According to new US Health Department guidelines, women should no longer bother to get mammograms until they’re 50 (previous guidelines said we should start at 40). They also said, and this blows my mind—women should stop doing breast self-exams because the “harm outweighs the benefits.”
What “harm” is the health department trying to protect us from?
Anxiety.
That’s right, ladies: Don’t trouble your pretty little heads getting tested for a disease that might kill you. Because as everyone knows, anxiety is way worse than, say, catching a life-threatening illness in time to treat it.
Yes, finding a lump in my breast, or getting a positive on a mammogram, would make me anxious. The thing about anxiety, though, is that it alerts you that something may be wrong. Something like, say, having breast cancer, which affects 1 in 69 women between 40 and 49 (odds that are far worse for black women, whose risk of death from cancer between 35 and 44 is twice that of white women.) Personally, I’d rather deal with a little anxiety than assume I’ll beat those odds.
However—as much as I’d like to be outraged by the patronizing, infantilizing attitude of the American medical establishment—I don’t actually believe the health department gives a shit about whether women are feeling “anxious.” Mammograms, biopsies, followup appointments—all those things are expensive, and insurance companies don’t like paying for things that are expensive. In their view, it’s better to have a few thousand more women die of detectable breast cancer every year than spend a few million bucks on tests and treatment that turn out to be unnecessary.
In somewhat better news for women, the Senate just unveiled a health care bill that ditches the reviled Stupak amendment, which would eliminate abortion coverage over time for all women, not just those participating in the government-run “public option” plan. That’s better than nothing, but it doesn’t mean health care reform is great for women. That’s because the Senate version reverts back to the existing Hyde amendment, which prohibits federal funding for abortions except in cases of rape, incest, or when a woman’s life is in danger. And the Senate version still has to be reconciled with the far more draconian bill passed by the House, where Speaker Nancy Pelosi built her majority by throwing women’s rights under the bus.
One footnote on the health care bill: Part of the funding for the Senate version would come from a 5 percent tax on cosmetic surgery. And while it’s true that most plastic surgery is performed on upper-middle-class and upper-class people, it’s also true that 91 percent of all cosmetic surgeries are performed on women—in part because women are under tremendous societal pressure to remain thin, large-breasted, attractive, and young at every age. Taxing plastic surgery, in other words, would disproportionately impact women, who are under disproportionate pressure to get plastic surgery.
It’s like a sin tax that only impacts one gender.
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You make some nice points, ECB, but it’s a little disingenuous of you not to note that the biggest harm the Health Dept. is trying to avoid is overtreatment–the same thing many health advocates are trying to avoid in suggesting changes in prostate cancer screening in men. Moreover, the anxiety worry may be less about gender stereotypes than about knowledge of a cancer if that knowledge doesn’t do anything to enable you to be healthier. Not sure whether that’s the case, but I’ve heard similar stuff re: prostate cancer. Your rant comes off as willfully ignorant.
re: knowledge of a cancer, I was referring to the super-slow-growing variety–the type you die with, not from.
I’m still confused after reading several stories about this.
What I’m reading in mainstream news articles quoting reasonable medical experts is that by not urging regular checks and screening for women from 40 to 49, there will be preventable deaths.
The downside seems to be “anxiety” as you point out, and unnecessary surgery.
When I first heard this news, I thought it was part of the larger issue that cancer screening isn’t producing less death. Rather, cancer screening across all forms of cancer (prostate and breast cancer more notably, I believe) reveals more indolent early-stage disease that doesn’t need to be treated.
Longitudinally, early screening reveals only fractionally more cancers that respond to early treatment for most cancers (not all).
That’s only assuming that women are the majority of people PAYING for the plastic surgery.
I’m no sociologist, but certainly there is a high instance of rich doofus husbands shelling out for their “Real Housewives of XYZ.”
It’s a laughable scale back indeed.
Eat more apples and drink some herbal tea, ladies. Also, be careful how much soy you take in: Soy inhibits estrogen and can promote various cancers in women, including breast cancer.
Unnecessary tests and surgeries lead to real medical accidents and real medical deaths. Realistically, they also lead to waste in the system that cause the cost of health care to rise for everyone. And since access is a product of cost, you end up having less access.
