Open Thread: Nov 17, 2009

Do you think women under the age of 50 should continue to recieve their annual mammogram?



Comments [44]

dlcottage's picture

mamo

I think this should be left up to the paitent and Dr.

Peace out
Rosie

Rusty's picture

"absolutely irresponsible"

Rep. Debbie Wasserman-Schultz, D-Florida, who was diagnosed with early stage breast cancer at 41, called the panel's recommendations "really disturbing" and "absolutely irresponsible."

"It's a very patronizing attitude that these scientists have taken," she said. "It's pretty outrageous to suggest that women couldn't handle more information."

http://tinyurl.com/yhfz2tq

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

SMBrown's picture

Is the rest of the developed world irresponsible?

Rusty, see my longer comment below.  My short response to this rep's statement is that most of the developed world adheres to the guidelines put forth by the task force--and they do NOT have worse outcomes.

Not2Taem's picture

So long, asshat

Off topic

A while back I posted a message about Kens 5 reporter Chris Marrou, who has made several on air comments derogatory to women and young girls. Several people contacted me to let me know that they had complained to the station management. Well ladies, one asshat down. He retires next week.

Laughing out loud

peacekitty's picture

Right on.

Right on.

"Fight Prime Time. Read a Book"

Grace Moon's picture

Congrats!

!

tweet tweet @gracemoon

Tex's picture

Excellent!

Y'all made a difference!

Twitter Time @kdhales

Rusty's picture

ACS rebuttal

The ACS website posted a rebuttal to the United States Preventive Services Task Force (USPSTF) research that includes gems like this:

“The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group. Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. The American Cancer Society feels that in both cases, the lifesaving benefits of screening outweigh any potential harms. Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early.

http://tinyurl.com/yk8q8fu

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

SMBrown's picture

Rusty, I'm afraid the

Rusty, I'm afraid the American Cancer Society (aided by the media) is distorting what the report 'stated.'  I just listened to a member of the task force (on the Lehrer Hour) who rebutted the ACS's charges.  The study is far more nuanced than it's being portrayed.  The main thrust is that routine screenings shouldn't necessarily start at 40, but consultations with one's doctors about screenings should begin then.  Also, the technology of mammography is called into question by this study, which is a good thing because most cancer specialists agree this is ancient technology that should have been upgraded long ago. 

Grace Moon's picture

saw the same segement on leher with gwen ifil

problem is not only the media but people don't get nuance. Also i thought ifil asked the pertitnet questions to both sides.

seems, both the mamograms and self exams statisically haven't proven to be effective ways of catching breast cancer. the mamogram catches 1 out of every 2000 women between the ages of 40-49. And as you said mysitcs screenings after 50 does not apply to women in risk catagories.

what i got of the whole things is:
- women's health is still poorly understood by the medical profession, a lot of money is spent on poor results, and unecessary treatments.
- women need to make individal decisions with their doctors, if you are in a risk catagory figure out what early kinds of prevenitative screening you need to do. Just as people at risk for skin cancer need to take more precaution than those who don't.
- There isn't a blanket set of rules ALL women should follow regarding their health.

As far as Rusty below, while yes some women may use the advice as a way to avoid going to the doc. That's not the Study's fault. Everyone needs to take their own health, seriously. If you eat fast food and smoke, you are in a risk catagory for everything. You wanna live well, you must be responsible for your own health, Can't blame a study that is presenting some statistical facts.

tweet tweet @gracemoon

Rusty's picture

nuance

Good morning, Mystics. I'm all for upgrading the technology. But for most women, mammograms is their only option right now. The biggest problem I have with the study is that some women will use any excuse to put off their mammogram. And many who should be screened will take this study as "proof" that they shouldn't.And some of them will get breast cancer. There was no nuance in the paragraph I cited from the ACS website.

The task force has only itself to blame if it doesn't like the way the findings were covered in the media. The media has a long history of screwing up reporting medical and scientific research and the task force should have known this. It was their job to get out in front; get on the talk shows and explain the results. Not wait until the firestorm hit. If members of the media read anything, they read the abstract. Here's the first paragraph of the Recommendations section of the abstract:

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take into account patient context, including the patient's values regarding specific benefits and harms. (Grade C recommendation)

Here's a link to the actual study for anyone who'd like to read it themselves:

http://www.annals.org/content/151/10/716.full

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

SMBrown's picture

Agree to disagree

Rusty, you make some good arguments, but alas, this is one where we're going to have to agree to disagree. 

I agree with Grace's comments (above).   I understand your concern about how this may encourage some women to put off getting their mammograms, and that as a result their cancers may be discovered later. 

But is it fair that I should have to undergo a perhaps unnecessary screening at the insistence of my doctor in the name of increasing some other woman's cancer awareness?  As Grace noted, we're all responsible for our health and I take mine very seriously.  I want as much available info as possible in order to weigh the pros and cons of a test that exposes me to radiation, so I am grateful for the information provided by this study.  Whilst the call for yearly mammograms post-40 has indeed increased awareness I think maybe now it's time to find new means of educating women about breast cancer rather than advocating blanket proscriptions that statistics do not support.

