I wasn't going to say anything but I have been thinking about it all day -- I agree with Elisabeth Hasselbeck and that bothers me. And, while I know it's what she's saying that is important, rather than the fact that it is she who is saying it, it still bothers me because I've never before agreed with her. But, here she's not talking politics. She's talking life and death. And she is right.
The subject here is the new guidelines for mammography and breast self-examination (BSE) released by the United States Preventive Services Task Force. Changing a recommendation made seven years ago by the same group, then composed of different members, the recommendation is that women under 50 not have mammograms and that the benefit of self-examination is highly questionable. There are exceptions to the recommendation but, if adopted, the recommendations are highly restrictive.
The Task Force says the percentage of women actually helped by mammograms and BSE is small -- the death rate is reduced by 15 percent -- and the potential harm from radiation and from the anxiety of a false positive on a test is greater than any benefit. But, if you or someone you love is one of that 15 percent, then it is well worth the risk, isn't it?
An article in The New York Times notes that " Congress requires Medicare to pay for annual mammograms. Medicare can change its rules to pay for less frequent tests if federal officials direct it to...Private insurers are required by law in every state except Utah to pay for mammograms for women in their 40s."
The recommendations were published in the Annals of Internal Medicine and immediately became a lightening rod for controversy.
On The View these new recommended guidelines were one of the "hot topics" of the day and Hasselbeck, whose mother had breast cancer that she found via BSE, was outraged. She went so far as to call it "gender genocide."
While I prefer not to go that far, I am still as outraged as she is. Sure, my reaction is an emotional one. But there is reason for that.
In June 1992, the weekend one of my daughters graduated from high school, I was diagnosed with breast cancer. I was not 50. I was, according to all the literature, not at a stage in my life where cancer would be natural as I was quite pre-menopausal. But I had cancer.
Furthermore, I had had a mammogram at the end of March that year. All was, the doc told me, well. Nothing was amiss.
So, I went on my merry way, sure I wouldn't have to worry about breast cancer until the time for the next annual mammogram rolled around. But, then, one night -- June 1, to be exact -- I was reading and had an itch under my breast. As I scratched it, I found what felt to me at the time like a huge boulder there.
I knew immediately I had cancer. I don't know how I knew, but I did. Three long weeks later, my personal diagnosis was confirmed by the surgical oncologist.
Of course, it wasn't anything like a "huge boulder." It was stage one cancer, but surgical biopsy revealed two distinct types of cancer in that breast. I was, of course, treated and every year on July 20 -- 10 days after the anniversary of my birth -- on the anniversary of my cancer surgery, I have a "birthday" party.
I believe my life was saved because I found the cancer at a very early stage and it was treated before it metastasized. I also believe I was lucky. I had my annual mammogram, I did monthly BSE and, still, I found it by chance.
The thing is, a week or so after I found the lump, when I would have routinely done my monthly BSE I would have found it. It would have still been early and eminently treatable. But, if I had to wait until I was 50? Or was convinced that BSE is useless? Well, who knows what would have happened? I don't like to think about it. I am not a scientist but a mammogram was always part of my annual wellness regimen. I never thought to worry about the potential radiation damage. I must be missing something.
Like Elisabeth Hasselbeck, my daughters are considered to be at high risk and will probably be eligible for mammograms before the age of 50, regardless of how these new guidelines are adopted.
But, while I might not go so far as to label this recommendation "gender genocide," I am very worried. My daughter's friend, in her 30s, was just diagnosed with breast cancer. Another very brave woman I know is battling the disease in her very early 40s. She had no history, no reason to be considered at risk. But she felt something and it was, indeed, cancer.
As noted above, I am not a scientist. But I am a reasonably intelligent woman whose life experience has taught her the benefits of vigilance in checking for breast cancer.
