Thursday, November 19, 2009

The Good News about Mammograms That No One Wants to Hear

Here's the bottom line, folks. The uproar over the "new" recommendation that women under 50 should not get regular mammograms is all about money not women's health.

In fact, since 1971 the science has been clear that women under 50 get no benefit from regular mammograms. That is, they die just as often from breast cancer as women who haven't gotten regular mammograms. But despite getting no benefit, all too many undergo unnecessary biopsies that leave scars both physical and mental.

That was the very clear message that just came from the expert panel that finally had the guts to tell the unvarnished truth to the public. You'd think this new clarification about the lack of benefits from an unnecessary test would be greeted with cheers.

Instead, it's been treated like an assault on women motivated by a dastardly effort--by those "death panel" advocates in the Obama Administration--to cut health care costs.

So rabid has the mammography industry become about protecting its profits that it has literally become "un-American" to tell the truth about mammography.

OK. You need proof. So let's talk.

First, why should you believe me? Because I've been writing about various aspects of women's health for 30 plus years, and I spent a year as an editor at MAMM, the women's magazine whose sole topic is women's cancers. I have a shelf-full of books about women's health including one that every woman should have: The Secret History of the War on Cancer, by Devra Lee Davis, the Director of the Center for Environmental Oncology at the University of Pittsburgh Cancer Institute. (Look here for more about her.)

Second, even though someone is not a doctor, some facts about human breasts are easy for all of us to understand and go a long way to explaining the situation.

For instance, you might ask, what are they actually looking for on the X-ray film from a mammogram? Dr. Davis explains that they are looking for tiny white dots or other white shapes. This white "stuff," if you'll excuse the lack of scientific language, is calcium that can be left behind by cancerous cells as they grow. The breasts of women who have stopped menstruating and who are generally over 50, are fatty, and the fat shows up as black, a great background against which to see the white dots.

But the breasts of women under 50 are not fatty; they are dense, and are "riddled with lots of white spots, making it really hard to make out any tumor within," Davis writes in her book. So radiologists can only use their best guess to diagnose a particular white spot as suspicious, and most of the time--that's most of the time--they are wrong.

How wrong? In any given year, 70 of every 1,000 women under age 50 who have a mammogram will be told something suspicious has been found, meaning that over the decade between the age of 40 and 50, 700 women out of 1,000 will be told to undergo a biopsy.

Now a biopsy is no small thing. A friend of mine who underwent two of them--no cancer was found--described "excruciating pain." She was left with significant scars. And the mental anguish as women wait for the biopsy and then the result is similarly painful. Davis calls it "terror."

So if there's no benefit in terms of extending life, and all this downside of pain and anxiety--plus the expense--women under 50 should be cheering, not filled with new anxiety because of the recent announcement.

I find it shameful that most of the media coverage about the recommendations has sounded almost hysterical. You can just see the hand-wringing. The moaning about what women should do now? How will they cope? Etc. Etc.

Let's get over it, ladies. This is a step forward, not back. The advice is clear: if you're under 50, you will get no benefit from regular mammograms unless you are in a high-risk category. Over 50, you'll only have to get one every other year. That means less radiation, fewer trips to the imaging center, less humiliation as you have your boobs squished between two plates, fewer unnecessary biopsies, less mental anguish.

And is it a bad thing if we save some money besides?

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