To your point that the task force should have done a better job of presenting this study--perhaps.  But I agree with Grace that their primary job is the science and gathering of statistics.  If we're going to hold them accountable, then I think the ACS should be held accountable for having a hissy-fit and attacking the study, undermining its credibility.  This shouldn't have come as such a huge surprise to the ACS--most of Europe, Canada, England and Australia follow the guidelines outlined by the task force.  And the US does not have better outcomes!

Rusty's picture

I'm agreeable to that

"but alas, this is one where we're going to have to agree to disagree." Works for me Mystics. Have a great rest of the week.

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

SMBrown's picture

The Medical Industrial Complex

In general I'm tired of cancer being big business for the medical industry.  I no longer give to the Cancer Society because I've told them I want more emphasis on research in preventing cancer, rather than all the expensive tests and treatments that follow once one is diagnosed.  We can't continue to pollute our air and water and then spend millions on curing cancer--that seems back-asswards to me. 

My girlfriend just had a very interesting/eye-opening experience when she noticed a lump on her abdomen.  A CAT scan was done, and the lump was benign (which we were already pretty sure of because of its location).  However, they spotted something on both her ovary and her kidney and wanted to do follow-up ultrasounds.  So now she's thinking she's got ovarian cancer or a kidney problem.  Turns out the ovary blip was nothing and the kidney cyst nothing to be concerned about.  She has now sworn off any major tests for the next several years because it stressed her out so much and she saw how it could become a series of dominoes, with one test following on from the next.

Another close friend of mine had cervical cancer several years ago.  She did not want to have a hysterectomy and found a doctor who would treat her without ripping her entire womb out.  She's been cancer-free for more than ten years, but recently her oncologist (different one) saw something on a scan and said she was a 'ticking time-bomb' and should have the hysterectomy.  He basically wore her down and since that she's decided she doesn't want to have kids anyway she opted for it.  She said they 'sliced and diced' her uterus every which way post-surgery and found NOTHING.  She's still fuming for having given in.

I have no history of breast cancer in my family and will thus be adhering (with relief) to the new guidelines.

All these tests are HUGELY expensive.  Resources are not limitless.  When Medicare was first created we didn't have CAT scans, ultrasounds, chemotherapy, etc.  It's no wonder healthcare costs are out of control--it's not just the fault of the insurance industry.

Not2Taem's picture

I do it, regularly.

I had my first exam and mam when I was in college. My sister had her first breast surgery in her early 20's and ended up going back for a bilateral radical. The family history sucks and for several years I considered having them whacked of prophylactically. At 49, I consider myself very lucky to have had several biopsies, but no removals.

MacLass_19's picture

This is horrible.....

I just heard the news, and I am appalled. I'm sure that the entire issue is about money.... Insurance companies don't want to pay for women's healthcare, regardless of whether it saves lives, or not. 

I received my first mammogram when I was 35, my GYNO strongly believes in setting a baseline on which to compare future tests. I feel good in knowing that she's pro-active. I also feel confident in knowing that her motivation is to save lives. I'm not so sure about those who have come up with the new 'guidelines'.....

 

SMBrown's picture

Why doubt the motivation?

I think doubting the motives of the task force is dead-wrong, and short-sighted.  The more information we have, especially from divergent perspectives, the better off we might be in the long run.  Perhaps the two approaches can be reconciled.  Whilst getting a baseline at the age of 40 or so might be a good idea, it might be overkill (not to mention unnecessarily expensive) to have yearly mammograms from that point on. 

MacLass_19's picture

I understand your point Mystics....

However, I've seen early detection save lives in my family. So, I may be the wrong one to discuss the issue with you. 

 

SMBrown's picture

I'm all for early detection,

I'm all for early detection, and saving lives--the question is are we going about it in the right way, and are we using the best technology?  As I said to Rusty above, this nuanced study is being distorted by the media and the 'cancer industry'--which despite the fact that mammography is a very flawed technology insists on pushing it on women as a 'must' regardless of effectiveness and without consideration of the patient's individual medical history/circumstances. 

foamy2's picture

well im just 24. i do the

well im just 24. i do the self tests and often get the second opinion Wink but i dont plan on getting them til im much older.. like 40s.  arent mammograms radioactivity? if thats so, getting them being younger and more often might cause more harm than good seeing that a woman's breast are particularly radiosensitive. 

Robin Rigby's picture

That's what I'm understanding

That's what I'm understanding this study is saying.  The mammogram isn't accurate enough for younger women to make the increased exposure to x-rays worth the risk.  

Joanne Robertson's picture

.

.

Lake's picture

I had my ...

first one this year!  I think it should be a part of the yearly exam. 

I understand doing it every few years.  Insurance is a huge issue for many and so many womens issue are not covered.   I'm thankful Illinois has a program for women who cannot afford exams.  It covers the exam and if anything is found it covers all of the treatment.   I hope the state can keep this benefit...we'll see.

 

Lake

Rusty's picture

The American Cancer Society strongly disagrees

The American Cancer Society strongly disagrees:

“The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. Our experts make this recommendation having reviewed virtually all the same data reviewed by the USPSTF, but also additional data that the USPSTF did not consider. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.