I reject the notion that we should only believe in science until one day science disagrees with your preconceived notions. Why not mammograms at age 18, ECB?
The sexist facade of this post is laughable, by the way. A similar recommendation regarding prostate exams to men was given recently.
Back when I was in grad school in epidemiology, the scientific evidence supporting starting breast cancer screening at age 50 was already quite clear. But a highly effective, baldly self-interested, media blitz by the ACS, radiologists, oncologists, et al. trumped all that research, and the scientific consensus was overruled by political expediency.
That was in the 1980s.
Now the same thing seems to be happening again. Except that there’s another two decades-worth of science that confirms the earlier work.
Sadly, though, it’ll won’t be the science that may eventually drive breast-screening policy to a responsible position. It’ll be the price tag.
I actually can relate to the new recommendations. My family has no history of breast cancer and I have low risk factors. When I was 27, I had a lump in my boob which is pretty normal. Boobs are lumpy. I ended up spending lots of time, worry and money getting an ultrasound and eventually a biopsy because there was a .01% chance it might be something bad.
There was nothing wrong with me. I just have normal lumpy boobs. True, it could have been something bad. But we face many risks everyday and I question whether it was worth it.
I don’t think that more testing is always best. And the stress is a factor. I read a recent study that showed that the stress hormones produced by waiting for results was the same as actually finding out you have cancer.
In the end, I think it’s a personal decision each woman has to make. The more information we have about the real effectiveness and limitations of testing empowers us to make an informed decision rather than just getting tests constantly.
@1 and 6,
Exactly. I really have no idea if the new recommendations are right or not, mostly because I can’t say I have the time or desire to read a bunch of studies, but its pretty clear that the question is not simply a matter of ‘anxiety’ nor just saving money(though resources are finite and we need to spend them wisely), but more one of safety and health. Mammograms involve radiation, and if there is a false positive the follow up tests and procedures carry risk as well. Hell we could all get annual full body MRIs, and it would most certainly catch a number of cancers, but it would cost billions and most certainly cause more harm than good.
This is a question of science and risk/reward not of politics.
I agree wholeheartedly with comment 6.
Imagine if you will that everyone had yearly full body scans. We would see all sorts of tumors and abnormalities. The extreme majority of them would be benign and harmless, but we would have to do tests, biopsies, and surgeries for them just in case. It’s true a few people would live because of this when they would have otherwise died. It’s not just that insurance companies would have to pay more money, everyone would. The people who get the tests have to pay more and it would increase insurance prices for everyone else. (A completely different topic but prices could be controlled some if hospitals had to actually compete with each other) Increases of price would mean poor people wouldn’t get even more care. Even if we had a mandatory public option there will likely be exceptions for those who can’t afford it. The biggest problem is that the extra unnecessary procedures have risks and not just anxiety. People will die and have complications because of them. The increase of radiations from scans will actually increase cancer rates.
It is a complex system trying to find out which is the best course with the least negative effects. It seems like common sense that more breast/prostate cancer checks would mean more lives saved and better lived lives but that isn’t necessarily the case. Alas, life is more complicated than that.
Dr. Susan Love, a nationally respected breast cancer researcher, said it very well on national TV earlier this week, if you want to protect your right to get radiated, by all means, go and get yourself radiated. It’s nice, though, to have a discussion about whether all that radiation might just be doing more harm than good.
As for self examination — we should all be touching our own breasts all the time. They’re part of our bodies. Touching them feels good. Touching them with soap and water is good basic hygiene. If we have a partner, and we so choose, we can let them touch our breasts on a regular basis too. If this happens then we don’t have to worry about whether or not “official” monthly self-examinations are recommended or not. We’ll notice if things are different.
Welcome to ObamaCare! Cut back service guidelines and save money, not lifes! Why treat anyone over 65, afterall, they just collect social security and cost us money. What do they add to society other than experience, perspective, guideance and a sense of history.
it’s only a personal decision if you are paying for it; if everyone is paying for it, thru govt. or thru insurance, then it’s a social decision that should be backed up by science.
