o'stephanie

o'stephanie
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Oregon, USA
Birthday
December 01
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DECEMBER 13, 2009 8:30PM

New Mammogram Advisory in Use in 20 States for Poor Women

Rate: 8 Flag

 US National Institutes of Health--National Cancer Insitute

According to an AP story on Saturday (Poor Turned Away From Free Cancer Screenings), at least twenty states are citing budgetary constraints which have “forced them to focus on those considered at highest risk” by excluding free screening for those described as lower risk (i.e. “women under 50”).  The AP report also cites an estimate by the American Cancer Society that “34,600 women between 40 and 49 will be found to have breast cancer nationwide; in that age group, 4,300 breast cancer deaths are projected this year”.  

The news item did not discriminate as to whether that ACS estimate of 4,300 deaths out of 34,600 women was predicated on the new or the old recommendations.  I wonder how many of those 34,000 women may have cancers which will wait for one more year to be discovered and treated. My breast cancer’s telltale calcifications were not present on last year’s mammogram.   

States which have cut budgets for free mammograms and PAP smears include Alabama, Arkansas, Carolina, Colorado, Connecticut, Illinois, Massachusetts, Minnesota, Missouri, Montana, Ohio, Pennsylvania, South Utah, and Washington. With no records of how many people are being denied free screening, the ACS was reported as being unaware of just how many women have been turned away. Here in Oregon, the AP story reports that the Breast and Cervical Cancer Program (BCCP) is limiting free mammogram screenings to 6,000 when 57,000 women are eligible. (However, those women with lumps are never turned away.)

Assurances from various political, insurance, and health officials that the recent U.S. Preventative Services Task Force guidelines recommending screening mammograms for those women over fifty would not affect women’s current access to screening are false. 

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The discrimination against health care based on ability to pay is deplorable. The mammography guidelines may result in the some women with early cancers slipping through the cracks. On the other hand, some of those women with very early cancers may have cancer that resolves itself, then again many women who are exposed to less radiation by not having as many mammograms may be spared the development of cancer. It's a conundrum that, by its very nature is unanswerable.
I'm not sure that cancer resolves itself. I suspect that when they talked about "cancers that would not harm the woman" that they mean the cancer I had--ductal carcinoma in situ. No doc now practicing tells any woman with that diagnosis to sit it out because they do not know which women it will progress with.
I was an x-ray tech for a couple decades and will post on the risks posed by radiation.
Screening needs to be available for everybody who wants it, regardless of age or socioeconomic factors. Young women die of breast cancer too. Men die of breast cancer.
So true, Natalie.
They are talking about screening. I would hope that, like Oregon's state program, other places would not turn away anyone with symptoms like a lump. The ACS has a lot of clout.
The "new" guidelines" are not new at all really, and what so many seem to not understand is that these revised guidelines are not directed at women in high risk groups (history of cancer, previous lumps, etc..), these women are directed to carry on with the same guidelines as they always have. It's the low risk women that are being advised to reduce mammography screenings. The reduction in xray screenings for these women might save more lives than the cancers that might be missed at an early stage, before a lump is felt.

What I do not understand about these directives is the admonition against breast self examination. I find it offensive along the lines of "women are reactionary and alarmist and imagine lumps where there are none." THIS makes no sense to me.
Good topic, O'Steph.
Kathy,
That south Utah struck me odd as well... Geographically, the south is a plain while the north is mountainous. ???

Ablonde,
You are right that the guidelines are not "new". The PTB have switched recommendations ever since 1963. You can see a great list from NYT here
Not screening women under 50 will not result in saving women's lives. The radiation is negligible. The following FAQ from A mammography x-ray might result in a breast tissue dose of about 0.3 cGy. If a woman received 10 mammograms as a young woman, the total dose would be about 3 cGy. What is the risk associated with such exposure? Keeping in mind that epidemiologic studies have not detected statistically significant increases below a dose of about 20 cGy, we do know that 100 cGy increases risk by about 40%. One can estimate that the 3 cGy from periodic mammography screenings would increase your risk by about 1.2% or a relative risk of 1.012. Such low risks are not detectable in human studies.
The other thing is that they really cannnot tell who is high risk. They tell us a lot of statistical data; however, family history does not even hold water since most women who get breast cancer have little or no family history at all like me.
I have insurance so I can make my own choice. Those women who do not have their choice taken away from them. It's all about fairness.

Hey Tai!
I don't think it can ever be known if radiological diagnostics aggravated cancers that may have self resolved. It's just not possible to test for that, and even if you were to design a model to try and answer that question the proving of it would be unethical. I'm of the opinion that nearly all human studies are flawed, usually in multiple ways for the simple reason that there are just too many variables and no true controls. The Framingham Study comes as close as we'll probably ever get, but I still wonder about the self reporting.