[empahis added]

full story here: http://tinyurl.com/yk8q8fu

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

Rusty's picture

testing

My daughter is a PA in oncology. She said catching one early at 40 is worth the false positive re-tests. She suggests having one mammogram 40. If it's clean regularly from 50 on.

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

minniesota's picture

Interesting

This new study also suggested every two years from 50 to age 74. Interesting. I currently receive a mammogram once a year. Maybe I only need one once every two years. There is no history of breast cancer in my family. I appear to be at low risk.

"A comprehensive analysis of various mammography screening schedules suggests that biennial (every two years) screening of average risk women between the ages of 50 and 74 achieves most of the benefits of annual screening, but with less harm." (from ScienceDaily)

Still searching for the right brainy quote.

Rusty's picture

cancer risk

I'll stick with my daughter's recommendations. She comes home with too many stories of women in their 30s and 40s with breast cancer. And we do have cancer on my dad's side of the family.

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

Robin Rigby's picture

I just saw the news story.

I just saw the news story.  They're saying there's a lot of false positives in younger women.  I saw an interview with Christina Applegate and the mammogram didn't catch her cancer, she had to have a different test and it was caught earlier than the mammogram can.  

I don't know the answer but I anticipate much debate.  

Grace Moon's picture

yeah i just heard the news too

I'm soooo confused!

So should women under 50 be getting a different kind of test!?

tweet tweet @gracemoon

Kelly McCartney's picture

Canadialand

I heard a long piece about all of this on the CBC when I was in Canada and I discussed it with one of my fiances there who is a mid-wife. What that report said was that the radiation exposure, the false-positives-induced anxiety, the unnecessary procedures and so forth weren't outweighing the benefits for the women under 50. They also indicated that manual breast exams are really, truly only effective when done by a fully trained practitioner. The self exams aren't that great.

Dana Fairbanks might fail to agree, but...

I also got a long email several years ago that was being circulated by a doctor purporting similar findings. He was particularly concerned about the radiation exposure. I think one of the things is that someone might have a very small, very slow-progressing something that would not actually develop into cancer, but the radiation could speed that along. Don't quote me on that one, but I seem to recall it as a point.

Won't you be my neighbor? @theKELword

Tex's picture

HOLD THE PRESSES!

Before I say anything.....define FIANCE as used above. Is there a diacritical mark missing from the e and another e? Are/Were you polygamy engaged in Canada? 

Smile

Twitter Time @kdhales

Not2Taem's picture

polygamy?

Is polygamy legal in Canada?

Tex's picture

Shhhhhhhhh!

What happens in Canada stays in Canada! 

Smile

Twitter Time @kdhales

Kelly McCartney's picture

Ooops

Absolutely... on all counts.

I am betrothed to two straight lovelies in Victoria who keep begging me to come back. But I'm thinking Vermont.

Won't you be my neighbor? @theKELword

Tex's picture

Ummm huh!

You are the woman! 

Wink

Twitter Time @kdhales

Kelly McCartney's picture

And thanks!

For the lesson of fiance vs fiancee. I guess I don't use that one enough to have learned it before now.

Won't you be my neighbor? @theKELword

Robin Rigby's picture

I don't know. The news story

I don't know. The news story I saw even said that there was no need to do self exams either. I do know Kaiser has sent me a reminder that I'm due. I've never had one either.

peacekitty's picture

I've actually never had one

I've actually never had one yet, which isn't good because an aunt and one of my sister's have had breast cancer.  I'd better get one soon, but my insurance no longer covers them which sucks.

"Fight Prime Time. Read a Book"

Grace Moon's picture

what?

your insurance doesn't cover them? holy christ when is this reform bill passing?

like really what does these companies do????

tweet tweet @gracemoon

Tex's picture

And...

heard the other day that IF they do pass the Health Care Reform bill it will be 3 YEARS before it goes into eexcept for those with pre-existing conditions which will take effect immediately. Is that true?!?!

Twitter Time @kdhales

Rusty's picture

twofer

They're trying to have as much of it take effect next year as possible. Part of the problem is that adding 40,000,000 people will put a lot of pressure on the system.

My solution - fund health care training NOW for the unemployed. You get a twofer - adding health care professional to the system to handle the onsslaught and a JOBS, JOBS, JOBS program.

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

Tex's picture

Thanks, Rusty!

You even understood what I meant with only an "e" for the word effect!  hehehehehe

Twitter Time @kdhales

Rusty's picture

drawl

I lived in Texas long enough to understand your drawl. (insert smiley emoticon thingie)

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna

Rusty's picture

sickening

HuffPo is documenting outrage after outrage about what insurance companies are trying to get away with:

Insurance Runs Out For 12-Year-Old Boy Without Arm

http://tinyurl.com/yzh593n

Reform should cover preventive measures 100% with no co-pay, but folks on the right are claiming that PM costs more than not having it.

"When you look for the bad in mankind expecting to find it, you surely will." ~ Pollyanna