Let’s talk about breast cancer, shall we? See, there’s a new set of guidelines put out by a U.S. government task force, and people are in a tizzy about it. The new guidelines recommend that women between 40 and 49 should not get routine screening mammograms, as the procedures lead to too many unnecessary biopsies and other interventions.
Hold the phone. I thought that forty was one of those big birthdays. You know, along with twenty-five when the car insurance premiums drop and sixty-five when the AARP starts sending mail. You know, the Big Four-Oh, the year we all start getting mammograms. And now you tell me that most women don’t need them till fifty?
People are pretty pissed off about these guidelines, and I suspect it is because we are all so programmed to assume that the nefarious Medical Industrial Complex, whatever exactly that might be, is holding annual secret meetings at the Cincinnati Convention Center in order to plan new and devious ways to slaughter innocent women and children for the sake of a quick buck.
This is, I think, the downside of the internet. Or, perhaps I should say a downside. People have way too much access to information, and everyone becomes a medical expert. Hey, I can Google drug names just as well as anyone out there, but that doesn’t mean I am qualified to evaluate the veracity of the 625,790 hits I get every time I do it. It’s all well and good to educate myself, but I am still thrilled to pieces there are folks out there who went to medical school to get a slightly more in-depth education. I like to trust my doctor, government and medical organization guidelines, and sometimes even (but don’t tell anyone) drug companies.
What can I say; I’m a throwback to a simpler time.
I have been trying to figure out why everyone is so mad about these new guidelines. OK, I get that folks think that the Medical Industrial Complex is trying to save some dough by cutting out unnecessary mammograms. Set aside for the moment the fact that there are health risks to a false positive and the fact that the money saved could go towards procedures that actually save lives. What I want to know is what do people think those evil cancer advocates have to gain from advising us to stop teaching Breast Self Exams?
No one is saying women should stop feeling themselves up in the shower. Hell, I think most people are in favor of that. They are simply saying that it is dumb to pour money into printing up little plastic doohickies for the shower and teaching women the proper technique because teaching Breast Self Exams doesn’t seem to actually save lives.
And isn’t that what it’s all about?
To be clear, the guidelines are talking about routine screening through mammograms. Women with an elevated risk or with a suspicious lump ought to still be getting the test done. And, the guidelines are about teaching BSE’s – the education programs do not seem to be effective. Nonetheless, breast awareness is much encouraged. If you are interested, here is a great site that covers the myths and truths of breast cancer.
Wheels on the bus 
i recently had a stereotactic breast biopsy because of a bad mammogram. all was well. i shudder to think about how much money it cost.
Lucky me- my mother had breast cancer in her early fifties, so I still get a mammogram at 40. Yay!
Re: breast self-exams, two doctors on NPR yesterday who disagreed about mammograms agreed about this recommendation. One argument was that by the time you’re going to be able to feel a lump even a centimeter in diameter, we’re past early detection. Which, of course, may be a further argument for mammograms at 40.
See I am one of the people in a “tizzy” my Mom’s doctor found a lump in her forties (from a mammogram), after various ultrasounds, it warranted being removed because they could tell it wasn’t just a cyst. It turns out we were lucky and it wasn’t cancer, HOWEVER, she was told if left, it could have caused precancerous cells to start “collecting”… one of my closest friends mothers would not be alive today if not for her mammograms in her 40’s….. and I am shocked that more woman are NOT OUTRAGED!!! I find this to be a very slippery slope, insurance companies (government run or not) can use these guidelines to start determining what they will pay for, and in the end, I believe they are saving money at the expense of woman’s lives…. what is next, ladies, I have been having routine pap smears since I was 18, never had one come back suspicious, shall I feel guilty for costing my insurance company for 13 years of unneeded testing?
oops just read that pap smear recommendations just changed today too……. of course they have!
Melanie, I’m not sure which Pap smear guidelines you’re referring to, but when I saw my doctor about three weeks ago she said the standard now was that if you have a clean history (three, I think), then you only need one every three years.
Unnecessary testing- interesting phrase. We don’t know it’s necessary… unless we test.
I’d be more upset about it if there were a better test. One of the things that has concerned me for a decade is the fact that you are subjecting the breast tissue to just that much more radiation the more mammograms you get. Especially if we’re talking about potentially vulnerable women (such as me), that in and of itself is a danger.
In Canada, the standard has always been testing at age 50. When I asked my doc about it years ago she said at the time that the evidence showed that the type of cancers younger women got weren’t helped by early detection, so she didn’t recommend it unless there were risk factors. However she was happy to send me for one if I wanted and she did. No problem. This is the advantage of a public health care system. So I wish that it wasn’t continually being eroded by private clinics being allowed by our current conservative gov’t.
Yes, the new age for a first pap smear is now recommended for 21, because of the new vaccine; however, I think that it is premature to assume that everyone has access and that everyone with access is actually getting vaccinated .
The ladies I work with all said they would pay for their daughters to get a pap at around 18 regardless of insurance.
I got the vaccine for my oldest daughter, but I’m not doing it for my youngest. My oldest almost fainted, and the daughter of a friend of mine actually did faint. And those are some of the milder side effects. The protection isn’t as high as it needs to be for me to risk the side effects.
I’ll be happy, of course, to pay for my younger child to get paps at 18 or younger.
It’s an evidenced-based recommendation. I’m all for that. We’re just more in line with what the WHO says and what Europe does, and it’s not like Europe has higher rates of breast cancer now. There are risks to mammograms, too. Plus, I read this thing about how cancer cures itself more than you’d think if you never find out about it. Kind of like having an early miscarriage–if you didn’t do the test, you’d never know.
thanks for this post. I work in media relations for a cancer hospital and we spent much of the week convincing people that these recommendations were seriously, like, OK, and please, talk to your doctor, and share your family history, but this is not rationing care, it actually is about protecting the patient from unnecessary procedures…more over, you need to pay very close attention to the people advocating against these guidelines…how much of their revenue comes from mammography and biopsies and etc?
As for the pap smear guidelines the timing was unfortunate – those were supposed to be announced all along last Friday and would not have drawn any furor at all if it they hadn’t been preceded by the breast brouhaha.
I think we should all take away the obvious wisdom you are advocating:
No one is saying women should stop feeling themselves up in the shower.