Monday, November 23, 2009

Talking Task Force

I feel the need to comment on the US Preventive Services Task Force report on mammograms that was released last week. The report essentially said that most women don't need mammograms until age 50 and then only every other year. Since I was 45 when diagnosed with breast cancer, several folks emailed me about the report and even more asked me how I feel about it. And well, I have to say, I kind of get what they are saying. In the sense that I understand. There is a way in which I agree as well.

Because here's the thing-- It wasn't a mammogram that caught my cancer early. It was me. It was a self-exam. I had my regular annual mammogram in July of 2008 and no cancer was visible. It was there, it just wasn't large enough to be picked up by the mammogram. By November (yep, 4 months later) it was large enough to be felt by me so I went to the doctor. Another mammogram was ordered, along with an ultrasound. That's when the cancer was diagnosed. But there's a big difference between the first and the second mammogram. The first mammogram is a screening mammogram--and that's the one they are saying I could have done without. And they're right--it was not of any use in catching my cancer. What was of use was the self exam. Based on that and the doctor's exam a diagnostic mammogram was ordered, and that's a mammogram that is different from what the task force is discussing. The task force isn't saying no mammograms until after 50. They are saying that in most cases it's not necessary. If there is a reason for a mammogram before age 50 (a lump is felt; family history; higher risk) then of course the doctors should order the mammogram.

This seems reasonable to me, on one hand. There are risks associated with the mammogram and if those can be avoided (not to mention that it's a really uncomfortable experience!), then so be it. And I do understand that there is a limited health care resource available. It comes down to the rationing of health care of course. Let's be clear--we are doing that now; it's like any other resource--there is only so much of it and choices have to be made as to where the resource can be spent. (Right now it seems we give any and all health care to those that can pay for it, and much less or none to those who can't.)  So if there is only so much that can be allocated to "breast cancer care" well, it makes more sense to allocate it to pay for the care of those that have been diagnosed and need treatment and cut back on screenings where it seems, according to the report, 1 life in 1,900 screenings would be saved (in women aged 40 to 49).

So that much I get. What I don't get is the discussion of self exams and women being stressed out or hysterical over possible breast cancer. First off, they can't stop us from doing self exams! That's a little ridiculous. And again, it was a self exam that allowed me to catch mine early (and even so, my cancer was at stage 1c--which means it skipped on aggressively through a and b in the four months since my July mammogram). No self exams and no mammograms for a woman in her 40s seems like saying "well if you get it in your 40s, just die." Makes no sense to me at all. Early detection is key. Of course you have to do your self exams! Just be realistic about it. Not everything you feel is cancer, but when you feel something unusual get it checked out and talk it over with your doctor. That's simple enough. Nothing to get hysterical about.

Oh, and the other thing I don't get? Why mammograms? Why is that what they were looking at? That doesn't seem like that expensive of a test. Since the US Preventive Services Task Force has such a broad, far-reaching name...I'm assuming we'll hear about some other procedures they're looking at for effectiveness as well. Right?

PS. I've still got the annoying cough. The positive thinking didn't work. And, I discovered yet another side effect of BC treatment. You know how sometimes when you cough so hard for so long your rib cage and stomach muscles start to hurt? Mine only hurt on the right side--the side that was radiated all summer. Hmmm. I guess it's been weakened.


  1. Teresa, you are absolutely right -- women should take charge of their own health, and be positively actively engaged in their own well-being. And that means not relying on the yearly mammogram, with the "whoa, glad that's over, I'm fine" response. If eliminating the basic mammogram that most women suffer through (and rely on!) will free up resources for better treatment and education, I'm for it. The key, as you suggest, is the self breast exam and really understanding what is normal in your breasts so you can tell when something is NOT normal. (i.e. your cancer wasn't the "pea shaped lump" we were instructed to look for) And not relying on a once a year machine or a once a year doctor's check up to give you that information. Thanks for the great post, Teresa. I was hoping you would weigh in on the task force recommendations.

  2. Thats all well and good. I am a little insensed that for YEARS I was told the value of mammograms and annual paps was crucial to the maintaining of health.The guidelines for hormone replacement therapy was also advocated for women for many years. I guess I question the integrity of the government guidelines as it always seems to be on the back of womens health care and issues. Was it all a lie or was it an income stream from "afraid" women. I just wonder sometimes. Did you know the vast majority of drug protocols is based on the male model? women do not react to drug therapy the same as men do but it is basically all predicated on male testing.Also, as to health care. I think the truly indigent get pretty good care in the medical facilities,based on all I know from our own county hospital. Care is often times better than regular hospitals that we have to pay for or get approval for. So, its all a big fat mess:Helga

  3. Teresa - I appreciated your rational,thoughtful reaction to the new suggested guidelines...sue


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