With diseases we can examine clusters, and so we saw that lots of kids, way more than normal, were getting leukemia downwind of nuclear testing sites in the 50s. Breast cancer? Clusters of that too, lots out on Long Island NY, but what looked like an environmental issue might well be an ethnic/genetic predisposition situation, even a combination of the two.

Now we are gaining ground with the mapping of the genome and the identification of "cancer" genes. Some apparently are highly predictive of breast/ovarian cancer. Could there be other genes that get "turned" on only with the presence of certain environmental conditions? There are so many questions.

I agree with you that it is very possible that these "guidelines" will likely be used to limit the services available to low income populations. If a screening does reveal a suspicious lump, these women aren't able to avail themselves of decent care and treatment, so I kind of wonder why are these people encouraged to even get screened. Yeah, the screening may be free, but if we find something you'll be hit up for a couple hundred grand easy, and we'll want cash for that, thanks very much.
Ablonde,
I agree that studies on human subjects are unethical; however, circumstances have presented opportunities. For 50 years,
25,000 female atomic bomb survivors in Japan were followed for over 50 years. Out of those only 173 breast cancer deaths occurred and only 41 (or 24 percent) were attributed to the radiation received in 1945. Of course, many factors come in to play there.

Young girls with growing breast tissue are vulnerable to radiation. As an x=ray tech, I always covered these areas if an x-ray was ordered for any of my young female patients.

I used to do mammograms in the early days before multpling screens were developed when the exposure was more than 10 times higher than it is today. During her lifetime currently, a woman would get more radiation from natural sources, for example if she lived or worked in a brick building.

I do not agree that a woman is better off not knowing about her cancer if she is poor. I've seen late-stage untreated breast cancer, and it is a horror. At least here in Oregon, there are resources such as the Medicaid Oregon Health Plan while most of our large hospitals have programs for the indigent. Our medical school has programs as well. Someone I know with pancreatic cancer is receiving services altho they are very poor.

It is the fact that these "advisories" are being used just a scant month after coming out to justify cutting services to the poor that bothers me.
Stephanie,
Thank you for this vital post. You write with such empathy and pathos in the finest sense on this subject.

This is a deeply grievous decision. It screams of negligence and short sighted-ness.

The purpose of such screenings and tests should originate in the compassionate and intelligent desire to detect and prevent the advancement of so deadly a disease. When there are so many areas where funding may be cut without making “lifeboat” decisions that affects suffering needy people it astounds me that this takes place.

Once again you bring to the forefront an issue which calls not only for our attention but responsible action to reverse. Thank you so much for this.
Rated and appreciated.
Dennis,

Merry Christmas to you in the bosum of your family. You are a remarkable man and an old soul.

Kindest regards,
Stephanie
o'stephanie, at the age of 47, I was diagnosed in January 2009, following a December 2008 mammogram that revealed a cancer that had been visible--and missed--on the December 2007 mammogram. Not a fan of the new guidelines.

The reason breast cancer deaths have declined? Early screenings. Are we exposed to radiation in the course of these screenings? Yes. And yet the death rate from breast cancer has still declined, leading me to conclude that screening early (and annually) isn't nearly as deadly as NOT screening.

The new guidelines mean more women will die. Period.
Susan,
You are my kind of woman! Short, sweet, and to the point.
As an old x-ray tech, I believe in the newest digital technology which magnifies and gives a great deal more detail, and--as said above--MRI.
When they cite unnecessary biospies from "false positives", folks think of surgery with general anesthesia. Needle core biopsy is done in the mammography office under a local anesthetic. Hurts but is not surgery.
I'm just suspicious when the panel cites saving women from the "anxiety" of yearly exams. Like they care. If the radiation was a problem, they would use that but they don't mention it.
This isn't health care. For too many, it's a death sentence. I'm glad to see you back and posting, Stephanie. Shalom.
I agree with you 100%. The argument that the new guidelines will save women from the anxiety of yearly exams--or the anxiety of waiting for the results of "unnecessary" second screenings, ultrasounds, or needle biopsies--is condescending and infuriating. We're so fragile that we can't take the anxiety? Yeah, I don't think so.

One of the things that has been especially infuriating to me is that stories like mine are dismissed as anecdotal, which marginalizes not only my experience, but also the experience of the many thousands of women under 50 who have been diagnosed with breast cancer.

Thanks for posting this. I knew this would happen. And this is just the beginning.
Timely and important post. Yes, this is just the beginning.
dynomyte,
Good to see you, my friend. Peace to you also.

Susanmihalic,
You bring up a good point--the individual stories are anecdotal (i.e. not the Scientific Method) while the peer reviewed literature deals with numbers divorced from humanity. To my reading, it was pretty much a numbers decision overlaid with a thin layer of concern about the "weaker sex".

Hello my dear O'K! So good to see you but miss you already.