Mammogram ruling backlash: Shock, anger, and vows to ignore the new guidelines

The simple fact is that, as emotive a topic as this is, the plural of anecdote is still not data - and the data suggests that the new guidelines for testing will have the same preventative effect.

Being an American living in the UK, I'm glad guidelines were changed for pap smears in the US, as evidence suggested that the annual tests were resulting in a large number of unnecessary and invasive procedures for transient cancer cell results. Until the data says otherwise, I think we should not get too wound up.

However I'm on board about the stupidity of no longer emphasizing self-exams. If nothing else there's no study or data to suggest that it has a negative impact, and self-awareness when it comes to your body is worth almost as much as any testing.

I have been following the discussions with interest too. It seemed to me that the choice of wording was insensitive and possibly caused more offence than it needed to. Or was it perhaps stated the way it was precisely to stir up a heated public discussion? For example, it is hard to understand how breast self examinations cause harm (as per the wording) without further explanation and discussion.

One thing I understood from listening from the further explanations which does not seem unreasonable to me is the differentiation between teaching formal breast self examinations (apparently not a cost-effective use of public funds), versus encouraging better body awareness. To me it seems a no-brainer to be in touch with changes to one's own body, and what one of the commentators (a physician) explained was that many women detect their own breast cancer 'naturally', e.g. in the course of taking a shower, rather than while doing a formal monthly breast exam. On the other hand, I don't know how one goes about encouraging better body awareness? Is this something requiring public funding? If formal self-exams are no longer pushed, will women who are prudish about their own bodies be at greater risk of undetected breast cancer, or were they statistical lost causes all along?

Anon,

And that's exactly the problem, isn't it? We don't know exactly how to balance the cost of a few women's lives with the cost of the screening (whether in terms of anxiety, health or financial cost). This is why we struggle.

I think that the struggle is even more difficult when it has been hard to educate a population about a certain level of screening to start with. Getting women to do self-exams, for instance. It's taken decades to get even a percentage of women to do self-exams without fear or embarrassment. I am sure that those who have worked to teach this now feel like they've moved several steps backward.

I thought it might be interesting to see what the Susan G. Komen folks have to say about this. This is from their website:

"How should women respond to this news? Calmly. There has always been debate about whether or not to recommend routine screening mammography for women in their 40s. The focus of the debate is the balance of risks and benefits. The most important potential benefit of screening mammography is a modest reduction in breast cancer mortality. Potential risks of mammography include false-positive test results (which lead to stress and additional testing), false-negative test results (a missed cancer), and overdiagnosis. Overdiagnosis refers to the diagnosis of a cancer that will never cause health problems during the life of a patient. Overdiagnosis leads to unnecessary cancer treatment.

"For young women, the balance of risks and benefits is different than for older women, and may not clearly favor screening (although this point continues to be debated). Young women are more likely than older women to experience some of the downsides of mammographic screening, and are also less likely to have breast cancer.

"The fact that the USPSTF and the American Cancer Society now have different screening recommendations for women in their 40s simply reinforces the importance of educating yourself about the potential risks and benefits of screening, talking with your physician, and making the decision that’s right for you."

Here's the site:

http://ww5.komen.org/default.aspx

If mammograms at 40 are great, why not 30? Or 20? Much as it may upset some women, from a cost-benefit standpoint, there has to be a cut-off. The same kind of uproar accompanied the recommendation that most prostate cancers shouldn't even be treated because they are very slow growing. What? Not treat a cancer? The ridiculous costs involved in treating prostate cancer didn't justify the iffy benefits. The same thing is happening with breast cancer.

Hi Diane - Plain and simple: following the new guidelines will cost women's lives. The numbers that were used to formulate the guidelines don't support the recommendations, nor does the real world knowledge of patients and healthcare providers. I'm not saying the old protocol was perfect by any means since the over reliance on mammograms to detect breast cancer also creates problems. What's really needed is a calm, rational, informed approach to developing the best guidelines possible - not decisions thrust on American women with little input and, apparently, little support from key health professionals.
Thanks for writing about this,
Pat

Thanks, Diane, for this lucid and objective posting. Personally, I'm very irritated by the study and recommendations. My breast cancer went to Stage 2 in one year, so waiting another year for a mammogram would likely have resulted in metastisis to lymph nodes or worse. Like you, I have friends who are alive because they were consciencious about annual mamms and/or self exams. I can't imagine a single one of them that I would sacrifice for the sake of cost-saving.

What makes me angry is that, by discrediting self exams, these respected scientists are recommending that women take LESS responsibility for their health, not more. It has taken us decades to empower women on health matters and this seems like a throw back to the dark ages.

And, with the disproportionate increase of breast cancer in overweight women and with obesity on the rise, what does the trend line look like? Were these conclusions made on historical data or factoring in the projections of newly diagnosed breast cancer in women carrying extra weight?

Finally, I think the recommendations are another example of "flash in the pan" reporting, that urgency that some scientists feel to publish their brilliant discoveries without fully understanding the effect on those affected.

Thanks for opening the debate.