Yes, my reaction to the recommended guidelines is emotional, but it is also solidly grounded in empirical experience. Thus, I will continue to do my best to convince others to exercise the same vigilance in trying to find breast cancer. And I fervently hope that, on this topic at least, Elisabeth Hasselbeck will not be silent. (And, though it's not really important, I hope the other "ladies of The View" and Oprah and all those influential women (Mrs. Obama?) join her and raise their voices on this subject.)
Hasslebeck has ties to the Cheny family as well as big oil.
Just so you know.
It's too bad that you are peddling that partisan political attack, suggesting that the Obama Administration intended on committing "gender genocide." Elisabeth Hasselbeck owes everyone an apology, and so do you.
Just so you know.
One of the most difficult things we have to deal with is facts disagreeing with our beliefs. Even more difficult is when more complete or better data contradicts previous conclusions. This leads to cognitive dissonance, and we have to reject concepts we were taught are true.
It can be a very emotional experience to have to reject concepts we believed true, and believed to be not just beneficial, but in this case life saving. Contradictory information threatens not just our beliefs, but it can threaten our perception of ourselves, especially if we're seen as a leader. But the very basis of Ms. Hasselbeck's belief in the current recommendations should lead her to embrace the new conclusions.
Perhaps because the current mammogram/BSE practices makes Ms. Hasselbeck feel more secure she's willing to reject the new study. But that's at best disingenuous and at worst hypocritical. I would prefer to think it is an emotional response. But this is about the science, not emotion. The science of medicine, the science of statistics, and the science that saves women's lives.
This is a difficult to consider unemotionally. Instead of rejecting them out-of-hand, accept the general conclusions, and encourage the data be further developed for specific categories (history, diet, exercise, current health, etc.) to better define individual risk. Insisting it's better to use older. less robust data may lead to bad health decisions, with unfortunate, even dire consequences.
If the Task Force recommended increasing mammography to twice a year. Ms. Hasselbeck would urge her viewers to turn off the TV immediately and call their doctor for an appointment. But they said the inherent risks of annual mammography and BSE to this specific demographic outweigh the benefits. Because the statistics disagree with what she was taught, Ms. Hasselbeck rejects them, and engages in ad hominem attack. Not attacking the research, but actually attacking the people who did the research.
Her (and I assume your) beliefs are based on the previous recommendations, which are based on older, but similar studies. The new research has the extra benefit of current regimen practices to create better, more controlled criteria and testing. And it disagreed with the older study.
Why does Ms. Hasselbeck accept the older study, but reject the new? Does she reject the methodology of the study? Does she reject that annual mammograms and BSE has resulted in poorer outcomes for the 40-something demographic (as a whole)? Does she reject that misdiagnoses and false positives have a greater negative effect than missed diagnoses? Or does she simply reject the conclusions? If so, she has to reject the older, similar study. But that would contradict her basis of opinion. She never offered any reason to reject it, save her specious, inflammatory "genocide" comment.
- cont'd
As for Hasselbeck's gender genocide comment, I think there is powerful sexism in these guidelines. It reeks of those "do you want fries with that mastectomy" drive-through breast surgeries. Can you imagine the same guidelines for prostate cancer?
Sincerely,
Elle
The recommendations/guidelines are for most, not ALL women. Those who are high risk can have as many mammograms as they want and usually begin before their 40th birthday. The recommendations are concerned about ALL women and the risks associated with repeated exposures to radiation. Premenopausal breast tissue may very well be more susceptible to radiation its postmenopausal counterpart.
You quote personal anecdotes of women you know and it is no doubt disturbing and painful to witness. This research and associated recommendations are about millions of women, many of whom will face biopsies, pain, and a real risk of actually developing the cancers from the radiation of the machines.
You say: "The Task Force says the percentage of women actually helped by mammograms and BSE is small -- the death rate is reduced by 15 percent -- and the potential harm from radiation and from the anxiety of a false positive on a test is greater than any benefit."
If the potential harm from radiation is greater than the benefit of 15 percent, the catastrophe is to continue recommending that every woman irradiate her breast looking for an early cancer while risking its development.