumulative effect of radiation, Dr. Eugene Robin, false positives, mammogram, medical rationing, new breast cancer guidelines, U. S. Preventive Services Task Force, x-rays