Last Monday a government task force came out with an opposition to the American Cancer Society's long-standing position that women in their 40's should be getting annual mammograms. The new recommendation states that women should begin getting mammograms at age 50 and limit them to every other year. These guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies. This panel of doctors and scientists, that did not include ANY oncologists, concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women's odds of survival.
As a woman and a physican, this is a personal issue. While I felt that yearly exams were a bit excessive and was also aware of the need for the healthcare system to be cost conscious, prevention and early detection is key to longevity and quality of life.
One of the most important things to come out of this current debate is that these types of global directives force every one of us to begin asking important questions when our health is at issue. Here are some questions to be asked regarding mammograms:
-Who was involved in the funding of the study? Who performed the data analysis. Is there a conflict of interest?
- Where did the initial criteria for testing that we have been following for the last 20 years come from and what is triggering the need for change? Is it valid to review current guidelines or is it financially motivated?
- What about radiation exposure? Is this a major issue for women who are being tested on a yearly basis?
Should women at the highest risk follow the same guidelines as outlined in this study as woman not considered to be at risk?
- How and/or will insurance companies immediately adopt these guidelines and what will or will not be covered moving forward?
This is a debate that will likely drag on for many years to come. As an advocate for patients and their right to get the proper diagnosis, I encourage the government, healthcare providers, women's advocacy groups and other concerned citizens to continue to offer up their comments, contact their local government officials and ask a lot of questions. While it is an emotional subject, the data and facts should be presented for all, directly and indirectly involved, to evaluate.
Mammography - Wikipedia, the free encyclopedia
Task force opposes routine mammograms for women age 40-49 - CNN.com
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Dr. Jeffrey Tice is an assistant professor of medicine at the University of California, San Francisco, where he studies breast cancer screening.
Question: Does the "risk" associated with mammograms in the study have anything to do with radiation exposure from the test?
Dr. Jeffrey Tice:
I think this is a very difficult and controversial question. There have been many attempts to quantify the risk and we think there is a risk, but it's probably very, very small. That's what the task force said and that's what most thoughtful reviews of this topic have said.
Dr. Otis Brawley:
I think that there is a risk of radiation. The ACS has recognized that if you do mass mammography for women in their 40s, 50s, 60s and beyond, you will cause a few cancers. [...] It's very small. And again, I would point to the nine randomized studies that tell us that if you screen a population, their risk of death from breast cancer will be lower than if you don't screen the population.
http://www.pbs.org/newshour/updates/health/july-dec09/mammogramqa_11-24.html
Had she not had the initial mammogram, my wife's story would undoubtedly have been different. Even the radiologist was amazed that her tumor was seen at this stage.
The argument on yearly mammograms goes on, but that was our experience.
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I have always had a strong aversion to having my breasts squeezed flat so I have never had a mammogram. I don't want the extra radiation, and I also am concerned about the possibility of small encapsulated cysts being burst so that the cancer cells get out.
I think mammograms suck and that if men had breasts, there would be a gentler, kinder test. Just my opinion.
John W. Gofman, M.D., Ph.D., an authority on the health effects of ionizing radiation, spent 30 years studying the effects of low-dose radiation on humans. He estimates that 75% of breast cancer could be prevented by avoiding or minimizing exposure to the ionizing radiation from mammography, X rays, and other medical sources.
Why is a radiologist promoting mammograms? Follow the money indeed! She should be providing this information, not me. I wish I could find the study I sent to someone a while ago which compared cancer rates of those who had annual mammograms and those in a place where screening has never been done. The radiated breasts lose, hands down.
Why is no one talking about the very exciting information about iodine for reversing fibrocystic breasts and as breast cancer preventative? Because it makes no one money so the M.D.'s do not know about it. Merck will talk about it? Eli Lilly? oh please...
Iodine and breast health is very real. See David Brownstein, MD and his work in this area.
EXACTLY what I wanted to say! Mammograms are undoubtedly, over the long run, dangerous. The act of trying to prevent cancers by exposing breast tissue to yearly radiation is logically causing them! I wish they'd tell the truth - that mammograms are in the end - harming women!
Brownstein is yet another quack out to con you out of your money by toying with your health. Just look at his website. He basically goes "Boo, drugs are bad. Big Pharma (yes he uses this phrase) is out to kill you for money. BUT YOU CAN BUY MY BOOK AND DVD AND LEARN TO LIVE LONGER AND HEALTHIER!"
He seems to think iodine and unrefined salt will cure pretty much everything that ails you.
He claims that iodine will cure/do the following:
ADHD
Breast Cancer
Detoxification
Fatigue
Fibrocystic Breasts
Graves' Disease
Hashimoto's Disease
Hypothyroidism
Improve the Immune System
And you can read all about it for only $15, or you can get the book/dvd combo for the low, low price of $30.
He also has a separate book/dvd explaining the miracle that is salt. Another that basically claims most drugs don't work but "natural remedies" do.
You claim that no one suggests this as a remedy because there's no money in it.
I think the much more OBVIOUS answer is that no one suggests this because it doesn't do anything. Brownstein suggests it on the other hand because it does make him money. He knows that you'll buy his books and dvds if he can convince you that some evil greedy people aren't looking out for you like he is.
However, thank you, Dr. Pavlov. I still say, "Follow the money." Maybe the previous recs were based on money/lobbyist influences.
Regardless, women have good reason to be suspicious about what's going on right now. You don't pound your chest and say, "Do this to live," then turn around and say, "Forget that," and expect to retain any trust without presenting the issues first and well.
I'm glad my wife and I live in Canada where no one except our doctor and ourselves has anything to say about the care we receive or decide not to receive. It appears to me that my wife has received far superior care here than in the 30 years we lived in the States. She just told me that she would agree with that statement.
Beyond the great GP we have, my wife has the option and uses a Women's Health Center that is totally dedicated to women's health issues. It is all part of the provincial medical service plan. She does not have to be "approved" to go there. Upon her request any tests performed or issues discussed will be emailed directly to our GP to keep him in the loop.
Both of us having survived the US "iIlness care system" feel we have found ourselves in medical nirvana. There are there problems, of course , but nothing to compare to what we experinced during the years we lived in the States. We wish you all the best as you fight for affordable, and accessble healthcare for all.
While Capitalism works for some things, it seems highly vulnerable to 'profit motive'. Breast cancer screening is perhaps a shining example.
I, for one, am glad to see some science based medical decisions for a change.
I believe all the questions asked in the article are answered in the task force report and accompanying journal article, except for the insurance question.