I'd be dead by now if it weren't for breast self-examination. And had my doctor been less convinced of his own guidelines regarding women without a known history of breast cancer, my cancer would have been detected earlier and I would have been treated sooner and less aggressively. I was 32 years old.
Does this mean the findings of the study about to change women's lives are worthless or tainted by the influence of insurance companies and planned medical cutbacks? Can't answer that yet, but I'd hate to think so.
I'll say this. I'm a social scientist with nearly twenty years conducting preventive medicine research. Research by leading scientists is informative, often instructive, but never the last word. And that is how most of them think as well. Even the best research can be influenced by the desires of those conducting it, those sponsoring it, guidelines for publication, and a host of other factors. This is why replication is so important. But even when studies are repeated, it is possible for biases, errors and oversights to be so as well.
The latest research is one more piece of information for the decision process women must make each year regarding mammography. That's it. If breast self-exam gives you greater peace of mind, no set of guidelines should deter you from it. If someone in your family found a lump in her breast that turned out to be breast cancer, what a team of doctors and researchers tells you is simply one piece of advice and perhaps irrelevant to your situation.
They are researchers looking at numbers. You are a person they do not know.
I have high regard for many of the doctors weighing in on this subject, but let me bring it back to you, your wife, mother, sister, or friend. Anecdotal information is valuable. It is part of the larger picture. You also need to know yourself. If you're more interested in being sure than worried about being scared, find yourself a doctor who agrees with you. And get the mammogram recommended by the American Cancer Society before the insurance companies take that option away.
Can you overdo worry about breast cancer? I suppose so. But gum disease concerns me too and no study is going to convince me to stop flossing. So, ignore all this condescending talk about women worrying and how we should be protected from our nervous selves and instead take the findings of the research as useful, additional information.
To your family and yourself, you are not a number. And your life is different from that of the people who seem to have the answers. Do what's best for you. I've found that fighting cancer is a bit of a crap-shoot anyway. The guidelines keep changing. Treatments improve. And you might in hindsight wonder if a different approach would have spared you some later problems. But there's much to be said for being glad that you're still here.
Later today I'm heading over to the YMCA to Lance Armstrong's Livestrong exercise program for cancer survivors. I don't think I'll find many people there saying, "I wish I'd known not to bother looking out for cancer at my age" or "I wish some doctors had protected me from worrying." No. We're going to enjoy our exercise thanks to Mr. Armstrong and the YMCA and be glad that when it came to our decisions, we did, after relevant information was considered, what seemed right for us.
Dr. Reardon also blogs at bardscove.
Follow Kathleen Reardon on Twitter: www.twitter.com/comebackskid
Breast Cancer Survivors Back Mammograms
Our government is minimizing breast mammography to save money not lives
When I had cancer, I was able to become unemployed so I could get Medicaid and get it cut out. (I lost my home in the process, but that is another story.) I can't get Medicaid now, no matter how poor I am because my daughter is now an adult. She has no insurance either. No matter the policies and recommendations, some of us are left "out in the cold". In fact, I sometimes feel as though I am not worth a damn, since my fellow citizens don't even consider me, and Americans like me a part of these discussions. It is like I am not even a person. How often should the uninsured get a mammogram or check for a tumor they can't get removed?
I absolutely agree. I just don't understand the reasoning that goes behind saying your life is worth less than another woman getting to forgo a stressful experience.
Just so you know.
One side of that debate points out that (1) the vast majority of convicts swept up in such sentences are non-violent and pose very low actual threat to public safety; and (2) the costs to society of incarcerating this population are astronomical, and could be spent far better elsewhere, like funding thousands of community programs that can actually reduce crime rates.
The other side holds that as long as there is the most miniscule of threats to anyone, anywhere, at anytime, then any cost is justified to make sure that a fearful public can sleep at night. In fact, let's build more gated communities and make a fortune selling home security systems that make people feel good even if they don't measurably reduce crime.
The politics of paranoia rule this country. The number of conspiracy theories cropping up in these message boards is (anecdotal) evidence enough.
Almost a million people are arrested for marijuana in this country evey year for marijuana, and 80% of those arrests are just for possession. Yet I can almost promise no where near 25% of those arrested are actually dangerous criminals.