Overtesting is usually something insurance copmanies favor…the more tests the higher the health costs…the better reason to bump the insurance premiums….the whole industry is a scam of over testing and overtreating and overpaying, just like when you get a fender bender and suddenly it’s two thousand dollars for a new fender. no one has an incentive to make fenders that are fixable for fifty bucks….
what’s happened now is perhaps a strategic release of info by big wigs to scare the women and help defeat health care reform.
don’t be fooled into taking the position that “science doesn’t not matter.”….
@6,
Why not mammograms at 18? Because women at 18 aren’t getting breast cancer. But as ECB pointed out in the post; having breast cancer affects 1 in 69 women between 40 and 49.
@7,
Sexist facade? This post doesn’t only talk about breast cancer. It talks about amendments restricting abortion rights and also issues re: plastic surgery.
ECB
Did you read the actual study you reference re: Stupak/Pitts?
It offers little more than a stream of circular reasoning and a serious of speculative “may result in x and if x then we may get y”. Hypothetical outcomes that promote its predetermined conclusion are deemed “likely” ones that undermine it are discounted.
If you don’t challenge its assumptions it makes enough sense, but there are an awful lot of them in there. It’s basically a Fox News version of public policy research.
I would recommend that interested folks take a look at the actual recommendations under discussion:
http://www.ahrq.gov/clinic/uspstf09/breastcancer/brcanrs.htm
Some quotes to lend context:
“The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”
“Adequate evidence suggests that teaching BSE does not reduce breast cancer mortality.”
“[The] number needed to invite for screening [is] 1904 (CI, 929 to 6378) to prevent 1 breast cancer death in women aged 39 to 49 years”
“Sin tax on one gender.” Eh. Only those members of the gender who are dumb or neurotic enough to get plastic surgery. (Talking about elective plastic surgery here.)
If women buy into the bullshit, it’s our own fault. Tax away.
@15, I will refer to you the last sentence in #17 regarding the efficacy of these tests.
18 year old women do, in fact, get breast cancer. I dated a girl just this summer who had a tumor removed that she discovered from a self-exam. (She was 22.) The tumor presented no risk. The hospital visit and surgery itself presented far more risk.
You and ECB both cite the “1 in 69″ figure, but seems not to mean what you think it means. The exact problem is over-diagnosis and over-treatment.
Regarding the sexist facade: “Don’t trouble your pretty little heads getting tested for a disease that might kill you” was made in the particular context of breast cancer screening. A similar comment would not have been made regarding the prostate cancer screening changes, even if those were equally “controversial.”
I find it hard to believe that scientists have made a decision based on the best way to be condescending to women. In fact, that is why “anxiety” is not listed as the sole reason for this conclusion despite the above assertion to the contrary.
(In case it wasn’t clear, one way to reduce to the “1 in 69″ women is to stop diagnosing breast cancer when it presents little or no risk.)
How would ECB feel if they balanced the tax on cosmetic surgery with one on hair replacement procedures?
Look, Erica, you’re just off base here. I totally love your rants, but when you’re writing about breast cancer, you should get your facts straight. It’s obviously a serious subject. I’ll just highlight two points:
1) The downside is not anxiety, it is anxiety plus unnecessary mammograms, biopsies, mastectomies, chemo, and radiation. Bad stuff.
2) The study in question did not look at medical economics in any way; it just asked the question, does early screening save lives? And it concluded that it doesn’t save lives. You can build a conspiracy theory out of it, but there’s not much to work with.
I agree that this study is not the final word on the subject and that it’s controversial, but I think it’s incumbent on Erica and Publicola to make sure they understand what they’re talking about before they hit “Post”.
My primary concern is that these recommendations are going to allow insurance companies (private companies for sure, as well as any public option)- to deny coverage for women who choose to have mammograms at the age of 40.
There’s a lot more though.
I’m married to a Kaiser doc who says he sees breast cancer in women under 50 all the time, but that he definitely sees it more often in women over 50. He believes that the annual mammograms have definitely resulted in lower loss of life due to breast cancer.
