A new Swedish study, which compares countries that offer mammograms to women in their forties against those which do not, refutes the controversial U.S. Preventive Services Task Force (USPSTF) recommendation that mammograms for women in this age group offer a “net benefit [which] is small”.
Dr. Hakan Jonsson of Umea University studied a sample size of 600,000 women with data gathered over 16 years. He determined that 1,250 screenings saved one life in this age group.If that one woman is you or someone you love, the “net benefit” is incalculable.
In 2009, the USPSTF recommended “biennial screening mammography for women aged 50 to 74 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms.”
One harm that women may perceive is the effect of radiation to the breast. As an ex-x-ray technologist, I know that the advances in imaging have dramatically decreased the radiation dose:
In my view, the USPSTF recommendation was suspect since one of their partners in “policy, population, and quality improvement” was America's Health Insurance Plans, a national professional association which represents 1,300 health insurance corporations. Considering that preventative care is now mandated without a copayment for those insured under the new rules now in effect, these corporations stand to cut their losses if they are able to cite this USPSFT recommendation as a reason to deny screening mammogram coverage to women in their forties. In fact, these recommendations have already been used to curtail mammogram services to poor women in twenty states.
The USPSFT recommendation to define "regular screening" as every two years is unacceptable to most women whose cancers were diagnosed by annual mammograms. My own breast cancer was picked up by an annual mammogram which appeared normal the preceding year.
Dr. Daniel Kopans, a professor of radiology at Harvard Medical School, endorsed the American Cancer Society’s recommendation that women begin yearly screening mammograms at the age of 40, stating:
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Comments
This is just so wrong.
rated with hugs
Breast cancer is my #1 charity, and I know quite a bit about this. The new studies showing higher risks from mammograms than previously suspected are not to be dismissed lightly. The key takeaway I get from all this is that the technology needs to be improved so the radiation doses can be lowered.
And the first line of defense, as always, is a through monthly self-exam.
Save the Ta Tas! :)
Thanks for the hug, honey! I need a steady diet of those! Must mention that I am doing quite well physically. Have been dealing with depression issues but have a handle on those and am accessing support for that and moving forward.
Once again, Canada proves saner than the U.S.
I was one of those women. At age 47 I was diagnosed with breast cancer thanks to a routine mammogram. AND AN IMPORTANT BIT OF INFORMATION ABOUT IT: the type of breast cancer I had does not form lumps. I would not have found it on my own until it was too late to treat it.
Thank you, O'Steph!!!
You are a man after my own heart. And please accept my thanks for your generosity for breast cancer research and patients. I have benefited from the Susan B Koman foundation which provided me with gas money to get to the medical school where I was treated and hotel rooms for the nights before my three surgeries this past year.
Thank you!
Advances have been made in lowering the dose and increasing accuracy in reading mammograms. It is a balance of benefits vs possible harms. Folks tend to be afraid of radiation; however, the risk is small if you have modern equipment weighed against the benefit of picking up cancer early before it is invasive and needs radiation therapy and chemotherapy.
Amen and hallelujah!
They state that these recommendations deal with populations not "specific disease or individuals" while ignoring the fact that populations are made up of individuals. It is criminal for them to state that there is "small net benefit" when it winds up allowing even one woman to die.
Oddly enough, the USPSTF does not mention radiation as a specific harm but cites "anxiety" of women undergoing annual exams. When the hell did corporate and governmental entities begin caring about how women feel?
I also did a 5K Walk for the Cure onboard a Holland America crusise I took to South America last year. I think it was 26 laps around the Promenade Deck, or something like that, and since I was walking with a cane at the time, I came in dead last... so dead that the after-walk party was over and the dishes cleared before I pulled in, but a purser was kind enough to round up the glass of pink lemonade I was promised on completion.
The thing that frustrates me is that it's hard to get other men involved in the cause... in general... my "Glimmer of Hope Project" was an exception. I mean, have you ever met a man who was not kindly disposed towards women's breasts? No. So why is it so hard to get men to rally and contribute to "Save the Ta Tas"?
I think it's the pink. I mean that seriously. Men are averse to wearing pink in general. Joe Biden wore a pink necktie and got creamed in the press. Personally, I look smashing in a blue pinstripe suit with a pink dress shirt, but I get about one of those occasions a year anymore, and it's hard to deal with the peer envy that I'm so bold.