Not to mention what are the consequences of decriminalizing marijuana? As we have seen in states that have done so, none. No rise in violence or crime or welfare or anything like that. Whereas the downside of more lax mammagram guidelines can result in people's deaths.
I don't necessarily disagree with you about the paranoia we are surrounded with. But there is a difference between paranoia and genuine danger. Many people are extremely paranoid about "stranger danger" and child abductions, even though a child's chance of being abducted by a stranger is something like 1 in 2 million. A woman's chance of getting breast cancer is 1 and 8. It is not paranoid to want to be cautious about a disease which affects 1 in 8 women.
Your numbers seem awfully high; what's your source? National Cancer Institute data indicate that for asymptomatic women aged 45-49 who haven't been screened in at least 9 mos, only 2.4% of positive screens result in a BC diagnosis, so a full 97.6% of positives are false alarms. Only about 1 in every 385 screens will actually be a true positive.
For women aged 40-44, the true positive rate drops to 1.5%; only 1 in nearly 600 screens will reveal an imminent BC diagnosis. (http://breastscreening.cancer.gov/data/performance/screening/)
It's like trying to find a needle in a haystack, and it consumes tremendous healthcare resources to do it. Is it worth it? I'd be the first to shout "yes, of course!" but you do have to stop and think about where else the same money could be going, perhaps research into more accurate detection methods, better treatments, or understanding the causes - things that will ultimately save more lives in the long-run.
Flossing is a preventive measure; a mammogram is a type of examination, like a dentist or hygienist poking at and examining the gums. If only there was a "flossing" measure -- something as simple as that -- to substantially reduce the risk of breast cancer.
A better syllogism is routine oral cancer examinations when visiting the dentist.
Perhaps you didn't notice when a recent panel made similar pronouncements about - yes- prostrate cancer, citing very similar concerns: i.e. that prostrate screening was leading to unnecessary and potentially harmful interventions. In fact, a friend of mine who recently had shown elevated PSA then had to go painful (and no doubt expensive) biopsy (12 "shots" into the gland though the anus), only to find out that nope, everything's otherwise normal.
Furthermore,there's no basis to your assumption that this is purely or primarily about cost cutting on women's benefits. I can understand your suspiciousness re. motives, but the task force has no authority to tinker with medical insurance benefits. Jumping to erroneous conclusions doesn't help this dialogue.
Having an oncologist or two on the panel wouldn't bother me, though I would definitely not want to turn such recommendations over to those with a very narrow operational paradigm and perspecive.
The tumor was deep in the tissue and very small. It could not felt with a physical exam.
If I had a mammogram every two years, the tumor would have been larger, the treatment more extensive and expensive and my survival rate would have diminished. I cannot imagine what they are thinking with the new recommendations and all I am seeing is so called reporters supporting them. Where are the other voices?
I am beginning to feel like chattel, first my womb is under the control of Stupack, and now my breast is held hostage to an insurance company. Will there be any insurance coverage for the rest of my medical care?
Scientifically, the rationale for instructing women not to do self exams evades me.
It is Quite Obvious that this is geared toward new guidelines for Health Care Reform! Insurance companies look at and take seriously these guidelines (whether or Not there is even ONE oncologist on the task force!) They have already reduced Women's benefits in this bill being debated in Congress, now they are further reducing our future benefits by reducing the guidlines for mammograms which is PROVEN TO REDUCE THE NUMBER OF DEATHS DUE TO BREAST CANCER!
Wake Up and smell the Special Interest Money!
BTW, stop with this notion of hacking off breasts with machetes. You're going to give the insurance industry ideas!! (I can't believe a woman would talk like that about her own body to begin with.)
tests for their health’s sake? Since it is them who will either suffer or benefit from stopping or continuing mammogram tests, the decision must come from them as well.
Like shops which sells Cherokee scrubs in a high cost, inconsistency of the recommendations with the current science shows an apparent attempt to simply reduce costs. Sadly, however, women may pay it with their own lives. And this is more likely to happen. Besides the influence of the agency as well as of the insurers, women may take the screening for granted over other important expenditures, especially now that the economy is down.