He also said that the recommendations from the task force are probably based on cost effectiveness ratios — e.g. the amount of medical spending required per additional year of quality life. The cost- effectiveness of preventative treatment changes depending on the population being served. My guess, without having read the report, is that the cost -effectiveness of requiring women under 40 to have annual mammograms is financially unjustifiable. Same goes for certain categories of men being tested for prostrate cancer. In a world of finite medical resources (and I’m not talking about health care reform, which my husband and I support. I’m talking about today’s system), lowering costs is critical to expanding inclusion.
There is so much more connected to this debate– like how many times a mammography machine has to be used before it pays for itself, lawsuits related to false positives and false negatives, and more– and like everyone else I am trying to wrap my brain around it.
Just my 2 cents.
This discussion illustrates what Congressman McDermott always says: the US has a sickness care system. There are drugs that are proven to prevent or reduce breast cancer for a reasonable price. Yet the medical /drug industry is only interested in the much more expensive and profitable services and drugs to be used after a person is sick.
Interesting that, while the general trend here is in disagreement with ECB (something I myself do a lot
), I kind of agree with her here. The rollback is meant to deny screening to a segment of the population in order to save a few bucks.
I see women nowhere near 50 years old developing and needing treatment for breast cancer. To tell me that women under 50 don’t need an annual screen strikes me as asinine, even if the chances of developing breast cancer are fairly low for women under 50. The chances of someone developing ANY type of cancer PERIOD are fairly low. That it prevents only a relative handful of deaths to screen 40-49 year olds belies the point that screening only prevents a relative handful of deaths period.
All that said, PCO37 made a very good point: Our system is geared towards treating ailments and sicknesses, not in preventatively maintaining good health. Maybe we need to focus more on using all those breast cancer research dollars to find preventative methods instead of developing new forms of painful chemo teatment, cancer management drugs and breast removal. But unfortunately, that’s where the money is, and that’s why researchers blow their money there. It’s always about money and never really about good health, because good health doesn’t make doctors any money.
CC, “He also said that the recommendations from the task force are probably based on cost effectiveness ratios”
Gomez, “The rollback is meant to deny screening to a segment of the population in order to save a few bucks.”
This is not true. The task force did not consider cost in its recommendations.
For example, things like self-exams have no direct medical cost, but they simply do not work and teaching someone to check their breasts when that test is ineffective is not a medical advance.
I think what everyone needs to realize is that if a sizeable lump appears in a woman’s breast who isn’t receiving mammograms, she’s going to feel it without “knowing” how to do a self-exam and is still going to go see her doctor about. No one is pretending cancer doesn’t exist in women between the ages of 40-49, just like we don’t pretend it doesn’t exist in women in their thirties.
Once again, I do not believe one can believe in science until it puts them in an uncomfortable situation. This study is medical advance even if it feels like a treat. The advance is that we know something is ineffective and have to focus on things that do work, or develop a way to determine if a tumor is fast- or slow-growing.
This is not the first time we’ve learned that cancer screening isn’t very effective for both men and women (with pretty little heads).
I think John Jensen makes a valid point that others continue to skirt. Resources are finite, and data can tell us how best to allocate those resources. An approach based on data can look cold, but it shouldn’t merely be dismissed.
The statement that we are only looking to save a few dollars ignores the reality of costs in health care. Paying money into statistically ineffective methodology doesn’t just take the money from a pot of unused money, it takes the money from statistically more effective methodology. What this debate is lacking is a voice that is arguing for those other expenditures, which are likely being underfunded, and which have dire consequences as well.
In other words, women are dying because we are poorly allocating money away from more effective treatment and diagnoses methodologies. Those matter too.
As the point has been made, if we are to believe in science and data, we have to look at what they are telling us. Sure, we don’t surrender human emotion and our ability to act contrary to the data, but we should be well-versed in the research. We should make our decision will full knowledge.
This post feels like it was written as a knee-jerk reaction without trying to understand the nuance of the larger issues at play.
@22: Exactly, all of that.
There’s no point in reacting with such know-nothing emotion to this. The recommendations were based on studies. And the 1 in 49 figure does not mean that 1 out of 49 woman in that age range develops breast cancer, it means that the probability is 1 in 49 for women in that age range. That’s very, very different. That kind of “statistic” should be used if you can’t use it properly.