So maybe we could think up an alternative to pink for the male contingent. I'm thinking a deep burgundy might do it. Whaddya think ‽
How right you are! You'd think they would look at the long term or, at the very least, the health of individuals. They are just like any corporation which goes for the short term gain.
Sexism also plays a part. If anyone doubts it, they need only look at insurance coroporations which will gladly pay for erectile dysfunction medication but not women's birth control. There is a double standard.
but hey, I'm no expert, I just think it's a good idea to treat the individual woman, not some statistical phantom
So glad that you did not have to wait three years until you turned 50 to get that lifesaving mammogram.
Personal testimonies put the lie in what the agencies and health insurance corporations recommend.
David,
I think burgandy is a wonderful choice!
And I would be remiss if I did not mention that men also are prone to breast cancer. It is probably more dangerous in this group because it is so unexpected.
You know, you might want to check out the site breastcancer.org which has 50,000+ women on it. You could do a post on your ideas to get more men involved. I think there are men who are passionate about beating this disease but lack organization.
Roy,
I did not go to the primary source on this one so there may well be some design problems. However, the sample size is huge.
The USPSFT has changed its mind over and over again about recommendations and will again.
I agree that women ought to be able to decide; however, those who are poor and unisured, may not get the choice per my past post on how states are curtailing programs for free mammograms.
This recommendation just appears so suspiciously ahead of health care reform that it makes me cringe.
Always so glad to see you, guy!
I am shocked that Cuba is that low since they have one of the best medical school programs in the world and free health care. Lacking money may be an object to good treatment. Diagnosis is not everything.
I was so grateful that my doc referred me to the medical school here. It has made such a difference. The breast surgeon in our town is a 24-carat quack.
Dr Spudman,
So glad to give good news to friends.
You know, it has helped so much to have support...
Right on, girl!
I worry that these recommendations will allow health insurance corporations (companies is too friendly a word...) to refuse to provide this for the insured.
It makes no sense to only allow mamms at 40 if you are at "high risk" because the majoriy of women who get breast cancer have had no family history. They play with statistics to get the results they want.
One recommendation that the USPSTF made was about MRI not being diagnostic; however, I had both mamms and MRI on my affected breast and the MRI showed my mass while the mamms did not. I am being followed at six month intervals via mamms and MRI now.
Bonnie, I am glad that you are fighting the good fight in California. We have our own idiot sports figure who has never held office who is running against a man we elected twice as governor. Frankly, I do not feel like providing the sports figurehead with on-the-job training. I will stop by.
The main cost isn't the imaging per se.
A number of them fall directly on women, which include testing a million perfectly healthy women to potentially save less than a thousand. And this million women would also include 10's of thousands that have false positives, have the absolute shit scared out of them, undergo unnecessary biopsies.
There is an imaging lobby in the US.
It looks now like men are being over treated for prostate cancer. I suppose women have the same right to demand more treatment.
Screening 100% of a relatively low risk, undifferentiated population seems like the least desirable way to achieve a result. Research to segregate this population into higher and lower risk groups, and, if useful, much more rigorous screening of higher risk groups seems more desirable.
However, I am not an expert in this. There is an imaging lobby and strong financial incentives to increase testing and procedures -- as well as other groups who have an interest in reducing the same.
I don't feel like this is my issue, and women can make up their own minds (as if they care about my opinion anyway). However, even if I am totally full of shit on this particular issue, the gross overuse of medical imaging will come back to haunt Americans.
Don't let an ER nuke your kid, "just in case".
From my female perspective - there is a lot of overdiagnosis and overtreatment in breast cancer. And women are unnecessarily turned into cancer patients when there are so many false positives, or readings of abnormalities that eventually go away on their own. My doctor, who I respect, has always been a fan of 'detect as soon as possible when cancer is small and more easily treated'. She and I will have this conversation soon and I will see if her mindset has changed, since the NEJM article suggests that treatment is so much better now, even more advanced cancers can be successfully eradicated.
Of course, no one who wants a mammogram for whatever reason should be denied one. And no one can dispute the testimony of those whose lives were saved through screening. But there is definitely room for debate. And I have to tell you, the medical establishment has not, historically, always done well by women. My sister is a DES daughter because my mother took this recommended drug during her pregnancy. It has caused lifelong health problems. I'll pass lightly over the uterus-perforating IUD and the cancer scare from the misread Pap smear. It wasn't so long ago that we were all made to feel like bad patients if we resisted, or even questioned, hormone replacement therapy, which was big pharma's last cash cow. That crap caused plenty of breast cancer on its own. Just saying, makes it hard to trust the party line.
