The news last week that the Unites States Preventive Screening Task Force was recommending women without risk factors begin mammograms at age 50 instead of 40 was the medical shot heard round the world. Within a day we had thousands of angry and confused emails from Americans scared by the loss of an essential protection against arguably the most feared of all cancers. This announcement caused an immediate reaction and backlash among survivors, the American Cancer Society, and even the White House. The frustration among Americans was so palpable that for the first time ever we broke into our production schedule to prepare a show for Monday. On the show, we bring together experts and patients to sort through the emotions, confusion, fear, anger and worry and attempt to answer the question on ever woman's mind: "What do I do now?"
In general, discouragement against mammography is the wrong message for anyone to take from these findings. A realization that one size doesn't fit all is a more productive social epiphany. This is not an occasion where standard medical protocols are radically changing or reimbursement by insurance companies suddenly takes a dramatic turn. It is however an occasion for analysis and reflection, and an important teaching opportunity for all women.
With so much disagreement over the new recommendations, there exists a greater risk of ambiguity than clarity. I do not want to offer an endorsement or a rejection of the recommendations, I want to give you the tools to make your own decisions. I believe that is best done by offering the following perspectives as a way of looking at the findings. There are pros and cons on each side of the debate, and they boil down to what type of person you are: do you subscribe to "peace of mind," or "power of me"? The "peace of mind" crowd doesn't mind trading the risk of a false positive for the benefit of early detection. They'll do anything to stop disease in its tracks, no matter the cost or inconvenience. "Power of me" folks, on the other hand, believe in the power of prevention and may defer screening tests until their age puts them into a high risk group.
There's no right answer, and both perspectives are perfectly appropriate. But I'm convinced that when people make decisions about their health, they fall into one of these two categories. By knowing your type and arming yourself with good information, you'll make smart choices about mammograms, especially given the controversial and somewhat confusing new recommendations.
That's exactly how we approach the story on our show on Monday. And then we explain exactly how these new screening guidelines might influence your decisions. First, a major reason for the heated response to the government appointed group's report has been the lack of clear understanding about what, exactly, a medical task force does. These groups consist of impartial and unbiased experts from various specialties who synthesize the latest scientific evidence to guide practicing physicians. Half of the task force members are women. We want these folks taking an aggressive stance against the status quo when appropriate because this pushes medicine to improve and catalyzes a national conversation so you are more informed and better cared for, even if you disagree with the task force's insights.
The recommendations are sometimes controversial, but it's important to remember they're designed to maximize benefits of screening while minimizing its risks. Of course there are many women who have had life-saving mammograms in their 40s and even 30s. Their stories are valid and important. But, when looking at the bigger picture, the task force has decided that younger women are much likelier to get unneeded biopsies or operations, or to have tumors missed altogether, than to have a true cancer detected early on. Plus, many identified cancers in younger women are not found in time, so the mammogram offers a false sense of security. We need better screening tools, so it's healthy to have an open debate and keep medicine self-reflective and accountable so it does not complacently tolerate currently available screening techniques.
Moreover, the task force recommendations on mammograms are not a blanket, one-size-fits-all prescription for every woman. Guidelines should never replace a dialogue with your own doctor that considers your individual risk. After all, you are the expert of your own body. That's also why I will say I disagree with the recommendation that physicians not focus on teaching breast self-exams. I continue to advise and encourage women to examine their breasts. Studies show that, especially in younger women, half of breast tumors are first detected during self-exam. So, get to know your breasts any way you like and don't worry about any specific examination techniques since none appears better than your own insightful fingers.
Finally, let me remind everyone that detection does not equal prevention. Mammograms do not cure or prevent cancer; they just find it. So do not forget the things YOU can do to help prevent breast cancer. For example: lose weight if you're overweight, keep it under two alcoholic drinks a day, and take 1000 units/day of Vitamin D. Remember, we cannot test to safety; we must live to safety.
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