Please, Gomez and others — don’t recommend apples and green tea. That’s just total patronizing BS, with no evidence whatsoever. If you find any scientifically-tested evidence that that regimen prevents breast cancer, present it. If not, shut up. What you say about soy is true; however, until about 5 years ago when it was proven that soy could be dangerous in the same way estrogen was, the people who recommend apples and tea were also recommending soy. Funny about that, isn’t it.
Yes, I’m reacting with emotion also, but not to the recommendations, rather to the silly reactions. If you’d been through as many false alarms including needle biopsies and yearly mammos and ultrasounds as I have, you would also.
The new recommendations don’t say not to do breast self-exams. They say that doctors shouldn’t teach breast self-exams. The reason? You are just as likely to find the lumps without being taught and without constant reminders as you would with both of those tactics. In other words, checking yourself out is fine. What’s not good is haranguing people to check themselves.
But I suspect you have just gone on news reports rather than read the recommendations.
It just struck me that the preponderance of comments on this have come from men (unless the posters are women using men’s names). Maybe that’s because most Publicola posters are men. But it’s a bit strange.
Re the comment from the woman married to a Kaiser doc who hasn’t read the recommendation: Your second-hand reports of your husband’s experience just isn’t too relevant. If your husband had posted, maybe so; if you’d read the full report of the recommendations, maybe so; if you’d had your own experience to relate, maybe so. But otherwise it’s hearsay from one doctor’s wife and that kind of comment doesn’t enlarge anyone’s knowledge.
What you say about insurance companies possibly denying coverage of exams doesn’t have any more validity than someone else’s claim that insurance companies want a lot of exams so they can make money. Neither claim makes much sense. Insurance companies make money from premiums. If they receive a lot of huge claims, they’ll raise premiums a lot. If they receive a lot of minor claims (and mammograms aren’t that expensive), they’ll raise premiums anyway but not that much. They’re not worried about going broke either way.
28. You’re right, Sarah. Don’t eat apples. Or drink green tea. Don’t even touch them. My mistake.
… what?! What, do you have information that proves that, say, apples and green tea CAUSE cancer? Because I don’t see any logical reason why you need to attack that.
If you need to get emotional, fine, but don’t just attack anything and almost everything in this thread because you got hit with a misdiagnosis or five by some dumbass doctors.
If anything, I’m an advocate of preventative medicine through healthy habits over leaning on doctors for health maintenance in general, and we can both probably find a few thousand experts who can agree with that notion. Don’t attack my notion that you should try to eat and live healthy because you’re still bitter about the past. What happened was terrible. Terrible things happen to all of us (don’t even get me start on the pediatrician who nearly killed me with a drug overdose as an infant because I was just some spic baby whose fate didn’t really matter). Deal with it, move on and don’t let it cloud your better judgment.
Gomez, you’re being much less logical than you usually are. You told women to eat apples and drink tea as a preventive. I said there’s no evidence that they prevent cancer, NOT that people shouldn’t eat/drink them. And I’m not bitter; I’m simply glad that this particular panel realizes some of the damage that can be done by overdiagnosing. Read their report, for petes sake. I wish people would do so instead of reacting the way they have to what is actual evidence of what prevents deaths and what has not proved to prevent deaths. That’s what this is all about: preventing deaths from breast cancer.
Healthy habits are great. Eat all the apples and whatever you want. But don’t count on healthy habits to prevent (or cure) any kind of cancer. Ask all the people who did so and felt betrayed because that magical thinking didn’t work. The “healthy habit” thing can be somewhat of a comfortable shawl around your shoulders that you think will keep an arrow from hitting you. This is real life; it doesn’t work that way. And I still think that someone who’s 1) been educated on the human body for XX years, 2) has been a practicing physician or researcher for XX years, and 3) has actually run or read reports of trials/studies and collated stats from them probably knows more than I do. They do make mistakes and some have been made on me also. But that didn’t made me swear off listening to physicians. So maybe I’m not the bitter one.
To wit, Sarah, a lot of people who believe they’re eating and living healthy aren’t eating or living as healthy as they think they are… but that’s a whole other topic.
Apparently ECB doesn’t respond to comments; Josh Feit responds but doesn’t read them. Good to know.