I value your opinion even if I think you are wrong and I do. Go ahead and weigh in, regardless of whether or not you own that particular body part.
As an ex-x-ray technologist, I know that folks are frightened of radiation. It is a real X to most folks which is why I included a link to the breakdown in exposure.
In another post about my own breast cancer, I commented on the following information:
For over 50 years, 25,000 female atomic bomb survivors in Japan were followed. Out of those only 173 breast cancer deaths occurred and only 41 (or 24 percent) of those were attributed to the radiation received in 1945.
My whole point here is that if those million women are not harmed by screening then why not prevent the early death of those thousand women? If you add their families in, you are looking at their deaths affecting at least 30 people each for a total of 30,000 people.
Isn't that 3% worth it?
And as far as choosing women who are at "high risk", most women who get breast cancer have NO family history. So, how would you find me? Or Susan Mitchell?
One of my supports during my own journey was breastcancer.org. 50,000+ women and I never saw anyone complaining about unnecessary biospies or annual mammograms. In fact, they are mad as hell with the USPSTF.
If you second guess your doctor about x-raying your child who is hurt enough to require an emergency room visit, you are placing your knowledge against your doctor's which might not be a good thing to do.
The USPSFT did not use increased radiation as a possible harm. They would have used it if there was peer reviewed evidence for it.
A good point made.
I remember years ago having a patient who had the telltale "orange peel" skin on her breast of very advanced cancer at her initial visit to her doctor. Fear had kept her away from the doctor.
Scanner,
So glad that Terri is a survivor! That "almost" can be very thought provoking.
You have a good point. Medicine appears to have a predilection for fooling women. The DES is a poignant case in point. I am sorry for your sister who has had to suffer this prenatal injury.
And, radiation is not simply a warm summer day, I know. However, the risk is so very slight--over ten years, it might increase a woman's chance of having breast cancer to 0.2%.
In young girls with developing breasts, there is evidence of harm because radiation affects quickly dividing cells. But, grown women should be able to run this slight risk in order to save their lives.
My problem with this USPSTF is that it may remove this screening tool from preventative care because they can disallow it as not being "recommended". If you have the $400, you can have one. If not--even if you want one, you cannot.
Damn, girl, if I ever need a back up, you are it!
(Love our guys...)
Good for you to watch your health like this. I never thought I would ever get it because I have few risk factors. I think they snow us with statistics but really do not know. That is why they do not condemn all screening--it works.
How could I forget my sister??
Love you, gal, and so glad you are here.
Thanks for this, o'stephanie. Rated.
You have summed it up beautifully.
"You get more nuked from living in a brick house than you will from this annual test, if numbers really matter in medicine. The only number that matters is the 1 (one) who lives because we looked. "
I do agree that even peer reviewed literature must be read with a critical eye. The fact that breast cancer deaths have declined is a potent argument that regular--ANNUAL--mammograms save lives.
The ONE is the only number that matters.
The USPSTF has actually recommended that women NOT be taught breast self examination. I guess they don't want us touching ourselves either...
Best Wishes,
Blittie
rated.
See! I told you so. Christine O' Donnell is surely against that part
You are so right about the frustration. Breast cancer is so complex and we get so much misinformation. As you say, they are unable to gauge risk for individual women, so the call to limit 40-somethings is artbitrary.
Boomer,
I am beginning to think that we are gonna be lined up one day for disposal.
BOKO,
I think like you, that this is an orchestrated effort on the insurance corporations part to forestall any loss of their enormous profits. This kind of thing is why Obama has been methodically kicking industry "partners" off the hundreds of "advisory committees" that the federal government has.
They all have their hands in each other's pockets and, mostly, ours.
I guess I like this study because it backs up what I have heard anecdotally. In my own experience, MRI was superior to mammography and involves no radiation to boot but the USPSTF recommends against it.
Blittie, kitty,
You are always welcome.
So glad to see you and to STILL be seeing you because you got regular mammograms in your 40s.
The USPSTF is a crock. Their chief medical officer discredited the study but also admitted that HE DID NOT READ IT. Then how does he know it is not true? By report, the studies they based their latest decision was 20 years old.
Erudite BOKO wrote in his comment:
"AHIP is doing this with a number of procedures---finding research that gives them some justification to cut cost, regardless of the consequences."
I think they are being proactive so that they can deny women services. Saving money on our breasts.