Yes, "breast cancer worry" is a factor listed as one of the "harms" of breast cancer screening. In fact, this "syndrome" is partly responsible for why the United States Preventive Services Task Force (USPSTF) recently stated that this "test" is no longer a screening recommendation for most 40-something women. Wait, there is more... physicians are also not to instruct women on self-breast exam because it too raises the ghastly specter of "breast cancer worry." The evidence to support this includes a study from Shanghai demonstrating that a self exam may cost more than it rewards...now we may have to say to patients, stop checking your breasts or you may begin to suffer from the current epidemic syndrome: "Breast Cancer Worry."
Reading the very article in The Annals of Internal Medicine announcing the USPSTF recommendation changes sends a chill up my spine. Yes, my livelihood depends on the care and screening of women, but I also care about those women, many of whom are my dear friends, long loved patients, and relatives of mine. I don't want them to end up with unnecessary biopsies, but one in eight (the incidence of breast cancer) is a very scary statistic. My fear is that actuarial tables analyzing benefits do not consistently reflect what is best for the individual patient. Consider this excerpt from the USPSTF statement:
"Thus, the absolute risk reduction from screening (as shown by the number needed to invite to screen) is greater for women aged 50 to 59 years than for those aged 40 to 49 years."
Basically, the task force analysis indicates that the acceptable number of women tested with mammogram to save one life is somewhere between 1300 (for 50-somethings) and 1900 (for 40-somethings). It clearly takes fewer 50-somethings screened to save a life than 40-somethings, and a line had to be drawn somewhere--so it was drawn at 50. Apparently due to lack of scientific data all bets are off from age 75, so no recommendation can be made for these women.
This (from a separate supporting article in The Annals of Internal Medicine) is even scarier:
"If program benefits are measured in life-years, the measure most commonly used in cost-effectiveness analysis, then our results suggest that initiating screening at age 40 years saves more life-years than extending screening past age 69 years (albeit at the cost of increasing the number of false-positive mammograms)."
In other words, the 40-something has more to gain than the 70-something from mammography screening...but apparently not as much as the 50-something who is at even higher risk than the 40-something. After all, if you start screening at 40, the 40-something will have 10 extra years of "Breast Cancer Worry" to deal with than the 50-something.
If you are confused, you are not alone. Most of the leading experts on the USPSTF panel have backgrounds in public health. That may mean that policy recommendations are weighted toward cost effectiveness, not merely saving or extending lives. Most medical organizations are responding to this recommendation with "ask your doctor," advisories. The problem is that insurance companies may run with the task force advice; it would save them millions.
The American Congress of Obstetrics and Gynecology has suggested that we docs in the trenches ignore the USPSTF change for now. The Department of Health and Human Services seems to be distancing themselves from the report (although the task force website link ends in .gov). The patients are questioning the controversy, and clinicians are trying to put out the mixed messages fires.
In the meantime I recently called another 40-something about the early breast cancer found on her mammogram. She is very worried, and very much alive. She is not going to die from "Breast Cancer Worry", or for that matter: breast cancer...she started having screening mammograms at age 40.
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The summer prior to her diagnosis my Wife complained of persistent lower-back pain which we were attributin
The song, "Honey", by Bobby Goldsboro was playing on the radio that Friday afternoon as we pulled up to her Father's door. Her Mother had succumbed to breast cancer in 1983. The dread was palpable. Later it was found that she had 4th Stage Breast Cancer. By the time it had been detected it had already metastasiz
After looking at the data they task force concluded that before the age of 50, unless a women has addiotiona
How many cancer announce to the victim whether they are slow- or fast-movin
The argument "few lives are saved" burns me up. Okay, so if your life got saved in your 40s, that makes you less worthy than if you are in your 50s?
Then there's the "risks of unnecessar
To those saying prostate cancer screening is getting targeted, too, my comment is, do not "improve" the situation for prostate screenings by making them worse for breast screenings
As for no conspiracy against women, please. Heart disease is the number 1 killer of women, yet the studies on women are still woefully lagging behind those of men, and studies on women heart patients in hospitals have shown they get less care than male heart patients.
While I didn't immediatel
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The new advice was sharply challenged by the cancer society.
"This is one screening test I recommend unequivoca
The task force advice is based on its conclusion that screening 1,300 women in their 50s to save one life is worth it, but that screening 1,900 women in their 40s to save a life is not, Brawley wrote.
That stance "is essentiall
...The American College of Obstetrici
Then came "Our Bodies Ourselves" and a revolution (kind of) started where women and women's issues were begun to be looked at more seriously.
But now, as there is a woman Speaker of the House, a woman who was almost President, women starting businesses right and left.... suddenly a possible suspect issue on a mammogram is too much for our pretty little heads to worry about. Heck, we shouldn't even touch ourselves because we might worry to much and maybe bother a doctor.
So what if a few hundred or thousand women under 50 go undiagnose
This has nothing to do with rationing health care (well maybe saving the insurance companies money). This has to do with trying to remind us how weak headed we are and how we have to be protected from worry, even when we aren't screened for cancer.
They think it is more important to protect us from ourselves than from cancer.
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Why not keep it where it is at 40 years old? Is there a scarcity of these machines if they're made available as an entitlemen
I'd like to get more informatio
3. Here is the actual statement posted by the USPSTF: "The USPSTF recommends against routine screening mammograph
They are not trying to argue that no women under the age of 50 should receive mammograph
4. The current buzzword in in the healthcare debate is "evidence-
Enjoy your weekend everyone.
I'd also like to mention that statistics are easily manipulate
1. The USPSTF was not allowed to consider cost in its recommenda
2. Doctors are charged with more than just saving lives. A doctor's responsibi
Good grief they act like half the population is running around in a state of hysteria. The reality is that a few women are bothering a few too many doctors and they don't like it.
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Curious,
Heather
The paternalis
(And of course, the politicizi
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I think the study addresses some valid issues. Regardless of "breast cancer worry" you have women having invasive surgery for DCIS which might lead to invasive cancer less than 20% of the time. That type tends to remain in the ducts doing you no harm. I would think that repeatedly smashing it along with your breasts during endless mammograms or having it sliced open during surgery to remove it would make it more likely to escape its safe confines. I would choose not to treat it anyway so why try so hard to find it.
My mother had one mammogram in her entire life and my sister never had one. I went through menopause early, didn't use HRT or hormonal birth control, have no immediate familial breast cancer so I feel good about my odds. My sister died at 55, mom at 78 and maternal grandma at 56 to other kinds of metastatic cancer but I don't let worry consume me over my "odds". Life is too short.
to blastocyst (above)...
Breast cancer worries are no big deal when you compare them to "death from late-diagn
What a patronizin