Sunday, November 22, 2009

New Mammogram Recommendations

I have been struggling with how I am going to approach this. When I heard the new government recommendations for mammograms, I was infuriated. However, as someone who has had some training in science, and more in maintaining objectivity in what I read, I needed to know more.

Part of the problem is that this recommendation is sheer statistics and looking at things from a financial aspect. We are not statistics. We are individuals. Part of me says that if one person is saved the horror that I have gone through, then it is worth it. Finding cancer when it is small rather than the 3 cm tumor I had when I started this dance in 1994 would probably have led to a better outcome for me and less invasive or drastic treatments. However, I was too young to have a mammogram (at age 34). I do know, however, several women who have been diagnosed in their 40s solely by finding it on a mammogram. So, what price is life? Who is going to determine which of us will find it at a later date or when it requires far more expensive treatments?

The comment that keeps on coming up is that 10% of mammograms produce false positives. Is it 10% of mammograms, or is it 10% of the mammograms which find things produce a false positive (which of course would be a much smaller number). While I suppose that if you had a false positive, it would be a pain to know that you went through the biopsies only to find it wasn't cancer after all (and I only know two people that this happened to, both women in whose families had lots of deaths and diagnosis of breast cancer), but I would think it would be a relief.

I wanted to find out what other countries did. How do they approach screening for breast cancer? I wasn't able to find it easily....heck, when I googled it under a variety of methods I couldn't find it at all.

I was also appalled at the recent recommendation that women not do self-breast exams. If I had done them and BELIEVED in what I found, then I probably wouldn't have spent 12 years of my life dealing with stage IV breast cancer. I probably would have found the cancer when it was smaller (as I did find a thickening and asked my husband if he thought it was anything --dumb dumb move, but I thought I was a hypochondriac...why did I have to worry about breast cancer? It wasn't in my family). Women who do self breast exams regularly know where their lumps are. If they feel a problem then they can check it out.

The response to that recently has been "well, usually women find it by accident (well, yah, if we don't do breast self exams, and I think the majority of women aren't too religious in doing them), and it would have to be fairly big if the tumor is deep." I'll grant you that...but I can honestly say that the tumor was MUCH larger when I waited for six months. Besides, what harm does it do? Again, if one woman finds something suspicious and checks it out and finds that it is cancer, then it works. If another woman looks for 100 times and finds nothing, then lucky her.

I think that most of us are afraid that by issuing this recommendation that soon insurance companies are going to use it as a mandate to not cover mammograms in our 40s. While today I saw that "insurance companies assure people that they are not going to change their coverage" I feel that this is bolderdash and it will only be a matter of time after the furor dies down that this is changed. After all, my own insurance company stopped covering wigs for women undergoing chemo as it is "cosmetic and not necessary" (fine for some women, not so fine for others....).

In addition, for doctors (and the Surgeon General) to just say "keep on doing what you're doing," and to "make the decision on your own" or "decide what is right for you" maddening. I know that it is better than it was for us in that we can participate in chosing our treatment, however sometimes getting advice or even the information we need to make the decision is like pulling teeth. Sometimes I feel like we are having to be our own doctors....and after all, how can we who do not have medical degrees and have the background make such decisions? I don't want a doctor to be imperialistic, but I do want a doctor who gives sound information, ON BOTH SIDES of the issue and points us to the studies and explains them so we can make a decision.

The other aspect of this whole thing, the recommendations for mammograms and the advice to stop doing self-breast exams, is that it trivializes breast cancer. I know, heart disease is still the number one killer of both men and women in the United States and we should pay particular attention to that, but I think that both heart and breast health is important.

I am particularly incensed at this "Breast cancer campaigns have helped raise awareness about breast cancer, as well as money for research. But all those pink ribbons have given women an inflated fear of the disease – and unrealistic expectations about the benefits of mammograms, says Lisa Schwartz, a doctor at the Veterans Affairs Outcomes Group in White River Junction, Vt." (the whole article may be found here). I wished to the ends of the earth that I had known that I was at risk for breast cancer just because I am a woman back in 1994 when I was first diagnosed. I can assure you, Lisa Schwartz, that we have REASON to fear breast cancer. I have spent most of my adult life fighting to stay alive just because of it. SHAME ON YOU! I want to know why more than 5 women from my graduating class have been diagnosed with breast cancer before the age of 50 (the graduating class of men and women from my high school was 96), three of us before we were 40 and one of us is now dead. If these aren't statistics to make you fear the disease, I don't know what is.

In addition, I'd really like to have my breast back. I would really like to have healthy bones which are not weakened by a six month course of treatment of CAF and a 9 month course of treatment of Taxol and having my ovaries removed. I'd really like to have a daughter who would remember what we did fun together, not remembering what I couldn't do because I was either in treatment or recovering or dealing with the side effects of the treatment to my pelvis.

I believe that early detection saves lives. I just can't believe that the "powers that be" are now suggesting that we not use the tools for early detection.


  1. Thanks Lisa,
    Your 'right from the heart' writing was so honest; the feelings so bare. I have lost 5 friends from breast cancer. One surviving friend as had her life changed because it has weakened her. She was in her early 40's. Another friend, in her 70's when it was found, is also surviving. she had a double masectomy, "So I won't have to worry or go through this again." I have had many biopsies, all negative. I am not getting a mamogram this year because I'm now on medicare and it is only covered.every-other year.
    I do not think we can raise too much awareness.
    Thanks again.
    Wishing you health, happiness and pure JOY on your Journey,

  2. Thanks, Ann. I really appreciate it.

  3. My mom's breast cancer was detected as a result of a screening test. My friend -- at 32 -- found her stage IV breast cancer through a self exam. Therefore, based on my ancillary experience, I think it's preposterous to discourage and/or marginalize the benefit of a NON-INVASIVE screening program (self-exam, coupled with mammograms) that can save lives. Why on earth do we want to reduce any part of this? I don't get it.

    Personally, I went to the oncologist for the first time when I was 26; by his definition, I had the breasts of a 50 year old and he was concerned for my well being. Given my mom's history, he ordered yearly mammograms so that a small problem didn't become a big one. Smart doctor.