What Matters Most?
Last week, another ‘new’ recommendation about screening mammograms was announced.
Another story hits the headlines telling women that they don’t need to have a mammogram, at least not until they are 45 years old and then at 54 only have their screenings every other year if “they expect to live till 65 years old.” (If expected to live??)
The announcement was another reason for women to be confused about what they should and shouldn’t do.
One more time when the headlines about screening raise questions about the value of mammography – confusion that could mean another woman’s life is lost.
Am I being too dramatic? Too alarmist?
No. I’m serious when I make that statement. Delaying annual screenings can result in the loss of life. It can also mean losing years of life that a woman could spend with her family and friends. It can also mean a totally different regimen of treatment—the difference between surgery alone and surgery with months of chemotherapy and radiation.
I read the entire announcement from the American Cancer Society with a heavy heart. At least they did their ‘research’ right, and didn’t use the flawed studies that led to the United States Preventative Services Task Force’s proposed recommendations that tell women to postpone screening until age 50. (Recommendations that have not yet been accepted.)
The articles that supported the ACS recommendations talked about how they follow those currently used in other developed countries, such as England, Canada, and Australia, which state that ‘screening women in their forties isn’t cost effective or a good use of healthcare dollars.’
No one has ever argued that screening younger women is ‘cost effective.’ At least not anyone in the breast cancer world I’ve worked in. We’ve always known that fewer breast cancers per 1000 are found in women under age 50. But what does ‘cost effective’ really mean? And who defines ‘good use’ of healthcare dollars? Especially if that forty year old is you or someone you love.
Another issue they discuss is the problem of false positives-those results that require women to have more testing after a screening mammogram. The idea that women are overwhelmed with anxiety due to false positives just doesn’t ring true.
In my book, The Women of The Rose, I talk about how the women I know aren’t unduly traumatized by having a follow-up test. They want to know what’s going on with their breast and relieved when the area in question proves to be a benign finding.
Of course, when mammograms are read by folks who know their stuff, the rate of recalls is low---and of those about half will have something that needs to be biopsied. That’s when a follow-up test counts the most. I don’t know many women who would want to bank the rest of their lives on a 50 50 chance. No, they’ll have the additional test and willingly.
Haven’t most of us had a lab test that didn’t come back in the normal ranges? Either we had to have it repeated in a couple of months or they ran additional tests. Even a simple urinalysis is accompanied by a ‘culture’ order if something shows up out of normal range. At least if the doctor ordering the urinalysis in the first place is smart enough to add that note.
I sure hope the national organizations with a lot more clout than The Rose continue to challenge that idea. Someone needs to.
Thank goodness the American College of Obstetricians and Gynecologists, the American College of Radiology and the Society of Breast Imaging continue to support the recommendation of starting mammograms at age 40 and having one every year after that.
There is no doubt in my mind that women need to start screening at age forty—in fact at The Rose we will continue to recommend a baseline at age 35.
Our experience and our statistics are absolutely clear: one half of all of our women who are diagnosed each year are diagnosed under the age of 50. Of the 325 we diagnosed last year, 157 fell in that range. We know screening younger women works. Thirty years of doing mammograms adds up to a lot of women and finding a lot of cancer. We’ve seen the number of 40 year-olds being diagnosed rise with each passing year. We know these women by name, met their families, comforted their children.
Thirty years of watching too many women die because their cancers were found too late makes me livid when I hear of ‘new’ recommendations or ‘new’ studies advising women to postpone it.
We’ve also seen the value of doing mammograms every year, not every other year.
This past February, one of our own was diagnosed. She’s the first to tell you that if she’d followed the every other year after age 54, her cancer would have grown to stage 2 or 3. She’s absolutely certain that annual mammograms work.
I wonder how many times we’ll have to endure another ‘new’ recommendation. I remember fifteen years ago when millions of women signed petitions against the USPSTF’s proposed recommendations downgraded screening for forty year olds. Those signatures stopped the recommendations from being accepted which meant insurance companies had to continue to cover screening mammograms at age 40.
At the end of the day, isn’t that the real issue? Even the American Cancer Society states that 40 to 44 year-olds should have screening mammograms if “they want to.”
Wanting to and having a test when insurance doesn’t cover it are two very different things. And it’s curious to me that preventative screenings which include mammograms are mandated to be covered by the Affordable Care Act. I guess these new recommendations, along with others, could in fact wind up negating that law.
And no, this approach isn’t about “empowering” a woman to make that health decision for herself. One premise being sported behind these recommendations is that they help a woman take her health in her own hands ‘after she’s discussed the pros and cons of having a mammogram against her risk factors with her personal physician.”
I don’t know many women who have the luxury of having hat discussion with their docs anyway—at least not in the 7 to 10 minutes we get to spend with him or her. Risk factors? We’ve learned that being a woman is risk factor enough.
But what I do know is that we don’t need another reason for a woman to not have annual screenings. We don’t need another set of barriers. She already has enough of those. Between having no time for herself to not having enough money to spend on basics much less screenings that used to be covered, she has enough barriers.
What she doesn’t have is a guarantee of life when diagnosed late. No matter how personal the treatment or how good it is, early detection still gives her the best chances.
No matter how they try to spin it, early detection does matter.
In the end, I hope we remember what matters most.