Mammogram Advice
Friday, November 20, 2009
AS A 15-YEAR survivor of breast cancer, I read with great concern the article, “New Mammogram Advice Raises Questions, Concerns” in the Tuesday paper. I am very aware of the controversy which surrounds the question of when women should begin having routine screening mammograms; however, according to the article, the U.S. Preventive Services Task Force, a government panel of doctors and scientists responsible for the new screening recommendations, not only stated that women should not start getting routine mammograms until age 50, but that women shouldn’t be taught to do breast self-exams because they “do no good.”
As a member of a family with a strong history of cancer, I had a sense from a very young age that I would probably develop cancer in my lifetime. My mother had bilateral breast cancer in her thirties, and her mother and younger sister both died of ovarian cancer in their forties. I discovered my tumor as a result of routine breast self-exam when I was 43 years old. My mother found her own lump accidently at the age of 37, and one of my sisters discovered hers at age 36. If any of the three of us had followed the guidelines announced this week, the odds are none of us would have survived. My other sister who was never able to feel the tumor which was the site of her breast cancer was the only one of the four of us to die of her cancer. Certainly in my family, knowledge of breast self-examination was critical, and I believe that it did a great deal of good.
We all know that women whose mother or sister(s) had breast cancer are at an increased risk of developing breast cancer as well. That unfortunately gives far too many women a false sense of security in the belief that because no one in their families has had breast cancer, they won’t get it either. The fact is that women like me and the members of my family are in the great minority of women diagnosed with breast cancer. We account for only somewhere between 5 to 12% of breast cancer patients. This means that the majority of those diagnosed with breast cancer do not carry a mutated gene which leads to hereditary breast cancer. Far more of the women diagnosed with breast cancer have no one in their families with breast cancer than those who have a “first degree” relative with breast cancer. If these women believe that their risk is minimal and they do not need to be screened for breast cancer until they are 50 or older and there is no point in their doing self-examination, they may pay far too dearly.
The article mentioned the number of false negatives which result from mammograms and the anguish a woman may feel as she undergoes unnecessary biopsies and/or waits for the results. What it fails to mention is that the most aggressive breast cancers tend to be those diagnosed in younger, premenopausal women. These women are the ones who can least afford delay in diagnosis of breast cancer.
What is the answer? Clearly, no one really knows. I understand that mammograms are generally less effective in pre-menopausal women with dense breasts, but I remain very concerned about advice that women not be taught to do self-examination. The fact remains, no matter the type of breast cancer a person has or her age at diagnosis, the earlier the cancer is diagnosed and treatment begins, the greater the odds of the patient’s survival. Women themselves are more likely to find their cancers in early stages. Like so many medical issues, it seems to me a decision which may best be left to the patient and her doctor.
Comments
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madpoet (anonymous) says...
I agree wholeheartedly! A member of my extended family died of breast cancer. She was under 50. She'd complained to her dr. of breast pain but he blew her off. Her mammogram did not find it either (misread is my guess). When she finally went to a second dr. and he ordered tests, she was diagnosed with stage 4 breast cancer. By this point it was already in her lymph nodes. They gave her 6 months to live but she hung on for almost 2 years for the sake of her young children. I would MUCH rather have a false positive and get further testing then go down her road and be told too, bad, it's too late now.
November 20, 2009 at 9:11 a.m. ( permalink | suggest removal )
HenryVIII (anonymous) says...
Well, they're only "recommendations", so you are free to get checked-out whenever you want. If you think it's necessary and you are concerned for your family and friends, tell your loved ones not to listen to these recommendations.
My automaker might recommend that I change my oil every 5000 miles. I personally feel, given the history of my car and nature of my driving, that I should change it more often. I am free to ignore these recommendations and change my oil whenever I please.
A recommendation is nothing more than advice that applies the majority. If you have a history of cancer in the family, then you probably aren’t in that majority and should get checked more often. Recommendations are not the end of the world; take some responsibility and decide whether you want to follow the recommendations or not.
'enry
November 20, 2009 at 9:47 a.m. ( permalink | suggest removal )
madpoet (anonymous) says...
The problem is, will the insurance companies pay for the tests or will it be out of pocket? The "recommendations" could well become guidelines later that insurance companies adopt. Now they're saying the same thing about pap smears. I have a friend who in her early 30s had an abnormal pap and had to have treatment to be sure it didn't develop into cervical cancer. According to the "new recommendations" she could have gone a year or more without it being caught and it could have become much worse. I think this is insurance companies wanting to save money.
November 20, 2009 at 1:44 p.m. ( permalink | suggest removal )
gooseylucy (anonymous) says...
You are absolutely correct Madpoet!! That is exactly what will happen. The big, bad insurance companies WILL use this as an excuse to no longer pay for these diagnostics. Then women will start dying younger and younger. It doesn't take a rocket scientist to figure this one out.
November 20, 2009 at 2:53 p.m. ( permalink | suggest removal )
tbluma (anonymous) says...
I think it's kinda funny that this all comes out just when Barry is half done shoving his health care down our throats.
November 20, 2009 at 3:28 p.m. ( permalink | suggest removal )
gooseylucy (anonymous) says...
Hey, you can't blame this one on our current President. This task force was put together by our last President. Yeah, W!! His actons are STILL haunting us!!
November 20, 2009 at 3:50 p.m. ( permalink | suggest removal )
Bibliophile (anonymous) says...
Madpoet is correct that insurance companies use reports like this one to set payment/coverage policies. Unfortunately, there were no oncologists on the panel that made this recommendation. Furthermore, the panel that made the recommendation was appointed by President Bush as a separate, independent panel. They are not part of the current administration's department of Health.
The fact remains that somewhere between half and two-thirds of the women diagnosed with breast cancer each year have NONE of the traditional warning signs and are the first person in their families to be diagnosed!
November 20, 2009 at 3:54 p.m. ( permalink | suggest removal )
spectator (anonymous) says...
Seems I read on-line at another site that this is coming to light now because the insurance companies, including obama's reformed plan, are trying to eliminate "unnecessary" tests. What a coincidence ! !
November 20, 2009 at 8:35 p.m. ( permalink | suggest removal )
chiefsfan (anonymous) says...
This is just very discouraging. HenryVIII, you can say all you want this is all a recommendation, and to go ahead and have the testing done if you want, the problem is insurance companies will not pay for these tests any longer. I'm sure a mammogram is a several hundred dollar test, it sure is a lot easier to get a $35 oil change for your car versus spending several hundred dollars for a routine test. True, what is a few hundred dollars versus your life, but I know I'm not the only one out there that could not afford this test. I don't understand why a insurance company would quit paying for a test that costs a few hundred dollars versus a insured getting cancer and the insurance company having to paying many, many hundreds of THOUSANDS of dollars for cancer treatment, but I know this is what is going to happen. It's a sad state of affairs when a person's health/life isn't important anymore.
November 20, 2009 at 9:36 p.m. ( permalink | suggest removal )
admireed (anonymous) says...
New York Times Op Ed had an interesting slant on this today
November 20, 2009 at 9:44 p.m. ( permalink | suggest removal )