Lynne Varner / Times editorial columnist
Mammogram debate and a false economy
New government breast cancer guidelines wrongly downplay the importance of mammograms and monthly breast self-exams.
Seattle Times editorial columnist
Obviously, I am not more knowledgeable about breast cancer than a government-led panel of experts. Yet I know enough to look askance at advice that only women 50 and older get mammograms every two years and those in their 40s skip the test altogether.
New cancer-screening guidelines, published in the Annals of Internal Medicine, fly in the face of conventional wisdom and long-standing consensus from cancer groups, radiologists and other experts that women get annual mammograms starting at age 40.
Science routinely second-guesses itself and women have often been caught in the middle. The controversy about estrogen-replacement therapy is one example where women were forced to weigh conflicting medical advice.
Moreover, the U.S. Preventive Services Task Force isn't nixing mammograms. They acknowledge the test's early-detection benefits.
But here's what galls me: Not enough lives are saved, the experts say, to justify mammography as a routine screener for breast cancer.
Here's a question: Of the lives saved by mammograms, which ones weren't worth the effort? Certainly my sister's life — saved not only by a mammogram's detection of something amiss, but by subsequent biopsies, surgeries and rounds of chemotherapy — was worth the effort and more.
But, says the panel of experts, mammograms' potential for harm outweigh their benefits. In about 10 percent of cases, they produce false-positive results, leading women to undergo unnecessary follow-up tests such as biopsies, and in worse case scenarios, surgery, radiation and chemotherapy.
Women are not to blame for false-positive readings. The solution is not to take away a woman's choice to have a mammogram, but rather to work to reduce the rate of false readings.
I can only imagine that if men were experiencing abnormally high rates of false positives on tests for testicular cancer, heads would be rolling in radiology departments nationwide.
Mammograms are not a walk in the park. I speak with experience as fresh as Monday when I rested against a chilly slab and experienced that familiar whack and intense pressure from a large machine built to flatten one's chest to the width of a slice of pita bread.
Would I prefer to forgo this experience? Absolutely, which explains why my annual exams tend to get scheduled only after a friendly, firm reminder from my physician.
I don't want to get mammograms. I have to. Spurring me on is not just my family narrative, but this reality: Breast cancer is the most commonly diagnosed cancer in American women, excluding skin cancer. It kills more women than any other cancer except lung cancer.
Last year, more than 182,000 American women were diagnosed with invasive breast cancer and 40,000 died of it.
If only those 40,000 women could be asked how they feel about being rescued from the trials of mammography. Better yet, how they feel about the guidelines' advice to eschew monthly breast self-exams because they have not proven to reduce mortality from breast cancer.
Adding to my annoyance is this intrusion of politics into medicine. Under health-care-reform legislation in Congress, the new recommendations would help set standards for what preventive services insurance plans would be required to cover.
Have insurance companies just been given a green light to refuse to cover mammograms for women under 50? If so, at nearly $200 a test, working women and those who are low-income have been dealt a life-threatening blow.
I know science must operate in large statistical terms but people are not numbers. If the life saved by a mammogram is my own, I am more than justified in wanting early and routine screenings.
Lynne K. Varner's column appears regularly on editorial pages of The Times. Her e-mail address is firstname.lastname@example.org
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